V-02.10: Laparoscopic radical cystoprostatectomy (LRC)

Purpose: We assessed the efficacy oflaparoscopy in removal of difficult ureteralstones.Materials and Methods: We attemptedlaparoscopic removal of difficult ureteralstones in 16 patients (10 males and 6females). We used transperitoneal ap-proach. 9 patients had proximal and 7patients had middle or distal ureteralstones. Our criteria for selecting the pa-tient for laparoscopic treatment werelarge size (� 1cm) of stone or failing intreatment with SWL or intracorporeallithotripsy. We used 3 (for proximal ure-teral stones) or 4 (for distal ureteralstones) trocars.Results: Transperitoneal laparoscopic ure-terolithotomy was successful in all of our16 patients. Operative time ranged from2.4 to 4.5 hours (mean 3.2 hours). Hospi-tal stay ranged from 3 to 14 days (mean6.3 days). All patients were stone-free onpost-operative KUB. Only in 3 patientscomplication (prolonged urinary leak) oc-curred and one of these needed open sur-gery for closing the ureteral incision. Fol-low-up IVP was performed in 10 patientsand stone residue or ureteral obstructionwas not found in anyone.Conclusion: Based on our experience,transpertioneal laparoscopic ureterolithot-omy is a safe practical alternative for opensurgery in patients with large ureteralstones or when less invasive proceduresfail to treat the stone.

V-02.09Potency- and continence preservingradical cystectomy withhemiprostatectomyWolf M, Wunderlich H, Schubert JFriedrich-Schiller-University, Dept. ofUrology, Jena, Germany

Introduction: Radical cystectomy hasbeen the gold standard for treatment ofmuscle invasive bladder cancer. However,this kind of therapy may have an impacton quality of life, including sexual-, uri-nary and social function. For this reasonwe performed prostate sparing surgeryduring radical cystectomy for invasivebladder cancer.Materials and Methods: Between De-cember 2003 and December 2005 34 pa-tients with a mean age of 63.2 years un-derwent radical cystectomy withhemiprostatectomy due to bladder cancer.Preoperative evaluation included a normaldigital rectal examination, PSA lower than4 ng/ml and an inconspicuous transrectalultrasound. All patients underwent pros-tate biopsy preoperatively. Surgery con-

sisted of radical cystectomy, hemiprostate-ctomy and resection of the prostateadenoma in the lower part of prostate aswell as regional lymphadenectomy. Thefollow-up was 1-24 months.Results: Postoperative pathologicalstage was pTis in 2 patients, pTa in 1,pT1 in 5, pT2 in 20 and pT3 in 6 cases.Except of 7 patients no patient had adeterioration of sexual function. 30 pa-tients were fully continent during day-time and nighttime. The mean operationtime was 225 minutes (� 42 minutes,ranged 167-370 minutes). Mean opera-tive blood loss was 499 ml (� 255 ml,ranged 100-1000ml).Conclusion: Radical cystectomy withprostate sparing surgery in patients withinvasive bladder cancer allowed preserv-ing the external urethral sphincter andthe neurovascular bundles. It is abso-lutely necessary that this procedure isrestricted to highly selected patients,especially without concomitant prostatecancer.

V-02.10Laparoscopic radicalcystoprostatectomy (LRC)Pena J, Prera A, Gonzalez J, Hannaoui N,Vicente E, Garcia D, Abad C, Prats JServicio de Urologıa, Hospital de Sa-badell, Corporacio Sanitaria Parc Tauli,Sabadell, Spain

Introduction: Laparoscopic surgery is inclear expansion in our country given thatit has been shown a decrease of the mor-bidity associated to open surgery with atleast the same oncological results. LRC asis shown in the video is a feasible andreproducible proceeding.Methods: We show a video of a LRC as isdone in our centre. Bilateral pelvic limphnode dissection is simultaneously done.Specimen is removed on block (cystopros-tatectomy and lymphadenectomy). Wepresent the case of 87-year-old male diag-nosed by TUR of a pT2 G III transitionalcell carcinoma with CT scan and bonescan negative for metastasis. Patient com-plained of gross haematuria and severedysuria. We indicated a LRC with a bilat-eral cutaneous ureterostomy as urine di-version.Results: Postoperative evolution was cor-rect and he was discharged at day 6 ofsurgery. Ileous last 24 hours. Blood lostwas minimum and no transfusion was re-quired. Surgery took four and a halfhours.Conclusion: LRC is a feasible proceedingto be done by teams with previous experi-

ence in laparoscopic surgery. In our expe-rience, initial learning curve has beenshorter than the laparoscopic prostatec-tomy one. The chance of a LRC in elderlypatients must be kept in mind.

V-02.11Photodynamic assisted detection andtreatment of superficial bladdercancer using the photosensitizerHexvix®Thomas K, Ray E, Murphy D, ChattertonK, Khan S, O’Brien TGuy’s and St Thomas’ NHS FoundationTrust, London, UK

Introduction: Photodynamic assistedtransurethral resection (TUR) of bladdertumour may improve completeness of tu-mour resection. More precise mapping ofbladder cancer could translate into betteroutcomes. This video describes the tech-nique of photodynamic diagnosis (PDD)using Hexvix® in our unit.Patients and Methods: There are cur-rently 4 ongoing studies using the intra-vesical photosensitizer Hexvix® in ourunit; 1) a randomised trial of photody-namic assisted TUR versus standard whitelight TUR for primary superficial bladdercancer; 2) check cystoscopy post BCG; 3)positive urine cytology/no evidence ofdisease; 3) multi-focal tumour recurrence.Patients are consented for participation inthe appropriate study. The photosensitizerHexvix® is instilled into the bladder onthe ward at least 90minutes before theprocedure. The D-Light system (Storz) isused for the cystoscopy as it allows aswitch between white and blue light. Ini-tially a “white” light cystoscopy is per-formed and a bladder map obtained. Us-ing the same equipment a “blue” lightcystoscopy is performed and any areas offluorescence photographed and biopsied.Results: The photosensitizer Hexvix® iswell tolerated with no complications todate. Visualisation and colour contrast be-tween fluorescent tumour and non-fluores-cent urothelium are excellent. The tech-nique and interpretation of fluorescencehave been easily acquired. The presenceand histology of lesions detected underwhite and blue light is being compared.Conclusion: The technique of photody-namic diagnosis using Hexvix® can beeasily established in clinical practice andshows promise in detecting and treatingsuperficial bladder cancer but results areawaited.

VIDEO SESSIONS

206 UROLOGY 68 (Supplement 5A), November 2006