Objective. Laparoscopic radical prostatectomy has shown excellent results concerning patient morbidity, with less blood loss compared to conventional surgery. Robot-assisted laparoscopy offers ...several additional important technical improvements and therefore it might be suggested that robotic radical prostatectomy would also offer surgical advantages. The objective of this study was to evaluate urinary continence for the first 72 cases of robot-assisted radical prostatectomy performed by a single surgical team. Material and methods. We analysed the outcomes of the first 72 consecutive patients to undergo robot-assisted prostatectomy for localized prostate cancer at our hospital between January 2002 and May 2004. A self-administered questionnaire concerning urinary status was mailed to the patients 3 and 6 months after surgery. Pre- and peroperative characteristics were obtained from patient medical records. The mean age was 61.2 years (range 36-71 years) and the mean preoperative prostate-specific antigen level was 6.3 ng/ml (range 2.3-10.7 ng/ml). The preoperative clinical stage was T1c, 67%, T2, 28% and T3, 5% and the mean Gleason sum was 6 (range 5-9). Results. Sixty-one of the 68 patients (90%) reported no use of pads and 6 (9%) used a maximum of 1 pad/day 3-6 months after surgery. One patient reported use of >1 pad/day 6 months after surgery. Three significant complications were noted: ureter injury, haemorrhage and femoral nerve injury. Conclusions. In this series, which represents the learning curve for one surgical team, only a tenth of the patients still required pads 3-6 months after surgery. Considering the short follow-up period, the results in this series will probably improve over time.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
We set out to present potency results after bilateral, unilateral, and semi-sparing of the neurovascular bundles after robotic prostatectomy. Two hundred and twenty-five consecutive robotic-assisted ...laparoscopic radical prostatectomies were performed by one surgeon (NPW) from the start of our robotic program in January 2002 until December 2005. Patient demographics, operative, and postoperative data were prospectively entered into a database. We have functional data for 183, 150, and 109 patients followed for 3, 6, and 12 months, respectively. Of 49 preoperatively potent patients 36 (73%, 95% CI 59-85%) had erections sufficient for intercourse at 12 month follow-up. If bilateral nerve sparing was performed, 13 (87%, 95% CI 59-85%) of the patients showed a return of potency sufficient for intercourse. In preoperatively potent patients who did not undergo a traditional nerve sparing due to a high-risk disease, semi-sparing of the neurovascular bundles showed a return of potency in 10 (53%, 95% CI 29-76%). After one-year follow-up, 66 of 71 (93%, 95% CI 84-98%) had no need for protective pads and two (3%) used more than one pad a day. In the first 100 patients there were 24 (24%) positive surgical margins and for the last 125 patients there were 18 (14%). Based on these data, we hypothesize that certain subgroups, e.g., men wanting to preserve their sexual potency but having a tumor that hinders a traditional nerve-sparing approach, may be particularly helped by robot-assisted laparoscopic surgery as compared with other techniques.
Nitrite and nitrate have been widely used as markers for nitric oxide (NO) formation in vivo and represent the major NO oxidation products in biological fluids. In the present study, the use of ...capillary electrophoresis (CE) in the measurement of nitrite and nitrate in human urine is described. Urine samples were electrophoresed in an extended light path fused‐silica capillary (104 cm; 75 νm ID) at an applied negative potential of 30 kV, and UV detection at 214 nm. Using electrokinetic sample injection (–6 kV×20 s), we found that urine concentration, pH, sodium and chloride interfered with nitrite and nitrate detection. The detection of nitrite and nitrate was decreased when hydrodynamic sample injection was used (30 mbar×60 s). However, basal levels of urinary nitrite (0.25 ± 0.05 νM) and nitrate (591 ± 115 νM) were detected and no interference by variations in urine concentration and pH was noted when hydrodynamic sample injection was used. Thus, hydrodynamic sample injection is convenient for the measurement of urinary nitrite and nitrate and avoids the effect of variations in urine matrices and pH on nitrite and nitrate detection.
Objectives. Nitric oxide (NO) is formed in many mammalian tissues, and a growing body of evidence suggests that NO is involved in cell growth and cell differentiation. Low concentrations of NO can ...stimulate cell growth; high concentrations result in cytostatic/cytotoxic effects. It has previously been shown that intravesical treatment with bacille Calmette-Guérin (BCG) for bladder cancer increases NO production in the human urinary bladder and that NO inhibits bladder cancer cell growth in vitro. In this study, we investigated nitric oxide synthase (NOS) activity in different bladder cancer cells and the role of the NO precursor
l-arginine in cell proliferation.
Methods. NOS activity was assessed by citrulline assay in cultured normal human urothelial cells and bladder cancer cell lines T24 and MBT-2 before and after treatment with cytokines. We also measured cell growth at various
l-arginine concentrations and after addition of the NOS inhibitor
N
G-nitro-
l-arginine (
l-NNA) in unstimulated and cytokine-stimulated cells.
Results. Normal urothelial cells, as well as T24 and MBT-2 cells, showed calcium-dependent NOS activity under basal conditions. The bladder cancer cell lines also showed calcium-independent NOS activity in contrast to the normal cells. After cytokine treatment, both the normal cells and the cancer cell lines showed a marked increase in calcium-independent NOS activity. There was a dose-dependent stimulation of cell growth in the cancer cell lines after
l-arginine addition, and this effect could be antagonized by
l-NNA. Cytokine treatment inhibited cell growth, and this inhibition was partly reversed by
l-NNA.
Conclusions. Normal urothelial cells and bladder cancer cell lines MBT-2 and T24 show NOS activity, and cytokine treatment induces calcium-independent NOS activity. Our results suggest that endogenous activity of the constitutively expressed form of NOS in unstimulated cells promotes cell proliferation, and NO production secondary to increased activity of the inducible form of NOS after cytokine treatment inhibits cell growth.
Nitric oxide (NO) is synthesized by a family of isoenzymes called NO synthases (NOSs) 1 and it plays a vital role as a mediator in the vascular, nervous and immune system 2. Three human NOS ...isoenzymes have been characterized and cloned. Endothelial NOS (eNOS) and neuronal NOS (nNOS) are Ca2+-dependent. Inducible NOS (iNOS) is Ca2+-independent and the synthesis of this enzyme is induced by several cytokines as well as by bacterial lipopolysaccharide 1. Increased production of NO occurs locally in tissues during inflammation although the role of NO in the pathogenesis of inflammation is not known 3. Induction of iNOS
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