Prostatic Capsule Research Articles

MP42-06 THE EN BLOC HOLEP TECHNIQUE: OUR EXPERIENCE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III1 Apr 2016MP42-06 THE EN BLOC HOLEP TECHNIQUE: OUR EXPERIENCE Alim Dymov, Nikolay Sorokin, and Andrey Vinarov Alim DymovAlim Dymov More articles by this author , Nikolay SorokinNikolay Sorokin More articles by this author , and Andrey VinarovAndrey Vinarov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.194AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Holmium laser enucleation of the prostate (HoLEP) has become an increasingly popular treatment for symptomatic benign prostatic hyperplasia (BPH) that allows complete removal of the tissue in the transition zone regardless of the prostate size. Despite the advantages of HoLEP, considerable training and a steep learning curve are required to master this surgical technique for safe operation. Usually, the traditional three-lobe technique described by Gilling is used for HoLEP. However, it is known that there are some difficulties in enucleating the median lobe. Sometimes a surgeon can even cause the prostate capsule perforation into the retrovesical space near the bladder neck, since the capsule is anatomically very thin and the exfoliation angle might be very sharp at that lesion. Recently, a new, ‘en bloc’ enucleation technique was introduced which enhances safety and shortens operative time. ? METHODS About 300 patients underwent HoLEP in our institution since 2013. 34 of them underwent HoLEP with the en bloc enucleation technique, with lateral median approach to the median lobe. The procedure included the following maneuvers: (1) Early encircling mucosal incision at apical adenoma, (2) Lateral to median exfoliation of median lobe at bladder neck, (3) Lateral approach to bladder neck at upper portion, (4) Retrograde exfoliation of hang down adenoma at 12 o’clock position, and (5) En bloc downward morcellation of the enucleated adenoma. A Lumenis VersaPulse® PowersuiteTM 100W was used in all cases with 1.4J/50 Hz settings. Total operating time, enucleation and morcellation time, adenoma weight, and complications were recorded.? RESULTS Prostate adenomas removed were divided into medium (40-79 grams, n=18) and large adenomas (=80 grams, n=16). For medium-sized adenomas (59 g ± 10.3), mean total operating time was 66 minutes ± 18, mean enucleation time was 36.3 min ± 12.1, and mean morcellation time was 10.7 min ± 4.4. For large adenomas (106.5 g ± 19.5), mean total operating time was 90.3 minutes ± 31.4, mean enucleation time was 47.1 min ± 20.3, and mean morcellation time was 21.7 min ± 12.6. No major intra- and postoperative complications were observed. Postoperative data showed that HoLEP is highly effective in the treatment of bladder outlet obstruction. A lower percentage of capsule perforations and fewer cases of stress urinary incontinence were observed in the en bloc HoLEP group compared with the traditional HoLEP group. ? CONCLUSIONS The use of the ‘en bloc’ technique may improve operative times, decrease complications rates, and even shorten the learning curve for urologists mastering the HoLEP procedure. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e571 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Alim Dymov More articles by this author Nikolay Sorokin More articles by this author Andrey Vinarov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V10-08 COMBINED ROBOTIC ASSISTED BLADDER DIVERTICULECTOMY AND PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE

You have accessJournal of UrologyRobotics – Benign Disease1 Apr 2016V10-08 COMBINED ROBOTIC ASSISTED BLADDER DIVERTICULECTOMY AND PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE Jed-Sian Cheng, Mahdi Zangi, and Shahin Tabatabaei Jed-Sian ChengJed-Sian Cheng More articles by this author , Mahdi ZangiMahdi Zangi More articles by this author , and Shahin TabatabaeiShahin Tabatabaei More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1588AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The standard management of large bladder diverticula (BD) with bladder outlet obstruction (BOO) is open surgery, but recent reports describe a robotic approach for diverticulectomy. However, robotic management of BOO in small prostates is technically difficult. Therefore, we describe a novel combination of photoselective vaporization of the prostate (PVP), and robotic assisted bladder diverticulectomy (RABD) for BD. METHODS Prior to RABD or at the same time as RABD, a PVP was performed transurethrally to the prostate capsule. Ureteral stents are placed if BD was close to the ureteral orifice. At the conclusion of RABD, the peritoneum is repaired so the bladder is in the retroperitoneal position. A cystogram is performed 5-7 days just prior to catheter removal. A retrospective review of PVP and RABD for benign BD was performed identifying patient characteristics, lasing time, joules, operative time, estimated blood loss (EBL), and length of stay (LOS). RESULTS A total of 10 patients underwent both PVP and RABD: 5 with PVP and RABD in separate settings and 5 received PVP and RABD together. The results are summarized in the table below. No significant differences were identified between the PVP performed separately vs. same time as RABD. CONCLUSIONS Combination photoselective vaporization of the prostate (PVP), and robotic assisted bladder diverticulectomy (RABD) for bladder diverticula is an effective treatment regardless of prostate size. This combination can be considered in the same setting with no significant changes in outcome. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e948 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jed-Sian Cheng More articles by this author Mahdi Zangi More articles by this author Shahin Tabatabaei More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impact of surgeon-defined capsular incision during radical prostatectomy on biochemical recurrence rates.

To determine the impact of intraoperative surgeon-defined incision of the prostatic capsule (CapI) on cancer recurrence and to give an overview of the different definitions of CapI. CapI during radical prostatectomy (RP) occurs in a non-negligible number of patients; still, its impact on biochemical recurrence (BCR) remains controversial as definition of CapI differs in literature. We analyzed the data of 3253 consecutive RP between 2009 and 2011. Occurrence and side of intraoperative CapI was documented by the surgeon. Factors influencing CapI were addressed using logistic regressions. The impact of CapI on BCR was analyzed using Cox regressions including traditional prognosticators. Median follow-up was 36.2months. Unilateral (bilateral) CapI occurred in 22.2% (12.1%) of patients. CapI was reported more often following open RP (p<0.0001) and nerve-sparing procedure (p=0.0004). Three-year BCR-free survival was 78.8, 79.9 and 82.1% (p=0.13) for patients with no, unilateral and bilateral CapI. In multivariate analysis, pT-stage (p<0.0001), Gleason grade (p<0.0005) and nodal status (p<0.0005) were significantly associated with BCR. However, CapI had no independent impact on BCR (unilateral vs. no CapI, p=0.55, bilateral vs. no CapI, p=0.32). Intraoperative CapI occurs in a relevant number of RP and is more frequent during nerve-sparing procedure and open RP. However, there seems to be no impact of CapI and its extent on the incidence of early BCR.

Corinebacterium urealyticum: increased incidence of infection and encrusted uropathy

IntroductionCorynebacterium urealyticum (CU) affects patients who are immunosuppressed, chronically ill or have undergone numerous operations. Obstructive uropathy (OU) is a complication of infection. Study objectiveTo demonstrate the growing increase in cases of infection by CU and OU in the past 5 years. Material and methodsA descriptive study was conducted of urological patients with CU-positive urine cultures (January 2009–December 2014). We calculated the annual distribution and clinical characteristics of infection by CU and OU. Minimum follow-up: 6 months. We obtained the statistical means and ranges of clinical parameters pre/post-therapy. ResultsThe total number of patients with CU was 115 (men, 87; women, 28). The mean age was 67.9 years (range, 6–95 years), and the annual distribution of cases for 2009, 2010, 2011, 2012, 2013 and 2014 was 9 (7.8%), 13 (11.3%), 9 (7.8%), 20 (17.4%), 31 (27%) and 33 (28.7%), respectively. The increase in cases for 2009–2014 was 300%. Multiple urological surgeries were performed in 89 cases (77.3%), with surgical complications in 77 cases (66.9%). Eighteen (15.6%) patients had OU (men, 13; women, 5), 12 had pyelitis (66.7%), 3 had cystopathy (16.6%), 2 had prostatic capsule disease (11.2%) and 1 had mesh calcification (5.5%). The analysis of the 18 cases with OU showed pre/postantibiotic therapy urine pHs of 8 (r, 6–9) vs. 6 (r, 5–7). All postantibiotic cultures were negative. Acidifying solution was applied in 5 cases, and surgery was performed in 13 cases (72.2%). The results from before/after the multimodal therapy showed renal impairment in 12 (66.6%) vs. 9 cases (50%) and glomerular filtration rates (GFR) of 45.8 (r, 6 to >90) vs. 52.7 (r, 13 to >90). The improvement in GFR was 6.94 points (T Wilcoxon; p=.102). The radiology results (incrustations) showed improvement in 13 patients (72.2%) and no change in 5 (27.8%). There was no specific mortality for CU. ConclusionsThe prevalence of infection by CU and OU is increasing. Antibiotic treatment is highly effective. Acidifying solutions are an acceptable option for reducing calcifications.

Augmented Reality Using Transurethral Ultrasound for Laparoscopic Radical Prostatectomy: Preclinical Evaluation

To guide the surgeon during laparoscopic or robot-assisted radical prostatectomy an innovative laparoscopic/ultrasound fusion platform was developed using a motorized 3-dimensional transurethral ultrasound probe. We present what is to our knowledge the first preclinical evaluation of 3-dimensional prostate visualization using transurethral ultrasound and the preliminary results of this new augmented reality. The transurethral probe and laparoscopic/ultrasound registration were tested on realistic prostate phantoms made of standard polyvinyl chloride. The quality of transurethral ultrasound images and the detection of passive markers placed on the prostate surface were evaluated on 2-dimensional dynamic views and 3-dimensional reconstructions. The feasibility, precision and reproducibility of laparoscopic/transurethral ultrasound registration was then determined using 4, 5, 6 and 7 markers to assess the optimal amount needed. The root mean square error was calculated for each registration and the median root mean square error and IQR were calculated according to the number of markers. The transurethral ultrasound probe was easy to manipulate and the prostatic capsule was well visualized in 2 and 3 dimensions. Passive markers could precisely be localized in the volume. Laparoscopic/transurethral ultrasound registration procedures were performed on 74 phantoms of various sizes and shapes. All were successful. The median root mean square error of 1.1 mm (IQR 0.8-1.4) was significantly associated with the number of landmarks (p=0.001). The highest accuracy was achieved using 6 markers. However, prostate volume did not affect registration precision. Transurethral ultrasound provided high quality prostate reconstruction and easy marker detection. Laparoscopic/ultrasound registration was successful with acceptable mm precision. Further investigations are necessary to achieve sub mm accuracy and assess feasibility in a human model.

Effects of β adrenergic receptor blocker carvedilol and cholinergic receptor blocker scopolamine on biological behaviors of prostate cancer in mice

Objective To investigate the effects of β adrenergic receptor blocker carvedilol and cholinergic receptor blocker scopolamine on the biological behaviors of prostate cancer in C57BL/6 mice. Methods From June 2014 to November 2014, sixty male C57BL/6 mice, 10 weeks old, were injected with RM-1 cells (0.5×106) into bilateral dorsal prostate capsules of each mice by microsyringe and were randomly divided into three groups, including carvedilol group (K), scopolamine group (D) and saline group (N) after modeling. In K group, the carvedilol (10 mg/kg) was given to mice through gastric tube. The normal saline was given to them by subcutaneous injection. In D group, the normal saline was given to mice through gastric tube. Meanwhile, the scopolamine (1 mg/kg) was injected subcutaneously. In N group, daily normal saline was given by through gastric tube and subcutaneous injection. At the seventh day of postoperation, five mouse were sacrificed in each group every three days to observe the local growth, invasion and metastasis of prostate cancer to pelvic nodes and liver. Immunohistochemical determination of prostate tumor was made by TH staining and VAChT staining in each group. Results The volume of the prostate cancer was gradually increased in three groups. There was no statistical difference of prostate volume among three groups on the day 7 and 10 post-operatively (all P>0.05). The prostate volume of K group, D group and N group on the day 13 were 0.05±0.04, 0.18±0.08, 0.14±0.05 cm3, respectively (P 0.05). The AOD of TH and VAChT in prostate cancer of K group, D group and N group on the day 10 were [(0.0114±0.016), (0.114±0.002), (0.059±0.008)] and [(0.025±0.011), (0.0226±0.003), (0.009±0.003)], respectively (P 0.05). Conclusions β adrenergic receptor blocker carvedilol can suppress the growth of prostate cancer and cholinergic receptor blocker scopolamine may can inhibit metastasis of prostate cancer. Key words: Prostatic carcinoma; Mouse; Carvedilol; Scopolamine

The factors predicting biochemical recurrence in patients with radical prostatectomy.

The main objective of this study was to evaluate the factors predicting recurrence in patients who underwent radical prostatectomy (RP) for localized prostate cancer. A total of 275 patients who underwent RP between 2000 and 2012 years in our clinic were evaluated retrospectively and 238 patients who met our criteria were included in the study. The effect of PSA values at diagnosis in addition the histopathological variables on the risk of recurrence was evaluated. Biochemical recurrence (BCR) is defined as "an increase of &gt; 0.2 ng/ml or more in the serum total PSA count". The statistical analysis of this study was done using SPSS for Windows Version 15.0 package program. Values below p &lt; 0.05 are accepted as statistically significant. The mean follow up, age and PSA of patients were 37,2 months, 66,01 ± 6,85 years and 11,12 ng/ml, respectively. BCR rate was 28% (68/238). Univariate analysis revealed that PSA levels during initial diagnosis (p &lt; 0.0001), Gleason score (GS) (p &lt; 0.0001), prostatic capsule involvement (p &lt; 0.005), extracapsular extension (p = 0.0001), seminal vesicle involvement (p &lt; 0.003) and surgical margin positivity (p &lt; 0.014) were significant factors in predicting recurrence, while multivariate analysis showed that PSA at initial diagnosis (p = 0.002) and GS (p = 0.003) were independent prognostic factors. PSA &gt; 10 ng/ml and Gleason score &gt; 7 are considered as the risk factors for BCR. Our study results showed that PSA value during initial diagnosis as well as Gleason score were independent factors in predicting BCR following radical prostatectomy.

Tumor contact length: A novel multiparametric MRI predictor of prostate cancer outcomes.

61 Background: Multiparametric MRI (MP-MRI) can visualize prostate tumors. MP-MRI characteristics (extraprostatic extension (ECE), tumor volume, etc.) can be predictive of final pathologic findings such as lymph node (LN) involvement, pathological ECE (pECE), and biochemical recurrence (BCR). These are pivotal in the decision-making process regarding treatment. Tumor contact length (TCL) is defined as the length of cancer in contact with the prostatic capsule. We evaluated the ability of MP-MRI determined TCL in predicting pECE, BCR and LN in patients undergoing radical prostatectomy. Methods: All patients who underwent a 3T MP-MRI at the NCI from 2007 to 2015 were retrospectively classed into no ECE, suspicious ECE (sECE) and frank ECE (fECE) based on MP-MRI findings. sECE was defined as tumor with capsular bulge on MRI while fECE was clear capsular obliteration and tumor extension beyond the prostatic capsule. Demographic data was obtained on patients with fECE and sECE on MP-MRI with the presence of pECE, LN, and BCR status following radical prostatectomy from a single surgeon (PP) experience. Chi-Square and Wilcoxon rank sum test were used to compare proportions and continuous variables respectively. Logistic regression was used to determine the predictive ability of TCL. Statistical significance was defined as p-value ≤0.05. Results: Of all 1,260 patients who underwent MP-MRI, we focused on 146 who had sECE (68) or fECE (78) on MP-MRI. Mean age was 60 years and median prostate specific antigen was 11.7 ng/ml. Logistic regression analysis showed that MP-MRI determined TCL was predictive of ECE (p=0.01), LN status (p=0.0001) on final pathology and BCR (p=0.05) during follow up. Patients with pECE had a longer median MP-MRI TCL (2.8 cm) compared to those without pECE (2.4 cm), p=0.04. When analyzed individually, fECE correlated with pECE (p=0.05) while s ECE did not correlate with pECE (p=0.11). Although, not statistically significant, the median MP-MRI TCL for sECE with pECE was still longer than in sECE with no pECE in the sub-group analysis. Conclusions: Longer TCL on MP-MRI can indicate presence of ECE, LN involvement at final pathology as well as predict BCR on follow up.

Ability of an epigenetic assay to identify anterior prostate tumors based on a negative 12-core biopsy.

131 Background: There is increasing awareness that anterior-predominant prostate cancers (PCa) are poorly sampled by 12-core transrectal ultrasound-guided (TRUS) prostate biopsies. Approximately one-fifth of all prostate tumors occur in this area, and many are high grade and extend beyond the prostatic capsule. An epigenetic assay, detecting PCa-specific DNA-methylation of GSTP1, RASSF1 and APC has shown to be a significant predictor for the presence of PCa in histopathologically cancer-negative biopsies through a cancer-associated field effect. It is currently unknown whether the field effect from an anterior-predominant cancer may be detected in standard posteriorly-directed sextant biopsy specimens. Methods: Seven patients with at least one prior negative TRUS biopsy were subsequently diagnosed with anterior-only PCa based on a transperineal mapping template prostate biopsy (MTPB). Three patients were diagnosed with low-grade Gleason score (GS) 6 tumors and four patients with GS ≥7 tumors. The outcome of the MTPB was compared with the result of the epigenetic test performed on the prior cancer-negative TRUS biopsy. Results: MTPB included a median of 68 cores (IQR 53-76). A total of 6 patients (86%) were methylation-positive at initial biopsy, suggesting that the field effect from these anterior-predominant cancers extends to the region of TRUS biopsy sampling. No methylation was found for one patient with only one GS6 positive core at MTPB and a tumor volume of 4%. Methylation intensities were higher for patients with GS ≥7 compared to those with GS6. A logistic regression model combining these intensities with traditional risk factors (PSA, age, TRUS-biopsy pathology and DRE) indicated higher risk scores for high-grade tumors. Conclusions: Aberrant DNA-methylation patterns are present in normal-appearing tissue from TRUS biopsy of patients with anteriorly located tumors. Although a small study, this is a unique cohort that underwent extensive sampling at re-biopsy demonstrating the presence of an anterior-predominant tumor. These results indicate that an epigenetic assay may be valuable even in patients with negative posteriorly-directed TRUS biopsies to detected anterior-predominant PCa.

Laparoscopic radical cystectomy with prostate capsule sparing. Initial experience.

IntroductionIn 2008, our department introduced a modified technique of laparoscopic radical cystectomy in which the prostatic capsule is spared in selected patients with bladder cancer. The different series published are mostly using the standard open procedure. The aim of this study is to describe this technique using the laparoscopic approach and present our preliminary results.Material and methodsThis study includes 20 patients selected by clinical analysis and imaging criteria operated using laparoscopic radical cystectomy with prostate capsule sparing at our department in the period between 2008 and 2012.ResultsPatient mean age was 58 years. Mean operative time was 390 minutes. Median follow-up was 36 months. No patient had bladder cancer recurrence. Only one patient died of disease progression, as the pathological findings was a pT3 pN1 Mx. Mean PSA before surgery: 1.3 ng/ml (03–2), mean PSA after surgery 1.0 ng/ml (0.08–1.7). No patients had prostate cancer recurrence. Satisfactory daytime and night-time continence was achieved. 90% of patients have sexual function preserved.ConclusionsProstate-sparing radical cystectomy remains one of the most controversial topics in urology today. The laparoscopic approach could be an alternative to conventional radical cystoprostatectomy in well selected patients, done in experienced institutions in order to find better functional results, with a low disease progression and recurrence rate.

Retinoic acid receptor α and retinoid X receptor α: Do they have a role in prognostication of prostate cancer?

Background: Androgens acting through the androgen receptor (AR) are essential for prostate development and normal prostate function. The evolving role of retinoids in cancer treatment and prevention is being extensively studied in many malignancies including prostate cancer. Effects of retinoids are mediated by retinoic acid receptors (RARs) and retinoid X receptors (RXRs). Materials and Methods: Sixty cases of prospective prostate cancer over 3 years were evaluated to study the immunohistochemical expression of AR, RARα, and retinoic X receptor α (RXRα). The expression findings were correlated with the clinicopathological parameters. Results: Of the total 60 cases, 26 cases (43.3%) were of advanced stage with the presence of tumor beyond the prostatic capsule. Histopathological examination revealed that 38 cases (63.3%) had Gleason score (5-7). Clinically, 45 (75%) cases were found to be hormone sensitive while 15 (25%) cases were hormone refractory. Immunohistochemically, 43 cases (71.6%) were positive for AR while RARα and RXRα expressions were positive in 36 (60%) and 34 (56.6%) cases. Immunohistochemical expression of AR was found insignificant in relation with Gleason score ( P = 0.2) and hormone response ( P = 0.6). The association between AR and tumor staging was found significant with 82.4% positivity in localized cancer ( P = 0.03). Association of RARα expression with Gleason score, tumor staging and hormone response were found significant ( P = 0.2, P = 0.1 and P = 0.2). RXRα expression however had a significant correlation with tumor stage with 67.6% of localized cancer showing positivity ( P = 0.05). Its correlation with Gleason score and hormone response however was not significant ( P = 0.3). Conclusions: RXR expression decreases with the advancing stage of prostate cancer. These findings possibly predict their implications on diagnostic and therapeutic strategies in prostate cancer.

Prostate capsule sparing radical cystectomy - a safe procedure for few.

The authors present a four-year experience with prostate capsule sparing (PCS) laparoscopic radical cystectomy (RC) [1]. First, these authors should be commended for their execution of a technically challenging procedure. Although this is a small series, the perioperative outcomes (operative time, blood loss, length of stay (LOS)) are similar to published data for the robotic-assisted procedure [2]. Of note, this paper once again shows that hospital LOS is not shortened with a minimally invasive approach, questioning the benefit to patients (the addition of PSC does not contribute to the perioperative convalescence). The authors present impressive potency (90%) and continence (90% day, 85% night) results, showcasing the quality of life (QOL) benefits of PCS. These numbers are consistent with other centers of excellence [3]. This leaves the oncologic outcomes as the controversial aspect of this procedure. There are two cancers to be considered: urothelial carcinoma of the prostate (UCP) and prostate adenocarcinoma (PC). As the authors point out, local recurrence rates of UCP are low with this technique (none in the present report). Similarly, Mertens et al. found UCP recurrence of <1% in 120 patients undergoing PCS RC [3]. In our opinion, this is the most important aspect of avoiding a total prostate resection. Lest we forget that the basis for en bloc prostate removal is to reduce the amount of urothelium left behind. With strict selection criteria such as that in this study, missed ductal or stromal invasion is unlikely. Tumor at or distal to the trigone and the presence of carcinoma in-situ are known risk factors for UCP at time of RC [4, 5], providing guidance for patient selection. Regarding the missed diagnosis of PC, we would contend that this is a substantially over-argued point. If the argument is related to the difficulty treating PC after one has undergone orthotopic neobladder creation, then consider the extremely low likelihood of requiring PC treatment after PCS RC in the literature (<1%). RC can be performed on patients who have previously undergone prostatectomy without added morbidity, so in the rare event of an occurrence of clinically significant PC, subsequent prostatectomy would likely be feasible. Given the significant QOL improvement associated with PCS, the criteria for prostate removal during RC should be based on preoperative clinical concern for PC, including biopsies as indicated. The continence and potency benefits of a PCS RC may both be realized with an orthotopic neobladder, a minority of urinary diversions (30–50% at high volume centers) [6]. However, the more commonly performed cutaneous diversion would see less benefit. Combine this fact with the average age of patients with bladder cancer requiring a RC (over 65, most with poor baseline potency) as well as the pathologic selection criteria, and you realize that PCS RC may be a great procedure, but only for a select few.

AUTHOR'S REPLY.

AUTHOR'S REPLY.

Corynebacterium urealyticum: aumento de la incidencia de infección y uropatía incrustante

IntroductionCorynebacterium urealyticum (CU) affects patients who are immunosuppressed, chronically ill or have undergone numerous operations. Obstructive uropathy (OU) is a complication of infection. Study objective: To demonstrate the growing increase in cases of infection by CU and OU in the past 5 years. Material and methodsA descriptive study was conducted of urological patients with CU-positive urine cultures (January 2009-December 2014). We calculated the annual distribution and clinical characteristics of infection by CU and OU. Minimum follow-up: 6 months. We obtained the statistical means and ranges of clinical parameters pre/post-therapy. ResultsThe total number of patients with CU was 115 (men, 87; women, 28). The mean age was 67.9 years (range, 6-95 years), and the annual distribution of cases for 2009, 2010, 2011, 2012, 2013 and 2014 was 9 (7.8%), 13 (11.3%), 9 (7.8%), 20 (17.4%), 31 (27%) and 33 (28.7%), respectively. The increase in cases for 2009–2014 was 300%. Multiple urological surgeries were performed in 89 cases (77.3%), with surgical complications in 77 cases (66.9%). Eighteen (15.6%) patients had OU (men, 13; women, 5), 12 had pyelitis (66.7%), 3 had cystopathy (16.6%), 2 had prostatic capsule disease (11.2%) and 1 had mesh calcification (5.5%). The analysis of the 18 cases with OU showed pre/postantibiotic therapy urine pHs of 8 (r, 6–9) vs. 6 (r, 5–7). All postantibiotic cultures were negative. Acidifying solution was applied in 5 cases, and surgery was performed in 13 cases (72.2%). The results from before/after the multimodal therapy showed renal impairment in 12 (66.6%) vs. 9 cases (50%) and glomerular filtration rates (GFR) of 45.8 (r, 6–>90) vs. 52.7 (r, 13–>90). The improvement in GFR was 6.94 points (T Wilcoxon; P=.102). The radiology results (incrustations) showed improvement in 13 patients (72.2%) and no change in 5 (27.8%). There was no specific mortality for CU. ConclusionsThe prevalence of infection by CU and OU is increasing. Antibiotic treatment is highly effective. Acidifying solutions are an acceptable option for reducing calcifications.

Transurethral Resection of the Prostate (TURP) Versus Original and PErFecTED Prostate Artery Embolization (PAE) Due to Benign Prostatic Hyperplasia (BPH): Preliminary Results of a Single Center, Prospective, Urodynamic-Controlled Analysis.

To compare clinical and urodynamic results of transurethral resection of the prostate (TURP) to original and PErFecTED prostate artery embolization (PAE) methods for benign prostatic hyperplasia. We prospectively randomized 30 patients to receive TURP or original PAE (oPAE) and compared them to a cohort of patients treated by PErFecTED PAE, with a minimum of 1-year follow-up. Patients were assessed for urodynamic parameters, prostate volume, international prostate symptom score (IPSS), and quality of life (QoL). All groups were comparable for all pre-treatment parameters except bladder contractility and peak urine flow rate (Q max), both of which were significantly better in the TURP group, and IIEF score, which was significantly higher among PErFecTED PAE patients than TURP patients. All groups experienced significant improvement in IPSS, QoL, prostate volume, and Q max. TURP and PErFecTED PAE both resulted in significantly lower IPSS than oPAE but were not significantly different from one another. TURP resulted in significantly higher Q max and significantly smaller prostate volume than either original or PErFecTED PAE but required spinal anesthesia and hospitalization. Two patients in the oPAE group with hypocontractile bladders experienced recurrence of symptoms and were treated with TURP. In the TURP group, urinary incontinence occurred in 4/15 patients (26.7 %), rupture of the prostatic capsule in 1/15 (6.7 %), retrograde ejaculation in all patients (100 %), and one patient was readmitted for temporary bladder irrigation due to hematuria. TURP and PAE are both safe and effective treatments. TURP and PErFecTED PAE yield similar symptom improvement, but TURP is associated with both better urodynamic results and more adverse events.

A new ultrasound and clinical classification for management of prostatic abscess.

In literature, most of the published data regarding prostatic abscess (PA) are case reports, whereas there is no standardization of the diagnostic and therapeutic routines. The purpose of this study is a new classification of ultrasound imaging of PA with clinical features correlation. We retrospectively analysed the ultrasound database archives and performed a MEDLINE® research of the peer reviewed literature on diagnosis and case reports of PA using the terms "prostate and abscess". PA can be classified into five Types: Type I - PA is present focally in a prostate lobe (≤ 10 mm). Type II - PA is present in a prostate lobe (&gt; 10 mm) and/or partially overcrosses the border of the midline prostatic glandular. Type III - PA is present in both glandular lobes form of multifocal areas (≤ 10 mm). Type IV - PA is present in both glandular lobes form of multifocal areas (&gt; 10 mm). Type V - PA involving intra or extraprostatic structures (bladder, urethra, seminal vesicles and prostatic capsule). The different ultrasound imaging and diagnostic criteria are listed for each type and subtype. The sonographic pattern of PA is usually characteristic and easily differentiated from other glandular lesions. The purpose of the study was to associate the use of TRUS to a clinical standardized classification in order to facilitate PA diagnosis and localization directing the clinician treatment to the correct management and adequate therapeutic treatment.

Light Reflectance Spectroscopy to Detect Positive Surgical Margins on Prostate Cancer Specimens

Intraoperative frozen section analysis is not routinely performed todetermine positive surgical margins at radical prostatectomy due to time requirementsand unproven clinical usefulness. Light reflectance spectroscopy, which measures light intensity reflected or backscattered from tissues, can be applied to differentiate malignant from benign tissue. We used a novel light reflectance spectroscopy probe to evaluate positive surgical margins on exvivo radical prostatectomy specimens and correlate its findings with pathological examination. Patients with intermediate to high risk disease undergoing radical prostatectomy were enrolled. Light reflectance spectroscopy was performed on suspected malignant and benign prostate capsule immediately following organ extraction. Each light reflectance spectroscopy at 530 to 830 nm was analyzed and correlated with pathological results. A regression model and forward sequential selection algorithm were developed for optimal feature selection. Eighty percent of light reflectance spectroscopy data were selected to train a logistic regression model, which was evaluated by the remaining 20% data. This was repeated 5 times to calculate averaged sensitivity, specificity and accuracy. Light reflectance spectroscopy analysis was performed on 17 exvivo prostate specimens, on which a total of 11 histologically positive and 22 negative surgical margins were measured. Two select features from 700 to 830 nm were identified as unique to malignant tissue. Cross-validation when performing thepredictive model showed that the optical probe predicted positive surgical margins with 85% sensitivity, 86% specificity, 86% accuracy and an AUC of 0.95. Light reflectance spectroscopy can identify positive surgical margins accurately in fresh exvivo radical prostatectomy specimens. Further study is required to determine whether such analysis may be used in real time to improve surgical decision making and decrease positive surgical margin rates.

Case report. Osteomyelitis van het os pubis als zeldzame, maar invaliderende complicatie na GreenLight lasertherapie van de prostaat

Case report. Pubic osteomyelitis, a rare but disabling complication after GreenLight Laser Therapy photoselective vaporization of the prostate Pubic osteomyelitis caused by prostatic capsule perforation and the extravasation of (infected) urine is a rare but disabling complication after photoselective vaporization of the prostate. We describe three cases with pubic osteomyelitis following 180-W GreenLight Laser (GGL) photoselective vaporization of the prostate. We hypothesize pubic osteomyelitis is caused by a combination of factors; the use of high power setting when vaporizing the ventral part of the prostate, together with perforation of the prostatic capsule with infected urine and possibly the period of post-operative drainage with a catheter. When conservative treatment is not successful and a fistula between the prostatic urethra and the pubic symphysis persists, open surgical treatment is optional

The correlation between the electrode configuration and histopathology of irreversible electroporation ablations in prostate cancer patients.

Purpose Irreversible electroporation (IRE) is a novel minimally invasive therapy for prostate cancer using short electric pulses to ablate prostate tissue. The purpose of this study is to determine the IRE effects in prostate tissue and correlate electrode configuration with the histology of radical prostatectomy (RP) specimens. We hypothesize that the area within the electrode configuration is completely ablated and that the area within the electrode configuration is predictive for the ablated area after treatment.MethodsA prospective phase I/II study was conducted in 16 consecutive patients with histopathologically confirmed prostate cancer scheduled for RP. Focal or extended IRE treatment of the prostate was performed 4 weeks prior to RP. The locations of the electrodes were used to calculate the planned ablation zone. Following RP, the specimens were processed into whole-mount sections, histopathology (PA) was assessed and ablation zones were delineated. The area of the tissue alteration was determined by measuring the surface. The planned and the histological ablation zones were compared, analysed per individual patient and per protocol (focal vs. extended).ResultsAll cells within the electrode configuration were completely ablated and consisted only of necrotic and fibrotic tissue without leaving any viable cells. The histological ablation zone was always larger than the electrodes configuration (2.9 times larger for the 3 electrodes configuration and 2.5 times larger for the ≥4 electrode configuration). These ablation effects extended beyond the prostatic capsule in the neurovascular bundle in 13 out of 15 cases.ConclusionsIRE in prostate cancer results in completely ablated, sharply demarcated lesions with a histological ablation zone beyond the electrode configuration. No skip lesions were observed within the electrode configuration.Clinical trialsClinicalTrials.gov Identifier: NCT01790451 https://clinicaltrials.gov/ct2/show/NCT01790451

3D localization of implanted radioactive sources in the prostate using trans-urethral ultrasound.

Prostate cancer is the most common cancer diagnosed in men in the United States. Many techniques have been developed to diagnose and treat prostate cancer. 3D Trans-Urethral Ultrasound (TUUS) is a new technique for the diagnosis and treatment of prostate disease. This research focuses on the potential of TUUS for therapy-guidance during and after transperineal interstitial permanent prostate brachytherapy (TIPPB). Computed tomography (CT) is currently used to determine the source locations and the effective radiation dose distribution throughout the tissue after the completion of the procedure. TUUS may be a viable alternative to CT for determining source locations within the prostate. Placement of the TUUS catheter into the urethra provides excellent 2D images of the prostate. In addition, the catheter can be used to acquire 3D volumetric data for 3D analysis of the prostate, associated tissue, and radioactive sources. Initial work on source localization was conducted on an ultrasound-equivalent prostate phantom. Cylindrical dummy radiation sources with diameter of .8 mm and length of 4.5 mm were placed into the prostate phantom for assessment with TUUS. The TUUS imaging device is a 10 fr catheter with a linear array of ultrasonic crystals at one end. The ultrasound catheter operates at 10 MHz and is controlled by the Acuson Sequoia ultrasound workstation. The catheter was placed in the phantom urethra and 3D scans were acquired. A corresponding CT was acquired for comparative purposes. Segmentation of the prostate capsule was done semi-automatically. Dummy radiation seed segmentation was conducted manually. Additional processing was necessary to account for image artifact and correctly reconstruct the seeds. The prostate shell and radioactive source reconstructions provide an excellent 3D representation. Comparison to the CT data suggests that the TUUS data provided: 1) greater resolution and 2) better soft tissue differentiation. The reconstructed sources were measured and corresponded to the physical dimensions of those placed in the phantoms. The method is now being evaluated on cadavers and patients.