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Polypropylene mesh tape for male sphinteric incontinence
LB1 SEMINAL VESICLE SPARING EFFECT OF PROSTATECTOMY ON ERECTILE FUNCTION
RADICAL
Beurton D., Dakir M.. Thomas L., Elard S., Slama A., Fontaine E HBpital Ambroise
Par&, Urology, Boulogne,
LB2 DETECTION COLLECTED DIAGNOSIS PROCEDURE
OF TELOMERASE ACTIVITY IN EPITHELIAL CELLS BY PROSTATE MASSAGE ALLOWS EARLY OF PROSTATE CANCER BY A NON INVASIVE
Vicentini C.‘, Tubaro A.‘, Gravina G.L.‘, Angelucci A.‘, Pascale E.‘, D’Ambrosio E.‘, Muzi P.‘, Paradiso Galatioto G.‘, Bologna M.’
France
INTRODUCTION & OBJECTIVES: Early diagnosis and selection of patients make the seminal vesicle involvement infrequent on pathologic reports of radical prostatectomy. Recent studies suggest that the seminal vesicle sparing (SVS) technique could improve restoration of erectile function. The aim of this study is to see if this technique improves the erectile function without worsening the prognosis. MATERIAL & METHODS: Between February 1999 and December 2001, radical prostatectomy was performed in 18 patients according to this technique. Mean age was 61 years old. Clinical stage was pTlc. Biopsy was positive in one lobe. Mean preoperative PSA was 8.95 (5.9-11). Mean Gleason score on pathologic reports of radical prostatectomy was 6.18 (6-8). Neurovascular bundles sparing was bilateral in 15 cases and unilateral in 3 cases. Seminal vesicle sparing was unilateral in 15 cases and bilateral in 3 cases. These patients were matched I : I with 18 patients who did not undergo seminal vesicle sparing radical prostatectomy (control group) during the same period. RESULTS: Follow-up ranges from I to 4 years. Erections were satisfactory with sexual intercourse, present without sexual intercourse and absent in 50%. 38.9% and 11.1% versus 6.7 %, 33.3% and 60%, respectively of the patients treated with the SVS technique versus no SVS technique. Time of restoration for sexual function was 7 months versus 12 months for patients with the SVS technique versus no SVS technique. At follow-up, all the patients were free of biochemical relapse. CONCLUSIONS: The seminal vesicle sparing radical prostatectomy improves significantly the restoration of erectile function. It can be performed without worsening the prognosis in patients with preoperative normal erectile function, Tic clinical stage, PSA level ~10 ngiml and Gleason score 57.
‘University of L’Aquila, Department of Surgery, L’Aquila, Italy, ‘University “La Sapienza”, Department of Urology, 2nd School of Medicine, Roma, Italy, ‘University “La Sapienza”, Department of Experimental Medicine, Roma, Italy. ‘CNR, Department of Neurobiology and Molecular Medicine, Roma. Italy INTRODUCTION & OBJECTIVES: Telomerase is a ribonucleoprotein complex present in cancer cells and absent in several benign, differentiated cells. In this study we tested the ability of a non-invasive assay to detect telomerase activity and to differentiate between Prostatic cancer (Pea) and Benign Prostatic Hyperplasia (BPH) on samples of epithelial cells shed by the prostatic glands and obtained after prostatic massage. MATERIAL & METHODS: Telomerase activity was determined by a telomeric repeat amplification protocol (TRAP) assay. We analysed 47 prostate massage fluid specimens of patients with non-suspicious digital rectal examination (DRE) for cancer, clinical evidence of Lower Urinary Tract Symptoms (LUTS) and without sonographic signs of PCs at the transrectal ultrasound (TRUS) evaluation. The histological diagnosis of Pea (20 cases), BPH (23 cases) and high-grade prostatic intraepithelial neoplasia (HGPIN, 4 cases) was later obtained after TRUS-guided biopsy or transurethral surgical resection (TURP). The whole procedure was double blind between the pathologists and the molecular biology operators. RESULTS: Telomerase activity was detected in I8 of 20 (90%) Pea cases, in 4 of 4 (100%) HGPIN cases, and in 3 of 23 (13%) BPH cases. The sensitivity (90%) and specificity (87%) of this method were calculated and the correlation of telomerase positivity with PSA levels evaluated. CONCLUSIONS: Our data indicate that telomerase activity detected by TRAP assay can substantially improve the distinction between Pea and BPH conditions in patients with non-suspicious DRE, clinical evidence of LUTS and no sonographic evidence of PCs. Moreover, in BPH patients with a telomerase positive result, it is necessary to enact a close follow-up for a possible early PCs detection.
LB3 POLYPROPYLENE INCONTINENCE
MESH
Cetinel B., Demirkcsen
FOR
0.. Kural AR. Onal B.
Cerrahpasa School of Medicine, Istanbul, Turkey INTRODUCTION incontinence is still procedures in male male sling technique
TAPE
MALE
’
Istanbul University,
Department
of Urology.
& OBJECTIVES: The management of male sphincteric challenging. Recently there has been a trend back to sling sphincteric incontinence. We present our experience with a using tension free vaginal tape (TVT) device.
MATERIAL & METHODS: A total of 12 patients 17-75 years old (median age 61) underwent this procedure. Sphincteric incontinence was due to radical prostatectomy in 3, transurethral ptostatectomy in 4, open prostatectomy in 2, spinal cord injury in 2, and myelomeningocele in I patient. All patients (one with detrusor overactivity) had urodynamic stress incontinence with a mean valsalva leak point pressure of 48.8 cm water (40-68). The procedure was performed using a perineal midline incision and perineal membrane was exposed with minimal dissection lateral to the bulbospongious and medial to the ischiocavemous muscle. A 5 cm long single transverse suprapubic incision was made and carried down to the rectus abdominis fascia. A polypropylene mesh sling was passed through the perineal membrane on each side and the limbs of the tape were withdrawn to the suprapubic incision with the help of TVT trocars. The tension of the tape was adjusted duri a retrograde sphincterometry until a retrograde leak point pressure of 30-50 l_# water was achieved. The two limbs of sling material were brought together with 310 prolene sutures over the rectus fascia and the excess of the limbs were cut. RESULTS: Average operative time was 65 minutes (45-l 10). Follow-up was 235.3 months (median 21). Overall urinary incontinence was cured (no leakage) and significantly improved (usage of one pad per day or less and/or declaration of minor urinary incontinence) in 9 (75%), and failed in 3 (25%) patients. Intermittent catheterisation was initiated in three patients with impaired detrusor contractions due to neurologic etiology. One patient had intra-operative bladder perforation. None of the patients had urethral erosion, wound infection or any other major complications. CONCLUSIONS: This procedure seems to be an effective and safe treatment for patients with sphincteric incontinence. Further experience with more patients and longer follow-up is mandatory to determine its long-term effectiveness. European
Urology
LB4
SPHINTERIC
Supplements
2 (2003) No. 1, pp. 216
WITHDRAWN
RADICAL
Beurton D., Dakir M.. Thomas L., Elard S., Slama A., Fontaine E HBpital Ambroise
Par&, Urology, Boulogne,
LB2 DETECTION COLLECTED DIAGNOSIS PROCEDURE
OF TELOMERASE ACTIVITY IN EPITHELIAL CELLS BY PROSTATE MASSAGE ALLOWS EARLY OF PROSTATE CANCER BY A NON INVASIVE
Vicentini C.‘, Tubaro A.‘, Gravina G.L.‘, Angelucci A.‘, Pascale E.‘, D’Ambrosio E.‘, Muzi P.‘, Paradiso Galatioto G.‘, Bologna M.’
France
INTRODUCTION & OBJECTIVES: Early diagnosis and selection of patients make the seminal vesicle involvement infrequent on pathologic reports of radical prostatectomy. Recent studies suggest that the seminal vesicle sparing (SVS) technique could improve restoration of erectile function. The aim of this study is to see if this technique improves the erectile function without worsening the prognosis. MATERIAL & METHODS: Between February 1999 and December 2001, radical prostatectomy was performed in 18 patients according to this technique. Mean age was 61 years old. Clinical stage was pTlc. Biopsy was positive in one lobe. Mean preoperative PSA was 8.95 (5.9-11). Mean Gleason score on pathologic reports of radical prostatectomy was 6.18 (6-8). Neurovascular bundles sparing was bilateral in 15 cases and unilateral in 3 cases. Seminal vesicle sparing was unilateral in 15 cases and bilateral in 3 cases. These patients were matched I : I with 18 patients who did not undergo seminal vesicle sparing radical prostatectomy (control group) during the same period. RESULTS: Follow-up ranges from I to 4 years. Erections were satisfactory with sexual intercourse, present without sexual intercourse and absent in 50%. 38.9% and 11.1% versus 6.7 %, 33.3% and 60%, respectively of the patients treated with the SVS technique versus no SVS technique. Time of restoration for sexual function was 7 months versus 12 months for patients with the SVS technique versus no SVS technique. At follow-up, all the patients were free of biochemical relapse. CONCLUSIONS: The seminal vesicle sparing radical prostatectomy improves significantly the restoration of erectile function. It can be performed without worsening the prognosis in patients with preoperative normal erectile function, Tic clinical stage, PSA level ~10 ngiml and Gleason score 57.
‘University of L’Aquila, Department of Surgery, L’Aquila, Italy, ‘University “La Sapienza”, Department of Urology, 2nd School of Medicine, Roma, Italy, ‘University “La Sapienza”, Department of Experimental Medicine, Roma, Italy. ‘CNR, Department of Neurobiology and Molecular Medicine, Roma. Italy INTRODUCTION & OBJECTIVES: Telomerase is a ribonucleoprotein complex present in cancer cells and absent in several benign, differentiated cells. In this study we tested the ability of a non-invasive assay to detect telomerase activity and to differentiate between Prostatic cancer (Pea) and Benign Prostatic Hyperplasia (BPH) on samples of epithelial cells shed by the prostatic glands and obtained after prostatic massage. MATERIAL & METHODS: Telomerase activity was determined by a telomeric repeat amplification protocol (TRAP) assay. We analysed 47 prostate massage fluid specimens of patients with non-suspicious digital rectal examination (DRE) for cancer, clinical evidence of Lower Urinary Tract Symptoms (LUTS) and without sonographic signs of PCs at the transrectal ultrasound (TRUS) evaluation. The histological diagnosis of Pea (20 cases), BPH (23 cases) and high-grade prostatic intraepithelial neoplasia (HGPIN, 4 cases) was later obtained after TRUS-guided biopsy or transurethral surgical resection (TURP). The whole procedure was double blind between the pathologists and the molecular biology operators. RESULTS: Telomerase activity was detected in I8 of 20 (90%) Pea cases, in 4 of 4 (100%) HGPIN cases, and in 3 of 23 (13%) BPH cases. The sensitivity (90%) and specificity (87%) of this method were calculated and the correlation of telomerase positivity with PSA levels evaluated. CONCLUSIONS: Our data indicate that telomerase activity detected by TRAP assay can substantially improve the distinction between Pea and BPH conditions in patients with non-suspicious DRE, clinical evidence of LUTS and no sonographic evidence of PCs. Moreover, in BPH patients with a telomerase positive result, it is necessary to enact a close follow-up for a possible early PCs detection.
LB3 POLYPROPYLENE INCONTINENCE
MESH
Cetinel B., Demirkcsen
FOR
0.. Kural AR. Onal B.
Cerrahpasa School of Medicine, Istanbul, Turkey INTRODUCTION incontinence is still procedures in male male sling technique
TAPE
MALE
’
Istanbul University,
Department
of Urology.
& OBJECTIVES: The management of male sphincteric challenging. Recently there has been a trend back to sling sphincteric incontinence. We present our experience with a using tension free vaginal tape (TVT) device.
MATERIAL & METHODS: A total of 12 patients 17-75 years old (median age 61) underwent this procedure. Sphincteric incontinence was due to radical prostatectomy in 3, transurethral ptostatectomy in 4, open prostatectomy in 2, spinal cord injury in 2, and myelomeningocele in I patient. All patients (one with detrusor overactivity) had urodynamic stress incontinence with a mean valsalva leak point pressure of 48.8 cm water (40-68). The procedure was performed using a perineal midline incision and perineal membrane was exposed with minimal dissection lateral to the bulbospongious and medial to the ischiocavemous muscle. A 5 cm long single transverse suprapubic incision was made and carried down to the rectus abdominis fascia. A polypropylene mesh sling was passed through the perineal membrane on each side and the limbs of the tape were withdrawn to the suprapubic incision with the help of TVT trocars. The tension of the tape was adjusted duri a retrograde sphincterometry until a retrograde leak point pressure of 30-50 l_# water was achieved. The two limbs of sling material were brought together with 310 prolene sutures over the rectus fascia and the excess of the limbs were cut. RESULTS: Average operative time was 65 minutes (45-l 10). Follow-up was 235.3 months (median 21). Overall urinary incontinence was cured (no leakage) and significantly improved (usage of one pad per day or less and/or declaration of minor urinary incontinence) in 9 (75%), and failed in 3 (25%) patients. Intermittent catheterisation was initiated in three patients with impaired detrusor contractions due to neurologic etiology. One patient had intra-operative bladder perforation. None of the patients had urethral erosion, wound infection or any other major complications. CONCLUSIONS: This procedure seems to be an effective and safe treatment for patients with sphincteric incontinence. Further experience with more patients and longer follow-up is mandatory to determine its long-term effectiveness. European
Urology
LB4
SPHINTERIC
Supplements
2 (2003) No. 1, pp. 216
WITHDRAWN