ABSTRACT Purpose: To analyze the association between obesity and urinary incontinence rate in men submitted to robot-assisted radical prostatectomy (RARP) in a high-volume cancer center. Materials and Methods: We reported 1.077 men who underwent RARP as the primary treatment for localized prostate cancer from 2013 to 2017. Patients were classified as non-obese (normal BMI or overweight) or obese men (BMI ≥30kg/m2). They were grouped according to the age, PSA level, D’Amico risk group, Gleason score, ASA classification, pathological stage, prostate volume, salvage/adjuvant radiotherapy, perioperative complications, and follow-up time. Urinary continence was defined as the use of no pads. For the analysis of long-term urinary continence recovery, we conducted a 1:1 propensity-score matching to control confounders. Results: Among the obese patients, mean BMI was 32.8kg/m2, ranging 30 - 45.7kg/m2. Only 2% was morbidly obese. Obese presented more comorbidities and larger prostates. Median follow-up time was 15 months for the obese. Complications classified as Clavien ≥3 were reported in 5.6% of the obese and in 4.4% of the non-obese men (p=0.423). Median time for continence recovery was 4 months in both groups. In this analysis, HR was 0.989 for urinary continence recovery in obese (95%CI=0.789 - 1.240; p=0.927). Conclusions: Obese can safely undergo RARP with similar continence outcomes comparing to the non-obese men when performed by surgeons with a standardized operative technique. Future studies should perform a subgroup analysis regarding the association of obesity with other comorbidities, intending to optimize patient counseling.

ABSTRACT Kidney cancer is the third most common urologic malignancy and a 2% annual increase in the incidence has occurred over the past two decades, largely because of the increased utilization of imaging. The majority of these tumors are small, so the indications for nephron-sparing surgery and for minimally invasive surgery are continually expanding. Complex kidney lesions, such as those completely endophytic, are still a challenge even for experienced surgeons. Our objective is to demonstrate the operative technique for laparoscopic partial nephrectomy with the aid of intra-operative ultrasound in a man with a totally endophytic renal lesion. Case: A 52 years old man, asymptomatic, with incidental renal mass of 2.9 cm, completely endophytic (R.E.N.A.L score 9p) submitted to partial laparoscopic nephrectomy. Surgical time was 2 hours, with 20 minutes of ischemia. Pathological anatomy confirmed tumor of clear cells T1a, free margins.

ABSTRACT Objectives Report the long-term outcomes of the AMS 800 artificial sphincer (AS) for the treatment post-prostatectomy incontinence (PPI) in a single center in Brazil. Materials and Methods Clinical data from patients who underwent the procedure were retrieved from the medical records of individuals with more than 1 year of follow-up from May 2001 to January 2016. Continence status (number of pads that was used), complications (erosion or extrusion, urethral atrophy, and infection), malfunctions, and need for secondary implantation were evaluated. The relationship between complications and prior or subsequent radiation therapy (RT) was also examined. Results From May 2001 to January 2016, 121 consecutive patients underwent AS implantation for PPI at an oncological referral center in Brazil. At the last visit, the AS remained implanted in 106 patients (87.6%), who reported adequate continence status (maximum of 1 pad/day). Eight-two subjects (67.8%) claimed not to be using pads on a regular basis at the final visit (completely dry). Revision occurred in 24 patients (19.8%). Radiation therapy (RT) for prostate cancer following radical prostatectomy was used in 47 patients before or after AS placement. Twelve patients with a history of RT had urethral erosion compared with 3 men without RT (p=0.004). Conclusion Considering our outcomes, we conclude that AS implantation yields satisfactory results for the treatment of PPI and should remain the standard procedure for these patients. Radiation therapy is a risk factor for complication.

De fevereiro de 1987 a junho de 1995, 92 pacientes com câncer de próstata avançado foram submetidos a bloqueio androgénico máximo (subcapsular orquiectomia e antiandrógeno), independente dos sintomas clínicos apresentados na sua admissão. A idade dos pacientes variou de 44 a 89 anos, com mediana de 70 anos de idade. No 6o, 36o e 60o meses, a sobrevida global foi de 80%, 38% e 20%, respectivamente. O PSA pré-operatório variou de 2 a 4017 ng/ml, com mediana de 98 ng/ml e 98% dos pacientes tinham PSA maior ou igual a 10 ng/ml. O primeiro PSA pós-operatório variou de 1 a 3840 ng/ml, com mediana de 20 ng/ml. Neste estudo retrospectivo, 97% e 88,2% dos pacientes tinham PSA pré-operatório maior que 4 e 20 ng/ml, respectivamente. Houve somente uma tendência de melhor sobrevida nos pacientes com PSA inicial de 2 a 99 ng/ml (p=0,06745) que com PSA maior que 100 ng/ml. Há uma tendência de diminuição do PSA até o sexto mês depois do início do tratamento. A sobrevida dos pacientes em 36 meses após o bloqueio androgênico máximo, de acordo com o primeiro nível do PSA de 1 a 4, 5 a 49 e maior que 49 ng/ml foi de 72%, 48% e 8%, respectivamente (p=0.00004). No último exame, 34 (37%) dos pacientes foram considerados estabilizados e 58 (63%) com progressão da doença.

OBJECTIVE: To evaluate the survival rate of patients with advanced prostate cancer in a univariate form, according to the preoperative and first postoperative determination of PSA levels. MATERIALS AND METHODS: From February 1987 to June 1995, 92 patients were submitted to maximum blockage androgen (subcapsular and antiandrogen orchiectomy), independent of clinical symptons shown upon admission to the Cancer Hospital. The antiandrogens (ciproterone acetate and flutamide) were administered until the patient present progression of the disease. RESULTS: The age of patients varied from 44 to 89, with a median of 70 years old. In the 6th, 36th and 60th months the global survival rate was 80%, 38% and 20%, respectively. The preoperative PSA ranged from 2 to 4017 ng/ml, with a median of 98 ng/ml (98% had PSA greater than or equal to 10 ng/ml). The first postoperative PSA ranged from 1 to 3840 ng/ml, with a median of 20 ng/ml. There was a tendency towards a better survival rate only in patients with initial PSA from 2 to 99 ng/ml (p=0.06745). The survival rate of patients at 36 months after the initial total blockage androgen, with first PSA level from 1 to 4, 5 to 49 and over 49 ng/ml was 72%, 48% and 8%, respectively (p=0.00004). In the final examination, 34 (37%) patients were considered stable and 58 (63%) had disease progression. CONCLUSION: The PSA determination performed on the 30th postoperative day is important in the evaluation of advanced prostate cancer prognosis.