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Early releases for January 24, 2012 (about CUAJ early releases)

Pursuit of sexual function post-radical prostatectomy
Can Urol Assoc J 2012. http://dx.doi.org/10.5489/cuaj.10192. Epub 24 Jan 2012
Lisa G. Smyth, Ivor M. Cullen, David M. Quinlan
Abstract

Detrusor underactivity is prevalent after radical prostatectomy: a urodynamic study including risk factors
Cite as: Can Urol Assoc J 2012. http://dx.doi.org/10.5489/cuaj.11038. Epub 24 Jan 2012
Doreen E. Chung, Benjamin Dillon, Jordan Kurta, Alexandra Maschino, Angel Cronin, Jaspreet S. Sandhu
Abstract

Salvage prostatectomy post-definitive radiation therapy: The Vancouver experience
Cite as: Can Urol Assoc J 2012. http://dx.doi.org/10.5489/cuaj.11056. Epub 24 Jan 2012
Niall M. Corcoran, Guilherme Godoy, Rodney C. Studd, Rowan G. Casey, Antonio Hurtado-Coll, Scott Tyldesley, S. Larry Goldenberg, Martin E. Gleave
Abstract

Ambulant monitoring of bladder oxygenation and hemodynamics using wireless near-infrared spectroscopy
Cite as: Can Urol Assoc J 2012. http://dx.doi.org/10.5489/cuaj.11060. Epub 24 Jan 2012
Andrew John Macnab, Babak Shadgan, Lynn Stothers, Kourosh Afshar
Abstract

Clinical and pathological variables that predict changes in tumour grade after radical prostatectomy in patients with prostate cancer
Cite as: Can Urol Assoc J 2012. http://dx.doi.org/10.5489/cuaj.11067. Epub 24 Jan 2012
Stavros Sfoungaristos, Petros Perimenis
Abstract

Prospective cost analysis of laparoscopic vs. open pyeloplasty in children: Single centre contemporary evaluation comparing two procedures over a 1-year period
Cite as: Can Urol Assoc J 2012. http://dx.doi.org/10.5489/cuaj.11096. Epub 24 Jan 2012
Katherine Moore, Armando J. Lorenzo, Suzanne Turner, Darius J. Bägli, Joao L. Pippi Salle, Walid A. Farhat
Abstract

Pursuit of sexual function post-radical prostatectomy
Abstract
Introduction: In the event of the implementation of prostate cancer screening, younger men will be diagnosed more frequently. Erectile dysfunction (ED) is a frequent long-term complication in men post-radical prostatectomy (RP). Since the introduction of RP, urologists have strived to improve postoperative sexual function. There is little literature, however, in the area of ED prescribing and
sexual pursuit in men post-RP. We assessed the pursuit of sexual function in this group of patients.
Methods: The study involved a detailed questionnaire sent to patients who have undergone radical retropublic prostatectomy RRP) by one surgeon in one institution to ascertain the impact of ED on lifestyle and ED therapy prescription use.
Results: There was a response rate of 59%; most patients who responded were in the 61 to 70 year age group at the time of the survey. About 25% of patients had intercourse more than once in the 4 weeks prior to the survey. A total 50% of patients had no problem or a very small problem with their sexual function. Overall 80% of patients were prescribed ED therapy, but less than 35% of them used it.
Conclusions: Sexual frequency peaked in younger patients who were 3 years or more from surgery. Of note, 46% of men either declined the offer of ED therapy or got the prescription and never used it. Only 34% of men had used their ED prescription in the last 4 weeks. Urologists frequently find that patients behave differently postoperatively, with less interest in sexual activity. Interestingly, we found that 50% of our patients classified their sexual function, as at most a small problem.

Detrusor underactivity is prevalent after radical prostatectomy: a urodynamic study including risk factors
Abstract
Introduction: The objective was to determine the prevalence of, and factors that predict, detrusor underactivity (DU) in patients presenting with incontinence or lower urinary tract symptoms (LUTS) following radical prostatectomy (RP). We also determined the prevalence of bladder outlet obstruction (BOO) and detrusor overactivity (DO) in this population.
Methods: Patients who underwent urodynamics post-RP were identified. Detrusor underactivity was defined as a maximum flow rate (Qmax) of =15 mL/s and detrusor pressure (Pdet) Qmax<20 cmH20 or maximum Pdet <20 cmH20 during attempted voiding. Abdominal voiding (AV) was defined as sustained increase in abdominal pressure during voiding. Bladder outlet obstruction and DO were identified using the Abrams-Griffiths nomogram and the International Continence Society criteria. Univariate logistic regression was used to determine factors predicting DU. The following factors were analyzed: age, year of RP, procedure type (minimally-invasive surgery [MIS] or open), postoperative radiation, nerve-sparing, clinical stage, biopsy Gleason grade and interval between RP and evaluation.
Results: Between 2005 and 2008, 264 patients underwent urodynamics post-RP. Detrusor underactivity was observed in 108 patients (41%; 95% CI 35%, 47%), of whom 48% demonstrated AV. Overall, BOO and DO were present in 17% (95% CI 12%, 22%) and 27% (95% CI 22%, 33%), respectively. On univariate analysis, only MIS RP was predictive of DU (univariate odds ratio 2.05 for MIS vs. open; p = 0.009).
Conclusion: Detrusor underactivity and AV are common in patients presenting for evaluation of incontinence or LUTS following RP. The etiology of DU in this setting is likely related to the surgical approach. Because DU may affect the success of male incontinence treatment with the male sling or artificial urinary sphincter, it is useful to document its presence prior to treatment. More studies are needed to elucidate the influence of DU on treatment success for male urinary incontinence following RP.

Salvage prostatectomy post-definitive radiation therapy: The Vancouver experience
Abstract
Introduction: Prostate cancer recurrence following primary radiation is common. If the recurrence remains localized to the prostate gland, surgical removal may result in long-term local control or cure. Despite the well-established oncological outcomes, salvage prostatectomy is infrequently performed or reported. We present our experience with salvage prostatectomy at a Canadian centre.
Methods: We identified all patients undergoing salvage prostatectomy at the Vancouver General Hospital between 1995 and 2010 from a prospectively recorded and maintained prostate cancer database. Details regarding initial presentation, delivery of radiotherapy, clinical features at the time of recurrence, as well as oncological and functional outcomes, were collected. Information regarding postoperative morbidity was collected prospectively and confirmed by retrospective chart review.
Results: Over a 15-year period, salvage prostatectomy was successfully completed in 21 patients. With a median follow-up period of 68 months (range: 2-122), 9 (43%) patients experienced a biochemical recurrence, with most failing within the first 2 years of surgery. There were 3 deaths in the cohort, all from prostate cancer, giving a prostate cancer specific and overall survival of 86%. The main postoperative morbidity was bladder neck contracture, occurring in 40%. One patient each developed a recto-urethral fistula and osteitis pubis. Physician-recorded data regarding continence was available in 13 (62%). Of these 13 patients, 10 (85%) men were
recorded as dry or using 1 pad per day.
Conclusions: This is the first Canadian centre to report that salvage prostatectomy can be performed with favourable oncological and functional outcomes.

Ambulant monitoring of bladder oxygenation and hemodynamics using wireless near-infrared spectroscopy
Abstract
Introduction: Near-infrared spectroscopy (NIRS) non-invasively detects changes in the concentration of the chromophores oxygenated (?O2Hb) and deoxygenated hemoglobin (?HHb) as the bladder detrusor muscle contracts during voiding. Such data provide novel information on bladder oxygenation and hemodynamics. We evaluated the feasibility of monitoring ambulant subjects using a wireless NIRS device.
Methods: The wireless device uses paired light-emitting diodes (wavelengths 760 and 850 nm) and a silicon photodiode detector. We monitored 14 asymptomatic subjects (10 adults, 4 children) and 6 symptomatic children with non-neurogenic lower urinary tract dysfunction (NLUTD) during spontaneous voiding after natural filling. The device was taped to the abdominal skin 2 cm above the symphysis pubis across the midline. The wireless NIRS data (patterns of change in chromophore concentration) were compared between subjects and to the data obtained using a laser-powered instrument.
Results: Graphs of ΔO2Hb, ΔHHb and total hemoglobin (ΔtHb) were obtained from all 20 patients. Data during uroflow showed reproducible patterns of bladder chromophore change between asymptomatic subjects (rise in ΔtHb/ΔO2Hb), consistent with laser instrument data. In contrast, all 6 symptomatic children had a negative trend in ΔtHb, with falls in ΔO2Hb. One adult experienced “shy” bladder and changes in hemodynamics/oxygenation occurred while bladder volume was unchanged.
Conclusion: Wireless NIRS bladder monitoring is feasible in ambulant adults and children; wireless and laser-derived data in asymptomatic subjects are comparable. Pilot data suggest that subjects with symptomatic NLUTD have impaired bladder oxygenation/hemodynamics. The fact that chromophore changes occur when bladder volume remains constant supports the concept that NIRS data are a physiologic measure.

Clinical and pathological variables that predict changes in tumour grade after radical prostatectomy in patients with prostate cancer
Abstract
Introduction: Preoperative Gleason score is crucial, in combination with other preoperative parameters, in selecting the appropriate treatment for patients with clinically localized prostate cancer. The aim of the present study is to determine the clinical and pathological variables that can predict differences in Gleason score between biopsy and radical prostatectomy.
Methods: We retrospectively analyzed the medical records of 302 patients who had a radical prostatectomy between January 2005 and September 2010. The association between grade changes and preoperative Gleason score, age, prostate volume, prostate-specific antigen (PSA), PSA density, number of biopsy cores, presence of prostatitis and high-grade prostatic intraepithelial neoplasia was analyzed. We also conducted a secondary analysis of the factors that influence upgrading in patients with preoperative Gleason score ≤6 (group 1) and downgrading in patients with Gleason score ≤7 (group 2).
Results: No difference in Gleason score was noted in 44.3% of patients, while a downgrade was noted in 13.7% and upgrade in 42.1%. About 2/3 of patients with a Gleason score of ≤6 upgraded after radical prostatectomy. PSA density (p = 0.008) and prostate volume (p = 0.032) were significantly correlated with upgrade. No significant predictors were found for patients with Gleason score ≤7 who downgraded postoperatively.
Conclusion: Smaller prostate volume and higher values of PSA density are predictors for upgrade in patients with biopsy Gleason score ≤6 and this should be considered when deferred treatment modalities are planned.

Prospective cost analysis of laparoscopic vs. open pyeloplasty in children: Single centre contemporary evaluation comparing two procedures over a 1-year period
Abstract
Introduction: Laparoscopy in pediatric urological surgery continues to gradually gain acceptance. Since economic implications are of increasing importance in our cost-containment environment, few studies have compared the expense associated with open to laparoscopic approaches. We present a prospective comparative cost-analysis between the laparoscopic (LP) and open pediatric pyeloplasty (OP).
Methods: Over a period of a year (2007-2008), 54 consecutives pyeloplasties were performed. The “traditional” OP was performed in 33 patients and the remaining 21 children underwent LP. Costs were prospectively collected for each group and divided based on amounts incurred by all different departments involved: nursing, laboratory, diagnostic imaging, pharmacy and operative room.
Results: Overall, the average cost for a LP was CDN$6240 compared to CDN$5079 for an OP with a median hospital stay of 2 days (range OP: 1-18, LP: 1-7). The main difference was found in operative room expenses (OP: $2508 vs. LP: $3925). The higher cost could not be solely explained by the use of disposable items, which only subtracts $335 per procedure (23.6% of the cost difference between OP and LP). Length of time spent in the operating room was 1.2 hours longer for the LP and appears to be the main factor explaining the cost difference.
Conclusion: Our findings show that at our institution, pediatric LP is more expensive than OP. This cost difference is mainly due to operating room time. For cost-containment purposes, efforts aimed at increasing efficiency in the operating room may help equalize both approaches.

About CUAJ early releases

CUAJ has adopted an early release model, in which papers are published online in advance of their print publication. The print publication schedule remains the same: February, April, June, August, October, December; however, CUAJ is now posting new early release articles on its website (www.cuaj.ca) every other month (January, March, May, July, September, November). CUAJ early releases articles only apply to research articles.