acid-phosphatase and Blood-Loss--Surgical

Laparoscopic pelvic lymphadenectomy (LPLND) can be performed safely and with minimal morbidity in the staging of prostate cancer. Its utility in evaluating patients at high risk for metastatic disease before primarily nonsurgical treatment modalities was evaluated.. Twenty-four consecutive patients who underwent LPLND between June 1993 and July 1996 were studied. These patients were considered poor surgical candidates based on several risk factors, as follows: elevation of serum PSA >20 in 19 patients (79%); elevation of serum acid phosphatase in 4 patients (17%); digital rectal examination findings indicative of extraprostatic extension or seminal vesical involvement in 14 patients (58%); and poorly differentiated tumors on prostate biopsy in 19 patients (79%). Nineteen patients (79%) had two or more of these risk factors. Median PSA for the entire series of patients was 35.2 ng/mL (range 7.9 to 133 ng/mL), and median Gleason score was 7 (range 5 to 9). Preoperative CT or MRI was negative for pelvic lymph node metastases in 17 of 23 patients (79%), and bone scan was negative in all 24 patients.. Unilateral (n = 2) or bilateral (n = 22) LPLND was performed in all patients. Six patients (25%) had lymph node metastases detected laparoscopically. Five of the six patients had palpable extraprostatic extension (T3a/b) or invasion of a seminal vesical (T3c), and in four of these patients the site of the metastatic lymph nodes was ipsilateral to the palpable prostate abnormality. None of the risk factors was independently predictive of lymph node metastases within this series of patients. An average of 10.8 +/- 6.5 lymph nodes was removed at a mean operative time of 174 +/- 10 minutes for patients undergoing bilateral LPLND. Estimated blood loss was minimal for 20 of 22 patients (92%) undergoing LPLND alone, and there were no complications requiring open exploration. Mean postoperative hospital stay was 1.2 +/- 0.5 days for patients undergoing LPLND alone.. LPLND can be used efficiently to identify patients with nodal metastases from select high-risk patients. This, in turn, can exclude such patients from noncurative local and regional therapy.

Topics: Acid Phosphatase; Biomarkers, Tumor; Biopsy; Blood Loss, Surgical; Bone and Bones; Evaluation Studies as Topic; Follow-Up Studies; Forecasting; Hospitalization; Humans; Intraoperative Complications; Laparoscopy; Length of Stay; Lymph Node Excision; Lymphatic Metastasis; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Pelvis; Physical Examination; Postoperative Complications; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Risk Factors; Safety; Seminal Vesicles; Time Factors; Tomography, X-Ray Computed

We examined for a possible correlation between coagulopathy and fluid absorption, serum level of prostatic acid phosphatase (S-PAP) and blood loss in 25 patients undergoing transurethral resections of the prostate (TURP). Blood coagulation parameters were measured before and at the end of TURP and 10 and 24 hours later. Fluid absorption was measured by the ethanol method. There was a close correlation between the changes in haemostatic parameters and blood haemoglobin concentration. No relationship was found between the coagulation status and fluid absorption, S-PAP or blood loss during the operation. Fibrinolysis was evidenced by increasing titres of fibrin degradation products in most patients. However, no increase occurred in the two patients who required reoperation because of severe postoperative bleeding, which implies that fewer blood clots were formed in these cases. We conclude that the coagulation parameters during and after TURP varies primarily with the dilution of the blood.

Topics: Absorption; Acid Phosphatase; Aged; Aged, 80 and over; Blood Coagulation; Blood Loss, Surgical; Ethanol; Fibrin Fibrinogen Degradation Products; Fibrinolysis; Hemoglobins; Hemostasis; Humans; Male; Middle Aged; Partial Thromboplastin Time; Postoperative Care; Preoperative Care; Prostate; Prostatectomy; Time Factors

A modified method of retropubic radical prostatectomy was devised. The root of the penis was compressed and the bilateral internal iliac arteries were clamped before the dissection of the prostate. The urethra was divided at the junction of the prostate and bladder so that the bladder stump thus created has the size of the tip of the middle finger. Vesicourethral anastomosis was done by Vest procedure. By this method 24 patients were operated. All patients except one were alive without recurrence after the mean follow-up of 32 months. This method seems to be good enough to recommend.

Topics: Acid Phosphatase; Aged; Biomarkers, Tumor; Blood Loss, Surgical; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Staging; Prognosis; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms