Preoperative Testosterone Research Articles

Inyección intraoperatoria de nanocoloide con tecnecio-99 metaestable para la localización de tumores intratesticulares no palpables en orquiectomías parciales

ObjectiveRadical orchidectomy is the standard treatment for malignant testis tumours. Radical orchidectomy results in androgen deprivation, infertility and impaired psychological well-being, especially in synchronous bilateral tumours, metachronous contralateral tumours or tumour in a solitary testis. According to the European Association of Urology Guidelines, if pre-operative testosterone level is normal and the tumour volume is less than 30% of the testicular volume, organ preserving surgery can be performed. For nonpalpable tumours, organ-sparing surgery needs a precise intraoperative localization with high-frequency ultrasound, especially for nonpalpable tumours. Matherial and methodsWe report two cases of nonpalpable intratesticular tumours successfully localised using 99mmTc nanocolloid injected with intraoperative US and detected with a γ-ray detection probe. ConclusionsThis method is easily reproducible and safe for the patient. This technique could guarantee complete excision of the tumour, especially if the mass is poorly delimited

Contemporary Role of Testis Sparing Surgery: A Systematic Review

Testis-sparing surgery (TSS) represents a therapeutic choice for testicular cancer (TC). However, international guidelines are very cautious about the use of the testis-sparing technique, namely due to the lack of certain indications and long-term oncological outcomes. The aim of this systematic-review is to illustrate current trends of what may today be the uses of organ-sparing surgery in TC, to evaluate the relationship between the organ-sparing safety and oncological features such as definitive histology, tumour size, and post-surgery oncological outcomes. This analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. An electronic search of the Medline and Embase was undertaken until September 2014. The search was limited to English-Language articles. Current indications of TSS are synchronous bilateral testicular tumours, metachronous contralateral tumours, or tumour in a solitary testis with normal preoperative testosterone levels. Moreover, histological characteristics should not be taken into account when performing a TSS approach. TSS outcomes for germ cell tumours are encouraging and we reported high rates of disease-free survival and a few cases of patients receiving neoadjuvant chemotherapy or radiotherapy. In light of the examined, TSS could be considered a viable alternative to radical surgery of the testis but it should be performed in specialised centres with competence.

Survey of pediatric urologists on the preoperative use of testosterone in the surgical correction of hypospadias

ObjectiveTo better characterize the current state of testosterone use in the surgical correction of hypospadias among pediatric urologists. MethodsAn email was sent via the pedsurology research listserv through the American Academy of Pediatrics, inviting members to participate in an anonymous survey regarding their use of preoperative testosterone in hypospadias correction. ResultsTwenty-seven responses were obtained for a response rate of 53%. Almost all responders practiced in North America, had exclusively pediatric patients in their practice, and had been in practice for 30 years or less. 55% were classified as high-volume surgeons, completing >50 cases yearly, 87% of whom use preoperative androgen therapy currently, compared with 67% of low-volume surgeons. Testosterone was prescribed primarily for a small appearing penis, reduced glans circumference, reduced urethral plate width, and/or proximal hypospadias. The effect of testosterone was determined primarily by evaluating penile appearance (59%). However, the majority (56%) of physicians stopped giving testosterone when they completed a predetermined regimen. ConclusionsWhile many pediatric urologists use testosterone prior to hypospadias repair, the practice patterns are variable. It appears that the use of testosterone is primarily limited to patients with proximal hypospadias, small appearing penis, reduced glans circumference or reduced urethral plate.

Association of Preoperative Testosterone Levels with Biochemical Failure in Men Undergoing Radical Prostatectomy

Background: Low testosterone levels in men treated with radical prostatectomy (RP) for prostate cancer have been associated with worse pathological stage and outcomes. Long-term data correlating preoperative testosterone levels and RP outcomes are presented. Methods: A total of 177 patients were identified who had preoperative testosterone levels and were treated with RP with long-term follow-up. Associations of testosterone levels with tumor stage, Gleason score, and time to biochemical failure (BCF) were assessed using Pearson's chi-square test, Mantel–Haenszel test, Spearman rank correlation, and life-table methods (Kaplan–Meier curves, log-rank test, Cox proportional hazards model) as appropriate. Testosterone was analyzed both as a continuous factor and as low (<300 ng/dl) versus normal testosterone levels. Results: The median testosterone level was 423 ng/dl, median age was 65 years, and median follow-up was approximately 15 years. A significant association between testosterone values below 300 ng/dl and positive surgical margin (p=0.0389) as well as seminal vesicle invasion (p=0.0182) was found. While patients with a testosterone level<300 ng/dl also showed a higher percentage of BCF over time (45% vs. 29% at 15 years), the difference was not statistically significant (p=0.076, log-rank test). When adjusted for known predictors of BCF (Gleason score, pre-RP prostate-specific antigen, seminal vesicle involvement, and positive surgical margin), the effect of testosterone as a continuous predictor was not statistically significant (p=0.57). Conclusion: The longest follow-up to date (15 years) correlating preoperative testosterone levels and RP outcomes is presented. With this study, low testosterone levels were significantly associated with a positive surgical margin and seminal vesicle invasion, and slightly higher (p=076) BCF rates.

Focal Surgery in Testis Cancer: Current State of the Art

Radical orchiectomy is the standard treatment of testicular neoplasia causing androgen insufficiency, infertility and psychological stress. Focal surgery allows the preservation of fertility, endocrine function and integrity of the genital anatomy, with preservation of the image of the male body. The EAU guidelines suggest focal surgery in case of synchronous bilateral tumors, metachronous contralateral tumours, tumour in solitary testis with normal pre-operative testosterone levels, when the tumor volume less than 30% of the testicular volume. There are two focal surgical techniques: tumorectomy and polar resection, followed by biopsies and frozen section of the resection bed. In case of benign tumours, the treatment is often curative. In case of malignancy, carcinoma in situ is frequently found in the surrounding tissues. Adjuvant treatment with chemotherapy or radiotherapy is performed with a fair success rate. These adjuvant treatments reduce or delete the functional benefits achieved by conservative surgery. The evidence of the literature suggests that focal surgery is a valid option for all patients with testicular tumours that are not palpable and small sized, with the advantage of avoiding unnecessary radical orchiectomy in most cases. Therefore, the selection criteria for focal surgery are the mass size (less than 25 mm) and a safety distance of the tumor from the rete testis, in order to preserve testicular vascularization. A close follow-up with ultrasound, testicular markers and radiological examinations is mandatory in case of germ cell neoplasia treated conservatively in patients with indications for conservative surgery.

Objective use of testosterone reveals androgen insensitivity in patients with proximal hypospadias

ObjectiveWe report preoperative testosterone stimulation based on glans width measurements in patients with midshaft and proximal hypospadias, revealing androgen resistance in those with proximal hypospadias. MethodsPatients had maximum glans width measured preoperatively. Those <14 mm initially received 2 mg/kg testosterone cypionate intramuscularly for two to three doses, with the aim of increasing glans width ≥15 mm. Not all patients achieved targeted growth, and some were subsequently treated with escalating doses of testosterone. Results5/15 midshaft patients had two to three doses of 2 mg/kg testosterone, with all increasing glans width to ≥15 mm. 29/47 proximal patients had testosterone, with 13 (57%) not reaching desired glans width. Six of these and another six patients had escalating doses from 4 to 32 mg/kg testosterone, with 11 then achieving targeted glans width. Relative androgen resistance was found in 19/29 (66%) proximal cases, including all treated patients with perineal hypospadias. Conclusions39/62 (63%) patients met objective criteria for preoperative testosterone stimulation based on glans width <14 mm, which is less than the average normal newborn glans diameter. Evidence of relative androgen resistance was found in 19 (49%), all with proximal hypospadias.

A rare association between Rathke’s cyst and hypophysitis in a patient with delayed sex development and growth failure

We report an 18-year-old Japanese male with a lack of secondary sex characterization and growth failure caused by a rare association between Rathke's cyst and hypophysitis. He was referred to us because of delayed secondary sex characterization. Endocrinological examination showed panhypopituitarism, and the replacement of hydrocortisone, levothyroxine, and desmopressin acetate (DDAVP) was initiated. Brain magnetic resonance imaging (MRI) showed a suprasellar region and a swollen pituitary stalk. The mass was partially resected using the transsphenoidal approach. The pathological diagnosis was hypophysitis and Rathke's cyst. Follow-up MRI performed 1 year after surgery showed that the size of sellar region had not changed. After surgery, in addition to pre-operative hormonal replacement, growth hormone and testosterone were initiated. Two years later, the size of sellar region remains unchanged. In conclusion, while an association between Rathke's cyst and hypophysitis is rare, we suggest that this condition should be included in differential diagnosis of the sellar region, even in adolescents.

Preoperative hormonal pattern in patients undergoing radical prostatectomy due to prostate cancer

ObjectiveThere is controversial evidence regarding preoperative testosterone levels related to poor prognosis factors after radical prostatectomy. The aim of this manuscript is to determine the relationship between preoperative testosterone levels and final pathologic report together to biochemical recurrence after radical prostatectomy (RP). Materials and methodsWe prospectively analyzed 143 patients submitted to RP from February 2008 to June 2010 in our center. Pre-treatment testosterone (T) and sex hormone-binding globulin (SHBG) levels were determined as part of our clinical protocol. Free calculated (fT) and bioavailable (bioT) testosterone were calculated using Vermeulen's formula. Low testosterone levels were defined as 346ng/dL or less. A comparative analysis with variables pTNM, positive margins, tumor burden, Gleason score, multifocality and biochemical recurrence (using both PSA>0.4ng/dL and PSA>0.2ng/dL as cut-off values) was performed, according to preoperative levels of T. ResultsVariables Gleason score, rate and number of positive margins, tumor burden, tumor multifocality, time to biochemical recurrence and pathological stage were not related to preoperative hormonal levels. Preoperative T<346ng/dL was not found to be related to PSA recurrence (PSA>0.4ng/dL log-rank, p=0.512), although a trend was observed when PSA>0.2ng/dL (log-rank, p=0.097). ConclusionPreoperative testosterone levels were not related to final pathological report or to biochemical recurrence.

998 IN 538 GLEASON 7 DERIVED FROM RADICAL PROSTATECTOMY, GRADE 4+3 IS MORE FREQUENT THAN 3+4 IN HYPOGONADIC PATIENTS

You have accessJournal of UrologyProstate Cancer: Localized (IV)1 Apr 2013998 IN 538 GLEASON 7 DERIVED FROM RADICAL PROSTATECTOMY, GRADE 4+3 IS MORE FREQUENT THAN 3+4 IN HYPOGONADIC PATIENTS Yann Neuzillet, Jean-Pierre RAYNAUD, Vincent MOLINIE, Camelia RADULESCU, Thierry LEBRET, and Henry BOTTO Yann NeuzilletYann Neuzillet Suresnes, France More articles by this author , Jean-Pierre RAYNAUDJean-Pierre RAYNAUD Paris, France More articles by this author , Vincent MOLINIEVincent MOLINIE Paris, France More articles by this author , Camelia RADULESCUCamelia RADULESCU Suresnes, France More articles by this author , Thierry LEBRETThierry LEBRET Suresnes, France More articles by this author , and Henry BOTTOHenry BOTTO Suresnes, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.582AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Fifteen percent of patients who underwent radical prostatectomy have hypogonadism defined as a total testosterone less than 3 ng/ml. Low testosterone (lowT) serum level in prostate cancer patients before treatment is associated with poor prognosis. Moreover, there is accumulating evidences that Gleason 7 prostate cancer shows heterogeneous behavior with Gleason 3 + 4 and 4 + 3 tumors conferring different prostate cancer specific mortality. The aim of this observational study was to characterize the aggressiveness of the prostate cancer assessed by the predominant Gleason pattern (pGP), in relation to preoperative testosterone serum concentration. METHODS 786 patients, referred to our Department (from 03/2007 to 09/2012) for a radical prostatectomy, had preoperative TT and Bioavailable Testosterone (samplings between 7 and 10 am) serum determinations (radio-immuno assayed in a central laboratory). GS and pGP was determined in prostate biopsies and prostate tissue specimens. RESULTS In prostate specimens, a GS7 was observed in 538 (68.4%) of the patients; 195 (24.8%) had a pGP4. Comparing the 195 patients with a pGP4 to the 343 with a pGP3, TT was lower (4.23±1.63 vs. 4.73±1.70 ng/mL, p=0.0009) and PSA higher (10.2 vs. 8.0 ng/mL, p<0.0001). Hypogonadism was more frequent (26% vs. 9%, p=0.0003). Extra prostatic extension was more frequently observed (22.5% versus 10.5%, p=0.0002). The 80 patients with TT <3.0 ng/mL were bigger (+8kg, p<0.0001) with a BMI highier (+ 2.7 kg/m2, p<0.0001). They had a higher percent of GS with a pGP4: 55.0% vs. 33.0% (p=0.0002). CONCLUSIONS The pGP in prostate specimens is of paramount importance, especially in case of a Gleason 7, to appreciate the outcomes and to choose the treatment. In cancer Gleason 7 in radical prostatectomy specimens, pGP4 is more frequent in hypogonadal patients. Preoperative testosterone should be used to improve the management of prostate cancer. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e409-e410 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yann Neuzillet Suresnes, France More articles by this author Jean-Pierre RAYNAUD Paris, France More articles by this author Vincent MOLINIE Paris, France More articles by this author Camelia RADULESCU Suresnes, France More articles by this author Thierry LEBRET Suresnes, France More articles by this author Henry BOTTO Suresnes, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Surgical castration for androgen-deprivation therapy of prostate cancer – relevance in current practice

Objective: Rapid control of the disease is essential in the management of patients with critical and symptomatic metastatic prostate cancer. Pharmacological castration has become the main form of androgen-deprivation therapy (ADT) for prostate cancer, with luteinising hormone-releasing hormone (LHRH) agonists being used in more than 90% of cases. Surgical castration has become the less preferred modality. This article aims to explore the clinical and economic advantages of bilateral sub-capsular orchidectomy (BSCO). Method: Pre- and post-operative serial testosterone levels were taken from patients who had BSCO for adenocarcinoma of the prostate. The half-life of testosterone was calculated. The cost of surgical castration on the National Health Service (NHS) was compared to the cost of LHRH agonists. Results: Ten patients with a median prostate-specific antigen (PSA) level of 93 ng/ml (range 26 to 4557 ng/ml) were included. Their mean random pre-operative testosterone level was 13.8 ng/ml (range 6.8 to 21.8 ng/ml). The mean half-life of testosterone was 61.7 minutes when calculated from the first two hours, and 67 minutes when calculated from the total drop with no significant variation ( p = 0.464). Four patients reached castrate levels of testosterone within four to six hours. The total cost of an inpatient BSCO in the NHS was £850 to £1154. This was more or less equivalent to one year’s worth of the commonly used LHRH agonists without including the cost of medical services. Conclusions: Testosterone has a short half-life and reaches castrate levels within hours of the BSCO procedure. Rapid castration by BSCO would benefit patients with critical metastatic disease. BSCO on the NHS in patients with more than one year of life expectancy is also economically beneficial.

Dihydrotestosteron verbessert die knöcherne Einheilung von Kobalt-Chrom-Implantaten

The osseointegration of actually rarely implanted cobalt-chromium implants can be critical in an elderly population. The aim of our study was to evaluate the effect of preoperative testosterone treatment on the osseointegration of cobalt-chromium implants. Press-fit implantation of 1.6 mm-diameter cobalt-chromium-molybdenum (CoCrMo) implants was performed in rats without pre-treatment in one group (n = 10) and after pre-treatment with 1 mg dihydrotestosterone (DHT) 2 days before surgery in the other group (n = 10). After 14 days, the specimens were examined by a pull-out test, histology and histomorphometry. The biomechanical testing delivered inconsistent data leading to no significant difference (6.45 ± 6.94 N vs. 4.66 ± 3.77 N). Histology showed closed contact between surrounding tissue and the implants in both groups. The bone/implant contact area was significantly enhanced after treatment with DHT (42.23 % ± 9.25 vs. 57.57 % ± 16.71, p < 0.05), while the ratio of osteoid was reduced (38.68 % ± 16.7 vs. 27.38 % ± 13.02, not significant). Pre-treatment with DHT enhances osseointegration of cobalt-chromium implants through enhanced mineralisation of peri-implant tissue. The treatment might additionally shorten postoperative rehabilitation due to its positive effects on musculature.

Perfil hormonal preoperatorio en pacientes sometidos a prostatectomía radical por cáncer de próstata

ObjectiveThere is controversial evidence regarding preoperative testosterone (T) levels related to poor prognosis factors after radical prostatectomy (RP). The aim of this manuscript is to determine the relationship between preoperative T levels and final pathologic report together to biochemical recurrence after RP. Materials and methodsWe prospectively analysed 143 patients submitted to RP from February 2008 to June 2010 in our centre. Pretreatment T and sex hormone-binding globulin levels were determined as part of our clinical protocol. Free calculated (fT) and bioavailable (bioT) T were calculated using Vermeulen's formula. Low T levels were defined as 346ng/dL or less. A comparative analysis with variables pTNM, positive margins, tumour burden, Gleason score, multifocality and biochemical recurrence (using both PSA>0.4ng/dL and PSA>0.2ng/dL as cut-off values) was performed, according to preoperative levels of T. ResultsVariables Gleason score, rate and number of positive margins, tumour burden, tumour multifocality, time to biochemical recurrence and pathological stage were not related to preoperative hormonal levels. Preoperative T<346ng/dL was not found to be related to PSA recurrence (PSA>0,4ng/dL log-rank, P=.512), although a trend was observed when PSA>0,2ng/dL (log-rank, P=.097). ConclusionPreoperative T levels were not related to final pathological report or to biochemical recurrence.

Role of Optimizing Testosterone Before Microdissection Testicular Sperm Extraction in Men with Nonobstructive Azoospermia

Although optimizing endogenous testosterone production before testicular sperm extraction is commonly practiced, whether improved preoperative testosterone levels enhance sperm retrieval remains unclear. We evaluated the influence of preoperative medical therapy in men with nonobstructive azoospermia before microdissection testicular sperm extraction. A total of 1,054 men underwent microdissection testicular sperm extraction from 1999 to 2010. Patients with preoperative testosterone levels less than 300 ng/dl were treated with aromatase inhibitors, clomiphene citrate or human chorionic gonadotropin before microdissection testicular sperm extraction with the goal of optimizing testosterone levels. Patient demographics, preoperative testosterone levels, sperm retrieval rate and pregnancy outcomes were recorded and compared in men with different baseline testosterone levels. Of the 736 men who had preoperative hormonal data 388 (53%) had baseline testosterone levels greater than 300 ng/dl. The sperm retrieval rate in these men was 56%. In the remaining 348 men with pretreatment testosterone levels less than 300 ng/dl, the sperm retrieval rate was similar (52%, p = 0.29). In addition, the sperm retrieval, clinical pregnancy and live birth rates were similar between men who responded to hormonal therapy and those who did not. Men with nonobstructive azoospermia and hypogonadism often respond to hormonal therapy with an increase in testosterone levels, but neither baseline testosterone level nor response to hormonal therapy appears to affect overall sperm retrieval, clinical pregnancy or live birth rates.

The efficacy of topical testosterone treatment on preputial microvessel density in distal hypospadias

To investigate the efficacy of topical testosterone treatment on the microvessel density (MVD) of hypospadiac prepuce. Materials and methods: The prepuces of 20 healthy children undergoing routine circumcision served as the control group, while the prepuces of 20 children undergoing hypospadias repair served as the hypospadias group. The hypospadias group was further divided into 2 equal subgroups (n = 10) as the hypospadias with or without testosterone treatment groups. The meatal locations were coronal and subcoronal in all of the patients with hypospadias. The prepuces were stained by immunohistochemical methods using panendothelial cell antigen CD31 in order to assay their MVD. The statistical analysis among the groups was done using one-way analysis of variance. Results: The MVD was significantly lower in the hypospadias without treatment group than in the control group (37.16 ± 18.20 vs. 58.75 ± 24.98; P = 0.037). Preoperative testosterone treatment increased the mean MVD to 51.92 ± 10.21 in the treatment group, but it was not statistically significant (P = 0.116). Conclusion: Topical testosterone treatment prior to hypospadias surgery restores defective MVD in the prepuce, but this desired effect is unsatisfactory with a single application of a high dose of testosterone.

Varicocele as a risk factor for androgen deficiency and effect of repair

• To determine whether men with varicoceles have lower testosterone levels than those without and to ascertain if testosterone levels increase after varicocelectomy. • We measured preoperative testosterone levels in 325 men with palpable varicoceles and in 510 men with vasectomy reversal without varicoceles who served as a comparison group. • The testosterone levels between groups were compared by age. Of the men with varicoceles, 200 had data on both pre- and postoperative testosterone levels, which were compared to assess postoperative changes. • Men with varicocele had significantly lower testosterone levels than the comparison group, with mean (sd) levels of 416 (156) vs 469 (192) ng/dL (P < 0.001). This difference persisted when analysed by age. • The testosterone levels significantly increased after repair from 358 (126) to 454 (168) ng/dL (P < 0.001). • Of the 70% of patients with postoperative improvement in testosterone levels, the mean (sd) increase in testosterone was 178 (142) ng/dL. The percentage change in testosterone levels was: 30% had no increase, 41% increased by ≤ 50%, 19% increased between by 51-100%, and 10% increased by >100%. • There was no association between change in testosterone level and age, laterality of varicocele, or varicocele grade. • Men with varicoceles had significantly lower testosterone levels than the comparison group of men with vasectomy reversal. • Microsurgical varicocele ligation resulted in a significant increase in serum testosterone levels in more than two-thirds of men. • These findings suggest that varicocele is a significant risk factor for androgen deficiency and that repair may increase testosterone levels in men with varicocele and low testosterone levels.

Analysis of Risk Factors for Glans Dehiscence After Tubularized Incised Plate Hypospadias Repair

We determined the incidence of glans dehiscence and the associated risk factors after tubularized incised plate hypospadias repair. All data for patients undergoing tubularized incised plate hypospadias repair, surgical details and postoperative outcomes were prospectively maintained in databases. Data were analyzed with simple and multiple logistic regression to determine if patient age, preoperative testosterone use, meatal location (distal, mid shaft or proximal), glansplasty sutures (chromic catgut vs polyglactin) or primary vs revision tubularized incised plate procedure was associated with an increased risk of glans dehiscence. Glans dehiscence occurred in 32 of 641 patients (5%). Age at surgery, preoperative testosterone use and glansplasty suture did not impact the risk of glans dehiscence. Glans dehiscence occurred in 20 of 520 distal (4%), 1 of 47 mid shaft (2%) and 11 of 74 proximal (15%) tubularized incised plate repairs, with the odds of glans dehiscence being 3.6 times higher in patients with proximal vs distal meatal location. Patients undergoing reoperative (9 of 64, 14%) vs primary tubularized incised plate (23 of 577, 4%) had a 4.7-fold increased risk of glans dehiscence. Proximal meatal location and revision surgery, most commonly for prior glans dehiscence, increase the odds of glans dehiscence by 3.6 and 4.7-fold, respectively, suggesting anatomical and/or host factors (wound healing) are more important than age, type of suture or preoperative testosterone use in the development of this postoperative complication.

461 FREE AND BIOAVAILABLE SERUM TESTOSTERONE WERE ELEVATED BY DECREASING SEX HORMONE BINDING GLOBULIN IN PROSTATE CANCER

INTRODUCTION AND OBJECTIVES: We aimed to identify the relationship between the serum testosterone (TS) axis and the prostate cancer and its association with clinicopathological features. METHODS: Between May 2006 and October 2009, 741 patients (mean age, 64.6 6.7 years) with prostate cancer undergoing RP without hormonal therapy or chemotherapy and age-matched 741 men (mean age, 64.6 7.2 years) who had visited health promotion center for routine health exam were enrolled prospectively. Total serum TS, sex hormone binding globulin (SHBG) and albumin were measured at 8 AM after midnight fasting. In the cancer group, we followed the hormone levels after RP. Between the two groups, we compared total serum TS, TS-derivatives and SHBG. In the cancer group, further subgroup analysis was done between the preoperative hormone levels and the perioperative changes in relationship with various clinicopathological characteristics. RESULTS: Lower levels of SHBG (53.8 21.5 vs. 59.0 23.9 nmol/L, p 0.001), total TS (4.09 1.54 vs. 4.31 1.64 ng/ml, p 0.001), higher levels of free TS (70.2 24.7 vs. 63.4 28.6 pg/ml, p 0.012), bioavailable TS (1.54 0.55 vs. 1.39 0.59 ng/ml, p 0.016), and free TS index (FTI) (8.98 3.46 vs. 7.97 3.45, p 0.001) were observed in the cancer group compared to the control group. Preoperative SHBG was an independent predictor for high pathologic Gleason score ( 7) (p 0.013, HR 1.540). After RP, both SHBG and total TS significantly increased from 53.8 21.5 to 59.0 22.9 nmol/L and from 4.09 1.54 to 4.30 1.22 ng/ml, respectively (both, p 0.001). Subsequently free TS was reduced from 70.2 24.7 to 64.26 18.01 pg/ml, bioavailable TS reduced from 1.54 0.55 to 1.42 0.40 ng/ml, and FTI from 8.98 3.46 to 7.89 3.15 (all, p 0.001). CONCLUSIONS: We have demonstrated that patients with prostate cancer have increased TS bioactivity compared to agematched controls. SHBG was an independent predictor of cancer differentiation. Following RP, enhanced TS bioactivity normalized and consequently preoperative low TS rebounded to the level comparable to the control group, which was mainly attributable to the postoperatively elevating SHBG, mechanism of which remains to be elucidated.

546 AN ALTERNATIVE FOR VENTRAL LENGTHENING IN CHILDREN WITH SEVERE PENILE CURVATURE THAT ALLOWS GRAFT COVERAGE DURING STAGED HYPOSPADIAS REPAIR

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia1 Apr 2011546 AN ALTERNATIVE FOR VENTRAL LENGTHENING IN CHILDREN WITH SEVERE PENILE CURVATURE THAT ALLOWS GRAFT COVERAGE DURING STAGED HYPOSPADIAS REPAIR Bruno Leslie, Bryce Weber, Rodrigo Romao, Walid Farhat, Darius Bagli, Armando Lorenzo, and Joao Pippi Salle Bruno LeslieBruno Leslie toronto, Canada More articles by this author , Bryce WeberBryce Weber toronto, Canada More articles by this author , Rodrigo RomaoRodrigo Romao toronto, Canada More articles by this author , Walid FarhatWalid Farhat toronto, Canada More articles by this author , Darius BagliDarius Bagli toronto, Canada More articles by this author , Armando LorenzoArmando Lorenzo toronto, Canada More articles by this author , and Joao Pippi SalleJoao Pippi Salle toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1271AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Staged repair using preputial grafts has become a popular option for proximal hypospadias with severe curvature. Corporal ventral lengthening (CVL) with autologous, xenogenic or synthetic grafts are often employed, however the initial lack of vascular supply precludes simultaneous superposition of free grafts during first stage urethroplasty. Herein we report preliminary results of a surgical strategy aiming to overcome this limitation, allowing concurrent CVL and preputial grafting for urethroplasty. METHODS The medical records of patients who underwent staged preputial graft urethroplasty (SPGU) for primary repair of perineal or penoscrotal hypospadias with severe curvature were retrospectively reviewed. All patients received pre operative testosterone. The decision to divide the urethral plate was made after complete degloving and urethral mobilization. Multiple deep ventral transverse incisions of the tunica albuginea from 3 to 9 o'clock position were performed in patients with persistent intrinsic curvature after plate transection. An inner preputial graft was then harvested and quilted directly over the incised albuginea, and a tie-over dressing applied. Second stage was done approximately 6 months later, when the graft was tubularized and covered with tunica vaginalis or dartos flap. Prior to tubularization an erection test was repeated and residual curvature addressed with dorsal plication (DP), if necessary. Age, outcomes, need for DP and complications were recorded. RESULTS 30 patients completed the two stages from 2006 to 2010. Mean age at first stage was 18 months (range 10m–11y) and mean interval between stages was 8 months (range 6–11). Mean follow up after the second stage was 16 months (range 6–36). All grafts took well and were suitable for tubularization. DP was required for minor residual ventral curvature in 14/30 (47%) patients. Relevant complications included a long urethral stricture secondary to balanitis xerotica obliterans (1), ventral skin contracture (1), small urethrocutaneous fistulas (2), glans dehiscence (2) and recurrence of mild curvature (2). The remaining 22 cases have no ventral curvature and early excellent cosmetic results, with a slitlike meatus placed in the glans. CONCLUSIONS Our results suggest that the use of deep ventral transverse corporeal incisions for correction of severe curvature allows SPGU and concurrent CVL. The early cosmetic and functional results with this approach are satisfactory with an acceptable complication rate. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e221-e222 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bruno Leslie toronto, Canada More articles by this author Bryce Weber toronto, Canada More articles by this author Rodrigo Romao toronto, Canada More articles by this author Walid Farhat toronto, Canada More articles by this author Darius Bagli toronto, Canada More articles by this author Armando Lorenzo toronto, Canada More articles by this author Joao Pippi Salle toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Could Serum Testosteron Level and Body Mass Index Predict Psa Relaps in Prostate Cancer Patients undergoing Radical Surgery?

Purpose: It is well-known that indicators such as biopsy and prostatectomy Gleason score , clinical and pathological stage and preoperative PSA level can be utilized in predicting PSA recurrence in cases who underwent radical prostatectomy (RP) with the diagnosis of organ-confined prostate cancer. The purpose of this study was to investigate the predictability of postoperative PSA recurrence by serum total testosterone levels as well as body mass index (BMI). Materials and methods: Fourty-eight patients in whom RP was planned with the diagnosis of prostate-confined cancer were enrolled in this study. The data recorded included the patient’s preoperative testosterone levels and BMI as well as age, serum PSA level, clinical stage, Gleason score on biopsy, the presence of PIN and surgical margin positivity. After operation, the patients were kept under follow up according to the guidelines. During the follow-up, the analysis of the selected markers was performed using T-test, Mann-Whitney U test, Chi square test, Anova and Roc analysis in cases with documented PSA recurrence. Results: Serum total testosterone level, BMI, surgical margin positivity and Gleason score and preoperative PSA level are independent variables that affect PSA recurrence. On Roc analysis, a testosterone level of less than 2,81 ng/dL was found to be significant for the prediction of PSA recurrence (p=0.04). Conclusion: From this study, we concluded that, besides proven risk factors for PSA recurrence (Pre op. PSA level, Gleason score, surgical margin positivity and stage), preoperative low testosterone levels and high BMI can also be predictive.

Low pretreatment total testosterone (&lt;3 ng/mL) predicts extraprostatic disease in prostatectomy specimens from patients with preoperative localized prostate cancer

• To investigate the relationship between pretreatment testosterone levels and pathological specimen characteristics, by prospectively examining serum androgen concentrations in a well-studied cohort of patients who underwent radical prostatectomy (RP) for localized prostate cancer. • A total of 107 patients with clinically localized prostate cancer had an assay of total testosterone before laparoscopic RP at our institution. • The results were classified into two groups based on the total serum testosterone: group1, < 3 ng/mL; group 2, ≥ 3 ng/mL. • Student's t-test was used to compare continuous variables, and Fisher's exact test or the chi-squared test was used to compare categorical variables. • Survival curves were established using the Kaplan-Meier method and compared using the log-rank test. In all tests, P < 0.05 was considered to indicate statistical significance. • All patients had localized prostate cancer based on digital rectal examination (DRE) and preoperative magnetic resonance imaging (MRI). Groups 1 and 2 were similar in terms of age, body mass index, preoperative co-morbidities (cardiovascular and diabetes mellitus), clinical stage of prostate cancer and preoperative PSA levels. • In pathological specimens, low total testosterone (< 3 ng/mL) was an independent risk factor for high Gleason score (> 7) and for locally advanced pathological stage (pT3 and pT4). • Higher preoperative testosterone correlated with disease confined to the gland. • There was no association between serum testosterone levels and surgical margin status, on the one hand, and biochemical recurrence on the other. • Low serum testosterone appears to be predictive of aggressive disease (Gleason score >7 and extraprostatic disease, pathological stage > pT2) in patients who underwent RP for localized prostate cancer.