Purpose
To assess the symptoms, quality of life and sexual well-being in patients with lower urinary tract symptoms due to benign prostatic hyperplasia LUTS/BPH treated with pumpkin seed soft extract ...(PSE) in routine practice.
Methods
This noninterventional study included 130 men treated for up to 24 months. The International Prostate Symptom Score (IPSS) and related quality of life, Aging Males’ Symptoms Scale (AMS), and International Index of Erectile Function (IIEF-5) were recorded. Descriptive statistical methods were applied. The mean with 95% confidence interval (CI) was calculated for the primary end point (change in IPSS after 12-month treatment).
Results
Analysis at 12 months included 83 patients mean (SD) age 65.2 (8.7) years and IPSS (15.6 (3.4), IPSS-QoL 3.4 (0.9). AMS and IIEF-5 indicated mild or mild to moderate disorder regarding sexual well-being and erectile dysfunction, respectively. After 12 months, the mean IPSS change from baseline was − 4.7 (95% CI − 5.4 to − 3.9), with 83% (95% CI 65.3 to 84.1) and 53% (95% CI 42.3 to 63.7) of the patients achieving reductions by at least 3 and 5 points, respectively. The proportion of patients with IPSS-QoL below 3 points (mostly satisfied) was 11% (9/83) at baseline and rose to 62% (51/83) and 73% (40/55) at 12 and 24 months, respectively. AMS and IIEF-5 scores did not indicate a negative impact on sexual function during treatment.
Conclusion
In men with a moderate LUTS suggestive of BPH, a low progression risk and an active sex life, treatment with pumpkin seed soft extract provided symptomatic relief, improved IPSS-QoL, and maintained sexual well-being.
Trial registration
DRKS00010729, June 22, 2016.
Circulating tumor cells (CTCs) provide accurate information on the clinical stage of cancer progression. The present study examined the clinical validity and feasibility of a new medical device for ...the
isolation of CTCs from the blood of patients with prostate cancer (PCa). The GILUPI CellCollector
(DC01) was applied in 188 cases. The CTC/prostate-specific antigen (PSA) profile of each patient was checked for therapeutic monitoring of patients with PCa. The CellCollector, which is a unique
approach for the isolation of CTCs, was compared with the CellSearch
system, which is the current standard. Overall survival (OS) and diagnostic performance were evaluated. By
isolation, 78.9% (56/71) of patients with metastatic disease (PCa-m) and 46.3% (24/53) of patients with localized disease (PCa-l) had ≥1 captured CTC. Kaplan-Meier analysis revealed that patients with PCa-m that had ≥5 CTCs had a significantly different OS compared with those with <5 CTCs (27.5 months vs. 37 months; HR 2.6; 95% CI 0.78-8.3). Patients with a higher number of CTCs at all time-points had the shortest median OS of 25 months (HR 1.9; 95% CI 0.4-11.6). The effectiveness of CTC isolation technologies demonstrated that in 65.7% of the applications, patients with cancer were positive for CTCs using the CellCollector. By contrast, the CellSearch system detected CTCs in 44.4% of applications.
isolation of CTCs demonstrated the clinical viability of the CellCollector, related to the current standard for the isolation of CTCs from patients with PCa. The advantage of the
device is that it overcomes the blood volume limitations of other CTC assays. Furthermore, the present study revealed that the CellCollector was well tolerated, and no adverse events (AEs) or serious AEs were reported.
Hyperbaric oxygenation (HBO), in addition to anti-infective and surgical therapy, seems to be a key treatment point for Fournier's gangrene. The aim of this study was to investigate the influence of ...HBO therapy on the outcome and prognosis of Fournier's gangrene.
In the present multicenter, retrospective observational study, we evaluated the data of approximately 62 patients diagnosed with Fournier's gangrene between 2007 and 2017. For comparison, 2 groups were distinguished: patients without HBO therapy (group A, n = 45) and patients with HBO therapy (group B, n = 17). The analysis included sex, age, comorbidities, clinical symptoms, laboratory and microbiological data, debridement frequency, wound dressing, antibiotic use, outcome and prognosis. The statistical analysis was performed with GraphPad Prism 7® (GraphPad Software, Inc., La Jolla, USA).
Demographic data showed no significant differences. The laboratory parameters C-reactive protein and urea were significantly higher in group B (group B: 301.7 vs. 140.6 mg/dL; group A: 124.8 vs. 54.7 mg/dL). Sepsis criteria were fulfilled in 77.8 and 100% of the patients in groups A and B respectively. Treatment in the intensive care unit (ICU) was therefore indicated in 69% of the patients in group A and 100% of the patients in group B. The mean ICU stay was 9 and 32 days for patients in groups A and B respectively. The wound debridement frequency and hospitalization stay were significantly greater in group B (13 vs. 5 debridement and 40 vs. 22 days). Initial antibiosis was test validated in 80% of the patients in group A and 76.5% of the patients in group B. Mortality was 0% in group B and 4.4% in the group A.
The positive influence of HBO on the treatment of Fournier's gangrene can be estimated only from the available data. Despite poorer baseline findings with comparable risk factors, mortality was 0% in the HBO group. The analysis of a larger patient cohort is desirable to increase the significance of the results.
Rotator cuff tears are a common cause of shoulder pain in the middle-aged population. The treatment of these lesions must be individualized on the basis of the type of patient, the clinical and ...anatomical picture. Arthroscopic debridement is indicated in painful massive tears, in the absence of severe functional impairment of the shoulder. The aim of this study is the evaluation of the medium term clinical results of this procedure. We retrospectively assessed patients who underwent arthroscopic debridement surgery for massive rotator cuff injury in the period between January 2011 and December 2016 at our institution. A group of patients underwent a follow-up evaluation during which the Constant Score, Oxford Shoulder Score and NRS pain score were compiled. Those who were unable to attend the evaluation were assessed through a telephone questionnaire aimed at investigating pain and degree of satisfaction with the treatment. 93% of patients were satisfied with the results obtained, with an average NRS of 1.31 for patients undergoing the medical examination and 0.68 for patients contacted by telephone. The mean Constant score of the evaluated patients was 75.6 ± sd, with a mean strength of 3.92 ± sd, while the mean value of the Oxford Shoulder Score was 16.8 ± sd. The study suggests that arthroscopic debridement is a viable option for the surgical treatment of massive rotator cuff tears. The clinical results and patient satisfaction are conditioned by the preoperative functional status: an optimal outcome can be expected for painful shoulders with sufficiently preserved active mobility.
Abstract
Background:
Circulating tumor cells (CTC) consist of a heterogeneous population of very rare cells of the primary tumor or its own metastases. A growing amount of evidence has shown that ...subpopulations of carcinoma cells undergo epithelial-to-mesenchymal transitions (EMT), resulting in their increased motility which facilitates their intravasation into the blood circulation. Gold standard of CTC-isolation is the CellSearchSystem based on epithelial cell adhesion molecule (EpCAM) enrichment, though it is known that EpCAM is downregulated in al advanced prostate cancers and in all CTCs. Furthermore these CTC isolation techniques are not able to isolate organ specific CTCs. The aim of this pilot study is the development of a prostate cancer specific functionalized wire, which detects prostate cancer specific circulating tumor cells (PCTC) in metastatic PCa patients. The CTC detection rate will be compared between an EpCAM functionalized wire and a PCa specific functionalized wire.
Methods:
We combined 4 antibodies against Prostate specific membrane antigen (PSMA), Prostate specific antigen (PSA), Prostate specific stem cell antigen (PSCA) and epithelial cell adhesion molecule (EpCAM). Evaluations of these antibodies were performed by immunofluorescence analysis of the human prostate cancer cell lines PC3 and LNCaP. PCa specific functionalization of the wire was determined with spiking experiments. Blood samples from healthy donors were spiked with PC-3 and LNCaP cells to test the wire for cell-binding. Afterwards blood of 15 metastatic castration-resistant prostate cancer (CRPC) patients with metastatic progression, documented by prostate-specific antigen or radiologic criteria, was investigated. These samples were simultaneously analyzed in the flow system with two different functionalized wires. The captured CTC and PCTC were identified by immunofluorescence staining using pan cytokeratin and Hoechst-33258 positive signals as well as CD45 negative criteria.
Results: The spiking experiments indicate that a sensitive ex vivo isolation with different functionalized wires is possible. In summary, PCTC counts ranged from 0-122 per PCTC (median 9) and CTC counts ranged from 0-22 per CTC (median 3). Our data shows that a more sensitive isolation of PCTC′s is possible using prostate cancer specific functionalized wire compared to EpCAM functionalized wire (p ≤ 0,001). The CTC isolation sensitivity was about 86% for PCa-functionalized wire and about 73% for EpCAM functionalized wire.
Conclusions: PCTC can be isolated with prostate cancer-specific functionalization of the wire. Simultaneously CTC that underwent EMT can be isolated. These organ specific subpopulations might have a prognostic effect on the clinical outcome and on the development of personalized medicine. This proof of concept shows how important it is to optimize the EpCam based CTC-detection.
Citation Format: Gerit Theil, Stefanie Schmidt, Kersten Fischer, Klaus Lücke, Paolo Fornara. The isolation of prostate cancer specific circulating tumor cells in the blood of patients with metastatic castration-resistant prostate cancer. abstract. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4964.
0% of all urinary tract injuries are iatrogenic lesions. Although they only occur in < 5%, they can lead to severe ipsilateral renal dysfunctions. These lesions can be treated with extensive ...knowledge on the genesis of the lesion, the anatomy, the individual patient's history and high operative expertise in diverse surgical methods.
In this article, we show which reconstruction options are possible, depending on the lesion's severity according to the AAST and EAU Guidelines from 2009 on the classification of ureter injuries, as well as the localisation. A special focus is on the anatomy. It is important to adhere to surgical ground principles, such as making sure all pathological tissue is removed, the ureter ends are spatulated and a tension-free and watertight anastomosis is maintained.
Iatrogenic ureter lesions are rare complications, but being able to deal with these frequently requires a urologist's expertise. Whenever surgeons operate close to the ureters, there is always a risk of an iatrogenic ureter lesion, which in turn requires that all available reconstructive measures are used dynamically.
Ureter complications are rare but require surgeons' excellent management expertise.
What's known on the subject? and What does the study add?
Whereas open nephron‐sparing surgery (NSS) represents the ‘gold standard’ in the surgical therapy of T1 renal tumours, with the advances in ...laparoscopic surgery, the refinement of intracorporeal suturing and the availability of haemosealant substances, the laparoscopic approach to NSS is increasingly used. Laparoscopic partial nephrectomy (LPN), however, is currently performed in just a few high‐volume reference centres, and its diffusion has been limited by the steep learning curve. Conversely, robot‐assisted LPN is emerging as a promising procedure, able to tackle the technical difficulties of LPN and leading to a broader diffusion of minimally invasive treatment of small renal masses.
Our study provides long‐term follow‐up outcomes concerning surgical and oncological outcomes and a detailed evaluation of the renal function in patients affected by T1 renal cancers who underwent LPN and OPN. We showed that LPN could be safely performed in the therapy of T1 renal cancer, without impairing renal function.
Objective
To evaluate the long‐term oncological and functional outcomes of laparoscopic partial nephrectomy (LPN) compared with open partial nephrectomy (OPN) for pT1 renal tumours.
Patients and Methods
In this retrospective single‐centre study, 340 consecutive patients underwent LPN and OPN for localized, incidentally discovered, renal masses of <7 cm (cT1).
The patients were matched for age, sex, body mass index, American Society of Anesthesiology score, tumour side (right or left kidney) and tumour characteristics (RENAL nephrometry score).
Demographic data, peri‐ and postoperative variables, including operating time, estimated blood loss, complications, hospital stay, renal function, histological tumour staging and grading, and metastasis rates were collected and analysed.
Results
The median (sem) operating time for LPN and OPN was 145.3 (45.4) min and 155.2 (35.6) min, respectively (P = 0.07). The median (sem) warm ischaemia time was 11.7 (2.2) min in the LPN and 14.4 (1.9) min in the OPN group (P = 0.03).
The median (sem) RENAL nephrometry scores for LPN and OPN were 5.9 (1.6) and 6.1 (0.3), respectively (P = 0.11).
During follow‐up, the biochemical markers of glomerular filtration were completely normalized, showing the absence of renal injury and there was no significant difference in glomerular filtration rate between the groups, with median (sem) rates of 79.8 (3.0) mL/min/1.72m2 for the LPN and 80.2 (2.7) mL/min/1.72m2 for the OPN group at 5‐year follow‐up.
The 5‐year overall survival and cancer‐specific survival rates, calculated using the Kaplan–Meier method, were 94% and 91% in the LPN group, and 92% and 88% in the OPN group.
Conclusion
LPN and OPN provide similar long‐term oncological outcomes in the therapy of T1 renal cancer. With regard to renal function, no damage to the kidney was found after LPN and OPN, with a complete normalization of renal function at the 5‐year follow‐up in both groups.
Abstract Background Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years. Objective To report a large multi-institutional worldwide series of LESS in ...urology. Design, setting, and participants Consecutive cases of LESS done between August 2007 and November 2010 at 18 participating institutions were included in this retrospective analysis. Intervention Each group performed a variety of LESS procedures according to its own protocols, entry criteria, and techniques. Measurements Demographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed. Conversions to reduced-port laparoscopy, conventional laparoscopy, or open surgery were evaluated, as were intraoperative and postoperative complications. Results and limitations Overall, 1076 patients were included in the analysis. The most common procedures were extirpative or ablative operations in the upper urinary tract. The da Vinci robot was used to operate on 143 patients (13%). A single-port technique was most commonly used and the umbilicus represented the most common access site. Overall, operative time was 160 ± 93 min and estimated blood loss was 148 ± 234 ml. Skin incision length at closure was 3.5 ± 1.5 cm. Mean hospital stay was 3.6 ± 2.7 d with a visual analog pain score at discharge of 1.5 ± 1.4. An additional port was used in 23% of cases. The overall conversion rate was 20.8%; 15.8% of patients were converted to reduced-port laparoscopy, 4% to conventional laparoscopy/robotic surgery, and 1% to open surgery. The intraoperative complication rate was 3.3%. Postoperative complications, mostly low grade, were encountered in 9.5% of cases. Conclusions This study provides a global view of the evolution of LESS in the field of minimally invasive urologic surgery. A broad range of procedures have been effectively performed, primarily in the academic setting, within diverse health care systems around the world. Since LESS is performed by experienced laparoscopic surgeons, the risk of complications remains low when stringent patient-selection criteria are applied.
Objective To identify risk factors for treatment failure of men with the adjustable transobturator male system (ATOMS) for treating stress urinary incontinence (SUI). Patients and Methods Sixty-two ...patients with SUI after prostate surgery were provided with an ATOMS. The self-defined criteria for treatment failure (implant removal A, no improvement or ≥3 pads/24 hours B, and no improvement or ≥150 mL urine loss/24 hours C) were compared to anamnestic, clinical, and time-specific parameters: age, Charlson comorbidity index (CCI), urine culture (UC), previous ineffective implants, body mass index, radiotherapy, renal function (serum creatinine), smoker status, urethral strictures, SUI severity, surgery time, time to and season at implantation, and port system application. Results After a median follow-up of 17.7 months, 9 ATOMS (15%) were removed due to infection (8) or dysfunction (1); 23% and 16% had treatment failure of criteria B and C. Dry rate/overall success rate was 61%/87%. Age alone was no risk factor but the CCI and a positive UC were univariate significant predictors of the criteria A, B, and C. Besides, previous devices and renal failure were significantly associated with implant removal (A) and SUI severity with criterion C. In multivariate analysis, previous devices ( P = .0163), positive UC ( P = .0190), and SUI severity ( P = .0123) were the strongest predictors of A, B, and C, respectively. Conclusion A poor CCI, preoperative positive UC, severe SUI, and previous implants lead to more treatment failure and removal. Age, body mass index, radiotherapy, urethral strictures, current smoking, time-specific parameters, seasonality, and port system application did not influence the outcome.
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