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Paula Domino M, Vertosick EA, Vickers AJ, Eastham JA, Sandhu JS. The Association Between Low Preoperative Serum Testosterone and Post-radical Prostatectomy Urinary Function. Urology 2023; 180:190-193. [PMID: 37516254 DOI: 10.1016/j.urology.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE To determine if hypogonadism leads to delayed urinary function recovery post-radical prostatectomy (RP) by studying the effect of preoperative factors including age, membranous urethral length, radiation therapy, and Body Mass Index on urinary continence in patients with or without hypogonadism. MATERIALS AND METHODS We identified 1209 patients treated by RP with both pretreatment T and post-treatment urinary outcome. We assessed whether there was an association between low preoperative T level (prenoon T ≤ 300 ng/dL) and continence (using ≤1 pad/d) at 6 and 12months post-RP. Patient-reported continence was used when available, otherwise, surgeon-assessed continence was used. Logistic regression models were used, adjusted for age at RP and nerve-sparing status. RESULTS Median age at RP was 61 (Intraquatile Range (IQR) 56, 66), 92% of patients had at least one nerve spared and 99% were continent at baseline. Continence in patients with low T was nonsignificantly lower at 6months (odds ratio 0.69, 95% confidence interval 0.44, 1.06; P = .10) and nonsignificantly higher at 12months (odds ratio 1.07, 95% confidence interval 0.71, 1.58; P = .8). Sensitivity analyses excluding patients with preoperative metastasis or treated with androgen deprivation therapy (ADT) and including testosterone as a continuous predictor were consistent with the primary analysis; similarly finding no evidence of an association. CONCLUSION Although we cannot rule out an effect on early continence, overall the evidence does not suggest that low serum testosterone adversely impacts urinary function recovery after RP. This finding can be used to counsel patients enrolled in neoadjuvant ADT trials or those patients undergoing RP who have had prior ADT, such as in the setting of oligometastatic disease.
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Affiliation(s)
- M Paula Domino
- Voiding Dysfunction and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, MS
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James A Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jaspreet S Sandhu
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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Latest Evidence on Post-Prostatectomy Urinary Incontinence. J Clin Med 2023; 12:jcm12031190. [PMID: 36769855 PMCID: PMC9917389 DOI: 10.3390/jcm12031190] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
A radical prostatectomy is frequently used as the first-line treatment for men with prostate cancer. Persistent urinary incontinence after surgery is one of the most severe adverse events. We report the results of a comprehensive literature search focused on post-prostatectomy urinary incontinence (PPI), performed by a panel of experts on non-neurogenic lower urinary tract symptoms. The data on the prevalence and timing of PPI are very heterogeneous. The etiology of PPI can be multifactorial and mainly dependent on patient characteristics, lower urinary tract function or surgical issues. The medical history with a physical examination, the use of validated questionnaires with a voiding diary and pad tests are determinants in identifying the contributing factors and choosing the right treatment. Lifestyle intervention and urinary containment are the most frequently used strategies for the conservative management of PPI, while antimuscarinics, beta-3 agonists and duloxetine (off-label) are drugs indicated to manage PPI with a concomitant overactive bladder. Surgical therapies for the management of post-prostatectomy SUI include non-adjustable trans-obturator slings in men with mild-to-moderate incontinence and an artificial urinary sphincter in men with moderate-to-severe incontinence.
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Fendereski K, Ghaed MA, Calvert JK, Hotaling JM. Hypogonadism and urologic surgeries: a narrative review. Transl Androl Urol 2022; 11:1045-1062. [PMID: 35958902 PMCID: PMC9360521 DOI: 10.21037/tau-22-308] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Objective Previous studies indicated that the treatment of male hypogonadism can be beneficial for intraoperative and postsurgical outcomes. In this study, we aimed to determine the impact of male hypogonadism on urologic surgeries. We provided an overview of the key studies in the field with the focus on the outcomes of urologic surgeries in hypogonadal men with/without testosterone replacement therapy (TRT). Methods We performed a literature review in PubMed and Google Scholar databases for the most relevant articles pertaining to the outlined topics without placing any limitations on publication years or study designs. We included full-text English articles published in peer reviewed journals between January 1970 and March 2022. Key Content and Findings Androgen deficiency is a common finding after major urologic surgeries. Although guidelines recommend against TRT in men with prostate carcinoma, recent investigations showed no association between TRT and disease progression and recurrence. Indeed, recent evidence suggested that low androgen levels could be related to high grade prostate carcinoma and increased risk of upgrading from low to high grade disease. Investigations on the application of TRT in benign prostatic hyperplasia (BPH) patients also revealed contrasting results. While some studies suggested higher rates of prostate-related events in men who received TRT, others showed that TRT could alleviate urinary symptoms in hypogonadal men with BPH. Decreased testosterone level is commonly seen in bladder cancer patients. The treatment of perioperative androgen deficiency can reduce postoperative morbidities and lower the risk of recurrence in these patients. Low testosterone levels are observed in approximately half of the men who undergo artificial urinary sphincter (AUS) placement and can increase the risk of complications. Conclusions The role of testosterone treatment in patients with urologic diseases such as prostate carcinoma and BPH is controversial. Further investigations are needed to determine the impact of hypogonadism and TRT on the outcomes of urologic surgeries in patients with androgen deficiency.
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Affiliation(s)
- Kiarad Fendereski
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Mohammad Ali Ghaed
- Department of Urology, Rasoul Akram Hospital, Iran university of Medical Sciences, Tehran, Iran
| | - Joshua K Calvert
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Kim DK, Parihar JS, Kwon YS, Kim S, Shinder B, Lee N, Farber N, Ahlering T, Skarecky D, Yuh B, Ruel N, Kim WJ, Rha KH, Kim IY. Risk of complications and urinary incontinence following cytoreductive prostatectomy: a multi-institutional study. Asian J Androl 2019; 20:9-14. [PMID: 28440262 PMCID: PMC5753561 DOI: 10.4103/1008-682x.196852] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Emerging evidence has suggested that cytoreductive prostatectomy (CRP) allows superior oncologic control when compared to current standard of care androgen deprivation therapy alone. However, the safety and benefit of cytoreduction in metastatic prostate cancer (mPCa) has not been proven. Therefore, we evaluated the incidence of complications following CRP in men newly diagnosed with mPCa. A total of 68 patients who underwent CRP from 2006 to 2014 at four tertiary surgical centers were compared to 598 men who underwent radical prostatectomy for clinically localized prostate cancer (PCa). Urinary incontinence was defined as the use of any pad. CRP had longer operative times (200 min vs 140 min, P < 0.0001) and higher estimated blood loss (250 ml vs 125 ml, P < 0.0001) compared to the control group. However, both overall (8.82% vs 5.85%) and major complication rates (4.41% vs 2.17%) were comparable between the two groups. Importantly, urinary incontinence rate at 1-year after surgery was significantly higher in the CRP group (57.4% vs 90.8%, P < 0.0001). Univariate logistic analysis showed that the estimated blood loss was the only independent predictor of perioperative complications both in the unadjusted model (OR: 1.18; 95% CI: 1.02–1.37; P = 0.025) and surgery type-adjusted model (OR: 1.17; 95% CI: 1.01–1.36; P = 0.034). In conclusion, CRP is more challenging than radical prostatectomy and associated with a notably higher incidence of urinary incontinence. Nevertheless, CRP is a technically feasible and safe surgery for selecting PCa patients who present with node-positive or bony metastasis when performed by experienced surgeons. A prospective, multi-institutional clinical trial is currently underway to verify this concept.
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Affiliation(s)
- Dae Keun Kim
- Department of Urology, CHA Seoul Station Medical Center, CHA University, CHA Medical School, Seoul 04637, Korea.,Department of Urology, School of Medicine, Graduate School, Hanyang University, Seoul 04763, Korea
| | - Jaspreet Singh Parihar
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA
| | - Young Suk Kwon
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA.,Department of Biostatistics, Rutgers School of Public Health, The State University of New Jersey, New Brunswick, NJ Piscataway 08854, USA
| | - Sinae Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA.,Department of Biostatistics, Rutgers School of Public Health, The State University of New Jersey, New Brunswick, NJ Piscataway 08854, USA
| | - Brian Shinder
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA
| | - Nara Lee
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA
| | - Nicholas Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA
| | - Thomas Ahlering
- Department of Urology, University of California, Irvine School of Medicine, Orange 92687, USA
| | - Douglas Skarecky
- Department of Urology, University of California, Irvine School of Medicine, Orange 92687, USA
| | - Bertram Yuh
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte 91010, USA
| | - Nora Ruel
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte 91010, USA
| | - Wun-Jae Kim
- Department of Urology, Chungbuk National University College of Medicine, Cheongju 28644, Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, College of Medicine, Yonsei University, Seoul 03722, Korea
| | - Isaac Yi Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA
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5
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Rastrelli G, Reisman Y, Ferri S, Prontera O, Sforza A, Maggi M, Corona G. Testosterone Replacement Therapy. Sex Med 2019. [DOI: 10.1007/978-981-13-1226-7_8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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6
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Abstract
BACKGROUND Prostate cancer is a global health problem; its incidence is on the rise in Chinese and usually fraught with both physical and psychological symptomatology. OBJECTIVE The aim of this study is to explore the relationships among demographic and disease characteristics, resourcefulness, depressive symptoms, and health related quality of life (HRQOL). METHODS A descriptive, correlational design was used. A total of 200 individuals with prostate cancer were recruited. The participants completed a self-report regarding their depressive symptoms and HRQOL. Using a structural equation modeling approach, all relationships among the factors, mediators, depressive symptoms, and HRQOL were analyzed. RESULTS The more resourcefulness that participants perceived, the more likely they were to report better HRQOL. The best-fitted structural equation model included individual demographics and disease characteristics and resourcefulness as significant predictors of HRQOL. Moreover, this structural model explained 72%, 76%, and 57% of the variance in physical quality of life, mental quality of life, and depressive symptoms, respectively. In addition, resourcefulness had a positive mediating effect on increasing the physical and mental quality of life and decreasing the depressive symptoms for patients with prostate cancer. CONCLUSIONS Resourcefulness helps patients with prostate cancer build a positive attitude and that it is crucial for enhancing the HRQOL of patients. By using the proper resourcefulness strategy, that is, either personal (self-help) or social (help-seeking), nursing professionals can substantially contribute to enhancing the HRQOL for patients with PC. IMPLICATIONS FOR PRACTICE Knowledge of risk factors for HRQOL would be useful for nursing professional in detecting health problems and treatment options.
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Corona G, Rastrelli G, Reisman Y, Sforza A, Maggi M. The safety of available treatments of male hypogonadism in organic and functional hypogonadism. Expert Opin Drug Saf 2018; 17:277-292. [PMID: 29334271 DOI: 10.1080/14740338.2018.1424831] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In the case of primary male hypogonadism (HG), only testosterone (T) replacement therapy (TRT) is possible whereas when the problem is secondary to a pituitary or hypothalamus alteration both T production and fertility can be, theoretically, restored. We here systematically reviewed and discussed the advantages and limits of medications formally approved for the treatment of HG. AREAS COVERED Data derived from available meta-analyses of placebo controlled randomized trials (RCTs) were considered and analyzed. Gonadotropins are well-toleratedand their use is mainly limited by higher costs and a more cumbersome treatment schedule than TRT. Available RCTs on TRT suggest that cardiovascular (CV) and venous thromboembolism risk is not a major issue and that prostate safety is guaranteed. The risk of increased hematocrit is mainly limited to the use of short terminjectable preparations. EXPERT OPINION In the last few years the concept of 'organic' irreversible HG and 'functional' or age- and comorbidity-related HG has been introduced. This definition is not evidence-based. The majority of RCTs enrolled patients with 'functional' HG. Considering the significant improvement in body composition, glucose metabolism and sexual activity, TRT should not be limited to 'organic' HG, but also offered for 'functional'.
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Affiliation(s)
- G Corona
- a Endocrinology Unit, Medical Department , Maggiore-Bellaria Hospital, Azienda-Usl Bologna , Bologna , Italy
| | - G Rastrelli
- b Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences , University of Florence , Florence , Italy
| | - Y Reisman
- c Department of Urology , Amstelland Hospital , Amsterdam , The Netherlands
| | - A Sforza
- a Endocrinology Unit, Medical Department , Maggiore-Bellaria Hospital, Azienda-Usl Bologna , Bologna , Italy
| | - M Maggi
- b Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences , University of Florence , Florence , Italy
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8
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Salonia A, Adaikan G, Buvat J, Carrier S, El-Meliegy A, Hatzimouratidis K, McCullough A, Morgentaler A, Torres LO, Khera M. Sexual Rehabilitation After Treatment For Prostate Cancer—Part 2: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med 2017; 14:297-315. [DOI: 10.1016/j.jsxm.2016.11.324] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 11/15/2016] [Accepted: 11/19/2016] [Indexed: 01/06/2023]
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9
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Namiki S, Mitsuzuka K, Kaiho Y, Yamada S, Adachi H, Yamashita S, Saito H, Ito A, Nakagawa H, Takegami M, Arai Y. Serum luteinizing hormone concentration is significantly associated with recovery of urinary function after radical prostatectomy. BJU Int 2015; 117:450-5. [PMID: 25684579 DOI: 10.1111/bju.13083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To perform a longitudinal investigation of the correlation between functional recovery and sex hormone concentrations after radical prostatectomy (RP). PATIENTS AND METHODS A total of 72 consecutive patients undergoing RP between January 2012 and June 2013 were prospectively included and serially followed after surgery for comparative analysis. Their luteinizing hormone (LH) and total testosterone (TT) concentrations were measured before surgery and 3 and 12 months after surgery. They also filled out a health-related quality of life questionnaire before and at 1, 3, 6 and 12 months after surgery. RESULTS The mean LH concentration increased from 4.28 U/L at baseline to 5.53 U/L at 3 months and remained high at 12 months after RP (both P < 0.001). There were no significant changes in the TT concentration after RP. LH at baseline was negatively correlated with the urinary function (UF) score at 3 and 12 months after RP (P = 0.030 and 0.032, respectively). After RP, subjects with high baseline LH (n = 37) were more likely than those with low LH concentrations to report lower UF scores (P = 0.014). Multivariate analysis of variance in an interaction of time × LH concentration for UF scores indicated a significant relationship between changes in UF score and LH concentration (P = 0.004). CONCLUSIONS Radical prostatectomy affects sex hormones by increasing LH concentrations, while TT concentrations remain stable after surgery. Baseline LH concentrations are significantly associated with the recovery of urinary outcomes after RP.
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Affiliation(s)
- Shunichi Namiki
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Urology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan
| | - Koji Mitsuzuka
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiro Kaiho
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shigeyuki Yamada
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hisanobu Adachi
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinichi Yamashita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideo Saito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Haruo Nakagawa
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoichi Arai
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Gacci M. Editorial comment. J Urol 2014; 192:1161. [PMID: 25014525 DOI: 10.1016/j.juro.2014.03.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mauro Gacci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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11
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Gacci M, Baldi E, Tamburrino L, Detti B, Livi L, De Nunzio C, Tubaro A, Gravas S, Carini M, Serni S. Quality of Life and Sexual Health in the Aging of PCa Survivors. Int J Endocrinol 2014; 2014:470592. [PMID: 24744780 PMCID: PMC3976934 DOI: 10.1155/2014/470592] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 02/02/2014] [Indexed: 12/19/2022] Open
Abstract
Prostate cancer (PCa) is the most common malignancy in elderly men. The progressive ageing of the world male population will further increase the need for tailored assessment and treatment of PCa patients. The determinant role of androgens and sexual hormones for PCa growth and progression has been established. However, several trials on androgens and PCa are recently focused on urinary continence, quality of life, and sexual function, suggesting a new point of view on the whole endocrinological aspect of PCa. During aging, metabolic syndrome, including diabetes, hypertension, dyslipidemia, and central obesity, can be associated with a chronic, low-grade inflammation of the prostate and with changes in the sex steroid pathways. These factors may affect both the carcinogenesis processes and treatment outcomes of PCa. Any treatment for PCa can have a long-lasting negative impact on quality of life and sexual health, which should be assessed by validated self-reported questionnaires. In particular, sexual health, urinary continence, and bowel function can be worsened after prostatectomy, radiotherapy, or hormone treatment, mostly in the elderly population. In the present review we summarized the current knowledge on the role of hormones, metabolic features, and primary treatments for PCa on the quality of life and sexual health of elderly Pca survivors.
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Affiliation(s)
- Mauro Gacci
- Department of Urology, University of Florence, Careggi Hospital, Viale Gramsci 7, 50121 Florence, Italy
| | - Elisabetta Baldi
- Department of Experimental and Clinical Biomedical Sciences, Section of Clinical Pathophysiology, University of Florence, Italy
| | - Lara Tamburrino
- Department of Experimental and Clinical Biomedical Sciences, Section of Clinical Pathophysiology, University of Florence, Italy
| | - Beatrice Detti
- Radiotherapy, University Hospital Careggi, University of Florence, Italy
| | - Lorenzo Livi
- Radiotherapy, University Hospital Careggi, University of Florence, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, University “La Sapienza”, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, University “La Sapienza”, Rome, Italy
| | - Stavros Gravas
- Department of Urology, University Hospital of Larissa, Larissa, Greece
| | - Marco Carini
- Department of Urology, University of Florence, Careggi Hospital, Viale Gramsci 7, 50121 Florence, Italy
| | - Sergio Serni
- Department of Urology, University of Florence, Careggi Hospital, Viale Gramsci 7, 50121 Florence, Italy
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Mauro G. Editorial comment to preservation of the internal sphincter and of the proximal urethra during retropubic radical prostatectomy: a safe option for well-selected cases. Int J Urol 2013; 21:526. [PMID: 24256428 DOI: 10.1111/iju.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Gacci Mauro
- Department of Urology, University of Florence, Florence, Italy.
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13
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Campodonico F, Manuputty EE, Campora S, Puntoni M, Maffezzini M. Age is predictive of immediate postoperative urinary continence after radical retropubic prostatectomy. Urol Int 2013; 92:276-81. [PMID: 24157865 DOI: 10.1159/000353414] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 05/30/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Immediate continence is a goal to take into consideration for better patient satisfaction after radical prostatectomy. Factors predicting urinary continence at catheter removal were investigated. MATERIALS AND METHODS We evaluated preoperative, operative, clinical, hormonal and pathological variables in a homogeneous series of radical retropubic prostatectomies (RRPs) following the principles of urinary sphincter restoration technique. RESULTS The study included 201 patients who underwent RRP. The overall immediate continence rate at catheter removal was 67.7% (136 patients); 28.8% (58 patients) were using one protective pad daily and 3.5% (7 patients) were incontinent. At 6-month follow-up incontinence had reached the lowest level of 2.5% (5 patients) and at 12 months the patients using one pad daily had decreased to 11.9% (24 patients). Multivariate logistic analysis showed that the only two factors independently associated with immediate continence were age <65 years (OR = 2.63, 95% CI 1.13-5.88, p = 0.02) and potency (OR = 3.6, 95% CI 1.2-10.7, p = 0.01) adjusting for D'Amico risk group, surgical margins, extracapsular extension, clinical stage, PSA, testosterone, LH and FSH. No significant association was noted for PSA, hormonal levels, hospital stay, prostate size, clinical stage, risk group, TNM stage, pathological Gleason score or extracapsular extension. CONCLUSIONS In our series age <65 years was associated with immediate continence after RRP. Moreover, patients who were immediately continent had a 3.6-fold probability to be potent within 12 months.
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14
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Gacci M. Editorial comment. J Urol 2013; 190:1238; discussion 1239. [PMID: 23850565 DOI: 10.1016/j.juro.2013.04.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M Gacci
- Department of Urology, University of Florence, Florence, Italy
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15
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Gacci M, Tosi N, Vittori G, Minervini A, Corona G, Cai T, Morelli AM, Vignozzi L, Serni S, Maggi M, Carini M. Changes in sex hormone levels after radical prostatectomy: Results of a longitudinal cohort study. Oncol Lett 2013; 6:529-533. [PMID: 24137361 PMCID: PMC3789060 DOI: 10.3892/ol.2013.1420] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/28/2013] [Indexed: 11/16/2022] Open
Abstract
The changes in testosterone and gonadotropin levels in patients who have undergone radical prostatectomy (RP) for clinically localized prostate cancer (PCa) remain unclear. The aim of the present study was to prospectively evaluate the changes in serum testosterone (Te), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in the early months after RP for PCa and the correlation between these hormones at various follow-up times. A total of 100 male patients with clinically localized PCa were consecutively included in the study. The serum levels of Te, LH and FSH were measured prior to RP (baseline) and at 1 and 3 months post-operatively. Changes in the levels of Te, LH and FSH between the baseline and at 1 and 3 months after RP were analyzed with paired sample t-tests. The correlations between LH and Te levels at the various follow-up times were evaluated with a Spearman’s rank correlation coefficient. At 1 month subsequent to RP, the Te levels were significantly decreased (baseline vs. 1 month, P=0.021) and subsequently recovered to the pre-operative value at 3 months (baseline vs. 3 months, P=0.372). The mean Te level at baseline was 15.3 nmol/l, while at 1 and 3 months it was 13.8 and 14.4 nmol/l, respectively. By contrast, the levels of LH and FSH were significantly increased at 1 and 3 months post-surgery, compared with the baseline value (baseline vs. 1 or 3 months, P<0.0001). The pre-operative correlation between LH and Te was lost 1 month after RP and recovered after 3 months. Notably, the LH level at 1 month was markedly correlated with the Te levels recorded after 3 months. In the present study, patients developed compensated hypergonadotropic hypogonadism 3 months after RP.
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Affiliation(s)
- Mauro Gacci
- Department of Urology, University of Florence, Florence, Italy
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16
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Urtiaga G, Campos V, Collares T, Leon P, Deschamps J, Seixas F, Collares T. Associação entre proteínas do plasma seminal, motilidade e viabilidade espermática em coelhos submetidos a doping genético. ARQ BRAS MED VET ZOO 2013. [DOI: 10.1590/s0102-09352013000100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Neste trabalho foi estudada a correlação entre o perfil proteico do plasma seminal e a motilidade e viabilidade espermática em coelhos submetidos ao tratamento com vetores de expressão contendo o gene da eritropoetina (EPO) e com EPO recombinante humana. Foram identificadas, em coelhos submetidos ao tratamento com vetor de DNA contendo o gene da EPO, duas bandas proteicas associadas a alterações na motilidade espermática - 48kDa à baixa motilidade (P<0,05) e 18kDa à alta motilidade (P<0,05) - e esse fator foi associado a maior viabilidade espermática (P<0,05). Em coelhos submetidos ao tratamento com EPO recombinante, um fator proteico, 63kDa, associou-se à alta motilidade espermática (P<0,05), enquanto dois, 26 e 40kDa, foram associados à alta viabilidade espermática (P<0,05). Esses resultados sugerem que o doping genético pode ocasionar mudanças no perfil proteico do plasma seminal, provocando alterações na motilidade e viabilidade espermática.
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Chung E, Brock G. Sexual Rehabilitation and Cancer Survivorship: A State of Art Review of Current Literature and Management Strategies in Male Sexual Dysfunction Among Prostate Cancer Survivors. J Sex Med 2013; 10 Suppl 1:102-11. [DOI: 10.1111/j.1743-6109.2012.03005.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Buvat J, Maggi M, Guay A, Torres LO. Testosterone Deficiency in Men: Systematic Review and Standard Operating Procedures for Diagnosis and Treatment. J Sex Med 2013; 10:245-84. [DOI: 10.1111/j.1743-6109.2012.02783.x] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Campodonico F, Manuputty EE. Nerve-sparing approach during radical prostatectomy is strongly associated with the rate of postoperative urinary continence recovery. BJU Int 2012; 110:E430. [DOI: 10.1111/j.1464-410x.2012.11623_3.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mosli HA. Review Article: Practical Aspects of Testosterone Deficiency Syndrome in Clinical Urology. AFRICAN JOURNAL OF UROLOGY 2012. [DOI: 10.1016/j.afju.2012.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ng E, Woo HH, Turner S, Leong E, Jackson M, Spry N. The Influence of Testosterone Suppression and Recovery on Sexual Function in Men With Prostate Cancer: Observations From a Prospective Study in Men Undergoing Intermittent Androgen Suppression. J Urol 2012; 187:2162-6. [DOI: 10.1016/j.juro.2012.01.080] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Indexed: 01/02/2023]
Affiliation(s)
- Evan Ng
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia
| | - Henry H. Woo
- Sydney Adventist Hospital Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sandra Turner
- Westmead Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Eugene Leong
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia
| | - Melanie Jackson
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia
| | - Nigel Spry
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia
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Risques prostatiques de la testostérone : nouveau retour du balancier? Basic Clin Androl 2012. [DOI: 10.1007/s12610-012-0171-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Résumé
Depuis les années 1940, la testostérone (T) est réputée dangereuse pour la prostate, bien que sans preuve solide. Les études longitudinales ne montrent pas de corrélation entre taux de T et incidence des cancers de la prostate (CaP), dont les formes graves sont au contraire associées à des taux faibles de cette hormone. Les essais cliniques randomisés contre placebo de traitement par la T n’ont pas montré d’augmentation de l’incidence du CaP dans les groupes T. Ces données rassurantes ont conduit certains à prescrire des traitements de substitution androgénique à des hommes porteurs de néoplasies intra-épithéliales prostatiques, ou précédemment traités pour un CaP de bon pronostic, ou sous surveillance active pour un tel cancer non traité, sans qu’apparaisse un risque élevé de progression ou de récidive du CaP sous ce traitement. Il ne fait pourtant aucun doute que la prostate normale et son cancer, au moins dans ses formes évoluées, sont faits de tissus androgénodépendants. Ces apparentes contradictions pourraient s’expliquer, outre par la possibilité d’une très faible diffusion de la T circulante dans le tissu prostatique, par l’hypothèse d’une saturation des récepteurs androgéniques prostatiques dès des niveaux très bas de T circulante, proches des taux de castration, expliquant qu’une augmentation de la T au-delà de ce niveau ne puisse pas stimuler le tissu prostatique. Quelques publications récentes d’évolution de CaP sous traitement androgénique, persistant parfois à l’arrêt de ce traitement, montrent qu’on ne peut pas généraliser les résultats très favorables des études précédentes. Des données objectives suggèrent aussi que le niveau de saturation du récepteur androgénique prostatique pourrait être en réalité proche de la limite inférieure des taux physiologiques de T. Il faut donc rester prudent avant d’élargir les indications du traitement par la T chez les hommes avec antécédent de CaP. Seules des études randomisées à grande échelle, en double insu contre placebo, permettront de se faire une idée exacte des risques auxquels expose ce traitement.
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Salonia A, Burnett AL, Graefen M, Hatzimouratidis K, Montorsi F, Mulhall JP, Stief C. Prevention and management of postprostatectomy sexual dysfunctions part 2: recovery and preservation of erectile function, sexual desire, and orgasmic function. Eur Urol 2012; 62:273-86. [PMID: 22575910 DOI: 10.1016/j.eururo.2012.04.047] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 04/23/2012] [Indexed: 01/07/2023]
Abstract
CONTEXT Sexual dysfunction is common in patients who undergo radical prostatectomy (RP) for prostate cancer (PCa). OBJECTIVE Review the available literature concerning prevention of, and management strategies for, post-RP sexual dysfunction in terms of postoperative treatments for erectile function (EF), sexual desire (SD), and orgasmic function (OF) impairment. EVIDENCE ACQUISITION A literature search was performed using Google and PubMed databases for English language original and review articles either published or e-published up to November 2011. EVIDENCE SYNTHESIS We propose a rational description of many of the clinically available preventive and therapeutic strategies for the preservation and recovery of post-RP EF. A huge amount of preclinical data show that tissue damage ultimately leads to structural alterations, and the literature stresses that rehabilitation and treatment are undoubtedly better than leaving the erectile tissue to its unassisted fate; likewise, the timing of any rehabilitation and treatment is of major clinical importance. However, no specific recommendation emerges regarding the structure of the optimal rehabilitation or treatment regimen. The role of postoperative erectile dysfunction (ED) treatment of those patients who received a non-nerve-sparing RP was also extensively discussed. The literature almost completely lacks a systematic and comprehensive debate about SD (ie, low libido) and OF (ie, decreased intensity of orgasm, dysorgasmia, and climacturia) in patients undergoing RP. Psychological and sexual counseling is of major importance to improve any rehabilitation and treatment of postoperative EF, SD, and OF impairment. CONCLUSIONS Despite the great number of possible rehabilitation approaches proposed, these approaches should be considered only as strategies, since incontrovertible evidence of their effectiveness for improving natural EF recovery is limited. Conversely, numerous effective therapeutic options are available for treating post-RP ED. SD and OF have not yet been fully assessed in patients who underwent RP.
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Affiliation(s)
- Andrea Salonia
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
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Corona G, Gacci M, Baldi E, Mancina R, Forti G, Maggi M. Androgen Deprivation Therapy in Prostate Cancer: Focusing on Sexual Side Effects. J Sex Med 2012; 9:887-902. [DOI: 10.1111/j.1743-6109.2011.02590.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Peyromaure M. Re: factors determining functional outcomes after radical prostatectomy: robot-assisted versus retropubic. Eur Urol 2011; 61:220-1. [PMID: 22122874 DOI: 10.1016/j.eururo.2011.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Michaël Peyromaure
- Cochin Hospital, Department of Urology, 27 rue du Faubourg Saint Jacques, Paris 75014, France.
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Mitchell SA, Jain RK, Laze J, Lepor H. Post-Prostatectomy Incontinence During Sexual Activity: A Single Center Prevalence Study. J Urol 2011; 186:982-5. [DOI: 10.1016/j.juro.2011.04.088] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Indexed: 11/28/2022]
Affiliation(s)
| | - Rajat K. Jain
- New York University Langone Medical Center, New York, New York
| | - Juliana Laze
- New York University Langone Medical Center, New York, New York
| | - Herbert Lepor
- New York University Langone Medical Center, New York, New York
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Factors Determining Functional Outcomes After Radical Prostatectomy: Robot-Assisted Versus Retropubic. Eur Urol 2011; 60:413-9. [DOI: 10.1016/j.eururo.2011.05.011] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 05/03/2011] [Indexed: 01/08/2023]
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Abstract
BACKGROUND Androgens play an essential role in the development and differentiation of the prostate gland; their contribution to pathological conditions, such as benign prostatic hyperplasia and prostate cancer (PC), remains unclear. AIM We reviewed relationships between androgens and the prostate both in physiological and pathological conditions. MATERIAL AND METHODS A systematic search of published evidence was performed using Medline (1969 to September 2010). RESULTS Androgen-dependency of prostate growth is evident only in the hypogonadal condition, but not in the eugonadal state (the "saturation hypothesis"). There is unequivocal evidence that reducing androgen signaling to the hypogonadal range can reduce PC growth and patient symptoms. At physiological testosterone concentration there is no link between androgen levels and PC risk. In addition, different strategies of androgen deprivation (ADT) for advanced PC are only palliative and rarely cure patients. Preliminary evidence indicates that a low androgen milieu is associated with tumor aggressiveness. Transition to androgen-independence is complex and involves both selection and outgrowth of preexisting androgen resistant clones, as well as adaptative upregulation of genes that help the cancer cells to survive and grow after ADT. Because androgens are essential for the regulation of fat distribution, insulin sensitivity, and lipid and bone metabolism, recent publications have highlighted the concept that ADT may also be involved with an increase in overall, as well as cardiovascular, morbidity and mortality. CONCLUSIONS While ADT still represents a cornerstone for the palliative therapy of a small fraction of aggressive PC, a "misuse and/or abuse" of ADT should be avoided.
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Affiliation(s)
- G Corona
- Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
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