Extended lymph node dissection during radical prostatectomy for prostate cancer remains a disputed area. Sentinel lymph scans help identify the first lymph node stages in the lymph drainage of the prostate. This study was designed to investigate the detection rate of lymph node metastasis by extended lymph node dissection and sentinel lymph node scanning in patients undergoing radical retropubic prostatectomy (RRP) for localized prostate cancer. In this study at our department from 2005 to 2006, a total of 108 patients with localized prostate carcinoma were treated with radical prostatectomy including extended lymph node dissection. A sentinel lymph node scan with 160 MBq of technetium-99m-Nanocoll (Tc) was performed 1 day before surgery. A C-Trak gamma probe (AEA Technologies, Morgan Hills, CA, USA) was used intraoperatively to detect the sentinel lymph nodes. Scan findings were correlated with tumor stage, Gleason score, prostate-specific antigen (PSA) level, and histological lymph node status. Scans revealed sentinel lymph nodes on the film 2 h after Tc administration in 98 of 108 patients (91%). Histologically proven lymph node metastases were detected in 15 of those 98 patients (15%) with a positive sentinel scan. Those 15 patients had a PSA level greater than 10 ng/ml or a Gleason score greater than 6 and at least a pT2 tumor. Specifically, six patients had a pT2 tumor, and nine patients had a pT3 tumor. Of patients placed in a risk group defined as PSA above 10 ng/ml or Gleason score greater than 6, 15 out of 50 patients (30%) had sentinel positive lymph nodes with metastasis. These data suggest that extended sentinel lymph node dissection helps identify lymph node metastasis in patients with PSA above 10 ng/ml or a Gleason score above 6 in 30% of cases. Further studies will show whether these numbers will hold true in patients undergoing radical prostatectomy for prostate cancer.

The plurilamellar appearance of this group could be rated as a pathognomonic symptom of the Gorlin-Goltz syndrome.

Stress urinary incontinence is rare in men. Despite the improvements in diagnostic approaches to prostate diseases and surgical interventions on the prostate, stress incontinence has tended to increase in recent decades. The most frightening operative complication for both the patient and the surgeon is incontinence, which is one of the important factors in the treatment of the affected patients. The limited degree of continence considerably lowers the quality of life for the affected men and their partners. There is little information available about the pathophysiology of iatrogenic stress incontinence, which more likely affects older men rather than young men. The available information is based on a few experimental studies. Besides the direct damage to the muscular or neurological component of the external sphincter, insufficient length of the functional urethra and impaired bladder function seem to play an important role in the genesis of postoperative incontinence. In order to improve the postoperative continence status after radical prostatectomy a number of different operative modifications have been introduced. Preservation of the bladder neck, puboprostatic ligaments, and the neurovascular bundle as well as leaving the tips of the seminal vesicles seem to have a positive impact on the degree of postoperative continence.

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Prostate cancer (PCA) is the most frequent onlocological disease in men. Every year there are ca. 202.000 new cases of prostate cancer in Europe. Curative treatment of this carcinoma via brachytherapy is becoming increasingly significant (20-30% of all curative approaches). Initial staging and thus allocation to risk groups prior to the commencement of therapy is esspecially important for successful brachytherapy treatment.Low-dose-rate (LDR) brachytherapy (i.e. SEED implantation) distinguishes itself both with respect to the procedure as well as the indication from high-dose-rate brachytherapy (afterloading procedure). Both treatment procedures are employed as monotherapy as well as in combination with external radiation.LDR monotherapy is reported to achieve biochemically relapse-free outcome of up to 90% in low-risk tumours during 10-year follow-up periods. Combined HDR tele- and brachytherapy is reported to achieve a biochemically relapse-free outcome of 80-90% with intermediate- and high-risk tumours in long-term follow-up.While randomized studies are as yet missing, it is still possible to derive the following application algorithms from monitoring studies and cohort studies: application of LDR monobrachytherapy must be restricted to low-risk tumorus. Combined HDR tele- and brachytherapy can be sucessfully applied in cases of intermediate- and high-risk tumours. The outcome depends significantly on the initial, pre-therapy PSA value and Gleason score. Posttherapeutically, the nadir value is crucial with respect to predicting the biochemically relapse-free outcome.