Significance of postbiopsy hemorrhage observed on preoperative magnetic resonance imaging in performing robot-assisted laparoscopic radical prostatectomy.
OBJECTIVE
Due to lack of tactile feedback, dissection of surgical planes during delicate procedures of nerve-sparing robot-assisted laparoscopic radical prostatectomy (RALRP) can be hampered more by postbiopsy hematomas or adhesions compared with open surgery. Thus, we investigated association between extent of postbiopsy hemorrhage observed via preoperative magnetic resonance (MR) imaging with surgical difficulty of RALRP.


METHODS
We reviewed records of 154 men who received prostate biopsy, MR imaging, and subsequently, nerve-sparing RALRP for clinically localized prostate cancer within 2 weeks of MR imaging. We scored degree of postbiopsy hemorrhage as shown on T1-weighted MR imaging (hemorrhage score) and analyzed potential association of hemorrhage score with variables representative of surgical difficulty (operative time, estimated blood loss, and margin positivity) and functional outcomes (urinary continence and erectile function).


RESULTS
Among our subjects, total hemorrhage score demonstrated no significant associations with interval from biopsy to MR imaging (p = 0.210). In multivariate analyses, prostate volume and total hemorrhage score were observed to be significantly associated with operative time (p = 0.004 and 0.039, respectively) and estimated blood loss (p = 0.009 and 0.023, respectively). Patients' age and total hemorrhage score was observed to be independent predictor of the return of erectile function sufficient for vaginal intercourse at 6 months following RALRP (p = 0.003 and 0.036, respectively).


CONCLUSIONS
Degree of postbiopsy hemorrhage observed in preoperative MR imaging may be predictive of surgical difficulty for RALRP. Such findings provide concrete evidences that aftereffects of prostate biopsy have significant impact on performing RALRP.
Hong
Sung Kyu
SK
Department of Urology, Bundang Hospital, Seoul National University, 300, Gumi-dong, Bundang-gu, Seongnam, Kyunggi-do, 463-707, Korea.
Kim
Dae Sung
DS
Lee
Won Ki
WK
Park
Hongzoo
H
Kim
Jeong Kwon
JK
Doo
Seung Hwan
SH
Jeong
Seong Jin
SJ
Yoon
Cheol Yong
CY
Byun
Seok-Soo
SS
Hwang
Sung Il
SI
Lee
Hak Jong
HJ
Lee
Sang Eun
SE
D000368:Aged; D001706:Biopsy / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome