Is Laparoscopic Nephropexy Improving the Quality of Life

Short- and long-term effectiveness of laparoscopic nephropexy was evaluated in patients with symptomatic nephroptosis especially quality of life of the patients and repositioning of the ptotic kidney.In 87 patients with symptomatic nephroptosis laparoscopic nephropexy was performed from 1994 to 2003. In 86 patients trans-abdominal approach was used and retroperitoneal in one patient. Visual pain scale was used for pain evaluation before surgery and six month after surgery. At the same period creatinine serum concentration, urine examination, i.v. urography and ultrasound in supine and erect position was made. There was statistical significant decrease of pain from 6.5±1.055 (SD) to 2.4±1.577 (SD) (p=0.000), according to visual scale, and decrease of urinary tract infections (p=0.000) in patients after laparoscopic nephropexy. Average operative time was 45.9±8 (SD) min., and hospital stay 3.4±0.7 (SD) days. Reposition of the kidney was successful in 70 of 80 patients. Laparoscopic nephropexy importantly improved the quality of life in patients with symptomatic nephroptosis. Surgical procedure was safe and successful in most of the patients

Tissue Ischemia Due to CO2 Pressure during Laparoscopic Radical Prostatectomy

Laparoscopic radical prostatectomy is nowadays one of the most frequently performed urological surgical procedures. For insufflation in laparoscopic radical prostatectomy (LRP) CO2 is used, with the pressure in the operative region between 12 and 15 mm Hg. At the microcirculation level, the pressure is lower, which raises the possibility of ischemic tissue damage during the procedure. The activity of glutathione peroxidase (GSH-px), superoxide dismutase (SOD) and catalase (CAT) was measured at the beginning and immediately after the end of the surgery in 44 patients who underwent LRP and in 11 who underwent retropubic radical prostatectomy (RRP). Capillary endothelial damage was assessed by applying immunohistochemical and morphometric methods to tissue samples from the urinary bladder neck, which contains all layers of the bladder wall. Measurement of the enzyme activity showed no significant increase of GSH-px (p-0.431), SOD (p-0.220) and CAT (p-0.434) levels. Neither immunohistochemical analysis of the bladder neck capillaries with i-nitric oxide synthase (i-NOS) nor morphometric analysis showed signs of endothelial ischemic damage

The TMPRSS2 and ERG rearrangements and their prognostic role in prostate cancer of Slovenian patients

Namen: Rak na prostati (CaP) je najpogostejša rakasta bolezen pri moških in eden glavnih razlogov zbolevnosti in umrljivosti. V zadnjih letih je vse več raziskav o novih tumorskih označevalcih za zgodnjo diagnozo prostatičnega karcinoma. Z dokazanimi napovednimi vrednostmi novih markerjev bi bolje razumeli naravni potek bolezni, omogočili zgodnejše in zanesljivejše odkrivanje karcinoma ter pripomogli k natančnejši napovedi progresa in metastaziranja bolezni pri posamičnem bolniku. Bolniki in metode: Opravili smo retrospektivno raziskavo na vzorcih prostate 202 bolnikov, pri katerih smo zaradi dokazanega karcinoma prostate naredili laparoskopsko radikalno prostatektomijo na urološkem oddelku Splošne bolniš nice Slovenj Gradec. Bolniki so bili operirani v obdobju od januarja 2010 do julija 2011. Morfološke značilnosti in klasične napovedne dejavnike karcinomov smo zbrali iz histopatoloških izvidov in jih potrdili tudi z revizijo preparatov. Za raziskavo smo konstruirali tkivne mreže. Tako pripravljene preparate smo obdelali po metodi fluorescentne hibridizacije in situ. Rezultati: V tumorskem tkivu bolnikov smo odkrili tri glavne oblike preurejanja genov: fuzijo TMPRSS2:ERG smo našli pri 63 (42 %) bolnikih, cepitev TMPRSS2 pri dvanajstih in cepitev ERG pri osmih bolnikih. Fuzijo TMPRSS2:ERG in cepitev TMPRSS2 hkrati smo ugotovili le pri enem bolniku. Pri treh bolnikih smo odkrili istočasno fuzijo TMPRSS2:ERG in cepitev ERG. Ko smo primerjali skupino 63 bolnikov z gensko fuzijo TMPRSS2:ERG in Gleasonov stadij pred operacijo, smo uporabili Freeman-Haltonovo varianto Fisherjevega natančnega testa, pri tem pa med spremenljivkama nismo našli statistične povezave (p = 0,19). Če smo analizirali odnos med gensko fuzijo in stadijem pT v celi kohorti bolnikov, povezave nismo mogli ugotoviti. Ko pa smo razdelili bolnike v dve skupini, eno s stadijem pT2 in drugo s pT3, smo odkrili statistično značilno povezavo med stadijem pT3 in osnovno gensko fuzijo. Med 62 bolniki s stadijem pT3 smo našli gensko fuzijo pri 34 (55 %) bolnikih. Z uporabo Fisherjevega natančnega testa smo odkrili statistično zanesljivost s p = 0,01. Po uporabi Bonferronieve korekcije pa je bila vrednost p še vedno zanesljiva z vrednostjo 0,05. V naslednjem koraku smo preverili še povezavo med gensko fuzijo in stadijem pN. Bolnike z opravljeno elektivno disekcijo bezgavk smo razdelili v dve skupini, in sicer pN0 in pN1. Za ta del odvisnosti smo uporabili Freeman-Haltonovo raširitev Fisherjevega natančnega testa. Med obema spremenljivkama nismo našli statistične povezave (p = 0,66). Za analizo bolnikov z ugotovljenim stadijem N smo izbrali skupino s tumorskim stadijem pT3. Pokazalo se je, da je korelacija z gensko fuzijo statistično značilna (p = 0,02). Ko pa smo uporabili še Bonferronievo korekcijo, vrednost p ni dosegla 0,05. V nadaljnjih statističnih obdelavah smo skupino bolnikov s stadijem pT3 razdelili na dvoje ‒ v skupino z razširjeno limfadenektomijo in skupino brez tega posega. Pri bolnikih, kjer posega nismo opravili, smo gensko fuzijo odkrili v 25 (64 %) primerih. Povezava med gensko fuzijo in to značilnostjo je dosegla statistično vrednost p = 0,039. Zaključek: Na podlagi naših rezultatov pričakujemo, da bi pri bolnikih s fuzijo TMPRSS2:ERG, odkriti že na biopsiji prostate, dokazali stadij T3 po radikalni prostatektomiji v več kot polovici primerov (64 %). Podatek je pomemben predvsem za bolnike s predoperativno nizkimi PSA in GS, kar sicer kaže na rak z nizkim ali zmernim tveganjem, vendar bi tako resno podcenili razširjenost bolezni. Ker bi pri teh bolnikih torej pričakovali lokalno napredovano bolezen oziroma stadij-pT3, bi z radikalnejšim posegom dosegli nižji odstotek pozitivnih robov (ki v zadnjih smernicah še vedno dosegajo 33,5‒66 %). Pri bolnikih s klinič nim stadijem pT3 pričakujemo limfogene metastaze v 7,9‒49 odstotkih.Background: More specific diagnostic modalities, prognostic indicators of progression and a better understanding of prostate cancer biology are high priorities in prostate cancer research. Methods: The study cohort consisted of 202 operable prostate cancer Slovenian patients who underwent laparoscopic radical prostatectomy. We retrospectively constructed tissue microarrays of their prostatic specimens for fluorescense in situ hybridization study, obtaining appropriate signals for 148 patients. Results: The following genetic aberrations were found: TMPRSS2:ERG fusion, TMPRSS2 split (a non-ERG translocation) and ERG split (an ERG translocation without involvement of TMPRSS2). TMPRSS2:ERG gene fusion happened in 63 patients (42%), TMPRSS2 split in 12 patients and ERG split in 8 patients. The association between TMPRSS2:ERG gene fusion and pT stage was significant (p=0.01). Of 62 patients with pT3 stage, 34 (55%) had TMPRSS2:ERG gene fusion. In the group of patients with pT3 in which we did not perform an extended lymph node dissection, we detected TMPRSS2:ERG gene fusion in 25 patients (64%) with p=0.04. Conclusions: Our results indicate that it would be possible to predict pT3 stage at final histology from TMPRSS2:ERG gene fusion at initial core needle biopsy. This is important for patients with preoperative prostatic specific antigen and Gleason score values that indicate low or intermediate risk prostate cancer. Consistent with our findigs, we expect T3 stage at the final histology in these patients. Thus we would achieve a lower percentage of positive section margins and better functional and oncological results in patients with indication for nerve sparing prostatectomy

TMPRSS2:ERG gene aberrations may provide insight into pT stage in prostate cancer

Background: TMPRSS2:ERG gene aberration may be a novel marker that improves risk stratification of prostate cancer before definitive cancer therapy, but studies have been inconclusive. Methods: The study cohort consisted of 202 operable prostate cancer Slovenian patients who underwent laparoscopic radical prostatectomy. We retrospectively constructed tissue microarrays of their prostatic specimens for fluorescence in situ hybridization, with appropriate signals obtained in 148 patients for subsequent statistical analyses. Results: The following genetic aberrations were found: TMPRSS2:ERG fusion, TMPRSS2 split (a non-ERG translocation) and ERG split (an ERG translocation without involvement of TMPRSS2). TMPRSS2:ERG gene fusion happened in 63 patients (42 %), TMPRSS2 split in 12 patients and ERG split in 8 patients. Association was tested between TMPRSS2:ERG gene fusion and several clinicopathological variables, i.e., pT stage, extended lymph node dissection status, and Gleason score, correcting for multiple comparisons. Only the association with pT stage was significant at p = 0.05: Of 62 patients with pT3 stage, 34 (55 %) had TMPRSS2:ERG gene fusion. In pT3 stage patients, stronger (but not significant) association between eLND status and TMPRSS2:ERG gene fusion was detected. We detected TMPRSS2:ERG gene fusion in 64 % of the pT3 stage patients where we did not perform an extended lymph node dissection. Conclusions: Our results indicate that it is possible to predict pT3 stage at final histology from TMPRSS2:ERG gene fusion at initial core needle biopsy. FISH determination of TMPRSS2:ERG gene fusion may be particularly useful for patients scheduled to undergo a radical prostatectomy in order to improve oncological and functional results