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

Painful ejaculation; an underestimated sexual possible underlying serious etiology

Painful ejaculation, a previously an underestimated ejaculatory and sexual dysfunction, has gained increased attention being one of the significant sexual dysfunctions associating LUTS of BPH. Other underlying etiopathologic factors are not well studied, To study the underlying etiologic factors responsible for painful ejaculation in a group of patients having this symptom as the main complaint and the efficacy of different treatment modalities. Furthermore we want to test our hypothesis that in suspected cases of genital TB, it is better to search for it in semen rather than in urine. 60 male patients with painful ejaculation were enrolled in this study. Their mean age was 39,4 +/- 8.7 years while the mean duration of their complaint was 15.4 +/- 4.8 months. Patients were subjected to thorough history taking and physical examination including DRE. Patients were extensively investigated by urinalysis, urine culture, Ziehi Neelsen [Z,N.] staining and PCR for acid fast bacilli in both urine and semen ,semen culture, semen culture for TB, TRUS [ +/- biopsy] and/or cystoscopy when indicated in addition to PSA determination in all men above 50 years old. Associated symptoms were premature ejaculation, chronic prostatitis manifestations, ED, cystitis manifestations, infertility, partner dyspareunia or hemospermia in that order of frequency. Significant physical findings included BPH [15], epididymal mass[1], recurrent epididymoorchitis [1] scrotal sinus [1] and prostatic carcinoma [1], UTI was proved by urine culture in 20case with E-coli strains predominantly isolated. Urine PCR for TB was positive in 5 patients [13% sensitivity and 100% specificity] while same test in semen yielded astonishingly high incidence of TB in 40 patients [100% sensitivity and 91% specificity].Semen culture for TB confirmed its presence in 38 out of 40 PCR positive specimens. TRUS findings included calcular prostatitis [7], BPH [15], Prostatic adenocarcinoma [1], pathologic seminal vesicles [15],ejaculatory duct obstruction [3] and prostatic cysts [2]. Treatment of the underlying etiologies produced significant improvement of pain. Alpha blockers improved pain in 93% and 70% of BPH and chronic prostatitis patients respectively. Painful ejaculation may be an important indicator of a serious underlying disease such as prostatic carcinoma. In our locality genitourinary TB is prevalent among this group of patients. We introduce the application of PCR in semen as a highly sensitive and specific test which should be done whenever genitourinary TB is suspected as it showed better sensitivity than same test in urine. Alpha blockers proved effective in relieving painful ejaculation in BPH patients and to less extent in chronic prostatitis patients