Long-term evaluation of functional and oncological outcome of nephron- sparing surgery for treatment of renal tumours: a single center experience

We present oar experience with open nephron-sparing surgery [NSS] for treatment of renal masses. We retrospectively reviewed the clinical and pathological data of 106 patients [108 renal units] who underwent NSS /or renal masses between 1983 and 2007 at our institution. Patients' characteristics, the indication of surgery, the preoperative workup, the pathological reports, the postoperative complications, renal function and the oncological outcome were studied. All the patients were followed-up for amean of 60.6 +/- 32.8 [range, 9.4-144.8] months. Renal cell carcinoma [RCC] was diagnosed in 83 patients [85 renal units], while benign lesions were found in 23. Patients were classified according to the indication of NSS into elective group [n =60] and imperative group [n = 46]. Both groups were comparable regarding sex, clinical presentation, tumour site, and tumour laterality. Patients in the elective group were significantly younger and had significantly smaller tumours. Patients with RCC of both indications were comparable regarding Fuhrman grade while those with elective indication had significantly higher number of T1a tumours and those with imperative indication had significantly higher number of conventional tumours. Although perioperative complications were significantly more frequent among the group of imperative indication, they did not result in significant increase in hospital stay. The 5-year progression free and cancer specific survival were 89.6 +/- 4.9% and 93.8 +/- 4.3%, respectively in the imperative group, while no tumour recurred in the elective group. Of patients in the imperative group, one quarter had major changes in serum creatinine compared to basal value and only 3 patients progressed to end-stage renal disease, while in the elective group all patients had either stable or minor changes in serum creatinine postoperatively. NSS is a valid alternative in the treatment of small renal tumours. In. patients with solitary kidneys, it can safely preserve rend function and effectively treat malignancy

Early versus late rehabilitation of erectile function after nerve-sparing radical cystoprostatectomy: a prospective randomized study

To assess the value of early rehabilitation in patients who underwent nerve-sparing radical cystoprostatectomy based on a prospective randomized trial. Between March 2003 and March 2005, Twenty one patients underwent nerve-sparing [NS] cystoprostatectomy. Preoperative sexual Junction of all patients was evaluated by International Index of Erectile function questionnaire [IIEF] and penile Duplex ultrasound [PDU]. Patients who did not recover spontaneous erection at the 2[nd] month postoperatively were randomly divided into 2 groups; Group [1] received the erectogenic therapy at the 2[nd] month postoperatively and group [2] started it at the 6[th]- month. The pharmacological therapy constitutes of sildenafil citrate 50mg twice weekly to be increased to 100mg if the patients did not obtained an adequate response. If this regimen failed we shifted to ICI of PGEI. The treatment continued for 6 months in both groups. The erectile function status was evaluated at the end of the treatment program by IIEF questionnaire and PDU. Three patients [14%] regained their spontaneous erection within 2 months postoperatively and the remaining 18 were divided randomly into two groups. Six out of nine [66.7%] patients recovered unassisted erection after treatment in the first group compared to 3 out of 9 [33.3%] patients in the second group. Two patients in the first group and 3 patients in the second group still needed sildenafil therapy on demand basis. The remaining 4 patients are still using ICI of PGEI on demand. At final evaluation, a significant improvement was found in the EF, the intercourse satisfaction and overall satisfaction domains [P=0.02, 0.03 and 0.02 respectively] in patients in the early rehabilitation group compared with those in late rehabilitation group. Regarding PDU findings, significant improvement in EDV was elicited in the early rehabilitation group compared with the pretreatment value [p=0.03]; however, this was not translated into a significant difference between both groups. Early rehabilitation provides good and rapid recovery of erectile function in patients managed by nerve-sparing radical cystoprostatectomy

Independent value of DNA ploidy as a prognostic indicator in patients with nonmetastatic renal cell carcinoma

Several studies performed on tumours from different organs have shown that DNA ploidy is art additional predictor for survival. However the significance of DNA ploidy as an independant prognostic for patients with renal cell carcinoma [RCC] is less clear. Therefore purpose of this study is to assess if DNA flow cytometry data in RCC valuable prognostic information. One hundred sixty-eight consecutive patients were selected from 226 patients with RCC who underwent nephrectomy at our institution between 1983 and 1995. All patients were free of metastatic or locally irresectable disease preoperatively. DNA content was analysed by flow-try. DNA ploidy of the tumour tissue was compared with tumour pathologic stage [TNM 1997], grade, histological subtypes and disease related survival rates. Different prognostic factors were studied us-both univariate and multivariate analyses. Of the 168 tumours analysed, 92 [54.8%] displayed diploid and 76 [45.2%] had aneuploid pattern. Statistical correlations were between DNA ploidy pattern and each of tumour size, stage and grade. Significant high incidence of tumour recurrence was observed among patients with aneuploid tumours [46%] when compared with that diploid population [17, 4%] [P<0.001]. According to univariate analysis, tumour size, stage, grade and DNA ploidy had significant impact on patients outcome. On rnultivariate analysis, DNA ploidy in addition to tumour stage and grade were sign4ftcant independent prognostic factors. DNA ploidy is a reliable prognostic factor for RCC and yields considerable information for patient management and predicting clinical outcome

placebo-controlled double-blind study of tadenan the treatment of benign prostatic obstruction

This study was carried out to report the experiment with tadenan [a plant extract of Pygeum africanum] in the treatment of men with symptomatic benign prostatic hyperplasia [BPH]. 100 patients with symptomatic BPH were enrolled into this study. In a double-blind prospective randomized manner, the patients were divided into 2 equal groups receiving either Tadenan 25 mg or an identical-looking placebo. The patients were asked to take 2 capsules at morning and evening for 8 weeks. The patients were assessed by calculation of symptom score, physical examination, uroflowmetry tests, measurement of post-voiding residual urine and transrectal ultrasonography. These studies were performed before treatment, at the end of the 8-week course of treatment and 8 weeks after treatment. If compared with pretreatment values, patients of both Tadenan and placebo groups showed a significant improvement in the total Boyarsky score, a significant increase in the peak flow rate, and a significant reduction in the post voiding residual urine. However, the changes in all of these parameters were comparable in patients of both groups at the end of the treatment and 8 weeks after treatment. The prostatic weight showed no change after treatment in both groups