W dniach 1-3.09.1994 r. odbył się 24 Zjazd Polskiego Towarzystwa Urologicznego
w Krakowie, na którym zaprezentowali swoje prace wybitni urolodzy europejscy.
W bież±cym numerze zamieszczamy trzy kolejne streszczenia prac autorów:
PROF. F.H. SCHRODER (Holandia)
PROF. L. BOCCON-GIBOD (Francja)
PROF. W. VAHLENIECK (Niemcy)
24th Urological Congress took place on l-3rd September 1994 in Cracow. Some major
achievements in the field of urology were presented by eminent European Urologists.
Here we publish abstracts of their papers:
\\\"RADICAL PROSTATECTOMY: A COMPARISON OF THE PERINEAL AND
L. BOCCON-GIBOD (France)
\\\"RADICAL PROSTATECTOMY AS A MONOTHERAPY FOR LOCALLY
ADVANCED (STAGE T 3) PROSTATE CANCER\\\".
FRITZ M. SCHRODER (The Netherlands)
\\\"RADICAL RETROPUBIC PROSTATECTOMY AND RECONSTRUCTION OF
THE URETHROVESCAL JUNCTION WITH A TUBULARIZED ANTERIOR
W. VAHLENSIECK (Germany)
RADICAL PROSTATECTOMY AS A MONOTHERAPY FOR LOCALLY ADVANCED
(STAGE T3) PROSTATE CANCER
Dies von den Ouden, Peter J.T. Davidson, Wim Hop and Fritz H. Schroder
From the Departments of Urology and Epidemiology/Biostatistics, Erasmus University and Academic Hospital, Rotterdam, The Netherlands
Within a prospective protocol initiated in 1977, 100 patients with locally extensive prostate
cancer (stage T3, 1982 tumor, nodes and metastasis classification) were treated by pelvic node dissection and radical prostatectomy as monotherapy. Adjuyant treatment was not given until disease progression. Radical prostatectomy, except for 3 young patients with a single micrometastasis, was not done if positive lymph nodes were found at frozen section. Six patients had positive lymph nodes at permanent sections, but not at frozen section. Average follow-up was 43.9 months (range 1 to 155 months). Histological grade was determined according to the Mostofi system. Progression was determined biochemically (prostate specific antigen elevation) and clinnically by evidence of metastatic disease, either histologically proved or evidenced as new hot spots of bone scan or chest X-rays. Of the 100 patients 41 did not undergo radical prostatectomy: 39 because of positive lymph nodes and 2 because of evidence of a stage pT4 tumor at surgical exploration. Of those 59 patients who underwent radical prostatectomy 9 had positive lymph nodes, while 2 had stage pT4, 39 stage pT3 and 9 stage pT2 tumors. Only 1 of the 9 patients with lymph node metastases is free of biochemical or clinical progression. Disease also progressed in both stage pT4, 27 of 39 stage pT3 and none of the 9 stage pT2 cases. A total of 22 patients was free of clinical or biochemical progression. Clinical progression was evidenced in approximately half of the cases as distant and local progression. Data on stage T3 disease were compared to those of 129 Radical prostatectomy for prostatic carcinoma should be considered in stage Tl dwratr and, possibly, stage T2 and in all grades of malignancy, providing a life expectancy of 10 years or more can be assumed (Fig. 1). Cases of distant metastases should be excluded and, at operative staging, either no regional metastases should be present or else radical lym- phadenectomy should seem feasible. As in the case of all malignancies, ablation of tumour offers the best prognosis, but even when a merę reduction of the tumour mass can be accomplished, the effect of radio- and chemotherapy will probably be enhanced. Operative measures for the treatment of prostatic carcinoma
I. Radical prostatectomy
1. Stages T1-T2, NO, MO, after exclusion of metastases by lymphadenectomy and with
a life expectancy of at least 10 years.
II. Radical transurethral prostatic resection
(eventually with cryo-treatment or radiation therapy)
1. Stage TO, NO, MO (incidental carcinoma) for definite exclusion of recurrences
2. Stages T1-2, NO, MO if radical prostatectomy is not possible
3. All other stages for treatment of residual urine
Ryc. 1. Possibilities and indication for the operative treatment of prostatic cancer.
Radical prostatectomy is a major procedure and one must therefore decide on the basis of
the biological situation whether the risk should be taken or alternative treatment modalities should be advised. Improvements made in operative techni±ues, preoperative care and anaesthesia are important as regards the stress on the patient as well as surgical success and the avoidance of complications.
In order to extirpate the tumour-bearing prostate as radically as possible, the dissection
of the urethra must be performed distally at least 2 cm (preferably 3-4 cm) below the apex (Fig. 2). After the dissection of an appropriate part of the bladder neck, even when a good mobilization of the bladder and the distal urethra is achieved, problems will occasionally anse with the reconstruction. This can be avoided if a tube is constructed from the anterior bladder wall to bridge the defect (Fig. 3), (Barnes & Wilson, 1949; Flocks & Culp, 1953).
MATERIALS, RESULTS AND DISCUSSION
Twenty-one radical prostatectomies have been carried out with this techni±ue at our
hospital. In some cases radical lymphadenectomy was also performed simultaneously. All patients survived the operation. In two cases postoperative strictures developed. In two cases postoperative strictures developed. However, they were both efficiently treated by dilatation and a 14-day treatment with Uro-Stilloson.
Sometimes complete continence had already been achieved when the catheter was removed
at about the 14th day postoperatively. In other cases, this adaptation lasted up to 1 year.
Permanent incontinence occurred in two cases. This problem has been described in 15 cases by
Tanagho & Smith (1972), who also had 3 failures on the basis of neurogenic deffects and 2 failures due to insufficient musculature. Absolute continence was later achieved in 9 of these cases, which confirmed the results of Islam (Islam, Boyd & Laughlin, 1971). Recently good results in 4 cases of postoperative incontinence were reported by Neto (1978).
As shown in Fig. 6, the urodynamic findings of Tanagho & Smith could be confirmed by
us; the pressure profile of the urethra showed a typical increase in this patient 3 years after radical prostatectomy. The urethra stress profile of the same patient showed that the urethra pressure was clearly above the pressure of the urinary bladder when coughing (Fig. 7). This means that the patient should be absolutely continent. We hope that our observations may be of help to those faced with deciding on radical prostatectomy. With increasing experience and improvement of the techni±ue, the results may