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ABSTRACT: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The effect of TURP on overall sexual function and particularly erectile function (EF) is controversial with conflicting results based on a low level of evidence. The effects of monopolar and bipolar TURP (M-TURP and B-TURP, respectively) on EF are similar, as has been shown in a few non-focused randomized control trials (RCTs). For the first time, the present study offers focused results of a comparative evaluation of the effects of B-TURP and M-TURP on overall sexual function, as quantified with the International Index of Erectile Function Questionnaire (IIEF-15) in an international, multicentre, double-blind RCT setting. OBJECTIVE: To compare monopolar and bipolar transurethral resection of the prostate (M-TURP and B-TURP, respectively) using a true bipolar system, for the first time in an international multicentre double-blind randomized controlled trial focusing on the overall sexual function quantified with the International Index of Erectile Function Questionnaire (IIEF-15). Other baseline/perioperative parameters potentially influencing erectile function (EF) after TURP were secondarily investigated. MATERIALS AND METHODS: From July 2006 to June 2009, consecutive TURP candidates with benign prostatic obstruction were prospectively recruited in four academic urological centres, randomized 1:1 into M-TURP/B-TURP arms and followed up at 6 weeks, 6 and 12 months after surgery. In all, 295 eligible patients were enrolled. Overall sexual function was quantified using self-administered IIEF-15 at baseline and at each subsequent visit. Total IIEF/domain scores were calculated and EF score classified erectile dysfunction severity. Differences in erectile dysfunction severity at each visit compared with baseline (EF evolution), classified patients into 'improved', 'stable' or 'deteriorated'. Pre-postoperative IIEF/domain scores and differences in the distribution of EF evolution were compared between arms throughout follow-up. RESULTS: In all, 279 patients received the allocated intervention; 218/279 patients (78.1%) provided complete IIEF-15 data at baseline and were considered in sexual function analysis. Complete IIEF-15 data were available from 193/218 (88.5%), 186/218 (85.3%) and 179/218 (82.1%) patients at 6 weeks, 6 months and 12 months, respectively. Sexual function did not differ significantly between arms during follow-up (scores: IIEF, P = 0.750; EF, P = 0.636; orgasmic function, P = 0.868; sexual desire, P = 0.735; intercourse satisfaction, P = 0.917; overall satisfaction, P = 0.927). Resection type was not a predictor of any sexual function changes observed. Distribution of EF evolution did not differ between arms at any time (M-TURP vs B-TURP at 12 months: improved, 23/87 [26.4%] vs 18/92 [19.6%]; stable, 53/87 [60.9%] vs 56/92 [60.8%]; deteriorated, 11/87 [12.7%] vs 18/92 [19.6%]; P = 0.323). CONCLUSION: There were no differences between M-TURP/B-TURP in any aspect of sexual function.
BJU International 03/2013; · 2.84 Impact Factor
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European urology 12/2012; · 7.67 Impact Factor
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ABSTRACT: BACKGROUND: Pooled data from randomised controlled trials (RCTs) with short-term follow-up have shown a safety advantage for bipolar transurethral resection of the prostate (B-TURP) compared with monopolar TURP (M-TURP). However, RCTs with follow-up >12 mo are scarce. OBJECTIVE: To compare the midterm safety/efficacy of B-TURP versus M-TURP. DESIGN, SETTING, AND PARTICIPANTS: From July 2006 to June 2009, TURP candidates with benign prostatic obstruction were consecutively recruited in four centres, randomised 1:1 into the M-TURP or the B-TURP arm and regularly followed up to 36 mo postoperatively. A total of 295 patients were enrolled. INTERVENTION: M-TURP or B-TURP using the AUTOCON II 400 electrosurgical unit. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Safety was estimated by complication rates with a special emphasis on urethral strictures (US) and bladder neck contractures (BNCs) recorded during the short-term (up to 12 mo) and midterm (up to 36 mo) follow-up. Efficacy quantified by changes in maximum urine flow rate, postvoid residual urine volume, and International Prostate Symptom Score was compared with baseline, and reintervention rates in each arm were also evaluated. RESULTS AND LIMITATIONS: A total of 279 patients received treatment after allocation. Mean follow-up was 28.8 mo. A total of 186 of 279 patients (66.7%) completed the 36-mo follow-up. Posttreatment withdrawal rates did not differ significantly between arms. Safety was assessed in 230 patients (82.4%) at a mean follow-up of 33.4 mo. Ten US cases were seen in each arm (M-TURP vs B-TURP: 9.3% vs 8.2%; p=0.959); two versus eight BNC cases (M-TURP vs B-TURP: 1.9% vs 6.6%; p=0.108) were collectively detected at the midterm follow-up. Resection type was not a significant predictor of the risk of US/BNC formation. Efficacy was similar between arms and durable. A total of 10 of 230 patients (4.3%) experienced failure to cure and needed reintervention without significant differences between arms. High overall reintervention rates, withdrawal rates, and sample size determination not based on US/BNC rates represent potential limitations. CONCLUSIONS: The midterm safety and efficacy of B-TURP and M-TURP are comparable. TRIAL REGISTRATION: Netherlands Trial Register, NTR703 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=703).
European urology 10/2012; · 7.67 Impact Factor
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ABSTRACT: INTRODUCTION: Acquired bladder diverticula (BD) in men over the age of 60 are usually due to bladder outlet obstruction (BOO) secondary to prostatic enlargement. In cases of clinical significant BD with persistent symptoms or complications surgical excision should be considered. In the treatment of BD it is important to address the BOO with a bladder outlet procedure either simultaneously or in a staged fashion. PRESENTATION OF CASE: We present to the best of our knowledge, the first case of sequential robotic-assisted bladder diverticulectomy (RABD) combined with robotic-assisted radical prostatectomy (RARP) in a patient with large diverticula and malignant prostate enlargement as the cause of BOO. DISCUSSION: Concomitant open radical prostatectomy and bladder diverticulectomy series have been described, while minimal invasive procedures combining BD excision with relive of BOO especially due to benign prostatic enlargement have been reported to be safe and effective. CONCLUSION: Concomitant RABD with RARP is a safe and effective procedure with excellent oncological and functional results.
International journal of surgery case reports. 10/2012; 4(1):81-84.
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ABSTRACT: To evaluate the effect of hexaminolevulinate (HAL)-induced fluorescence during resection of noninvasive bladder cancer on tumor recurrence compared with resection under white light.
Between 2008 and 2010, 102 consecutive patients with suspected bladder cancer were randomized to undergo transurethral resection with either conventional white light or combination of white light and HAL-induced fluorescence. Difference in tumor recurrence rate and recurrence-free survival between the 2 groups was evaluated. Subgroup analysis on recurrence-free survival was performed for different tumor parameters.
Cystoscopy at 3 months revealed tumor recurrence in 6 of 45 (13.3%) patients of the white light group compared with only 1 of 41 patients of the HAL group (2.4%) (P < .001). The recurrence-free rates in white light patients at 12 and 18 months were 56.3% and 50.6%, respectively, compared with 91% and 82.5% in HAL patients (P = .0006). In subgroup analyses, recurrence-free survival was similar between the 2 groups when solitary tumors were treated (P = .3525). However, the HAL group had a favorable recurrence-free survival compared with the white light group when multifocal tumors (P < .001), primary tumors (P = .0237), recurrent tumors (P = .0189), nonaggressive (papillary urothelial neoplasm of low malignant potential and low grade) tumors (P = .0204), or aggressive (high grade and carcinoma in situ) tumors (P = .0134) were treated.
HAL significantly aids resection of non-muscle-invasive bladder cancer with the result of reduction in tumor recurrence rates.
Urology 08/2012; 80(2):354-9. · 2.43 Impact Factor
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BJU International 06/2012; 109(11):E38-40. · 2.84 Impact Factor
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Thorsten Bach,
Rolf Muschter,
Roland Sroka,
Stavros Gravas, Andreas Skolarikos,
Thomas R W Herrmann,
Thomas Bayer,
Thomas Knoll,
Claude-Clément Abbou,
Guenter Janetschek,
Alexander Bachmann,
Jens J Rassweiler
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ABSTRACT: Laser treatment of benign prostatic obstruction (BPO) has become more prevalent in recent years. Although multiple surgical approaches exist, there is confusion about laser-tissue interaction, especially in terms of physical aspects and with respect to the optimal treatment modality.
To compare available laser systems with respect to physical fundamentals and to discuss the similarities and differences among introduced laser devices.
The paper is based on the second expert meeting on the laser treatment of BPO organised by the European Association of Urology Section of Uro-Technology. A systematic literature search was also carried out to cover the topic of laser treatment of BPO extensively.
The principles of generation of laser radiation, laser fibre construction, the types of energy emission, and laser-tissue interaction are discussed in detail for the laser systems used in the treatment of BPO. The most relevant laser systems are compared and their physical properties discussed in depth.
Laser treatment of BPO is gaining widespread acceptance. Detailed knowledge of the physical principles allows the surgeon to discriminate between available laser systems and their possible pitfalls to guarantee high safety levels for the patient.
European urology 02/2012; 61(2):317-25. · 7.67 Impact Factor
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ABSTRACT: Primary adenocarcinoma of the seminal vesicles (ASV) is a very rare neoplasm with less than 50 histologi-cally confirmed cases reported in the literature. The diagnosis is complex and is based on a combination of immunohistochemical, clinical and radiological findings. Biopsy is not always conclusive, and surgical resection is usually required to determine whether the tumor originated from the seminal vesicles. We pres-ent a case of primary ASV that was discovered upon investigation of inguinal lymphadenopathy. A history of recent hormonal manipulation for the treatment of infertility may be associated with the development or the progression of this rare tumor. ÖZET Seminal vezikülün primer adenokarsinomu (SVA), histolojik olarak doğrulanmış ve literatürde rapor edil-miş 50'den az vakayla çok nadir görülen bir neoplazmadır. Teşhisi karmaşıktır ve immünohistokimya-sal, klinik ve radyolojik bulguların bir kombinasyonuna dayanır. Biyopsi her zaman tatmin edici değildir ve tümörün seminal veziküllerden orijin alıp almadığına karar vermek için genellikle cerrahi rezeksiyon gereklidir. İnguinal lenfadenopati incelemesine dayanarak bulunan primer SVA'lı bir olgu sunmaktayız. İnfertilite tedavisi için yakın zamanlı hormonal manipülasyon öyküsü, bu nadir tümörün gelişmesi veya ilerlemesiyle ilişkili olabilir.
Turkish Journal of Urology. 01/2012; 38:48-51011.
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Nephro-urology monthly. 01/2012; 4(2):423-4.
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ABSTRACT: Spontaneous retroperitoneal bleeding is a rare but potentially life-threatening event of varied etiology. Herein we report a case of bilateral non-traumatic retroperitoneal hemorrhage.
A 50-year-old Greek man, who was on a non-steroidal anti-inflammatory agent (nimesulide) for ankylosing spondylitis, presented with a right retroperitoneal hematoma combined with contralateral subcapsular renal hematoma. Bleeding on his right side was successfully controlled by arterial embolization with coils, whereas the left renal hematoma was treated conservatively. His recovery period was uneventful.
This is the first reported case of bilateral retroperitoneal bleeding in a patient receiving nimesulide for ankylosing spondylitis. The application of minimally invasive techniques resulted in the desired positive outcome with preservation of both renal units.
Journal of Medical Case Reports 12/2011; 5(1):568.
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Urology 10/2011; 78(4):913-4. · 2.43 Impact Factor
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ABSTRACT: We report a 2-center study of factors affecting the stone-free rate after percutaneous nephrolithotomy in horseshoe kidneys.
The postoperative stone-free rate after percutaneous nephrolithotomy was evaluated in 47 male and 11 female patients with horseshoe kidneys. All data were collected prospectively. Patient and procedure related factors predicting the stone-free rate were analyzed by univariate and multivariate tests.
The mean ± SD stone burden was 7.62 ± 7.18 cm(2) (range 1 to 45) and the stone was larger than 10 cm(2) in 14 patients (24.1%). Complex stones and staghorn stones were present in 21 (36.2%) and 19 patients (32.7%), respectively. The overall stone-free rate was 65.5%. Complex stones (p = 0.01), stone burden greater than 5 cm(2) (p = 0.013), stone burden greater than 10 cm(2) (p = 0.012), multiple stones (p = 0.006) and staghorn stones (p <0.001) were related to adverse outcomes on univariate analysis. Logistic regression analysis revealed that staghorn calculi was the only factor that significantly predicted the stone-free rate (p = 0.002). A patient with staghorn calculi in the horseshoe kidney was 45 times more likely to have a lower stone-free rate after percutaneous nephrolithotomy than a patient without staghorn calculi in the horseshoe kidney.
Stone parameters are important when treating calculi in horseshoe kidneys. Staghorn calculi are associated with a lower stone-free rate after percutaneous nephrolithotomy.
The Journal of urology 09/2011; 186(5):1894-8. · 4.02 Impact Factor
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ABSTRACT: The aim of the present review was to study factors influencing training and the maintenance of skills in performing ureteroscopy (URS). We searched on the following keywords in the Medline, Embase and Cochrane databases: renal or ureteric stone; ureteroscopy; endourology; educational; training; learning curve; expertise; skill; residency; practice; simulator; and robotics. We have defined, when possible, levels and grades of evidence, based on 2009 recommendations of the Oxford Centre for Evidence-Based Medicine. We found that technological advancement and surgeon experience is a predictive factor for success or complications of URS. Experience may be related to special endourology training, time passed after basic training and the number of procedures performed. Studies suggest that a resident must perform a certain amount of cases to gain proficiency with URS, but there is still a need for well designed studies for the learning curve of URS to be accurately defined. Training models may be useful for training in URS and stone disintegration. Stone centres that provide all the endoscopic treatment options seem to provide the best conditions to ensure a sufficient volume of patients required. Defining minimum requirements for training in URS and for maintaining certification is a major challenge, as is defining the learning curve in URS. Careful curriculum design in high-volume stone centres may be the key to optimizing URS training.
BJU International 09/2011; 108(6):798-805; discussion 805. · 2.84 Impact Factor
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ABSTRACT: To compare the perioperative efficacy and safety of bipolar (B-) and monopolar transurethral resection of the prostate (M-TURP) in an international multicentre double-blind randomized controlled trial using the bipolar system AUTOCON(®) II 400 ESU for the first time.
From July 2006 to June 2009, consecutive transurethral resection of the prostate (TURP) candidates with benign prostatic obstruction were prospectively recruited in four academic urological centres, randomized 1:1 into an M-TURP or B-TURP arm and followed up for 6 weeks after surgery. A total of 295 eligible patients were enrolled. Of these, 279 patients received treatment (M-TURP, n= 138; B-TURP, n= 141) and were analysed for immediate postoperative outcomes and perioperative safety. In all, 268 patients (M-TURP, n= 129; B-TURP, n= 139) were analysed for efficacy, which was quantified using changes in maximum urinary flow rate, postvoid residual urine volume and International Prostate Symptom Score at 6 weeks compared with baseline. Safety was estimated using sodium and haemoglobin level changes immediately after surgery and perioperative complication occurrence graded according to the modified Clavien classification system. Secondary outcomes included operation-resection time, resection rate, capsular perforation and catheterization time.
No significant differences were detected between each study arm except that postoperative decreases in sodium levels favoured B-TURP (-0.8 vs -2.5 mmol/L, for B-TURP and M-TURP, respectively; P= 0.003). The lowest values were 131 mmol/L (B-TURP) and 106 mmol/L (M-TURP). Nine patients ranged between 125 and 130 mmol/L and the values for three patients were <125 mmol/L after M-TURP. The greatest decrease was 9 mmol/L after B-TURP (two patients). In nine patients (M-TURP) the decrease was between 9 and 34 mmol/L. These results were not translated into a significant difference in TUR-syndrome rates (1/138: 0.7% vs 0/141: 0.0%, for M-TURP and B-TURP, respectively; P= 0.495).
In contrast to the previous available evidence, no clinical advantage for B-TURP was shown. Perioperative efficacy, safety and secondary outcomes were comparable between study arms. The potentially improved safety of B-TURP that is attributed to the elimination of dilutional hyponatraemia risk, a risk still present with M-TURP, did not translate into a significant clinical benefit in experienced hands.
BJU International 05/2011; 109(2):240-8. · 2.84 Impact Factor
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ABSTRACT: In this multicenter study we compared the outcome of percutaneous nephrolithotomy in patients with and without malrotated kidneys.
A total of 44 patients (group 1) at 6 institutions who underwent percutaneous nephrolithotomy for kidneys with simple malrotation were enrolled in our study. Attending physicians in our group also provided the same number of cases of percutaneous nephrolithotomy done for nonmalrotated (normal) kidneys (group 2). Group 2 patients were selected by match pairing. Operative and postoperative data on the 2 groups were compared using the chi-square, Student t and Fisher exact tests.
As a result of match pairing, the 2 groups were similar in age, gender, body mass index, and stone size and site. Mean ± SD stone size was 5.9 ± 3.5 cm(2) in group 1. Multiple access attempts were required in 9 (20.5%) and 7 cases (15.9%) in groups 1 and 2, respectively (p >0.05). Mean fluoroscopy time was 7.0 ± 3.9 minutes in the malrotated kidney group and 7.3 ± 4.5 minutes in the nonmalrotated kidney group (p >0.05). The mean hemoglobin decrease after percutaneous nephrolithotomy was significantly higher in group 1 (-1.9 vs -1.3 gm/dl, p = 0.008) but the blood transfusion rate was similar in the 2 groups. The procedure success rate in groups 1 and 2 was 77.3% and 79.5%, respectively (p >0.05).
Percutaneous nephrolithotomy is safe and effective even in patients with larger kidney stones and malrotated kidneys.
The Journal of urology 03/2011; 185(5):1737-41. · 4.02 Impact Factor
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ABSTRACT: The treatment of urinary lithiasis has been revolutionized during the last three decades. Minimally invasive therapies in the form of endoscopic surgery in companion with the advent of shock wave lithotripsy have diminished the role of open stone surgery. Laparoscopy, another minimally invasive treatment, is continuously gaining place in the treatment of urinary stones, mainly replacing open surgery. We have tried to identify the level of the evidence and grade of recommendation, according to the evidence-based medicine criteria, in studies supporting the laparoscopic approach to stone extraction. The highest level of evidence (IIa) was found for laparoscopic ureterolithotomy. It is technically feasible with the advantage of being minimally invasive and having lower postoperative morbidity compared to open ureterolithotomy. It is mostly recommended (grade B) for large impacted stones or when endoscopic ureterolithotripsy or shock wave stone disintegration have failed. Laparoscopic pyelolithotomy is feasible but rarely indicated in the present era (III/B). Laparoscopic nephrolithotomy may be indicated to remove a stone from an anterior diverticulum or when PNL or flexible ureteroscopy have failed (III/B).
Urological Research 10/2010; 38(5):337-44. · 1.23 Impact Factor
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ABSTRACT: To clarify the current indications, factors influencing outcome and methods to predict and improve the results of shock wave lithotripsy for the treatment of renal and upper ureteral calculi.
English literature on the Medline and MeSH databases was reviewed. Key words used for search included shock wave lithotripsy, calculi, stones, renal, kidney, ureter, efficacy, prediction, improvement and guidelines.
Shock wave lithotripsy still has certain indications for renal and upper ureteral stones. Major impact on outcome has the stone size, with a diameter of less than 20 mm being the cutoff point. Shock wave monotherapy should not be used for larger stones and should be combined with other treatment modalities such as percutaneous nephrolithotomy or ureteroscopy. Other factors influencing outcome include stone number, composition and location, existence of congenital abnormalities, obesity and bleeding diathesis. Nomograms, artificial neural networks and computed tomography are useful adjuncts in predicting the outcome. Potential methods of improvement are the decrease of shock wave rate, the progressive increase in lithotripter output, the use of two simultaneous or sequential pulses and the use of expulsive and chemolytic treatment.
Shock wave lithotripsy continues to be a significant part in the urologists armamentarium for the treatment of renal and upper ureteral stones.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 03/2010; 82(1):56-63.
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Aristotelis Bamias,
Alexandra Karadimou,
Sofia Lampaki,
George Lainakis,
Lia Malettou,
Eleni Timotheadou,
Kostas Papazisis,
Charalambos Andreadis,
Loukas Kontovinis,
Ioannis Anastasiou,
Kostas Stravodimos,
Ioannis Xanthakis, Andreas Skolarikos,
Christos Christodoulou,
Kostas Syrigos,
Christos Papandreou,
Evangelia Razi,
Urania Dafni,
George Fountzilas,
Meletios A Dimopoulos
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ABSTRACT: The treatment paradigm in advanced renal cell carcinoma (RCC) has changed in the recent years. Sunitinib has been established as a new standard for first-line therapy. We studied the prognostic significance of baseline characteristics and we compared the risk stratification with the established Memorial Sloan Kettering Cancer Center (MSKCC) model.
This is a retrospective analysis of patients treated in six Greek Oncology Units of HECOG. Inclusion criteria were: advanced renal cell carcinoma not amenable to surgery and treatment with Sunitinib. Previous cytokine therapy but no targeted agents were allowed. Overall survival (OS) was the major end point. Significance of prognostic factors was evaluated with multivariate cox regression analysis. A model was developed to stratify patients according to risk.
One hundred and nine patients were included. Median follow up has been 15.8 months and median OS 17.1 months (95% CI: 13.7-20.6). Time from diagnosis to the start of Sunitinib (<or= 12 months vs. >12 months, p = 0.001), number of metastatic sites (1 vs. >1, p = 0.003) and performance status (PS) (<or= 1 vs >1, p = 0.001) were independently associated with OS. Stratification in two risk groups ("low" risk: 0 or 1 risk factors; "high" risk: 2 or 3 risk factors) resulted in distinctly different OS (median not reached [NR] vs. 10.8 [95% confidence interval (CI): 8.3-13.3], p < 0.001). The application of the MSKCC risk criteria resulted in stratification into 3 groups (low and intermediate and poor risk) with distinctly different prognosis underlying its validity. Nevertheless, MSKCC model did not show an improved prognostic performance over the model developed by this analysis.
Studies on risk stratification of patients with advanced RCC treated with targeted therapies are warranted. Our results suggest that a simpler than the MSKCC model can be developed. Such models should be further validated.
BMC Cancer 02/2010; 10:45. · 3.01 Impact Factor
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ABSTRACT: Myofibroblastic tumor, also known as inflammatory pseudotumor or pseudosarcoma, is a benign tumor with mesenchymal origin. Bladder location is very uncommon. We report the case of a 58-year-old man with a history of von Recklinghausen's disease who complained for painless macroscopic hematuria 5 months after suprapubic prostatectomy. The radiograph evaluation revealed a bladder tumor, and the pathologic examination following a transurethral resection showed inflammatory myofibroblastic tumor of the bladder. The patient finally underwent a radical cystectomy due to the uncertain pathogenesis of inflammatory myofibroblastic tumor as well as the rarity of cases published on bladder tumors in Von Recklinghausen's patients.
Case Reports in Medicine 01/2010; 2010.
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ABSTRACT: Prostate cancer is a common disease affecting males. Despite initial sensitivity to hormone treatment, prostate cancer eventually progresses to a castration-resistant stage (CRPC), which carries an ominous prognosis. Lanreotide is a long-acting somatostatin analog with the same properties with the native peptide. It has been shown to be highly efficacious in treating various hypersecretoty disorders and tumors. Lanreotide has been administered to patients with CRPC within a novel treatment concept, with the aim of targeting not only cancer cells but also various factors secreted in the tumor cell milieu that confer protection from apoptosis. Within this concept, lanreotide has been administered as part of the "antisurvival factor therapy" in combination with dexamethasone and a gonadotropin releasing hormone (GnRH) analog. It has also been given combined with oestrogens in patients with CRPC. The so far published series have documented a clinical response in many patients treated along with significant improvement in parameters related to quality of life. In view of these promising results, large-scale, randomized, controlled trials are warranted to clearly define the exact role of lanreotide and other somatostatin analogs in the treatment of patients with CRPC.
Expert Opinion on Pharmacotherapy 03/2009; 10(3):493-501. · 3.20 Impact Factor
