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Radical Retropubic Prostatectomy (radical + retropubic_prostatectomy)

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Medical Sciences	100%

Selected Abstracts

Radical retropubic prostatectomy with running vesicourethral anastomosis and early catheter removal: Our experience

INTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2009
Choichiro Ozu
Objectives: To assess the outcomes of patients undergoing radical retropubic prostatectomy (RRP) with a running vesicourethral anastomosis and catheter removal on postoperative day 3 or 5. Methods: From February 2006 through December 2007, 55 patients underwent RRP at our institution. All procedures were performed by a single surgeon using a running suture for the vesicourethral anastomosis. A cystogram was carried out before catheter removal in all patients. The initial 23 of 55 patients (Group 1; n = 23) had the cystogram on postoperative day 5, the other 32 patients (Group 2; n = 32) had the cystogram on postoperative day 3. Removal of the catheter was only carried out if there was no anastomotic extravasation. Results: The success rate of catheter removal in group 1 and 2 was 100% and 96.9%, respectively. Overall continence rates were 83.3%, 87% and 90.7% at 24, 48 and 72 h after removal of the catheter, respectively. There was no significant difference in terms of continence rate between groups 1 and 2. None of the patients had acute urinary retention and/or anastomotic stricture after catheter removal. Conclusions: These findings suggest that an advanced running vesicourethral anastomosis during RRP is technically feasible, allowing safe early catheter removal in most patients. [source]

Pharmacological prophylaxis of venous thromboembolism in contemporary radical retropubic prostatectomy: Does concomitant pelvic lymphadenectomy matter?

INTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2008
Benjamin C Jessie
Abstract The prevention of venous thromboembolism is a major concern in cancer patients undergoing pelvic surgery. Radical retropubic prostatectomy is a common treatment for localized prostate cancer and has been identified as a high risk procedure for postoperative venous thromboembolism. However, most patients diagnosed with prostate cancer in the current era have clinically localized, low volume disease and the risk of venous thromboembolism is very low. Multiple guidelines exist for the prevention of venous thromboembolism in patients undergoing radical retropubic prostatectomy and pharmacological venous thromboembolism prophylaxis is recommended. Most urological surgeons in the USA however, do not routinely utilize pharmacological prophylaxis. A major concern arises when radical retropubic prostatectomy is performed with a concomitant pelvic lymphadenectomy. Pharmacological prophylaxis is known to increase the rate of lymph drainage and the rate of lymphocele formation. Evidence suggests that lymphocele may be an independent risk factor for venous thromboembolism in the postoperative period. These factors raise concern over current guidelines calling for routine use of pharmacological venous thromboembolism prophylaxis in radical retropubic prostatectomy especially when lymphadenectomy is performed simultaneously. [source]

Radical retropubic prostatectomy through a minimal incision with portless endoscopy: Our initial experience

INTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2006
HIDEO KIYOKAWA
Abstract, Twenty-one patients with clinically localized prostate cancer underwent minilaparotomy radical retropubic prostatectomy through a single 5-cm midline or Pfannenstiel incision. A 30° laparoscope was usually positioned around the edge of the incision to facilitate the procedure. The mean operating time was 255 min. The mean blood loss was 859 mL, and no patient required an allogenic blood transfusion. Postoperative pain was noticeably reduced, especially in the Pfannenstiel incision group. Endoscope-assisted minilaparotomy did not involve a learning curve, and could be useful for most urologic surgeons as minimally invasive surgery. [source]

Imaging with radiolabelled monoclonal antibody (MUJ591) to prostate-specific membrane antigen in staging of clinically localized prostatic carcinoma: comparison with clinical, surgical and histological staging

BJU INTERNATIONAL, Issue 9 2005
Vinod Nargund
OBJECTIVE To evaluate the reliability of prostate scintigraphy using a radiolabelled antibody (MUJ591) raised against the external domain of prostate-specific membrane antigen (PSMA) in the staging of early prostate cancer. PATIENTS AND METHODS This was a prospective study of 16 patients who had radical retropubic prostatectomies (median PSA 9.75 ng/mL). All patients underwent PSMA imaging using MUJ591 radiolabelled with 99mTc using a photo-reduction technique. RESULTS The findings of prostate imaging and histology were identical in seven patients. Scans showed understaging and overstaging in six and three patients, respectively. CONCLUSIONS PSMA scintigraphy using 99mTc-labelled MUJ591 identifies the presence of prostate cancer, but is not sensitive in delineating micro-invasion of the capsule, seminal vesicles or bladder neck. As in other studies it seems to be useful in detecting prostate bed recurrence and distant micrometastasis. [source]

Radical retropubic prostatectomy with running vesicourethral anastomosis and early catheter removal: Our experience

Pharmacological prophylaxis of venous thromboembolism in contemporary radical retropubic prostatectomy: Does concomitant pelvic lymphadenectomy matter?

Original Article: Prospective comparative study of single dose versus 3-day administration of antimicrobial prophylaxis in minimum incision endoscopic radical prostatectomy

INTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2008
Mizuaki Sakura
Objective: From the critical stand point against the overuse of antimicrobial agents, appropriate reduction of antimicrobial prophylaxis (AMP) should be considered. We have prospectively reduced AMP and evaluated the occurrence of surgical site infection (SSI) following radical retropubic prostatectomy (RRP) by minimum incision endoscopic surgery (MIES). Methods: A total of 101 consecutive patients who underwent MIES-RRP for prostate carcinoma were classified into two groups according to AMP dose. The 3-day group of 52 patients received tazobactam sodium/piperacillin sodium (TAZ/PIPC) 2.5 g intravenously before the operation and continued twice daily until postoperative day 2, and the single dose group of 49 patients received TAZ/PIPC 2.5 g intravenously only once before the operation. Additional antimicrobial agents were given only when SSI occurred. The occurrence of SSI and remote infection (RI) were analyzed. Results: There was no significant difference in the rate of SSI occurrence between the 3-day group (3.8%) and single dose group (6.1%) (P = 0.6). RI did not increase in the single dose group. Conclusion: Antimicrobial prophylaxis dose was successfully reduced without increasing SSI or RI. A single dose of AMP is feasible to prevent SSI and RI and would be a standard regimen in MIES-RRP. Active surveillance of postoperative infection is mandatory to promptly administer antimicrobial treatment as the need arises. [source]

Impact of salvage therapy for biochemical recurrence on health-related quality of life following radical prostatectomy

INTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2007
Shunichi Namiki
Objective: To determine the impact of salvage therapy for prostate-specific antigen (PSA) recurrence on the health-related quality of life (HRQOL) of patients after radical retropubic prostatectomy (RP). Methods: Between January 2000 and December 2003, a total of 249 patients who underwent RP were available for 2-year follow up. Of the respondents, 203 men did not show evidence of recurrence (group A), and 46 men received salvage hormonal therapy and/or radiotherapy after RP because of a rise in PSA (group B). The general and prostate-target HRQOL was assessed with the Medical Outcomes Study 36-Item Short Form and University of California, Los Angeles Prostate Cancer Index, respectively. Patients completed the HRQOL instruments by mail at baseline and at 24 months after RP. Results: All of the patients completed both questionnaires. At baseline no significant differences were found between the two groups in any of the HRQOL domains. There were significant improvements in mental health and social function for the patients without biochemical recurrence postoperatively. Repeated measure anova revealed significantly different patterns of alteration in several general HRQOL domains among the treatment groups. The urinary and bowel domains were equivalent between the two treatment groups at baseline and 24 months after RP. The patients treated with salvage hormonal therapy tended to show delayed recovery of sexual function. Conclusion: Using a self-administered questionnaire, biochemical recurrence following RP was found to impose a substantial burden in patients with localized prostate cancer. [source]

Comparison of bone-anchored male sling and collagen implant for the treatment of male incontinence

INTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2006
RAHMI ONUR
Aim: To compare the effectiveness of transurethral collagen injection and perineal bone-anchored male sling for the treatment of male stress urinary incontinence (SUI). Methods: Seventy-one men with SUI underwent either transurethral collagen injections (n = 34) or perineal bone-anchored male sling (n = 37) between June 1999 and October 2003. Most of the patients in each group had radical retropubic prostatectomy and/or external beam radiation therapy (EBRT) in relation to the cause of incontinence. There was one patient in both groups who only had EBRT for the cause. The mean duration of incontinence were 4.2 and 4.4 years, respectively. Collagen injections were carried out transurethrally either under regional or general anesthesia until co-aptation of mucosa was observed. The male sling was placed under spinal anesthesia with a bone drill using either absorbable or synthetic materials. Retrospectively, all patients were assessed for continence status and procedure-related morbidity, if present. The outcome of both procedures was also compared with the degree of incontinence. Results: Ten (30%) patients in the collagen group showed either significant improvement or were cured following injections. Preoperatively, the mean pad use in collagen group was 4.5 (SD 2.8) per day, whereas it was 2.2 (SD 1.1) after the injection(s). Collagen injection failed in 24 (70%) of the patients. Patients who received the male sling had a mean preoperative pad use of 3.7 (SD 1.5) and postoperatively, the number decreased to 1.6 (SD 1.2). Most of the patients in this group were either totally dry or significantly improved (n: 28, 76%). There was a statistically significant difference between two groups in respect to success rate (P < 0.05). Analysis of treatment outcome with the degree of incontinence revealed that the male sling is most effective in patients with minimal-to-moderate incontinence. Conclusions: Our results suggest that the male sling, a minimally invasive procedure, is more effective than collagen implant in the treatment of mild-to-moderate SUI in men. [source]

Radical retropubic prostatectomy through a minimal incision with portless endoscopy: Our initial experience

Identification and validation of risk factors for vesicourethral leaks following radical retropubic prostatectomy

INTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2005
VINCENT J GNANAPRAGASAM
Aims: To identify risk factors for anastomotic leaks at cystography following radical retropubic prostatectomy (RRP). Methods: In phase 1 the records of a 107 RRP patients were reviewed. Data collected included comorbidity, pathological factors and intra- and postoperative complications. From these, risk factors were identified that were associated with a leak at cystography. In phase 2 (n = 46) we prospectively tested if the risk factors identified could predict an anastomotic leak. Results: In phase 1 the only identifiable risk factors were that of a difficult anastamosis, an unsatisfactory intraoperative test flush and the presence of a urinary tract infection. One or more of these events were found in 17/25 (68%) of the patients who leaked (P < 0.0001). Of the eight leaks missed, five were classed as minimal and did not require repeat cystography. Within the prospective phase 2 cohort one or more risk factors were present in 7/10 (70%) of the patients who leaked. In contrast, the identified risk factors were present in only 5/36 (13.8%) of the patients who did not leak (P < 0.001). The specificity of the test was 86.1% with a sensitivity of 70%. This gave a positive predictive value of 58.3% and a negative predictive value of 91.1%. Three leaks (two minimal and one moderate) would have been missed but 31 (67.3%) patients would have avoided an unnecessary radiological study. Conclusion: Using a retrospective and prospective cohort of patients we have shown that a cystogram following RRP can be safely avoided in the absence of the identified risk factors. [source]

Diagnostic value of serum prostate-specific antigen in hemodialysis patients

INTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2003
MASAHIRO SUMURA
Abstract Background: The value of serum prostate-specific antigen (PSA) screening was examined to detect prostate cancer in men receiving hemodialysis. Methods: Forty-one male patients age 60,95 (median age, 70 years) receiving hemodialysis were investigated for PSA levels. We set the cut-off point at 4 ng/mL (the usual reference range). Digital rectal examination (DRE) and transrectal ultrasonography (TRUS) of the prostate were performed in patients whose PSA was more than 4 ng/mL and/or who expected further examination of the prostate. When prostate cancer was suspected, biopsy of the prostate was performed. In patients with prostate cancer, magnetic resonance imaging, computed tomography and bone scintigraphy were performed to diagnose the clinical stage. Results: The mean serum level of PSA was 2.10 ± 0.49 ng/mL. In this screening study, four of 41 men required further examinations for prostate cancer. Two of four refused further examinations. The other two were diagnosed with prostate cancer. The incidence of prostate cancer was at least 5% in our hemodialysis patients. One man, whose clinical stage was T2aN0M0, was treated with radical retropubic prostatectomy. Another man, whose clinical stage was T2bN0M0, was treated with luteinizing hormone-releasing hormone analogue. Conclusion: In our preliminary study, prostate cancer screening with PSA was useful for the early detection of prostate cancer in hemodialysis patients. If possible, DRE and TRUS should be performed in conjunction with PSA tests. [source]

Wound infiltration with magnesium sulphate and ropivacaine mixture reduces postoperative tramadol requirements after radical prostatectomy

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009
P. TAUZIN-FIN
Purpose: This prospective, randomized, double-dummy study was undertaken to compare the effects of magnesium sulphate (MgSO4) administered by the intravenous vs. the infiltration route on postoperative pain and analgesic requirements. Methods: Forty ASA I or II men scheduled for radical retropubic prostatectomy under general anaesthesia were randomized into two groups (n=20 each). Two medication sets A and B were prepared at the pharmacy. Each set contained a minibag of 50 ml solution for IV infusion and a syringe of 45 ml for wound infiltration. Group MgSO4.IV patients received set A with 50 mg/kg MgSO4 in the minibag and 190 mg of ropivacaine in the syringe. Group MgSO4/L received set B with isotonic saline in the minibag and 190 mg of ropivacaine +750 mg of MgSO4 in the syringe. The IV infusion was performed over 30 min at induction of anaesthesia and the surgical wound infiltration was performed during closure. Pain was assessed every 4 h, using a 100-point visual analogue scale (VAS). Postoperative analgesia was standardized using IV paracetamol (1 g/6 h) and tramadol was administered via a patient-controlled analgesia system. The follow-up period was 24 h. Results: The total cumulative tramadol consumption was 221 ± 64.1 mg in group MgSO4.IV and 134 ± 74.9 mg in group MgSO4.L (P<0.01). VAS pain scores were equivalent in the two groups throughout the study. No side-effects, due to systemic or local MgSO4 administration, were observed. Conclusion: Co-administration of MgSO4 with ropivacaine for postoperative infiltration analgesia after radical retropubic prostatectomy produces a significant reduction in tramadol requirements. [source]

Preoperative erectile function is one predictor for post prostatectomy incontinence,

NEUROUROLOGY AND URODYNAMICS, Issue 1 2007
S. Wille
Abstract Aims The precise etiology of post prostatectomy incontinence (PPI) is not fully understood and risk factors are not yet comprehensively defined. It has been reported that sparing of the neurovascular bundle during prostatectomy improves postoperative erectile function, whereas the influence on urinary control is unclear. From daily clinical experience we made the impression that patients who are in the best shape have better erections and better continence. We therefore searched our database for a possible correlation between the preoperative erectile function and the incidence of PPI. Patients and Methods Four hundred three patients who underwent radical retropubic prostatectomy between January 2000 and May 2003 were enrolled into this retrospective study. Data of 327 patients (response rate 81%) at a median follow-up of 26 months were analyzed using the validated International Index of Erectile Function (IIEF 5), the validated Urinary Distress Inventory (UDI6) and a standardized urinary symptom inventory. Continence was defined as usage of no or one pad daily. Erectile Dysfunction (ED) was defined as none/mild or moderate/severe with an IIEF 5 score of 17 or more or less than 17, respectively. Results Univariate and mulitvariate logistic regression analysis including preoperative IIEF 5 scores, age and nerve sparing prostatectomy, identified preoperative erectile function as significant predictor for PPI (P,=,0.024), whereas age (P,=,0.759) and nerve sparing prostatectomy (P,=,0.504) did not predict PPI. Conclusion Erectile function is a predictor of PPI and should be recorded preoperatively. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source]

Urinary incontinence and voiding dysfunction after radical retropubic prostatectomy (prospective urodynamic study)

NEUROUROLOGY AND URODYNAMICS, Issue 1 2006
Attila Majoros
Abstract Aims During this prospective study we analyzed the effects of radical retropubic prostatectomy (RRP) on bladder and sphincter function by comparing preoperative and postoperative urodynamic data. The aim of the study was to determine the reason for urinary incontinence after RRP and explain why one group of patients will be immediately continent after catheter removal, while others need some time to reach complete continence. Methods Urodynamic examination was performed in 63 patients 3,7 days before and 2 months after surgery. Results Forty-three (68.2%) and 53 (84.1%) patients regained continence at 2 and 9 months following RRP, respectively. Ten patients (15.9%) were immediately continent after catheter removal. Urodynamic stress incontinence was detected in 18 (28.6%), and detrusor overactivity incontinence in 2 (3.2%) patients 2 months after surgery. The amplitude of preoperative maximal voluntary sphincteric contractions was significantly higher in the postoperative continent group (125 vs. 96.5 cmH2O, P,<,0.0001). The patients who were immediately continent following catheter removal had no lower urinary tract symptoms (LUTS) and urodynamic abnormality preoperatively, and they had significantly higher preoperative and postoperative maximum urethral closure pressure (at rest and during voluntary sphincter contraction) than those who became continent later on. Conclusions These data suggest that the main cause of incontinence after RRP is sphincteric weakness. In the continent group, those who became immediately continent had significantly higher maximum urethral closure pressure values at rest and at voluntary sphincteric contraction even before the surgery. Neurourol. Urodynam. © 2005 Wiley-Liss, Inc. [source]

Assessment of the intrinsic urethral sphincter component function in postprostatectomy urinary incontinence

NEUROUROLOGY AND URODYNAMICS, Issue 3 2002
Christian Pfister
Abstract Postprostatectomy incontinence remains a disabling condition. Sphincter injury, detrusor instability, and decreased bladder compliance have been previously reported as major factors. The aim of this study was to evaluate the urethral sphincter intrinsic component, which may provide passive continence. A urodynamic evaluation was performed in 20 patients undergoing a radical retropubic prostatectomy in the preoperative period and 3 months after surgery. Patients with disabled urinary incontinence underwent a new urodynamic evaluation 6 months later. The urethral pressure profile was measured just before, then 10, 20, and 30 minutes after the injection of 0.5 mg/kg moxisylyte chlorhydrate, an alpha adrenergic blocker. Three different pressure components were defined in urethral sphincter capacity: baseline, adrenergic, and voluntary. A postoperative intrinsic urethral sphincter pressure component was found in 17 patients and its value was under 6 cm H2O in five cases of severe incontinence. No significant difference was observed for these patients on urethral profile components 6 months later. In contrast, in cases of significant intrinsic component value, no incontinence was observed in most patients. Passive continence after radical prostatectomy should be a matter of concern and may also explain paradoxical incontinence, despite high voluntary urethral pressure obtained after reeducation. A follow-up evaluation of the intrinsic sphincter component is suggested, by using an alpha receptor blockage test during urodynamic studies in the management of patients with postprostatectomy incontinence. Neurourol. Urodynam. 21:194,197, 2002. © 2002 Wiley-Liss, Inc. [source]

ORIGINAL RESEARCH,MEN'S SEXUAL HEALTH: Orgasmic Dysfunction After Open Radical Prostatectomy: Clinical Correlates and Prognostic Factors

THE JOURNAL OF SEXUAL MEDICINE, Issue 3 2010
Yvette Dubbelman MD
ABSTRACT Introduction., Erectile function after radical retropubic prostatectomy (RRP) is extensively discussed in literature. However, less is known about orgasm after RRP. Aim., To analyze sexual function, in particularly orgasmic function, in men before and after RRP. Methods., Between 1977 and 2007 a RRP was performed in 1,021 men. All men were interviewed by their follow-up physician using a standardized interview about sexual function before and after RRP at regular intervals during a 2-year follow-up. The questions were related to sexual interest, sexual activity, spontaneous erections, and orgasmic function. Main Outcome Measures., Sexual function, in particularly orgasmic function, before and after RRP. Factors potentially influencing orgasmic function, such as patients age, type of operation, pathological stage and continence status were analyzed for their predictive value. Results., Information about preoperative and postoperative sexual activity and spontaneous erection was available in 596 and 698 men, respectively. Additional questions were asked on sexual interest (N = 425) and orgasmic function (N = 458). Pre-operatively, sexual interest, sexual activity, spontaneous erections and orgasmic function were normal in 99%, 82.1%, 90.0% and 90% of men, respectively. After operation these values decreased to 97.2%, 67.3%, 29.4% and 66.8%, respectively. Orgasmic function was preserved in 141 of 192 men (73.4%) after a bilateral nerve sparing procedure, in 90 out of 127 men (70.9%) after a unilateral nerve-sparing procedure and in 75 of 139 men (54.0%) after non-nerve sparing technique. Postoperatively, orgasm was present in 123 (77.4%) men below the age of 60 years and in 183 (61.2%) men of 60 years and older (P < 0.0001). Orgasmic function was significantly affected by age ,60 years, non-nerve sparing procedure and severe incontinence (more than two pads/day). Conclusions., After RRP, orgasmic function is still present in the majority of men. A non-nerve sparing operation, age, and severe urinary incontinence are risk factors for orgasmic dysfunction after RRP. Dubbelman Y, Wildhagen M, Schröder F, Bangma C, and Dohle G. Orgasmic dysfunction after open radical prostatectomy: Clinical correlates and prognostic factors. J Sex Med 2010;7:1216,1223. [source]

Postoperative Orgasmic Function Increases over Time in Patients Undergoing Nerve-Sparing Radical Prostatectomy

THE JOURNAL OF SEXUAL MEDICINE, Issue 1pt1 2010
Andrew Salonia MD
ABSTRACT Introduction., Postprostatectomy orgasmic function (OF) remains poorly defined. Aims., To assess OF over time in patients who underwent bilateral nerve-sparing radical retropubic prostatectomy (BNSRRP) for organ-confined prostate cancer (PCa). Methods., Baseline data were obtained from 334 consecutive preoperatively sexually active PCa patients at hospital admission; data included a medical and sexual history, IIEF domain scores, and ICIQ-SF. Questionnaire were then completed every 12 months postoperatively, and patients participated in a semistructured interview at the 12-month (191/334 [57.2%] patients), 24-month (95/334 [28.4%] patients), 36-month (42/334 [12.6%] patients), and 48-month (19/334 [5.7%] patients) follow-up (FU). Main Outcome Measures., IIEF-OF domain values throughout the FU. Multivariate linear regression analysis (MVA) of the association between predictors (patient's age, IIEF-erectile function [EF], ICIQ-SF, and the use of postoperative proerectile pharmacological treatments) and the IIEF-OF at 12-month, 24-month, and 36-month FU. Results., Preoperative mean (median) IIEF-OF was 7.6 (10). The anova analysis showed an increase of the IIEF-OF values (P = 0.008; F = 4.009) throughout the FU (namely, IIEF-OF 12-month: 6.1 [6]; 24-month: 7.2 [8]; 36-month: 7.3 [8]; and 48-month: 7.7 [9.50]). The 12-month MVA showed that while proerectile oral therapy did not affect postoperative OF (P = 0.150; Beta 0.081), IIEF-OF linearly increased with IIEF-EF (P < 0.001; Beta 0.425). Conversely, IIEF-OF linearly decreased with patient's age (P < 0.001; Beta ,0.135) and with ICQ-SF scores (P < 0.001; Beta ,0.438). The 24-month and 36-month analyses showed that IIEF-OF still linearly increased with IIEF-EF (P < 0.001; Beta 0.540, and P < 0.001; Beta 0.536 respectively at the 24- and 36-month FU), whereas pharmacological therapy, rate of urinary continence, and patient's age did not significantly affect postoperative OF. Conclusions., Postoperative OF significantly ameliorates over time in patients undergoing BNSRRP. The higher the postoperative EF score, the higher the OF throughout the FU time frame. Salonia A, Gallina A, Briganti A, Colombo R, Bertini R, Da Pozzo LF, Zanni G, Sacca A, Rocchini L, Guazzoni G, Rigatti P, and Montorsi F. Postoperative Orgasmic Function Increases over Time in Patients Undergoing Nerve-Sparing Radical Prostatectomy. J Sex Med 2010;7:149,155. [source]

ORIGINAL RESEARCH,BASIC SCIENCE: Cavernous Neurotomy in the Rat is Associated with the Onset of an Overt Condition of Hypogonadism

THE JOURNAL OF SEXUAL MEDICINE, Issue 5 2009
Linda Vignozzi MD
ABSTRACT Background., Most men following radical retropubic prostatectomy (RRP) are afflicted by erectile dysfunction (ED). RRP-related ED occurs as a result of surgically elicited neuropraxia, leading to histological changes in the penis, including collagenization of smooth muscle and endothelial damage. Aim., To verify whether hypogonadism could contribute to the pathogenesis of RRP-ED. Methods., Effects of testosterone (T), alone or in association with long-term tadalafil (Tad) treatment in a rat model of bilateral cavernous neurotomy (BCN). Main Outcome Measures., Penile tissues from rats were harvested for vasoreactivity studies 3 months post-BCN. Penile oxygenation was evaluated by hypoxyprobe immunostaining. Phosphodiesterase type 5 (PDE5), endothelial nitric oxide synthase (eNOS), and neuronal nitric oxide synthase (nNOS) mRNA expression were quantified by Real Time quantitative reverse transcription polymerase chain reaction (qRT-PCR). Results., In BCN rats, we observed the onset of an overt condition of hypogonadism, characterized by reduced T plasma level, reduced ventral prostate weight, reduced testis function (including testis weight and number of Leydig cells), with an inadequate compensatory increase of luteinizing hormone. BCN induced massive penile hypoxia, decreased muscle/fiber ratio, nNOS, eNOS, PDE5 expression, increased sensitivity to the nitric oxide donor, sodium nitroprusside (SNP), and reduced the relaxant response to acetylcholine (Ach), as well as unresponsiveness to acute Tad dosing. In BCN rats, chronic Tad-administration normalizes penile oxygenation, smooth muscle loss, PDE5 expression, SNP sensitivity, and the responsiveness to the acute Tad administration. Chronic Tad treatment was ineffective in counteracting the reduction of nNOS and eNOS expression, along with Ach responsiveness. T supplementation, in combination with Tad, reverted some of the aforementioned alterations, restoring smooth muscle content, eNOS expression, as well as the relaxant response of penile strips to Ach, but not nNOS expression. Conclusion., BCN was associated with hypogonadism, probably of central origin. T supplementation in hypogonadal BCN rats ameliorates some aspects of BCN-induced ED, including collagenization of penile smooth muscle and endothelial dysfunction, except surgically induced altered nNOS expression.Vignozzi L, Filippi S, Morelli A, Marini M, Chavalmane A, Fibbi B, Silvestrini E, Mancina R, Carini M, Vannelli GB, Forti G, and Maggi M. Cavernous neurotomy in the rat is associated with the onset of an overt condition of hypogonadism. J Sex Med 2009;6:1270,1283. [source]

Intraoperative Assessment of an Implantable Electrode Array for Cavernous Nerve Stimulation

THE JOURNAL OF SEXUAL MEDICINE, Issue 8 2008
Arthur L. Burnett
ABSTRACT Introduction., Erectile dysfunction remains a major functional complication of radical prostatectomy in the modern era despite surgical techniques to preserve the penile autonomic nerve supply. Aim., To develop and evaluate a neurostimulation system for cavernous nerve electrical stimulation for future use as a chronic implantation device that neurotrophically promotes erectile function recovery following radical prostatectomy. Method., After radical retropubic prostatectomy, the neurovascular bundle was stimulated using a temporarily placed electrode array of an implantable neurostimulation system (20 Hz frequency, 260 µ seconds pulse width, 5 mA,60 mA amplitude up to 10 minutes), and penile circumference increases were measured. Main Outcome Measure., Increase in penile circumference. Results., Among 12 men (mean age 60.3 years) enrolled in this study, 6 (50%) demonstrated measurable increases in penile circumference in response to cavernous nerve stimulation. Among these six men, the mean increase was 5.0 mm (range 1.6 mm to 7.0 mm). Temporary surgical placement of the device was done with relative ease, and there was no evidence of injury to the neurovascular bundle. Conclusions., A chronic implantable nerve stimulation system for cavernous nerve stimulation having possible neuromodulatory effects on the recovery of penile erections after radical prostatectomy is feasible. Burnett AL, Teloken PE, Briganti A, Whitehurst T, and Montorsi F. Intraoperative assessment of an implantable electrode array for cavernous nerve stimulation. J Sex Med 2008;5:1949,1954. [source]

Quantitative PSA RT-PCR for preoperative staging of prostate cancer

THE PROSTATE, Issue 4 2003
Ralf Kurek
Abstract BACKGROUND The clinical value of detecting prostate specific antigen (PSA) mRNA in the peripheral blood mononuclear cell fraction of patients (pts) by standard RT-PCR assays with localized prostate cancer remains controversial. We used a quantitative RT-PCR assay to measure the PSA mRNA copy number in addition to the qualitative PSA RT-PCR and correlated the results with clinical parameters. METHODS Total RNA was extracted from the peripheral blood mononuclear cell fraction of 115 prostate cancer pts prior to radical retropubic prostatectomy (RP) who received 3 months of neoadjuvant androgen deprivation. For quantitative RT-PCR, a PSA-like internal standard (IS) was added to each sample prior to reverse transcription and the PCR products for PSA and IS were selectively detected with fluorescent europium chelates after hybridization. Corresponding qualitative PSA,RT-PCR was performed for all samples. RESULTS The median PSA copy number was 126 (range: 0,37988). There were no significant correlations established between qualitative or quantitative RT-PCR results and given clinical parameters. Corresponding quantitative and qualitative RT-PCR results were significantly associated (P,=,0.01). CONCLUSIONS We were unable to show any additional value of quantitative as well as qualitative PSA RT-PCR for preoperative staging of prostate cancer so far. Nevertheless, the long-term follow up of the patients has to be awaited. Prostate 56: 263,269, 2003. © 2003 Wiley-Liss, Inc. [source]

Prediction of extraprostatic cancer by prostate specific antigen density, endorectal MRI, and biopsy Gleason score in clinically localized prostate cancer

THE PROSTATE, Issue 1 2003
Akio Horiguchi
Abstract Backgrounds The present study was designed to identify the preoperative parameters, including PSA-based parameters, and endorectal MRI, predictive of pathological stage in males who underwent radical prostatectomy. Methods We studied 114 patients who underwent radical retropubic prostatectomy and pelvic lymphadenectomy for clinically localized prostate cancer. Clinical stage was assessed by DRE, pelvic CT scan, endorectal MRI, and bone scan. The correlation between the preoperative parameters, including PSA-based parameters, clinical stage, and histological findings of biopsy specimens, and the pathological stage was analyzed. Logistic regression analysis was performed to identify a significant set of independent predictors for local extent of disease. Results Seventy-six (66.6%) patients had organ confined cancer and 38 (33.4%) patients had extraprostatic cancer. Of the 38 patients with extraprostatic cancer, four had seminal vesicle involvement, while, none had pelvic lymph node involvement. Biopsy Gleason score, PSA, PSA-,1-antichymotrypsin (PSA-ACT), PSA-density (PSAD), PSA-transition zone density, PSA-ACT density, and PSA-ACT transition zone (TZ) density were significantly higher and percent free PSA was lower in the patients with organ confined cancer than those with extraprostatic cancer (P,<,0.01). PSAD showed the largest area under the ROC curve (AUC) among those parameters (AUC,=,0.732). Sixty-eight (74.7%) of 91 patients with T2 on endorectal MRI had organ confined cancer, while 15 (65.2%) of 23 patients with T3 had extraprostatic cancer (P,<,0.01). Multivariate logistic regression analysis indicated that Gleason score (,7 vs. ,6), endorectal MRI findings, and PSAD were significant predictors of extraprostatic cancer (P,<,0.01). Conclusions The present study demonstrated that preoperative PSAD was the most valuable predictor among PSA-based parameters for extraprostatic disease in patients with clinically localized prostate cancer. The combination of PSAD, endorectal MRI findings, and biopsy Gleason score can provide additional information for selecting appropriate candidates for radical prostatectomy. Prostate 56: 23,29, 2003. © 2003 Wiley-Liss, Inc. [source]

Intraoperative radiotherapy during radical prostatectomy for intermediate-risk to locally advanced prostate cancer: treatment technique and evaluation of perioperative and functional outcome vs standard radical prostatectomy, in a matched-pair analysis

BJU INTERNATIONAL, Issue 11 2009
Bernardo Rocco
OBJECTIVE To evaluate a novel approach with intraoperative radiotherapy (IORT) administered in the surgical field, after pelvic lymphadenectomy (PL) and before radical retropubic prostatectomy (RRP), evaluating acute and late toxicity, complications and biochemical progression-free survival (bPFS), as the adequate treatment of locally advanced prostate cancer is still a controversial issue. PATIENTS AND METHODS Between June 2005 and October 2007, 33 consecutive patients with intermediate-risk or locally advanced prostate cancer were selected for PL + IORT + RRP. IORT was delivered by a mobile linear accelerator in the operating room (electron beam, 12 Gy at 90% isodose). According to the pathological findings further adjuvant radio- or hormone therapy could be administered. The median follow-up was 16 months. This group was compared retrospectively with a historical group of 100 patients who had undergone RRP and further adjuvant therapy, selected with equivalent criteria. The comparison was conducted as a matched-pair analysis. The perioperative outcomes (surgical time, estimated blood loss, blood transfusions, days of catheterization, days of drainage, days of hospitalization), continence as the functional outcome, acute and late toxicity, rate of complications and bPFS were evaluated and compared. RESULTS The baseline characteristics of the two groups were equivalent but the node count and the number of positive lymph nodes was higher in the IORT group. The IORT group had longer surgery, and a shorter hospital stay and catheterization. There were no differences in continence rate, and no major complications in either group. The acute and late toxicity and bPFS were equivalent. A retrospective comparison and the short follow-up were the major limitations. CONCLUSIONS IORT administered before RRP seems a feasible approach, with little effect on the variables evaluated. [source]

After radical retropubic prostatectomy ,insignificant' prostate cancer has a risk of progression similar to low-risk ,significant' cancer

BJU INTERNATIONAL, Issue 2 2008
Shomik Sengupta
OBJECTIVE To assess progression and survival among patients with small-volume, well-differentiated, organ-confined prostate cancer found at radical retropubic prostatectomy (RRP), often defined as being ,insignificant', thus testing whether they are indeed ,insignificant'. PATIENTS AND METHODS We identified 6496 men treated for prostate cancer by RRP between 1990 and 1999, and defined ,insignificant' tumours as those in men having a prostate-specific antigen (PSA) level of <10 ng/mL before RRP, a cancer volume of ,0.5 mL, a specimen Gleason of score ,6 and stage ,pT2. Survival was assessed using the Kaplan-Meier method and compared using the two-sided log-rank test. RESULTS ,Insignificant' tumours were found in 354 (5.5%) men, of whom only one had metastatic progression and none died from prostate cancer, with a median (range) follow-up of 9.2 (0.8,15.6) years. Biochemical progression-free survival (87% vs 85%, respectively, at 10 years, P = 0.5), systemic progression-free survival (100% vs 99%, P = 0.3), overall survival (91% vs 88%, P = 0.16) and cancer-specific survival (100% in each group, P = 0.32) were each similar among men with ,insignificant' prostate cancer and men with low-risk (defined by Gleason score, preoperative PSA level, seminal vesicle and surgical margin status) ,significant' cancer. Clinical stage, biopsy Gleason score and preoperative PSA doubling time were multivariably predictive of ,insignificant' tumours at RRP. CONCLUSIONS ,Insignificant' prostate cancer at RRP is associated with a comparable risk of biochemical progression as low-risk ,significant' cancer. Although clinical predictors for ,insignificant' pathology can be identified, it remains to be established whether such patients can be safely managed conservatively. [source]

A curved Lowsley retractor improves manoeuvrability of the prostate during ascending radical retropubic prostatectomy

BJU INTERNATIONAL, Issue 6 2007
Rolf Gillitzer
First page of article [source]

The incidence and treatment of lymphoceles after radical retropubic prostatectomy

BJU INTERNATIONAL, Issue 3 2005
Amrith Raj Rao
No abstract is available for this article. [source]

The effect of sampling more cores on the predictive accuracy of pathological grade and tumour distribution in the prostate biopsy

BJU INTERNATIONAL, Issue 3 2004
A.A. Makhlouf
The technique for taking prostatic biopsies has received a major evaluation from many departments around the world in terms of the number of cores, site of biopsy, complications, need for local anaesthesia or sedation, etc., and the authors from Charlottesville review their technique. They present data confirming the impression that increasing the number of cores increases diagnostic sensitivity. Authors from Chapel Hill have performed a pilot study into the concept that cyclooxygenase (COX)-2 inhibitors inhibit tumour growth in prostate cancer, both in vivo and in vitro. In a few patients they found evidence to suggest that COX-2 inhibitors may be of value in patients with prostate cancer, concluding that a large trial is indicated. Vascular endothelial growth factor (VEGF) is known to be an important angiogenic factor. The authors from Sweden assessed its value as a marker in renal cancer cells. They found it to be present in most such cells, and found that the correlation between VEGF expression and tumour stage and prognosis was valuable in terms of progression of renal cancer. OBJECTIVE To determine if increasing the number of cores at biopsy improves the predictive accuracy of the Gleason score or aids in anticipating the location and volume of prostate tumour. PATIENTS AND METHODS The charts of 75 consecutive patients who underwent radical retropubic prostatectomy for clinical T1,2 adenocarcinoma of the prostate were reviewed retrospectively; 31 patients had a sextant biopsy (group 1) and 44 had ,,8 cores taken (group 2). The concordance between biopsy data and final prostatectomy Gleason score, tumour location and volume was determined for each group. RESULTS There were no differences in mean age, prostate-specific antigen level before biopsy or biopsy Gleason score for the two groups; 58% of group 1 had their final pathological grade changed after prostatectomy, vs 29% of group 2 (P < 0.05). In neither group was there a significant correlation between the percentage of cores positive for tumour and the percentage volume of prostate involved with cancer, or the ability of the biopsy to predict tumour location. CONCLUSION Taking ,,8 biopsy cores improved the pathological grading accuracy, which may be valuable in choosing a treatment for the patient with newly diagnosed prostate cancer. [source]

Urinary incontinence after radical retropubic prostatectomy: the outcome of a surgical technique

BJU INTERNATIONAL, Issue 4 2003
A. Moinzadeh
It is a reflection of the many manuscripts submitted on urological oncology in general, and prostate cancer in particular, that I am publishing 10 papers in this section this month. Seven of these relate to the latter subject. The authors from the Lahey Clinic describe their technique of radial prostatectomy and include a novel method of posterior bladder plication. They report an early return to continence and conclude that the technique is important in achieving their excellent results. In another study the group from Stockport show that patients often make decisions about types of treatment for prostate cancer having been strongly influenced by their partner, who in turn may have had pre-existing conceptions about this. They recommend early involvement of the partner to help in this very important decision-making. The two papers on bladder cancer describe possible prognostic factors, both clinical and laboratory-based, from a large experience in Hamburg and Mansoura. OBJECTIVE To analyse the incidence of incontinence after radical retropubic prostatectomy (RRP) and the time to return of continence, using an RRP technique including a novel posterior bladder plication PATIENTS AND METHODS We retrospectively reviewed the medical records of 200 consecutive patients who underwent RRP between September 1995 and February 1997, by one surgeon, at our institution. Patient characteristics including age, preoperative prostate-specific antigen (PSA) level and Gleason grade, were assessed. Continence was assessed before and after RRP by either a third-party patient interview or a prospective validated questionnaire. Continence was defined as not requiring the use of any sanitary pads or diapers. The continence rate was determined immediately after catheter removal, and at 3, 6, 12 and 15 months after RRP. RESULTS The mean age of the patients was 59.4 years, the preoperative PSA level 8.5 ng/mL and the Gleason grade 6.1. The time to continence and percentage of continent patients was 63.5% immediately, 82% at 3 months, 91% at 6 months, and 98.5% at 12 months after RRP. At 15 months, 199 of 200 consecutive patients were continent (99.5%). CONCLUSION With our technique there was an early return to continence and only a minor incontinence rate at 15 months. The cumulative effect of sequential technical manoeuvres in our RRP technique, including posterior bladder plication, is critical for continence after RRP. [source]

An unrandomized prospective comparison of urinary continence, bowel symptoms and the need for further procedures in patients with and with no adjuvant radiation after radical prostatectomy

BJU INTERNATIONAL, Issue 4 2003
T. Hofmann
OBJECTIVE To prospectively assess, using a questionnaire-based study, the relative differences and changes in urinary continence and bowel symptoms, and the need for further surgery, within the first year after radical retropubic prostatectomy (RRP) in patients with and with no adjuvant radiotherapy (aRT). PATIENTS AND METHODS The study included 96 men with clinically organ-confined adenocarcinoma of the prostate who underwent RRP between March 1998 and June 1999. A subset of 36 patients was recommended aRT of the prostatic fossa (median dose 54 Gy) because of positive surgical margins and/or seminal vesicle involvement. Using a mailed questionnaire all patients were prospectively assessed at 4-month intervals for the first year after RRP. RESULTS Valid data were analysed from 83 patients (overall response rate 86%), of whom 30 (36%) had received aRT. At 4 months a significantly lower proportion used no pads and significantly more used 1 pad/day in the aRT than in the RRP group (both P < 0.05). Eight and 12 months after RRP there was no statistically significant difference between the groups in urinary incontinence. However, 53% of men in the aRT group had stool urgency and 13% reported fecal incontinence at 4 months, compared with 1.9% and none (both P < 0.01) of the RRP group. At 1 year after RRP bowel symptoms and fecal continence improved in the aRT group and there was no significant difference for these symptoms between the groups. Starting aRT early (, 12 weeks after RP) or late (> 12 weeks) had no significant effect on urinary continence, bowel symptoms and fecal incontinence. Apart from dilatation of urethral strictures in one patient in each group, no further procedures were reported during the follow-up. CONCLUSION A moderate dose of aRT after RRP had a temporary effect on subjective urinary continence at 4 months but not at 8 and 12 months. More patients receiving aRT reported significant bowel symptoms at 4 and 8 months than those with RRP only, but at 1 year most of these symptoms had resolved and there were no significant differences between the groups. [source]

Laparoscopic hernia repairs may make subsequent radical retropubic prostatectomy more hazardous

BJU INTERNATIONAL, Issue 7 2003
H. Cook
No abstract is available for this article. [source]