Resistance Exercise Training Increases Muscle Mass and Strength in Prostate Cancer Patients on Androgen Deprivation Therapy.

PURPOSE: This study aimed to assess the effects of 20 wk resistance exercise training with or without protein supplementation on body composition, muscle mass, muscle strength, physical performance, and aerobic capacity in prostate cancer patients receiving androgen deprivation therapy (ADT). METHODS: Sixty prostate cancer patients receiving ADT were randomly assigned to perform 20 wk of resistance exercise training with supplementation of 31 g whey protein (EX + PRO, n = 30) or placebo (EX + PLA, n = 30), consumed immediately after exercise and every night before sleep. A separate control group (CON, n = 36) only received usual care. At baseline and after 20 wk, body composition (dual-energy x-ray absorptiometry), muscle mass (computed tomography scan), muscle strength (1-repetition maximum strength tests), physical performance (Timed Up and Go Test, 30-Second Chair Stand Test, and Stair Climb Test), aerobic capacity (cardiopulmonary exercise test), and habitual dietary intake (food diary) were assessed. Data were analyzed using a two-factor repeated-measures ANOVA. RESULTS: Over time, muscle mass and strength increased in EX + PRO and EX + PLA and decreased in CON. Total fat mass and fat percentage increased in EX + PRO and CON, but not in EX + PLA. Physical performance did not significantly change over time in either group. Aerobic capacity was maintained in EX + PLA, but it decreased in EX + PRO and CON. Habitual protein intake (without supplements) averaged >1.0 g·kg body weight -1 ·d -1 , with no differences over time or between groups. CONCLUSIONS: In prostate cancer patients, resistance exercise training counteracts the adverse effects of ADT on body composition, muscle mass, muscle strength, and aerobic capacity, with no additional benefits of protein supplementation.

Endoscopic Transvesical Adenomectomy of the Prostate, a New Minimal Invasive Approach for Large Benign Prostate Hyperplasia. A Description of the Technique and the Results of the First 40 Patients.

OBJECTIVE: The objective of this study is to present the results in the first 40 patients treated with a new minimal invasive technique in the treatment of large-volume benign prostate hyperplasia: the endoscopic transvesical adenomectomy of the prostate (ETAP). PATIENTS AND METHODS: From 2014 to 2016 we performed the ETAP in 40 patients with large volume benign prostate hyperplasia (>80 cc). The mean volume on ultrasound was 117 cc. The mean baseline Qmax was 8.1 ml/s and the International Prostate Symptom Score was 20.5. Seventeen patients (43%) had a urinary retention preoperatively. A cystotomy through a small infraumbilical incision was performed and a camera port was placed through the bladder dome. A pneumovesicum was created and 2 instrument ports were placed into the bladder. The prostate was transected and removed in 1 piece through the umbilical incision. RESULTS: The operation was completed in all 40 patients, without need for conversion. The mean operation time was 102 minutes with a mean blood loss of 185 ml. The average hospital stay was 5 days. There were no grade V complications and 1 grade IV complication. The transfusion rate was 2.5%. After the procedure, all 40 patients were able to void spontaneous. The Qmax increased to 21.2 ml/s (+13.1 ml/s) and the International Prostate Symptom Score decreased to 7.5 (-13 pts). CONCLUSION: This study shows that the ETAP is a feasible, safe, and truly minimal invasive procedure. The functional outcomes are promising as well. We believe the ETAP is good alternative to open surgery.

Neurophysiological testing to assess penile sensory nerve damage after radical prostatectomy.

INTRODUCTION: Radical prostatectomy (RP) can lead to erectile dysfunction due to surgical injury of the cavernous nerves. However, there is no simple, objective test to evaluate cavernous nerve damage caused by RP in clinical practice. AIM: To assess the value of the measurement of penile thermal and vibratory sensory thresholds to reflect cavernous nerve damage caused by RP. METHODS: We included 42 consecutive patients who underwent RP with cavernous nerve sparing (laparoscopic approach, N = 12) or without cavernous nerve sparing (laparoscopic, N = 13; retropubic, N = 11; or transperineal, N = 6). Penile thermal (warm and cold) and vibratory sensory thresholds were measured twice, together with the Erectile Dysfunction Symptom Score (EDSS), 1 month before and 2 months after RP. MAIN OUTCOME MEASURES: Penile sensory thresholds for warm, cold, and vibration sensations. RESULTS: Penile sensory thresholds for warm (P < 0.0001) and cold (P < 0.0001) sensations significantly increased after non-nerve-sparing RP, but not after nerve-sparing RP. Vibration threshold only increased after transperineal non-nerve-sparing RP (P = 0.031). EDSS values were significantly increased in all groups of patients 2 months after surgery. CONCLUSIONS: Sensory nerve fibers carrying penile skin sensations travel with the cavernous nerves in the pelvis. Therefore, testing these sensations may help to evaluate the extent of cavernous nerve damage caused by RP. In this series, post-operative changes in penile sensory thresholds differed with the surgical technique of RP, as the cavernous nerves were preserved or not. The present results support the value of quantitative penile sensory threshold measurement to indicate RP-induced cavernous nerve injury.

How do different tests evaluate sensation in the lower urinary tract?

OBJECTIVE: Different tests can be used to evaluate lower urinary tract (LUT) sensation. The purpose of this study is to compare sensory tests in patients with voiding disorders. MATERIAL AND METHODS: Seventy patients with various functional disorders of the LUT were admitted for a cystometry and an electrical perception threshold test of the bladder (bEPT) and distal urethra (uEPT). A pudendal EPT (pEPT) and pudendal somatosensory evoked potentials (pSSEP) were also determined. Correlations were calculated for somatosensory (uEPT, pEPT and pSSEP latency) and viscerosensory tests (volumes at filling sensations and bEPT). RESULTS: Fifty of the 70 patients (71%) had normal bladder filling sensations, with abnormal bEPT in 21/50 (41%), including 11 (22%) with no sensation at maximal electrical stimulation. Twenty out of 70 (29%) had an abnormal pattern of filling sensation, with increased bEPT in 13/20 (65%) and no sensation at electrical stimulation in 8/13 (40%). No significant correlation exists between filling sensation and bladder electrical perception thresholds (r < 0.005, p > 0.243). pEPT correlated with uEPT and SSEP (r > 0.035, p < 0.041). CONCLUSIONS: In patients with functional voiding disorders, the EPT can be disturbed independently of the bladder filling sensation. No significant correlation exists between volumes of filling sensations and bEPT (r < 0.005, p > 0.243). Therefore, both tests provide complementary information. Somatosensory tests of the pudendal nerve are correlated, so performing SSEP, pEPT and uEPT provides poor additional information to one of these tests alone. Somatosensory pudendal tests cannot be used to quantify filling sensation.

Predicting tumour location in radical prostatectomy specimens: same-patient comparisons of 21-sample versus sextant biopsy.

OBJECTIVE: To determine the value of a 21-sample biopsy protocol in predicting tumour localization in radical prostatectomy (RP) specimens, compared with sextant biopsies. PATIENTS AND METHODS: In all, 300 consecutive patients underwent 21-sample prostate biopsies, followed by RP. The protocol consisted of sextant, three midline, six far lateral and six transitional zone biopsies. Tumour locations on biopsies and RP specimens were compared. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV) and accuracy were calculated. RESULTS: There was no difference between sextant and 21-sample biopsies for sensitivity (38% vs 36%; P=0.50) and specificity (84% vs 87%; P=0.46), but the NPV was higher for 21-sample biopsies (57% vs 68% ; P<0.001). The PPV was higher in the sextant biopsies (74% vs 59%; P=0.007). Sextant, transitional zone and far lateral biopsies were re-grouped in six regions. Compared with 21-sample biopsies, sensitivity (54%) and PPV (79%) were higher (P<0.001), while specificity (74%) and NPV (46%) were lower (P=0.05 and P=0.001, respectively). CONCLUSION: A negative biopsy does not confirm the absence of cancer in the corresponding site in the RP specimen in a sextant or 21-sample biopsy protocol and cannot be used as a prognostic element before RP. A positive biopsy does not always correspond with a tumour in the same zone of the RP specimen. When 21-sample biopsies are re-grouped in to six regions, the value of a positive biopsy increases. A positive biopsy corresponds thus to a tumour in the same region, rather than in precisely the same location. The results of this study could help in the biopsy protocol used for making surgical decisions, e.g. preserving the bladder neck or neurovascular bundles.

Healthy, middle-aged, history-free, continent women--do they strain to void?

PURPOSE: We evaluated to what extent abdominal straining is used for voiding in an asymptomatic, continent, healthy, middle-aged female population. MATERIALS AND METHODS: A total of 32 women (mean age 49 +/- 6 years old) could be prospectively included. Technical investigations consisted of flowmetry, pressure flowmetry with EMG and electrosensation evaluation. Some data were compared with those of stress incontinent women investigated prospectively in the same way. RESULTS: There were 4 women who were excluded from analysis because of abnormal sensory evaluation. The symptom-free participants voided with low detrusor pressure, a high flow rate and no residual. A large segment (42%) used additional abdominal straining to void on cystometry and reported that such straining was their usual habit for voiding at home. Straining was seen as frequent in women with stress incontinence. However, significantly more women with stress incontinence used straining without detrusor contraction. CONCLUSIONS: These healthy middle-aged women without a history of pelvic surgery, or symptoms or signs of urological, anorectal or gynecological problems, voided with a mean Pdetmax of 25 cm H(2)O, mean Qmax of 29 ml per second, and the majority without residual. Many of them strained during detrusor contraction and this had not led to the development of signs or symptoms. The way straining is done may make the difference in that during reflex bladder contraction and urethral relaxation, additional straining may have little negative effect. If straining is used to void without the initiation of the micturition reflex, voiding dysfunction and incontinence might develop more easily.

Systemic oxybutynin decreases afferent activity of the pelvic nerve of the rat: new insights into the working mechanism of antimuscarinics.

AIMS: In a rat model, intravesical oxybutynin was recently shown to suppress pelvic afferent nerves. This study evaluates if a similar effect exists after systemic administration of oxybutynin. METHODS: Twenty-four single afferent bladder nerves were identified in 15 rats. Based on their conduction velocities they were grouped as C or Adelta fibers. Bladder filling parameters and afferent nerve spike rate were simultaneously recorded 30 min before administration of saline (nine fibers) or oxybutynin (15 fibers, 1 mg/kg), and again 30, 60, 90, 120, and 150 min after systemic saline or drug administration. RESULTS: No change in C or Adelta afferent spike rate was observed after saline injection (P > 0.90). In the study group, a decrease in afferent activity was noted after systemic administration of oxybutynin for C fibers, which were statistically significant 90 (P < 0.004) and 120 min (P < 0.028) after drug delivery. After 150 min, the spike rate was still lower compared to the baseline filling, without reaching the level of significance (P > 0.09). For the Adelta fibers the decrease in afferent spike rate was already significant at 30 min (P < 0.005) and remained significant during all subsequent fillings (P < 0.012). To avoid a possible confounding influence of the bladder compliance, which increased significantly after injection of oxybutynin (P < 0.011), afferent activity during bladder filling was recalculated. Normalized afferent sensitivity of C and Adelta fibers decreased significantly after injection of oxybutynin. This means that the decrease in afferent spike rate is not the result of an increased compliance. CONCLUSIONS: The findings of this study strongly suggest that oxybutynin directly or indirectly influences bladder sensory nerves, inhibiting the afferent part of the micturition reflex.

Does the cystometric filling rate affect the afferent bladder response pattern? A study on single fibre pelvic nerve afferents in the rat urinary bladder.

AIMS: To study the effect of physiological and supraphysiological filling rates on the response pattern of single fibre pelvic nerve afferents of the rat urinary bladder. MATERIALS AND METHODS: A total of 37 single afferent bladder units were identified electrophysiologically and their mechanosensitive properties studied. Afferent activity of 13 units was studied at filling rates of 40 and 200 microl/min. Afferent activity of the other units was studied at 200 and 400 microl/min. RESULTS: At the physiological filling rate of 40 microl/min two clearly different types of response pattern were noted. However, at higher supraphysiological filling rates, all units exhibited nearly the same pattern. The difference in mechanosensitive properties of the units that showed a change in response pattern at the supraphysiological filling rate, was characterized by a decrease in pressure at which afferent firing rate peaked. For all units it was found that an increase in filling rate induced an increase in the activation pressure threshold for afferent units, whereas the afferent firing rate at all pressures decreased. CONCLUSIONS: In rats supraphysiological filling rates delay afferent activation, lower afferent firing activity and even change the characteristics of some afferents completely. These data may elucidate some of the differences between ambulatory and conventional urodynamics observed in man.

Current perception thresholds in the lower urinary tract: Sine- and square-wave currents studied in young healthy volunteers.

AIMS: To establish normative current perception threshold (CPT) values with neuroselective sine-wave current in the lower urinary tract and to compare these values with square-wave current CPTs. MATERIALS AND METHODS: 10 female and 8 male healthy volunteers were used for this study. A filling cystometry was performed and CPTs were determined with square-wave current at a frequency of 2.5 Hz and with neuroselective sine-wave current at 5 (C-fiber), 250 (Adelta-fiber), and 2000 Hz (Abeta-fiber) in the bladder, the posterior, and the distal urethra. RESULTS: Bladder CPTs were significantly higher compared with CPTs in the posterior urethra (P < 0.028) and in the distal urethra (P < 0.002) with all three sine-wave frequencies. No significant difference was found with any sine-wave frequency between the posterior and distal urethra (P > 0.30). Using square-wave pulses at 2.5 Hz, CPTs decreased towards the distal urethra, with a significant difference between the three stimulation sites (P < 0.0001). At all sites tested, the CPT's determined with sine-wave current at 2000 Hz were significantly higher than those at 250 Hz (P < 0.002) and 5 Hz (P < 0.001). No significant difference was found between 5 Hz and 250 Hz at any site in the LUT (P > 0.50). At all sites, CPTs determined with square-wave pulses at 2.5 Hz were significantly higher than those determined with sine-wave current at all frequencies (P < 0.001). CPTs determined with all sine-wave currents were not correlated with CPTs using square-wave pulses. There was no correlation between the volumes at which sensation of filling occurred and the CPTs. CONCLUSIONS: We described normative values in young healthy volunteers at three sites in the LUT using sine-wave current. Although this type of current is said to be neuroselctive, this needs to be confirmed. Stimulation with sine-wave current is different and might be more physiologic compared to square-wave stimulation. Our data show that sine-wave current stimulation at 5 Hz, 250 Hz, and 2000 Hz can probably not be used as a semi-objective measurement of the sensation of bladder filling because no correlation was found between CPTs and the cystometeric sensation of filling.