Associate Professor of University of Santo Tomas Faculty of Medicine and Surgery, Department of Surgery, Section of Urology. Chair, Institute of Urology, St. Luke’s Medical Center QC. Philippines
_______________________________________________________________________________________ Introduct... more _______________________________________________________________________________________ Introduction: Robotic-assisted radical prostatectomy (RAP) is the dominant minimally invasive surgical treatment for patients with localized prostate cancer. The introduction of robotic assistance has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. The purpose of this video is to demonstrate the early retrograde release of the neurovascular bundle without open the endopelvic fascia during RAP. Materials and Methods: A 51-year old male, presenting histological diagnosis of prostate adenocarcinoma, Gleason 6 (3+3), in 4 cores of 12, with an initial PSA=3.41ng/dl and the digital rectal examination demonstrating a prostate with hardened nodule in the right lobe of the prostate base (clinical stage T2a). Surgical treatment with the robot-assisted technique was offered as initial therapeutic option and the critical technical point was the early retrograde release of the neurovascular bundle with endopelvic fascia preservation, during radical prostatectomy. Results: The operative time was of 89 minutes, blood loss was 100ml. No drain was left in the peritoneal cavity. The patient was discharged within 24 hours. There were no intraoperative or immediate postoperative complications. The pathological evaluation revealed prostate adenocarcinoma, Gleason 6, with free surgical margins and seminal vesicles free of neoplastic involvement (pathologic stage T2a). At 3-month-follow-up, the patient lies with undetectable PSA, continent and potent. Conclusion: This is a feasible technique combining the benefits of retrograde release of the neurovascular bundle, the preservation of the pubo-prostatic collar and the preservation of the antero-lateral cavernous nerves.
Continuing experience with the use of Nd:YAG laser-fibre prostatectomy over the past 4 years has ... more Continuing experience with the use of Nd:YAG laser-fibre prostatectomy over the past 4 years has produced encouraging results. Of the 198 patients we treated with the 60-W/60-s technique, 74 were available for evaluation after undergoing laser ablation of the prostate between October 1990 and July 1994. In all, 29/74 and 9/74 patients were available for 24 and 36 months of follow-up, respectively. The American Urological Association (AUA) symptom scores, peak uroflow (Qmax) rates and post-void residual urinary volumes show marked improvement. Following laser ablation of the prostate (LAP), complications have included 16 patients with post-procedural recurrent obstructive symptoms requiring revision. Three patients developed urinary tract infection, two developed bladder-neck stenosis, four fully anticoagulated patients with clot retention required blood transfusion and three patients had epididymo-orchitis. The results show a sustained reduction in AUA symptom scores and maintained improvement in peak flow rates and residual volumes, with stabilization of the above-mentioned parameters occurring within 12-36 months. The results demonstrate the continued durability of the outcome of LAP.
Continuing experience with Nd:YAG noncontact sidefiring laser fibers over the past 4 years has sh... more Continuing experience with Nd:YAG noncontact sidefiring laser fibers over the past 4 years has shown encouraging results. Thus far, of the 198 patients treated with the 60 W/60 seconds technique since October 1990, a total of 74 were available for long-term evaluation (69 at 12 months and 29 at 24 months). The AUA Symptom Scores, Qmax (peak uroflow rates), and postvoiding residual urine volumes demonstrated marked improvement. The complications included 16 instances of recurrent obstructive symptoms necessitating revision. Three patients suffered urinary tract infections, two patients developed bladder neck stenosis, four anticoagulated patients with clot retention required blood transfusions, and three patients had epididymoorchitis. Follow-up at 12 and 24 months showed sustained reduction in AUA Symptom Scores and maintained improvement of the peak flow rates and residual volumes. These results demonstrate the safety and clinical applicability of laser ablation of the prostate and its potential usefulness as a less invasive therapy for benign hyperplasia.
Percutaneous nephrolithotomy (PCNL) is the standard of care for large renal calculi which are no ... more Percutaneous nephrolithotomy (PCNL) is the standard of care for large renal calculi which are no longer suitable for extracorporeal shockwave lithotripsy. The key to success depends on the urologist's choice of instruments, preoperative and intraoperative access planning, patience, perseverance, skill and training. Percutaneous renal access is a crucial early step that may ultimately influence outcomes of PCNL in terms of overall stone-free rate and complications. Several techniques for access and tract dilatation are described in this chapter. Prone, supine or lateral positioning during renal access have inherent advantages and disadvantages. Similarly, various adjunct imaging modalities and instrumentation are available to increase success and decrease the risk of complications. Nonetheless, the most practical and effective approach still depends heavily on stone burden and renal anatomy, available instrumentation and equipment, and the surgeon's expertise and level of training.
Mucinous adenocarcinoma of the bladder is rare, occurring in 0.5-2.0% of bladder cancer. Most pat... more Mucinous adenocarcinoma of the bladder is rare, occurring in 0.5-2.0% of bladder cancer. Most patients present with hematuria, suprapubic pain and dysuria. Presented is a case of a 44 year old male with 4 month history of hematuria and terminal dysuria who underwent radical cystoprostatectomy with histopathology findings of mucinous adenocarcinoma. Upon diagnosis, 25% of patients have distant metastases and 50% have stage IV disease with 50% five years survival rate for stage I-III tumor with no stage IV patients surviving beyond two years. Hence, for this type of cancer, early diagnosis is crucial. Surgery is the mainstay of treatment and is resistant with chemotherapy and radiation. Thus, for patient with confirmed or highly suspicious mucinous adenocarcinoma of the bladder, timely radical resection is warranted.
Background: DARC (The Duffy antigen receptor for chemokines) is a kind of glycosylated membrane p... more Background: DARC (The Duffy antigen receptor for chemokines) is a kind of glycosylated membrane protein that binds to members of the CXC chemokine family associated with angiogenesis and has recently been reported to be implicated in diverse normal physiologic processes. This study aimed to investigate the involvement of DARC in angiogenesis, which is known to generate new capillary blood vessels from preexisting ones. Methods: HDMECs (Human dermal microvascular endothelial cells) were divided into two groups (DARC overexpression group, and control group). We used Brdu staining to detect cell proliferation, and wound healing assay to detect cell migration. Then tube formation assay were observed. Also, western blot and immunofluorescent staining were used to estimate the relationship between DARC and RhoA (Ras homolog gene family, member A). Results: HDMECs proliferation, migration, and tube formation were inhibited significantly when DARC was overexpressed intracellular. DARC impai...
Surgical removal of stones impacted in the submucosa of the distal ureter is difficult. A local-p... more Surgical removal of stones impacted in the submucosa of the distal ureter is difficult. A local-prototype visual urethrotome was evaluated for the management of submucosal vesicoureteral stones and as an aid in the removal of a Dormía basket with an entrapped stone impacted in the submucosa of the vesical portion of the ureter. A total of 14 male and 11 female adult patients were included. Fifteen patients required ureteral meatotomy to release the stone. Transurethral ureteral meatotomy is a precise and safe procedure associated with minimal complications when carefully done. Our local-prototype instrument proved to be a simple, economical, and valuable tool.
Abstract Canine and clinical trials of laser ablation of the prostate (LAP) have demonstrated its... more Abstract Canine and clinical trials of laser ablation of the prostate (LAP) have demonstrated its ability to ablate hyperplastic tissue successfully. This therapy has emerged to challenge transurethral resection of the prostate (TURP), considered to be the'gold standard'of ...
This is a case of a 74-year-old obese male presented with moderate lower urinary tract symptoms a... more This is a case of a 74-year-old obese male presented with moderate lower urinary tract symptoms and an elevated prostate specific antigen (PSA) of 48.21ng/ml. Multiparametric MRI of the prostate revealed a markedly enlarged prostate (225grams) with a PIRADS 5 lesion at the left posterior peripheral zone. Prostate biopsy done revealed prostate adenocarcinoma Gleason 7(3+4). Metastatic workup was negative for distant metastasis hence the patient was advised robot-assisted laparoscopic prostatectomy (RALP). Several difficulties were encountered during the surgical technique. The usual posterior approach was not feasible because incising the peritoneum over the rectovesical pouch would not be able to expose the vas deferens and seminal vesicles. An anterior approach was instead done, but this was still difficult due to the lack of space for proper exposure and movement of instruments. The posterior dissection was also challenging; three successive suspension stitches were necessary in o...
_______________________________________________________________________________________ Introduct... more _______________________________________________________________________________________ Introduction: Robotic-assisted radical prostatectomy (RAP) is the dominant minimally invasive surgical treatment for patients with localized prostate cancer. The introduction of robotic assistance has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. The purpose of this video is to demonstrate the early retrograde release of the neurovascular bundle without open the endopelvic fascia during RAP. Materials and Methods: A 51-year old male, presenting histological diagnosis of prostate adenocarcinoma, Gleason 6 (3+3), in 4 cores of 12, with an initial PSA=3.41ng/dl and the digital rectal examination demonstrating a prostate with hardened nodule in the right lobe of the prostate base (clinical stage T2a). Surgical treatment with the robot-assisted technique was offered as initial therapeutic option and the critical technical point was the early retrograde release of the neurovascular bundle with endopelvic fascia preservation, during radical prostatectomy. Results: The operative time was of 89 minutes, blood loss was 100ml. No drain was left in the peritoneal cavity. The patient was discharged within 24 hours. There were no intraoperative or immediate postoperative complications. The pathological evaluation revealed prostate adenocarcinoma, Gleason 6, with free surgical margins and seminal vesicles free of neoplastic involvement (pathologic stage T2a). At 3-month-follow-up, the patient lies with undetectable PSA, continent and potent. Conclusion: This is a feasible technique combining the benefits of retrograde release of the neurovascular bundle, the preservation of the pubo-prostatic collar and the preservation of the antero-lateral cavernous nerves.
Continuing experience with the use of Nd:YAG laser-fibre prostatectomy over the past 4 years has ... more Continuing experience with the use of Nd:YAG laser-fibre prostatectomy over the past 4 years has produced encouraging results. Of the 198 patients we treated with the 60-W/60-s technique, 74 were available for evaluation after undergoing laser ablation of the prostate between October 1990 and July 1994. In all, 29/74 and 9/74 patients were available for 24 and 36 months of follow-up, respectively. The American Urological Association (AUA) symptom scores, peak uroflow (Qmax) rates and post-void residual urinary volumes show marked improvement. Following laser ablation of the prostate (LAP), complications have included 16 patients with post-procedural recurrent obstructive symptoms requiring revision. Three patients developed urinary tract infection, two developed bladder-neck stenosis, four fully anticoagulated patients with clot retention required blood transfusion and three patients had epididymo-orchitis. The results show a sustained reduction in AUA symptom scores and maintained improvement in peak flow rates and residual volumes, with stabilization of the above-mentioned parameters occurring within 12-36 months. The results demonstrate the continued durability of the outcome of LAP.
Continuing experience with Nd:YAG noncontact sidefiring laser fibers over the past 4 years has sh... more Continuing experience with Nd:YAG noncontact sidefiring laser fibers over the past 4 years has shown encouraging results. Thus far, of the 198 patients treated with the 60 W/60 seconds technique since October 1990, a total of 74 were available for long-term evaluation (69 at 12 months and 29 at 24 months). The AUA Symptom Scores, Qmax (peak uroflow rates), and postvoiding residual urine volumes demonstrated marked improvement. The complications included 16 instances of recurrent obstructive symptoms necessitating revision. Three patients suffered urinary tract infections, two patients developed bladder neck stenosis, four anticoagulated patients with clot retention required blood transfusions, and three patients had epididymoorchitis. Follow-up at 12 and 24 months showed sustained reduction in AUA Symptom Scores and maintained improvement of the peak flow rates and residual volumes. These results demonstrate the safety and clinical applicability of laser ablation of the prostate and its potential usefulness as a less invasive therapy for benign hyperplasia.
Percutaneous nephrolithotomy (PCNL) is the standard of care for large renal calculi which are no ... more Percutaneous nephrolithotomy (PCNL) is the standard of care for large renal calculi which are no longer suitable for extracorporeal shockwave lithotripsy. The key to success depends on the urologist's choice of instruments, preoperative and intraoperative access planning, patience, perseverance, skill and training. Percutaneous renal access is a crucial early step that may ultimately influence outcomes of PCNL in terms of overall stone-free rate and complications. Several techniques for access and tract dilatation are described in this chapter. Prone, supine or lateral positioning during renal access have inherent advantages and disadvantages. Similarly, various adjunct imaging modalities and instrumentation are available to increase success and decrease the risk of complications. Nonetheless, the most practical and effective approach still depends heavily on stone burden and renal anatomy, available instrumentation and equipment, and the surgeon's expertise and level of training.
Mucinous adenocarcinoma of the bladder is rare, occurring in 0.5-2.0% of bladder cancer. Most pat... more Mucinous adenocarcinoma of the bladder is rare, occurring in 0.5-2.0% of bladder cancer. Most patients present with hematuria, suprapubic pain and dysuria. Presented is a case of a 44 year old male with 4 month history of hematuria and terminal dysuria who underwent radical cystoprostatectomy with histopathology findings of mucinous adenocarcinoma. Upon diagnosis, 25% of patients have distant metastases and 50% have stage IV disease with 50% five years survival rate for stage I-III tumor with no stage IV patients surviving beyond two years. Hence, for this type of cancer, early diagnosis is crucial. Surgery is the mainstay of treatment and is resistant with chemotherapy and radiation. Thus, for patient with confirmed or highly suspicious mucinous adenocarcinoma of the bladder, timely radical resection is warranted.
Background: DARC (The Duffy antigen receptor for chemokines) is a kind of glycosylated membrane p... more Background: DARC (The Duffy antigen receptor for chemokines) is a kind of glycosylated membrane protein that binds to members of the CXC chemokine family associated with angiogenesis and has recently been reported to be implicated in diverse normal physiologic processes. This study aimed to investigate the involvement of DARC in angiogenesis, which is known to generate new capillary blood vessels from preexisting ones. Methods: HDMECs (Human dermal microvascular endothelial cells) were divided into two groups (DARC overexpression group, and control group). We used Brdu staining to detect cell proliferation, and wound healing assay to detect cell migration. Then tube formation assay were observed. Also, western blot and immunofluorescent staining were used to estimate the relationship between DARC and RhoA (Ras homolog gene family, member A). Results: HDMECs proliferation, migration, and tube formation were inhibited significantly when DARC was overexpressed intracellular. DARC impai...
Surgical removal of stones impacted in the submucosa of the distal ureter is difficult. A local-p... more Surgical removal of stones impacted in the submucosa of the distal ureter is difficult. A local-prototype visual urethrotome was evaluated for the management of submucosal vesicoureteral stones and as an aid in the removal of a Dormía basket with an entrapped stone impacted in the submucosa of the vesical portion of the ureter. A total of 14 male and 11 female adult patients were included. Fifteen patients required ureteral meatotomy to release the stone. Transurethral ureteral meatotomy is a precise and safe procedure associated with minimal complications when carefully done. Our local-prototype instrument proved to be a simple, economical, and valuable tool.
Abstract Canine and clinical trials of laser ablation of the prostate (LAP) have demonstrated its... more Abstract Canine and clinical trials of laser ablation of the prostate (LAP) have demonstrated its ability to ablate hyperplastic tissue successfully. This therapy has emerged to challenge transurethral resection of the prostate (TURP), considered to be the'gold standard'of ...
This is a case of a 74-year-old obese male presented with moderate lower urinary tract symptoms a... more This is a case of a 74-year-old obese male presented with moderate lower urinary tract symptoms and an elevated prostate specific antigen (PSA) of 48.21ng/ml. Multiparametric MRI of the prostate revealed a markedly enlarged prostate (225grams) with a PIRADS 5 lesion at the left posterior peripheral zone. Prostate biopsy done revealed prostate adenocarcinoma Gleason 7(3+4). Metastatic workup was negative for distant metastasis hence the patient was advised robot-assisted laparoscopic prostatectomy (RALP). Several difficulties were encountered during the surgical technique. The usual posterior approach was not feasible because incising the peritoneum over the rectovesical pouch would not be able to expose the vas deferens and seminal vesicles. An anterior approach was instead done, but this was still difficult due to the lack of space for proper exposure and movement of instruments. The posterior dissection was also challenging; three successive suspension stitches were necessary in o...
Uploads
Papers by Dennis Lusaya