Surgical Specimen Weight Research Articles

The Correlation Between Body Mass Index and Prostate Volume: A Retrospective Analysis of Pre and Postoperative Measurements in Prostate Cancer Patients

ABSTRACTBackgroundThis study aims to assess the relationship between body mass index (BMI) and prostate volume, utilizing pre and postoperative measurements.MethodsA retrospective, observational study was conducted at a single site using data from an institutional database. Medical records of patients who underwent robot‐assisted radical prostatectomy were reviewed. Data included age, BMI, and prostate volumes measured through digital rectal exam (DRE), transrectal ultrasound (TRUS), magnetic resonance imaging (MRI), and surgical specimen weight (SPW).ResultsA total of 168 patients were identified and included in the analysis. Spearman's correlation test revealed a significant association between BMI and prostate volume for all measurement methods, reporting r = 0.146 (p = 0.047) for DRE, r = 0.268 (p < 0.0001) for TRUS, r = 0.177 (p = 0.021) for MRI and r = 0.234 (p = 0.002) for SPW. Linear regression analysis confirmed the significant association between BMI and prostate volume, reporting, respectively, R2 = 0.026 (p = 0.036) for DRE, R2 = 0.076 (p < 0.0001) for TRUS, R2 = 0.038 (p = 0.011) for MRI and R2 = 0.040 (p = 0.009) for SPW. Notably, considering the SPW the best way to estimate prostate volume, for every increase in BMI, the predicted increase of prostate volume is 0.865gr.ConclusionsThis study demonstrates a positive linear correlation between BMI and prostate volume, highlighting the importance of considering BMI in prostate volume assessments.

The impact of laparoscopic gynecological surgery training on the technicity index of a developing country center.

To compare laparoscopic gynecological surgery training between a developed country's reference center (host center) and a public reference service in a developing country (home center), and use the technicity index (TI) to compare outcomes and to determine the impact of laparoscopic gynecological surgery fellowship training on the home center's TI. The impact of training on the home center was assessed by comparing surgical performance before and after training. TI was assessed in 2017 in the host center, and before and after training in the home center. Epidemiological and clinical data, and information on reason for surgery, preoperative images, estimated intraoperative bleeding, operative time, surgical specimen weight, hospital stay length, complication and reintervention rates were collected from both institutions. Home center pre-training data were retrospectively collected between 2010 and 2013, while post-training data were prospectively collected between 2015 and 2017. A two-tail Z-score was used for TI comparison. The analysis included 366 hysterectomies performed at the host center in 2017, and 663 hysterectomies performed at the home center between 2015 and 2017. TI in the host center was 82.5%, while in the home center it was 6% before training and 22% after training. There were no statistical differences in length of hospital stay, preoperative uterine volume, surgical specimen weight and complication rate between centers. However, significantly shorter mean operative time and lower blood loss during surgery were observed in the host center. High-quality laparoscopic training in a world-renowned specialized center allowed standardizing laparoscopic hysterectomy procedures and helped to significantly improve TI in the recipient's center with comparable surgical outcomes.

The Comparison of Imaging and Clinical Methods to Estimate Prostate Volume: A Single-Centre Retrospective Study

Background: Prostate volume (PV) is a useful tool in risk stratification, diagnosis, and follow-up of numerous prostatic diseases including prostate cancer and benign prostatic hypertrophy. There is currently no accepted ideal PV measurement method. Objective: This study compares multiple means of PV estimation, including digital rectal examination (DRE), transrectal ultrasound (TRUS), and magnetic resonance imaging (MRI), and radical prostatectomy specimens to determine the best volume measurement style. Methods: A retrospective, observational, single-site study with patients identified using an institutional database was performed. A total of 197 patients who underwent robot-assisted radical prostatectomy were considered. Data collected included age, serum PSA at the time of the prostate biopsy, clinical T stage, Gleason score, and PVs for each of the following methods: DRE, TRUS, MRI, and surgical specimen weight (SPW) and volume. Results: A paired t test was performed, which reported a statistically significant difference between PV measures (DRE, TRUS, MRI ellipsoid, MRI bullet, SP ellipsoid, and SP bullet) and the actual prostate weight. Lowest differences were reported for SP ellipsoid volume (M = −2.37; standard deviation [SD] = 10.227; t[167] = −3.011; and p = 0.003), MRI ellipsoid volume (M = −4.318; SD = 9.53; t[167] = −5.87; and p = 0.000), and MRI bullet volume (M = 5.31; SD = 10.77; t[167] = 6.387; and p = 0.000). Conclusion: The PV obtained by MRI has proven to correlate with the PV obtained via auto-segmentation software as well as actual SPW, while also being more cost-effective and time-efficient. Therefore, demonstrating that MRI estimated the PV is an adequate method for use in clinical practice for therapeutic planning and patient follow-up.

Comparative study of surgical and oncological outcomes in oncoplastic versus non oncoplastic breast-conserving surgery for breast cancer treatment

SummaryBackground: Oncoplastic surgery has been increasingly used in breast cancer treatment and allows the performance of breast-conserving surgery in cases of larger tumors with unfavorable location or tumor-breast disproportion. Purpose: To compare surgical and oncological outcomes of patients undergoing oncoplastic and nononcoplastic breast-conserving surgery. Methods: Retrospective cohort study with convenience sampling of 866 patients who consecutively underwent breast-conserving surgery from 2011 to 2015. Results: The mean follow-up was 50.4 months. Nononcoplastic breast conservation surgery was performed on 768 (88.7%) patients and oncoplastic surgery on 98 (11.3%) patients. Patients in the oncoplastic group were younger (p<0.0001) and most were premenopausal (p<0.0001). Comorbidities such as diabetes (p=0.003) and hypertension (p=0.0001) were less frequent in this population. Invasive carcinoma >2 cm (p<0.0001), multifocality (p=0.004), ductal in situ carcinoma (p=0.0007), clinically positive axilla (p=0.004), and greater weight of surgical specimens (p<0.0001) were more frequent in the oncoplastic group. A second surgery for margin re-excision was more frequently performed in the nononcoplastic group (p=0.027). There was more scar dehiscence in the oncoplastic group (p<0.001), but there was no difference in early major complications (p=0.854), conversion to mastectomy (p=0.92), or local recurrence (p=0.889). Conclusion: Although used for the treatment of larger and multifocal tumors, surgical re-excisions were performed less often in the oncoplastic group, and there was no increase in conversion to mastectomy or local recurrence. In spite of the higher rate of overall complications in the oncoplastic group, major complications were similar in both groups.

Achieving margin clearance following oncoplastic breast surgery in comparison with simple wide local excision: a three-dimensional specimen assessment.

Pre-operative breast tumour radial dimensions often determine the choice between simple wide local excision (WLE) and oncoplastic breast surgery (OBS). We reviewed the three-dimensional interplay between tumour and surgical specimen dimensions in the two cohorts. Demographic, tumour and treatment data were collected for all patients undergoing OBS by a single surgeon and compared with a randomly selected cohort of WLE patients treated. The relationship between tumour and specimen medio-lateral, supero-inferior and antero-posterior dimensions were explored in both groups. Subgroup analyses were performed in the OBS cohort (parenchymal displacement versus replacement). We identified 60 OBS patients (63 breasts), comparing them with 60 WLE patients. Pre-operative tumour estimated size was significantly larger in the OBS cohort and concordant with macroscopic tumour radial dimensions and final microscopic tumour size. Surgical specimen weight was more than 3.5 times higher in the OBS group and its radial dimensions were almost double. No significant difference was observed for the antero-posterior dimensions. The rate of margin re-excisions and completion mastectomies were lower in the OBS cohort. WLE patients with positive margins had a lower tumour-to-specimen ratio, whereas, the requirement for further surgery in the OBS cohort was associated with larger tumour dimensions. Despite larger tumour dimensions, OBS is not inferior to WLE in providing clear surgical margins. Our analysis of the three-dimensional spatial relationship between cancer and surgical specimen, although not completely conclusive, can be helpful in the selection of the most appropriate surgical approach for every patient.

The Impact of Regional Variation in Clinical Practice on Thyroid Cancer Diagnosis: A National Population-Based Study

Objective: Regional variation in thyroid cancer incidence in Belgium, most pronounced for low risk cancer, was previously shown to be related to variation in clinical practice, with higher thyroid surgery rates and lower proportions of preoperative fine-needle aspiration (FNA) in regions with high thyroid cancer incidence (period 2004–2006). The objective of this study was to investigate regional thyroid cancer incidence variation in relation with variation in thyroid surgery threshold in a more recent Belgian thyroid cancer cohort. Methods: A population-based cohort of thyroid cancer patients that underwent a (near) total thyroidectomy in the period 2009–2011 (n = 2,329 patients) was identified and studied by linking data from the Belgian cancer registry and the Belgian health insurance companies, and case-by-case study of the pathology protocols. The execution of preoperative FNA and the thyroid resection specimen weight were compared between high and low thyroid cancer incidence regions. Thyroid weight in the pT1a-restricted group was studied as a proxy for surgical threshold for benign nodular goiter. Furthermore, time trend analyses were performed for the execution of FNA for the period 2004–2012. Results: Although a lower proportion of FNA in the high thyroid cancer incidence region persisted in the period 2009–2011 (41.2% [31.9–50.9] vs. 72.9% [64.9–79.7] in the low-incidence region (LIR), p < 0.001), a positive time trend was observed for the period 2004–2012. The median thyroid surgical specimen weight was lower in the high incidence region compared to the LIR (27.0 g [IQR 18.0–45.3] vs. 36.0 g [IQR 22.0–73.0], p < 0.0001), and this finding was corroborated in the pT1a-restricted group. Conclusion: Interregional differences in use of FNA and surgical thyroid specimen weight are consistent with an inverse relation between thyroid cancer incidence and thyroid surgery threshold, carrying risk for overdiagnosis.

Clinical Outcome of Immediate Transurethral Surgery for Benign Prostate Obstruction Patients with Acute Urinary Retention: More Radical Resection Resulted in Better Voiding Function.

Introduction: Transurethral surgery of the prostate is currently the gold standard treatment modality for patients with benign prostatic hyperplasia (BPH) with recurrent acute urinary retention. This study aimed to evaluate the outcome and predictors of patients receiving immediate surgery after acute urinary retention (AUR) episodes. Materials and Methods: From January 2016 to January 2017, we retrospectively included 714 patients who received transurethral surgery of prostate due to BPH. Among them, 158 patients received surgeries immediately after an AUR episode. General characteristics data including age, Body mass index (BMI), International prostate symptom score (IPSS score), prostate volume and Prostate-specific antigen (PSA) were reviewed. We also collected surgery-related parameters including surgical types, operation time, and specimen weight. Resection ratio was defined as (resected specimen weight)/(Transurethral ultrasound (TRUS) volume). The catheterization status on discharge, post-operative medication for BPH, and AUR within 3 months after operation were evaluated. Statistical analysis was performed with Statistical product and service solutions (SPSS). Results: The mean age of the patients was 73.5 years, with a BMI of 24 kg/m2. IPSS total score was 25 with a Voiding symptom/Storage symptom score (V/S score) of 14.6 and 10.4, respectively. A total of 74 (46.8%) patients still took medication for BPH for over 1 month after the surgeries, 28 (17.7%) patients were not catheter-free at the time of discharge, and 14 (8.9%) patients had AUR within 3 months after the surgeries. Surgical type did not impact the outcome of surgeries. In patients who received Transurethral resection of the prostate (TURP), the resection ratio is the only predictor for the catheterization status on discharge and post-operative medication for BPH within 3 months after operation. Conclusions: In patients with BPH-related AUR followed by immediate transurethral surgeries, more radical resection is significantly correlated with short-term medication-free and catheter-free status.

Effects of hormone therapy in patients who underwent male-to-female gender confirmation surgery

An estimated 1.4 million transgender individuals currently reside in the USA and this patient population is increasing on an annual basis (Am J Public Health 107: 1–8, 2017). Along with this census increase, there has also been an increasing number of gender confirmation surgeries being performed in the USA (American Society of Plastic Surgeons, 2016). Our primary objective was to study the effects of hormonal therapy on testicular volumetrics on transgender patients who underwent male-to-female (MtF) bottom gender confirmation surgery. Retrospective review of patients who underwent MtF bottom gender confirmation surgery. Based on World Professional Association for Transgender Health (WPATH) guidelines a minimum of 1 year of hormonal therapy was required in order to be included. Two groups were analyzed based on their hormone therapy regimen (estrogen and estrogen/progesterone). Demographics, comorbidities, body mass index (BMI), medications (and length of use), testicular volumetrics (weight, length of spermatic cord, volume), and post-operative complications (dehiscence, seroma, hematoma, infection, return to the OR) were analyzed. A total of 54 patients were analyzed. The mean age of the sample population was 37.7 (± 13.3) years old. The mean difference in BMI before and after hormonal treatment was − 0.14 (± 1.7) in the estrogen only group and + 0.3 (± 1.7) in the estrogen/progesterone (combined) group (p = 0.396). The mean weight of surgical specimens in the estrogen only and in the combined group was 30.2 (± 14.9) and 24.1 (± 8.7), respectively (p = 0.033). The spermatic chord length for patients in the estrogen group was 5.4 cm (± 1.7), and 4.5 cm (± 1.6) for patients in the combined group (p = 0.009). Of all the patients, 18 presented with minor wound dehiscence of labia majora. Analysis of complications regarding to the type of hormonal therapy they received showed no difference among patients in the estrogen only and the combined group (p = 0.859). Hormone therapy is an integral aspect of a multidisciplinary approach to transgender medicine and surgery. Further studies are required to elucidate systemic effects in detail and evaluate outcomes in a post-operative setting. Level of Evidence: Level III, risk /prognostic study.

Development of a surgical algorithm by using pre-operative imaging to predict mammoplasty cosmetic outcomes for large non-malignant tumours.

Use of mammoplasty for resection of large non-malignant tumours is not widely described. We aim to determine the optimal tumour to breast size ratio cut-off in this group of patients undergoing mammoplasty which could achieve satisfactory cosmetic outcomes. Patients who underwent mammoplasty from May 2014 to June 2017 for biopsy-proven large non-malignant tumours were included in the study. The demographics, tumour to breast size ratios, histological features and cosmetic outcomes of these patients were assessed. The tumour to breast size ratio was estimated in ten-percentiles of the relative volume of the tumour to the overall breast size based on ultrasound and/or mammogram images. Ten patients were recruited. Median age was 40 years old (range, 14-55 years old). One, four and five patients underwent vertical, wise pattern and round block mammoplasties respectively. The median tumour to breast size ratio was 55% (range, 20-90%). Histology revealed phyllodes and giant fibroadenoma in six and four patients respectively. Margins were clear in all cases. Mean weight and average maximum size of surgical specimen was 357.9 g (range, 28-1,186 g) and 99.3 mm (range, 35-165 mm) respectively. One patient developed partial nipple necrosis which was treated conservatively. All the patients with an estimated tumour to breast size ratio up to 70% reported good to excellent cosmetic outcomes, except for one patient who had a large tumour occupying 90% of her breast. Mammoplasty can be used successfully in patients with large non-malignant tumours. However, in patients with tumours occupying more than 70% of the breast, mammoplasty alone may not yield a good cosmetic outcome.

Radioactive Seed Localization or Wire-guided Localization of Nonpalpable Invasive and In Situ Breast Cancer: A Randomized, Multicenter, Open-label Trial.

To compare the rate of positive resection margins between radioactive seed localization (RSL) and wire-guided localization (WGL) after breast conserving surgery (BCS). WGL is the current standard for localization of nonpalpable breast lesions in BCS, but there are several difficulties related to the method. From January 1, 2014 to February 4, 2016, patients with nonpalpable invasive breast cancer or DCIS visible on ultrasound were enrolled in this randomized, multicenter, open-label clinical trial, and randomly assigned to RSL or WGL. The primary outcome was margin status after BCS. Secondary outcomes were duration of the surgical procedure, weight of surgical specimen, and patients' pain perception. Analyses were performed by intention-to-treat (ITT) and per protocol. Out of 444 eligible patients, 413 lesions representing 409 patients were randomized; 207 to RSL and 206 to WGL. Twenty-three did not meet inclusion criteria, chose to withdraw, or had a change in surgical management and were excluded. The remaining 390 lesions constituted the ITT population. Here, resection margins were positive in 23 cases (11.8%) in the RSL group compared with 26 cases (13.3%) in the WGL group (P = 0.65). The per-protocol analysis revealed no difference in margin status (P = 0.62). There were no significant differences in the duration of the surgical procedure (P = 0.12), weight of the surgical specimen (P = 0.54) or the patients' pain perception (P = 0.28). RSL offers a major logistic advantage, as localization can be done several days before surgery without any increase in positive resection margins compared with WGL.

Success of tumorsphere isolation from WHO grade IV gliomas does not correlate with the weight of fresh tumor specimens: an immunohistochemical characterization of tumorsphere differentiation.

BackgroundA trend of stage-by-stage increase in tumorsphere (TS) formation from glioma samples has been reported. Despite this trend, not all surgical specimens give rise to TSs, even World Health Organization (WHO) grade IV gliomas. Furthermore, it has been reported that differences in overall survival of primary glioblastoma patients depends on the propensity of their tumors to form TSs. However, the weights of fresh specimens vary from one surgical isolate to the next.MethodsAccordingly, we evaluated the relationship between the weights of surgical specimens in WHO grade IV gliomas with the capacity to isolate TSs. Thirty-five fresh WHO grade IV glioma specimens were separated into two groups, based on whether they were positive or negative for TS isolation, and the relationship between TS isolation and weight of surgical specimens was assessed.ResultsWe observed no significant difference in the weights of surgical samples in the two groups, and found that the optimal weight of specimens for TSs isolation was 500 mg.ConclusionThus, contrary to our expectations, the ability to isolate TSs from WHO grade IV glioma specimens was not related to the weight of fresh specimens.

The role of oncoplastic breast conserving treatment for locally advanced breast tumors. A matching case-control study.

BackgroundBreast conserving surgery (BCS) after neoadjuvant chemotherapy (NC) in patients with locally advanced breast cancer (LABC) is an infrequent procedure. In these patients the association with BCS and oncoplastic surgery (OS) is reported as a possible procedure in case-series, but there are limited case-control studies.MethodsA matched case-control study evaluated LABC submitted to NC and BCS. We evaluated 78 patients submitted to doxorubicin-cyclophosphamide regimen followed by paclitaxel regimen. The match case-control proportion was 2:1 and the patients were selected by tumor size, clinical T stage and year of diagnosis.Results52 underwent classic BCS and 26 OS. The average size tumor was 5.25 cm and 88.5% of the tumors were larger than 3 cm. The clinical and pathological group characteristics were similar, except the weight of surgical specimens (p = 0.004), and surgical margins (p = 0.06), which were higher in OS group. The rate of complete pathologic response was 26.9%. 97.4% received postoperative radiotherapy. At 67.1 months of follow up, 10.2% had local recurrence (LR) and 12.8% locoregional recurrence (LRR) and 19.2% died because disease progression. The overall survival at 60 months was 81.7%. After surgery the disease free-survival at 60 months was 76.5%. The was no difference between groups related to pathologic response (p = 0.42), LR (p = 0.71), LRR (p = 1.00), overall survival (p = 0.99) and disease specific survival (p = 0.87).ConclusionThis study corroborates the fact that OS is a safety procedure for LABC, offering the similar oncologic results observed in patients submitted to classic BCS.

Can Vascular Patterns on Preoperative Magnetic Resonance Imaging Help Predict Skin Necrosis after Nipple-Sparing Mastectomy?

Nipple-areola complex (NAC) and skin flap ischemia and necrosis can occur after nipple-sparing mastectomy (NSM). The purpose of this study was to correlate vascular findings on MRI with outcomes in patients who underwent NSM. Female patients at a single institution who underwent NSM and had a preoperative breast MRI between 2010 and 2014 were identified. Medical records were reviewed for patient demographics, surgical factors, and complications. Magnetic resonance images were reviewed by 2 radiologists, blinded to outcomes, for the presence of dual vs single blood supply to the breast. The association between blood supply on MRI with ischemic and necrotic complications after NSM was analyzed. One hundred and sixty-four NSM procedures were performed in 105 patients (mean age 45.5 years, range 25 to 69 years) who had a preoperative MRI. The majority of procedures were performed for malignancy (89 of 164 [54.3%]) or prophylaxis (73 of 164 [44.5%]). Nipple-areola complex or skin flap ischemia or necrosis occurred in 40 (24.4%) breasts. Ischemia or necrosis after NSM was less likely to occur in breasts with dual compared with single blood supply (20.8% vs 38.2%; p= 0.03). There was no association between surgical complications and age, BMI, smoking history, previous radiation therapy, indication for NSM, surgical specimen weight, surgical incision type, reconstruction approach, or operating surgeon on univariate analysis. Preoperative MRI characterization of breast vascularity can be considered when planning NSM. The presence of a dual blood supply to the breast on MRI is associated with a decreased risk of nipple-areola complex and skin flap ischemia and necrosis after NSM.

Long-term objective esthetic outcome after breast-conserving therapy.

The prediction of unfavorable long-term esthetic outcome (AO) is important for patient consultation. We aimed to analyze variables characterizing the improvement and impairment of AO over time after breast-conserving surgery. A subgroup of a prospective, monocenter cohort study was analyzed to evaluate the results of the BCCT.core software (Breast Cancer Conservative Treatment.cosmetic results) which was used to objectively assess the AO before (n = 356), shortly after (n = 294) and in median 3 years after surgery (n = 356). We analyzed potential influencing factors (such as body mass index, (y)pT-stage, weight of resected specimen, etc.) on the AO using logistic regression analyses (n = 256). Finally, we tried to characterize groups of patients with improving or impaired AO over time (n = 294). Predictors for an unfavorable AO were an axillary lymphadenectomy (OR = 4.05), a tumor in the 12 o'clock position (OR = 2.22), a tumor stage larger or equal to (y)pT2 stage (OR = 2.11), and a surgical specimen weight >75 g (OR = 2.71). Patients with lower specimen weight were more likely to improve in the long-term follow-up (p = 0.018), whereas patients with a higher (y)pT-stage tended to become impaired with time. Although overall AO decreased over time, nearly half of the patients with an unfavorable AO shortly after surgery improved in the long-term follow-up. Predictors of unfavorable AO can be used in patient consultation preoperatively to prepare them for the postsurgical period and/or to recommend surgical alternatives (e.g., more complex oncoplastic techniques). Knowledge of improvement and impairment may help patients and physicians in the postsurgical consultation setting.

Dissection Technique for Abdominoplasty

INTRODUCTION: Due to its popularity and high complication rate, abdominoplasty techniques have undergone a continuous process of evolution to provide better and safer results.1-2 The technique used to raise the abdominal flap has been implicated, but there are few studies, none is prospective and the results are contradictory.3-4 The aim of this study was to evaluate its effect on outcomes and complications after a full abdominoplasty, comparing two different techniques, the scalpel and the diathermocoagulation device (coagulation mode). METHODS: Prospective study that included women submitted to abdominoplasty with umbilical transposition, between January 2009 and December 2011, at a single centre. Two groups identified: group A, abdominoplasty performed with steel scalpel; and group B, abdominoplasty performed with diathermocoagulation. Several variables were determined including general characteristics, time until drain removal, daily and total volume of drain output, operative time, local and systemic complications; statistical analysis using SPSS v21.0; uni and multivariate analysis performed. RESULTS: A total of 119 full abdominoplasties were performed (group A, 39 patients; group B, 80 patients). There were no statistically significant differences between groups with respect to general characteristics, except for BMI, comorbidities and weight of surgical specimen; no differences for operative time, systemic complications, hematoma and necrosis incidence. The scalpel group had a significant reduction of 54,56 percent on total drain output, 2,65 days on time to drain removal; no cases of seroma or healing problems. There was a statistical difference on daily drain output (day 2, 3), with lower levels on scalpel group (Figure 1).Figure 1: Average daily drain output from group A (scalpel dissection, n=39) and group B (diathermocoagulation on coagulation mode, n=80). *Drain outputs were significantly lower in group A on postoperative day 2 and 3 (p<0.05, t test).CONCLUSIONS: Performing abdominal dissection with scalpel showed benefits on patient recovery, reducing time requested for drain removal, drain output, seroma and healing problems incidence.

1734 HIGH DENSITY LIPOPROTEIN (HDL) SERUM LEVELS ARE CORRELATED TO HISTOLOGIC FEATURES OF INFLAMMATORY INFILTRATE AND WEIGHT OF PROSTATIC ADENOMA IN MEN TREATED WITH SIMPLE PROSTATECTOMY FOR BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology and Natural History/Evaluation and Markers1 Apr 20121734 HIGH DENSITY LIPOPROTEIN (HDL) SERUM LEVELS ARE CORRELATED TO HISTOLOGIC FEATURES OF INFLAMMATORY INFILTRATE AND WEIGHT OF PROSTATIC ADENOMA IN MEN TREATED WITH SIMPLE PROSTATECTOMY FOR BENIGN PROSTATIC HYPERPLASIA Mauro Gacci, Raffaella Santi, Gabriella Nesi, Claudia Giannessi, Arcangelo Sebastianelli, Saverio Giancane, Saba Khorrami, Matteo Salvi, Linda Vignozzi, Annamaria Morelli, Giovanni Corona, Sergio Serni, Marco Carini, and Mario Maggi Mauro GacciMauro Gacci Florence, Italy More articles by this author , Raffaella SantiRaffaella Santi Florence, Italy More articles by this author , Gabriella NesiGabriella Nesi Florence, Italy More articles by this author , Claudia GiannessiClaudia Giannessi Florence, Italy More articles by this author , Arcangelo SebastianelliArcangelo Sebastianelli Florence, Italy More articles by this author , Saverio GiancaneSaverio Giancane Florence, Italy More articles by this author , Saba KhorramiSaba Khorrami Florence, Italy More articles by this author , Matteo SalviMatteo Salvi Florence, Italy More articles by this author , Linda VignozziLinda Vignozzi Florence, Italy More articles by this author , Annamaria MorelliAnnamaria Morelli Florence, Italy More articles by this author , Giovanni CoronaGiovanni Corona Bologna, Italy More articles by this author , Sergio SerniSergio Serni Florence, Italy More articles by this author , Marco CariniMarco Carini Florence, Italy More articles by this author , and Mario MaggiMario Maggi Florence, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1695AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Aim of our study is to correlate serum HDL levels with histologic features of inflammatory infiltrate and weight of surgical specimens of men treated with endoscopic or open prostatectomy for Benign Prostatic Hyperplasia (BPH). METHODS We enrolled 70 men (mean age: 79.6; mean BMI: 26.5) treated with transurethral resection or open prostatectomy for BPH. HDL serum levels were assessed for all patients preoperatively. All surgical specimens were weighted and blinded analysed by the same 2 pathologists: in particular inflammatory infiltrate was classified based on grade (mild, moderate, sever), extent (focal [10%], multifocal [10-50%], diffuse [>50%]), prevalent anatomical location (stromal, periglandular, glandular), and glandular disruption (present or absent). All these parameters were correlated with preoperative HDL and weight of surgical specimens of prostatic adenoma by using a Spearman correlation coefficient. RESULTS Preoperative HDL strongly was correlated with inflammatory infiltrate grade (p=0.012, r=-0.302) and extent (p=0.004, r=-0.004), and with the present of glandular disruption (p=0.006, r=-0.332); HDL resulted also correlated with the surgical specimens weight (p=0.000, r=-0.559). Accordingly, receiver operating characteristic (ROC) curves showed that inflammatory infiltrate grade, extent and the presence of glandular disruption predicted reduced HDL-cholesterol with an accuracy of 67.4%, 72.4%, 70.2% respectively. Moreover, the weight of prostatic adenoma was significantly correlated with the extent of inflammatory infiltrate (p=0.026, r=-0.212), the anatomical location (p=0.017, r=0.285) and glandular disruption (p=0.008, r=0.212). CONCLUSIONS Our study demonstrated that high serum levels of HDL can be significantly related to the increase of several histologic features of inflammation in prostatic adenomatous tissue. Moreover, the enhace of these markers of inflammation seems to induce the growth of weight of prostatic adenoma. These data suggest that METs can be determinant for the inflammatory pathogenesis of BPH and underline the importance of assessing HDL in men with severe LUTS/BPH. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e699 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mauro Gacci Florence, Italy More articles by this author Raffaella Santi Florence, Italy More articles by this author Gabriella Nesi Florence, Italy More articles by this author Claudia Giannessi Florence, Italy More articles by this author Arcangelo Sebastianelli Florence, Italy More articles by this author Saverio Giancane Florence, Italy More articles by this author Saba Khorrami Florence, Italy More articles by this author Matteo Salvi Florence, Italy More articles by this author Linda Vignozzi Florence, Italy More articles by this author Annamaria Morelli Florence, Italy More articles by this author Giovanni Corona Bologna, Italy More articles by this author Sergio Serni Florence, Italy More articles by this author Marco Carini Florence, Italy More articles by this author Mario Maggi Florence, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Is breast specimen shrinkage really a problem in breast-conserving surgery?

BackgroundBreast-conserving surgery currently focuses on improving margin clearance and excision volume, the main pathology report parameters for oncological and cosmetic outcomes.AimTo quantitatively evaluate discrepancies in surgical and pathological estimates of...

Scarpa Fascia Preservation During Abdominoplasty

Background: Abdominoplasty is one of the most popular body-contouring procedures. Previous studies described a superficial and deep compartment in the lower abdominal wall separated by Scarpa fascia. 1,2 Preservation of this fascial plane has been suggested as a way to lower the complication rate associated with conventional abdominoplasty. 3,4 The purpose of this study was to evaluate the effect of preservating Scarpa Fascia during a full abdominoplasty. Methods: A prospective study was perfomed, between November 2005 and November 2007, involving patients submitted to abdominoplasty, at the Department of Plastic Surgery of Sao Joao Hospital, Porto Medical School. Two groups of patients were created: classical full abdominoplasty (group A) and full abdominoplasty with preservation of Scarpa fascia in the infra-umbilical region (group B) (Figure 1) 4 . The variables analyzed were: age, body mass index (BMI), previous abdominal surgery, comorbid medical conditions, specimen weight, time to suction drain removal, total volume of drain output and length of hospital stay. T-student and Mann-Whitney test and χ2 test were used. Results: A total of 208 full abdominoplasties were performed (group A, 143 patients; group B, 65 patients). There were no statistically differences between groups respecting BMI, previous abdominal surgeries, comorbid medical conditions or surgical specimen weight (p>0.05). There were statistically significant differences respecting total volume of drain output (p recovery, reducing total drain output, time to drain removal and hospital stay.

Extraperitoneal Laparoscopic Millin Prostatectomy Using Finger Enucleation

We evaluated the feasibilty, safety and results of extraperitoneal laparoscopic Millin prostatectomy using finger enucleation through an additional 1 cm suprapubic incision. A total of 66 consecutive laparoscopic simple prostatectomies were performed with this technique in men with symptomatic bladder outflow obstruction and a prostate gland larger than 70 cc on transrectal ultrasound. Data such as operating time, intraoperative blood loss, transfusion rate, complications, catheterization period, hospitalization time and surgical specimen weight were prospectively collected and evaluated. Preoperative and 3-month postoperative International Prostate Symptom Score and urinary flow rates were used to assess the surgical outcome. Average operating time was 55 minutes with a mean estimated blood loss of 200 ml. No blood transfusion was necessary, and no conversion, complications or mortality was present. The mean postoperative catheterization period was 7.3 days with a mean hospital stay of 5.2 days. Mean enucleated tissue weight was 85.5 gm. At 3 months postoperatively the International Prostate Symptom Score improved to a mean of 5.8 (from a mean preoperative score of 29.5) while maximum urine flow improved to a mean of 18.5 ml per second (from a mean preoperative rate of 5.8 ml per second). This procedure is safe and fast with excellent functional outcomes. However, prolonged catheterization and hospitalization are still required.

Standardized Total Average Toxicity Score: A Scale- and Grade-Independent Measure of Late Radiotherapy Toxicity to Facilitate Pooling of Data From Different Studies

The search for clinical and biologic biomarkers associated with late radiotherapy toxicity is hindered by the use of multiple and different endpoints from a variety of scoring systems, hampering comparisons across studies and pooling of data. We propose a novel metric, the Standardized Total Average Toxicity (STAT) score, to try to overcome these difficulties. STAT scores were derived for 1010 patients from the Cambridge breast intensity-modulated radiotherapy trial and 493 women from the University Hospitals of Leicester. The sensitivity of the STAT score to detect differences between patient groups, stratified by factors known to influence late toxicity, was compared with that of individual endpoints. Analysis of residuals was used to quantify the effect of these covariates. In the Cambridge cohort, STAT scores detected differences (p < 0.00005) between patients attributable to breast volume, surgical specimen weight, dosimetry, acute toxicity, radiation boost to tumor bed, postoperative infection, and smoking (p < 0.0002), with no loss of sensitivity over individual toxicity endpoints. Diabetes (p = 0.017), poor postoperative surgical cosmesis (p = 0.0036), use of chemotherapy (p = 0.0054), and increasing age (p = 0.041) were also associated with increased STAT score. When the Cambridge and Leicester datasets were combined, STAT was associated with smoking status (p < 0.00005), diabetes (p = 0.041), chemotherapy (p = 0.0008), and radiotherapy boost (p = 0.0001). STAT was independent of the toxicity scale used and was able to deal with missing data. There were correlations between residuals of the STAT score obtained using different toxicity scales (r > 0.86, p < 0.00005 for both datasets). The STAT score may be used to facilitate the analysis of overall late radiation toxicity, from multiple trials or centers, in studies of possible genetic and nongenetic determinants of radiotherapy toxicity.