Role of laparoscopy in the lymph-node staging of urological malignancies

Preoperative or intraoperative staging is often necessary in malignancy in order to plan further treatment. Although various imaging techniques are al ready being used, new minimally-invasive approaches, such as laparoscopy, m ay change staging strategies. The role of laparoscopic lymph node staging o f urological malignancies is described. Most urologists agree that the use of laparoscopy for lymph-node staging of penile cancer or transitional-cell carcinoma (TCC) of the bladder or upper urinary tract, as well as for rena l tumours, has no benefit in terms of changing treatment. In patients with testicular cancer, inguinal orchiectomy is almost always the first therapeu tic step. In non-seminomatous tumours, inguinal orchiectomy is followed by either retroperitoneal lymphadenectomy (LAD), chemotherapy or surveillance. Recently, laparoscopic retroperitoneal LAD has been presented by a few cen tres with acceptable results. In patients with localised prostate cancer, p elvic LAD is the first operative step during radical prostatectomy, to excl ude lymph-node metastasis. In the one-step retropubic prostatectomy, lymph nodes are 'on the way' to the prostate. A few European and many American ur ologists prefer the two-step perineal prostatectomy. In such cases a laparo scopic LAD is performed according to a relevant elevation of the prostate-s pecific antigen (PSA) and radical prostatectomy negated when lymph nodes ar e positive. Laparoscopic lymphnode staging in urological malignancies is li mited to a group of patients with prostate cancer who are likely to have po sitive lymph nodes and to a few patients with testicular cancer.