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Wang LG, Montaño AR, Masillati AM, Jones JA, Barth CW, Combs JR, Kumarapeli SU, Shams NA, van den Berg NS, Antaris AL, Galvis SN, McDowall I, Rizvi SZH, Alani AWG, Sorger JM, Gibbs SL. Nerve Visualization using Phenoxazine-Based Near-Infrared Fluorophores to Guide Prostatectomy. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2304724. [PMID: 37653576 DOI: 10.1002/adma.202304724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/27/2023] [Indexed: 09/02/2023]
Abstract
Fluorescence-guided surgery (FGS) is poised to revolutionize surgical medicine through near-infrared (NIR) fluorophores for tissue- and disease-specific contrast. Clinical open and laparoscopic FGS vision systems operate nearly exclusively at NIR wavelengths. However, tissue-specific NIR contrast agents compatible with clinically available imaging systems are lacking, leaving nerve tissue identification during prostatectomy a persistent challenge. Here, it is shown that combining drug-like molecular design concepts and fluorophore chemistry enabled the production of a library of NIR phenoxazine-based fluorophores for intraoperative nerve-specific imaging. The lead candidate readily delineated prostatic nerves in the canine and iliac plexus in the swine using the clinical da Vinci Surgical System that has been popularized for minimally invasive prostatectomy procedures. These results demonstrate the feasibility of molecular engineering of NIR nerve-binding fluorophores for ready integration into the existing surgical workflow, paving the path for clinical translation to reduce morbidity from nerve injury for prostate cancer patients.
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Affiliation(s)
- Lei G Wang
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, 97201, USA
| | - Antonio R Montaño
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
| | - Anas M Masillati
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
| | - Jocelyn A Jones
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
| | - Connor W Barth
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
| | - Jason R Combs
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
| | | | - Nourhan A Shams
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
| | | | | | - S N Galvis
- Intuitive Surgical, Sunnyvale, CA, 94086, USA
| | | | - Syed Zaki Husain Rizvi
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201, USA
| | - Adam W G Alani
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, 97201, USA
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201, USA
| | | | - Summer L Gibbs
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, 97201, USA
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2
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Katsimperis S, Juliebø-Jones P, Ta A, Tandogdu Z, Al-Bermani O, Bellos T, Esperto F, Tonyali S, Mitsogiannis I, Skolarikos A, Varkarakis I, Somani BK, Tzelves L. Surgical techniques to preserve continence after robot-assisted radical prostatectomy. Front Surg 2023; 10:1289765. [PMID: 38026481 PMCID: PMC10655003 DOI: 10.3389/fsurg.2023.1289765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Radical prostatectomy significantly impacts the inherent anatomy of the male pelvis and the functional mechanisms of urinary continence. Incontinence has a considerable negative influence on the quality of life of patients, as well as their social and psychological wellbeing. Numerous surgical techniques have been demonstrated to support the preservation of continence during robot-assisted radical prostatectomy (RARP). In this in-depth analysis, we give a general summary of the surgical techniques used in RARP and their impact on incontinence rates.
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Affiliation(s)
- Stamatios Katsimperis
- 2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Anthony Ta
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Zafer Tandogdu
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Osama Al-Bermani
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Themistoklis Bellos
- 2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Senol Tonyali
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Iraklis Mitsogiannis
- 2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Skolarikos
- 2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Varkarakis
- 2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Bhaskar K. Somani
- Department of Urology, University of Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Lazaros Tzelves
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- 2nd Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
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3
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Gottumukkala RV, Lee LK, Tu W, Tempany CM, Fennessy FM. Local Staging of Prostate Cancer at MRI: What the Urologist and Radiation Oncologist Want to Know. Radiographics 2023; 43:e220100. [PMID: 37561642 PMCID: PMC10506065 DOI: 10.1148/rg.220100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 03/02/2023] [Accepted: 03/14/2023] [Indexed: 08/12/2023]
Abstract
This slide presentation provides an overview of prostate cancer risk stratification and management, reviews key anatomic and imaging principles pertaining to local staging of prostate cancer, and highlights inflection points where MRI findings regarding local staging may modify clinical management.
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Affiliation(s)
- Ravi V. Gottumukkala
- From the Department of Radiology, Brigham and Women’s
Hospital, 75 Francis St, Boston, MA 02115 (R.V.G, L.K.L., C.M.T., F.M.F); and
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton,
Alberta, Canada (W.T.)
| | - Leslie K. Lee
- From the Department of Radiology, Brigham and Women’s
Hospital, 75 Francis St, Boston, MA 02115 (R.V.G, L.K.L., C.M.T., F.M.F); and
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton,
Alberta, Canada (W.T.)
| | - Wendy Tu
- From the Department of Radiology, Brigham and Women’s
Hospital, 75 Francis St, Boston, MA 02115 (R.V.G, L.K.L., C.M.T., F.M.F); and
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton,
Alberta, Canada (W.T.)
| | - Clare M. Tempany
- From the Department of Radiology, Brigham and Women’s
Hospital, 75 Francis St, Boston, MA 02115 (R.V.G, L.K.L., C.M.T., F.M.F); and
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton,
Alberta, Canada (W.T.)
| | - Fiona M. Fennessy
- From the Department of Radiology, Brigham and Women’s
Hospital, 75 Francis St, Boston, MA 02115 (R.V.G, L.K.L., C.M.T., F.M.F); and
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton,
Alberta, Canada (W.T.)
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4
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Sigorski D, Wesołowski W, Gruszecka A, Gulczyński J, Zieliński P, Misiukiewicz S, Kitlińska J, Iżycka-Świeszewska E. Neuropeptide Y and its receptors in prostate cancer: associations with cancer invasiveness and perineural spread. J Cancer Res Clin Oncol 2023; 149:5803-5822. [PMID: 36583743 PMCID: PMC10356636 DOI: 10.1007/s00432-022-04540-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Neuropeptide Y (NPY) is a pleiotropic peptide, which is involved in many biological mechanisms important in regulation of cell growth and survival. The aim of this study was a comprehensive analysis of the NPY system in prostate pathology. METHODS The study was based on immunohistochemical analysis of NPY and its receptors, Y1R, Y2R and Y5R, in tissue samples from benign prostate (BP), primary prostate cancer (PCa) and PCa bone metastases. Tissue microarray (TMA) technique was employed, with analysis of multiple cores from each specimen. Intensity of the immunoreactivity and expression index (EI), as well as distribution of the immunostaining in neoplastic cells and stromal elements were evaluated. Perineural invasion (PNI) and extraprostatic extension (EPE) were areas of special interests. Moreover, a transwell migration assay on the LNCaP PCa cell line was used to assess the chemotactic properties of NPY. RESULTS Morphological analysis revealed homogeneous membrane and cytoplasmic pattern of NPY staining in cancer cells and its membrane localization with apical accentuation in BP glands. All elements of the NPY system were upregulated in pre-invasive prostate intraepithelial neoplasia, PCa and metastases. EI and staining intensity of NPY receptors were significantly higher in PCa then in BP with correlation between Y2R and Y5R. The strength of expression of the NPY system was further increased in the PNI and EPE areas. In bone metastases, Y1R and Y5R presented high expression scores. CONCLUSION The results of our study suggest that the NPY system is involved in PCa, starting from early stages of its development to disseminated states of the disease, and participates in the invasion of PCa into the auto and paracrine matter.
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Affiliation(s)
- Dawid Sigorski
- Department of Oncology, Collegium Medicum, University of Warmia and Mazury, 10-228, Olsztyn, Poland
- Department of Oncology and Immuno-Oncology, Warmian-Masurian Cancer Center of the Ministry of the Interior and Administration Hospital, 10-228, Olsztyn, Poland
| | | | - Agnieszka Gruszecka
- Department of Radiology Informatics and Statistics, Medical University of Gdansk, 80-210, Gdansk, Poland
| | - Jacek Gulczyński
- Department of Pathology and Neuropathology, Medical University of Gdańsk, 80-210, Gdańsk, Poland
- Department of Pathomorphology, Copernicus Hospital, 80-803, Gdańsk, Poland
| | - Piotr Zieliński
- Division of Tropical and Parasitic Diseases, University Center of Maritime and Tropical Medicine, 81-519, Gdynia, Poland
| | - Sara Misiukiewicz
- Human Science Department, School of Nursing and Health Studies, Georgetown University Medical Center, Washington, DC, USA
| | - Joanna Kitlińska
- Department of Biochemistry and Molecular and Cellular Biology, Georgetown University Medical Center, Washington, DC, 20057, USA.
| | - Ewa Iżycka-Świeszewska
- Department of Pathology and Neuropathology, Medical University of Gdańsk, 80-210, Gdańsk, Poland.
- Department of Pathomorphology, Copernicus Hospital, 80-803, Gdańsk, Poland.
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Tu W, Gottumukkala RV, Schieda N, Lavallée L, Adam BA, Silverman SG. Perineural Invasion and Spread in Common Abdominopelvic Diseases: Imaging Diagnosis and Clinical Significance. Radiographics 2023; 43:e220148. [PMID: 37319024 DOI: 10.1148/rg.220148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Malignancies and other diseases may spread by multiple pathways, including direct extension, hematogenous spread, or via lymphatic vessels. A less-well-understood route is the peripheral nervous system, which is known as perineural spread (PNS). In addition to accounting for pain and other neurologic symptoms, PNS affects both disease prognosis and management. Although PNS is commonly discussed in relation to head and neck tumors, there is emerging data regarding PNS in abdominopelvic malignancies and other conditions such as endometriosis. Due to improved contrast and spatial resolution, perineural invasion, a finding heretofore diagnosed only at pathologic examination, can be detected at CT, MRI, and PET/CT. PNS most commonly manifests as abnormal soft-tissue attenuation extending along neural structures, and diagnosis of it is aided by optimizing imaging parameters, understanding pertinent anatomy, and becoming familiar with the typical neural pathways of spread that largely depend on the disease type and location. In the abdomen, the celiac plexus is a central structure that innervates the major abdominal organs and is the principal route of PNS in patients with pancreatic and biliary carcinomas. In the pelvis, the lumbosacral plexus and inferior hypogastric plexus are the central structures and principal routes of PNS in patients with pelvic malignancies. Although the imaging findings of PNS may be subtle, a radiologic diagnosis can have a substantial effect on patient care. Knowledge of anatomy and known routes of PNS and optimizing imaging parameters is of utmost importance in providing key information for prognosis and treatment planning. © RSNA, 2023 Supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Wendy Tu
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Ravi V Gottumukkala
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola Schieda
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Luke Lavallée
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin A Adam
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Stuart G Silverman
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
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Hu H, Cui Y, Yang J, Cao Y. Loss of the Sympathetic Signal Produces Sterile Inflammation of the Prostate. Front Mol Neurosci 2022; 15:855376. [PMID: 35620446 PMCID: PMC9127543 DOI: 10.3389/fnmol.2022.855376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Neural innervations exert essential roles in the prostate. However, spatial distribution and regulatory function of such neural inputs are incompletely characterized. Here, we exploited the advanced whole-tissue immunolabeling and optical clearing technique to assess the 3D anatomy of autonomic innervations in the mouse and human prostate for the first time. We observed that sympathetic and parasympathetic inputs in the mouse prostate remained unaffected during castration-induced tissue regression. However, the pharmacologic destruction of sympathetic innervations in the mouse prostate led to sterile inflammation of the tissue, mimicking the disease condition of chronic non-bacterial prostatitis. Also, the genetic ablation of sympathetic inputs produced a similar inflammatory response. Furthermore, we showed that treatment of the specific β2-adrenergic receptor agonists could effectively mitigate the prostate inflammation caused by such sympathetic loss. Together, these results have elucidated the new immunomodulatory function of the sympathetic signal via the β2-adrenergic receptor in prostate inflammatory disease.
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Affiliation(s)
- Hao Hu
- Department of Urology, Peking University People’s Hospital, Beijing, China
| | - Yiwen Cui
- Peking University-Tsinghua University-National Institute of Biological Sciences Joint Graduate Program, Peking University, Beijing, China
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Jing Yang
- Shenzhen Bay Laboratory, Shenzhen, China
| | - Ying Cao
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Center for Life Sciences, Peking University, Beijing, China
- *Correspondence: Ying Cao,
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Kocjancic E, Chung E, Garzon JA, Haylen B, Iacovelli V, Jaunarena J, Locke J, Millman A, Nahon I, Ohlander S, Pang R, Plata M, Acar O. International Continence Society (ICS) report on the terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction. Neurourol Urodyn 2022; 41:140-165. [PMID: 34989425 DOI: 10.1002/nau.24846] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction has not been defined and organized into a clinically based consensus terminology report. The aim of this terminology report is to provide a definitional document within this context that will assist clinical practice and research. METHODS This report combines the input of the members of sexual health in men with LUT and PF Dysfunction working group of the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 18 rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). The Committee retained evidence-based definitions, identified gaps, and updated or discarded outdated definitions. Expert opinions were used when evidence was insufficient or absent. RESULTS A terminology report for sexual health in men with LUT and PF dysfunction, encompassing 198 (178 NEW) separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different speciality groups involved. Conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 years) review is anticipated to keep the document updated. CONCLUSION A consensus-based terminology report for sexual health in men with LUT and PF dysfunction has been produced to aid clinical practice and research. The definitions that have been adopted are those that are most strongly supported by the literature at this time or are considered clinical principles or consensus of experts' opinions.
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Affiliation(s)
- Ervin Kocjancic
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Eric Chung
- Department of Urology, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | | | - Bernard Haylen
- Department of Gynaecology, University of New South Wales, Sydney, New South Wales, Australia
| | - Valerio Iacovelli
- Department of Urology, San Carlo di Nancy General Hospital-GVM Care and Research, Tor Vergata University of Rome, Rome, Italy
| | - Jorge Jaunarena
- Division of Urology, Centro de Urologia CDU, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - Jennifer Locke
- Department of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Alexandra Millman
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Irmina Nahon
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Samuel Ohlander
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ran Pang
- Department of Urology, Guang An Men Hospital, Beijing, China
| | - Mauricio Plata
- Department of Urology, Universidad de los Andes School of Medicine, Fundación Santa fe de Bogotá University, Bogotá, Colombia
| | - Omer Acar
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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8
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Albisinni S, Dasnoy C, Diamand R, Mjaess G, Aoun F, Esperto F, Porpiglia F, Fiori C, Roumeguère T, DE Nunzio C. Systematic review comparing Anterior vs Retzius-sparing robotic assisted radical prostatectomy: can the approach really make a difference? Minerva Urol Nephrol 2021; 74:137-145. [PMID: 34714037 DOI: 10.23736/s2724-6051.21.04623-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Retzius-Sparing Robotic Assisted Radical Prostatectomy (RS-RARP) is a novel surgical approach to radical prostatectomy. Its pioneers have suggested an improved recovery of urinary continence, while maintaining adequate cancer control. Aim of this systematic review is to explore available data on RS-RALP and compare functional, oncologic and perioperative results of RS-RARP compared to anterior RARP. EVIDENCE ACQUISITION A search following PRISMA guidelines was performed including the combination of the following words: retzius AND sparing AND radical AND prostatectomy. 93 articles were identified and 13 were included in the systematic review, including 3 randomized controlled trials (RCT), 4 prospective studies and 6 retrospective studies. EVIDENCE SYNTHESIS All available randomized trials confirmed an improved immediate continence for RS-RARP, with rates ranging 51-71%, compared to 21-48% for anterior RARP. However, this advantage was progressively lost with no significant difference found after 6 months. Moreover, a prospective study found no discrepancy in terms of quality of life across the two techniques. Erectile function was difficult to compare, as patients had different baseline erectile function across studies and rate of neurovascular preservation was not comparable. Surgical approach remains controversial regarding positive margin rate, although related to the surgeon's experience and clinical stage. Biochemical recurrence-free survival appears similar between the two approaches. CONCLUSIONS RS-RARP improves early urinary continence recovery compared to anterior RARP, with this advantage being lost after 3 to 6 months. Erectile function and quality of life were however comparable between the two techniques. The results concerning the rate of positive margins remained controversial. Future studies with longer follow-up are needed to better assess oncologic outcomes.
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Affiliation(s)
- Simone Albisinni
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium -
| | - Cyrielle Dasnoy
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Romain Diamand
- Urology Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Georges Mjaess
- Urology Department, Hôtel Dieu de France - Université Saint Joseph, Beyrouth, Lebanon
| | - Fouad Aoun
- Urology Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium.,Urology Department, Hôtel Dieu de France - Université Saint Joseph, Beyrouth, Lebanon
| | | | - Francesco Porpiglia
- Division of Urology- San Luigi Hospital (Orbassano), Turin.,Department of Oncology, University of Turin, Turin, Italy
| | - Cristian Fiori
- Division of Urology- San Luigi Hospital (Orbassano), Turin.,Department of Oncology, University of Turin, Turin, Italy
| | - Thierry Roumeguère
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium.,Urology Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Cosimo DE Nunzio
- Urology Department, Sant'Andrea Hospital, Università degli Studi di Roma La Sapienza, Rome, Italy
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9
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Real-time, functional intra-operative localization of rat cavernous nerve network using near-infrared cyanine voltage-sensitive dye imaging. Sci Rep 2020; 10:6618. [PMID: 32313132 PMCID: PMC7171155 DOI: 10.1038/s41598-020-63588-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/27/2020] [Indexed: 12/02/2022] Open
Abstract
Despite current progress achieved in the surgical technique of radical prostatectomy, post-operative complications such as erectile dysfunction and urinary incontinence persist at high incidence rates. In this paper, we present a methodology for functional intra-operative localization of the cavernous nerve (CN) network for nerve-sparing radical prostatectomy using near-infrared cyanine voltage-sensitive dye (VSD) imaging, which visualizes membrane potential variations in the CN and its branches (CNB) in real time. As a proof-of-concept experiment, we demonstrate a functioning complex nerve network in response to electrical stimulation of the CN, which was clearly differentiated from surrounding tissues in an in vivo rat prostate model. Stimulation of an erection was confirmed by correlative intracavernosal pressure (ICP) monitoring. Within 10 minutes, we performed trans-fascial staining of the CN by direct VSD administration. Our findings suggest the applicability of VSD imaging for real-time, functional imaging guidance during nerve-sparing radical prostatectomy.
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10
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KleinJan GH, Sikorska K, Korne CM, Brouwer OR, Buckle T, Tillier C, van der Roest RCM, de Jong J, van Leeuwen FWB, van der Poel HG. A prediction model relating the extent of intraoperative fascia preservation to erectile dysfunction after nerve-sparing robot-assisted radical prostatectomy. J Robot Surg 2018; 13:455-462. [PMID: 30178300 DOI: 10.1007/s11701-018-0867-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/26/2018] [Indexed: 11/30/2022]
Abstract
Robot-assisted radical prostatectomy (RARP) is performed in patients with prostate cancer. Unfortunately, 10-46% of patients may still suffer from limited erectile function (EF) after RARP. This study aimed to develop a prediction model based on the extent of fascia preservation (FP) and postoperative EF after RARP. A previously developed FP score quantizing the extent and regions of nerve-preservation was determined in a cohort of 1241 patients who underwent RARP. The predictive value of the FP score for post-prostatectomy EF (following the international index erectile function (IIEF) score, EF domain) was analyzed. To increase the predictive value of the scoring system, the FP regions were related to postoperative EF, nerve distribution and co-morbidity factors. Finally, a prediction model for EF was developed based on the studied cohort. When corrected for the preoperative IIEF-EF, the FP score was shown to be a significant denominator for IIEF (p = 2.5 × 10- 15) with an R2 of 35%. Variable selection performed using the Akaike information criterion led to a final prediction model for postoperative IIEF after nerve-preservation based on the FP score. Furthermore, patient's age, preoperative IIEF score, CCIS and use of clips for nerve sparing were significantly associated with postoperative IIEF-EF. More anterior fascia preservation was correlated with better EF outcome and age was a strong independent predictor of EF outcome. In older men, the relative benefit of more extensive fascia preservation was at least similar to younger men, despite a lower baseline IIEF-EF score. Quantitative nerve-sparing FP scoring could be related to the postoperative IIEF-EF and integrated into a multivariate prediction model, which includes with age, use of surgical clips, the Charlson Comorbidity Index Score (CCIS), and preoperative IIEF-EF. When further validated the prediction model could provide patients and care-givers a qualitative estimation of EF outcome after RARP.
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Affiliation(s)
- G H KleinJan
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center (LUMC), Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AvL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - K Sikorska
- Department of Biometrics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AvL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - C M Korne
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center (LUMC), Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - O R Brouwer
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AvL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - T Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center (LUMC), Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - C Tillier
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AvL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - R C M van der Roest
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AvL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - J de Jong
- Department of Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AvL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - F W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center (LUMC), Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AvL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - H G van der Poel
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AvL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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11
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Pederzoli F, Campbell JD, Matsui H, Sopko NA, Bivalacqua TJ. Surgical Factors Associated With Male and Female Sexual Dysfunction After Radical Cystectomy: What Do We Know and How Can We Improve Outcomes? Sex Med Rev 2018; 6:469-481. [PMID: 29371143 DOI: 10.1016/j.sxmr.2017.11.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/09/2017] [Accepted: 11/16/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Sexual dysfunction after radical cystectomy (RC) is a frequent, though commonly overlooked symptom for both men and women. Improved oncological outcomes and the rising number of bladder cancer survivors mandate physicians to closely address and evaluate post-surgical sexual dysfunction and offer goal-directed treatment. Improvements in RC surgical techniques that promote post-operative sexual function have been proposed, alongside new quality-of-life inventories and sexual function therapeutic options; however, rigorous studies in the field are lacking. AIM To provide a comprehensive overview of post-RC sexual dysfunction and discuss new surgical techniques, sexual dysfunction evaluation, and novel treatment strategies. METHODS A non-systematic narrative review of the literature was performed through PubMed about sexual dysfunction in men and women after RC. OUTCOMES We reported on the surgical anatomy of sexual function-sparing RC, the most common inventories used to investigate sexual function in post-RC patients, and current treatment options. RESULTS Extensive knowledge about pelvic anatomy and nerve-sparing surgical techniques in men is well understood from studies about prostate anatomy and nerve-sparing prostatectomy. However, anatomical and surgical details of sexual-sparing RC in women needs further characterization. Several questionnaires are used to investigate sexuality after RC, but a standardized approach is still missing. Therapeutic options are available to treat sexual dysfunction, but limited studies have been conducted to specifically address the post-RC population. CONCLUSION Further work is needed to understand the best strategies to prevent and treat sexual dysfunction in patients after RC. Pederzoli F, Campbell JD, Matsui H, et al. Surgical Factors Associated With Male and Female Sexual Dysfunction After Radical Cystectomy: What Do We Know and How Can We Improve Outcomes? Sex Med Rev 2018;6:469-481.
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Affiliation(s)
- Filippo Pederzoli
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Vita-Salute San Raffaele University, Milan, Italy.
| | - Jeffrey D Campbell
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hotaka Matsui
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nikolai A Sopko
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Trinity J Bivalacqua
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Rutledge A, Jobling P, Walker MM, Denham JW, Hondermarck H. Spinal Cord Injuries and Nerve Dependence in Prostate Cancer. Trends Cancer 2017; 3:812-815. [DOI: 10.1016/j.trecan.2017.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 12/11/2022]
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13
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Yoon Y, Jeon SH, Park YH, Jang WH, Lee JY, Kim KH. Visualization of prostatic nerves by polarization-sensitive optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2016; 7:3170-3183. [PMID: 27699090 PMCID: PMC5030002 DOI: 10.1364/boe.7.003170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/23/2016] [Accepted: 07/26/2016] [Indexed: 05/03/2023]
Abstract
Preservation of prostatic nerves is critical to recovery of a man's sexual potency after radical prostatectomy. A real-time imaging method of prostatic nerves will be helpful for nerve-sparing radical prostatectomy (NSRP). Polarization-sensitive optical coherence tomography (PS-OCT), which provides both structural and birefringent information of tissue, was applied for detection of prostatic nerves in both rat and human prostate specimens, ex vivo. PS-OCT imaging of rat prostate specimens visualized highly scattering and birefringent fibrous structures superficially, and these birefringent structures were confirmed to be nerves by histology or multiphoton microscopy (MPM). PS-OCT could easily distinguish these birefringent structures from surrounding other tissue compartments such as prostatic glands and fats. PS-OCT imaging of human prostatectomy specimens visualized two different birefringent structures, appearing fibrous and sheet-like. The fibrous ones were confirmed to be nerves by histology, and the sheet-like ones were considered to be fascias surrounding the human prostate. PS-OCT imaging of human prostatectomy specimens along the perimeter showed spatial variation in the amount of birefringent fibrous structures which was consistent with anatomy. These results demonstrate the feasibility of PS-OCT for detection of prostatic nerves, and this study will provide a basis for intraoperative use of PS-OCT.
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Affiliation(s)
- Yeoreum Yoon
- Department of Mechanical Engineering, Pohang University of Science and Technology, San 31, Hyoja-dong, Nam-gu, Pohang, Gyeongbuk 790-784, South Korea
| | - Seung Hwan Jeon
- Department of Urology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137–040, South Korea
| | - Yong Hyun Park
- Department of Urology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137–040, South Korea
| | - Won Hyuk Jang
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, San 31, Hyoja-dong, Nam-gu, Pohang, Gyeongbuk 790-784, South Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137–040, South Korea
| | - Ki Hean Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology, San 31, Hyoja-dong, Nam-gu, Pohang, Gyeongbuk 790-784, South Korea
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, San 31, Hyoja-dong, Nam-gu, Pohang, Gyeongbuk 790-784, South Korea
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14
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Salomon L, Rozet F, Soulié M. La chirurgie du cancer de la prostate : principes techniques et complications péri-opératoires. Prog Urol 2015; 25:966-98. [DOI: 10.1016/j.purol.2015.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/06/2015] [Indexed: 11/25/2022]
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15
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Huri E. Novel anatomical identification of nerve-sparing radical prostatectomy: fascial-sparing radical prostatectomy. Prostate Int 2014; 2:1-7. [PMID: 24693527 PMCID: PMC3970983 DOI: 10.12954/pi.13038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 02/07/2014] [Indexed: 11/15/2022] Open
Abstract
Radical prostatectomy (RP) became a first choice of treatment for prostate cancer after the advance in nerve-sparing techniques. However, the difficult technical details still involved in nerve-sparing RP (nsRP) can invite unwanted complications. Therefore, learning to recognize key anatomical features of the prostate and its surrounding structures is crucial to further improve RP efficacy. Although the anatomical relation between the pelvic nerves and pelvic fascias is still under investigation, this paper characterizes the periprostatic fascias in order to define a novel fascial-sparing approach to RP (fsRP), which will help spare neurovascular bundles. In uroanatomic perspective, it can be stated that nsRP is a functional identification of the surgical technique while fsRP is an anatomic identification as well. The functional and oncological outcomes related to this novel fsRP are also reviewed.
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Affiliation(s)
- Emre Huri
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
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