Lymphovascular invasion is significantly associated with biochemical relapse after radical prostatectomy even in patients with pT2N0 negative resection margin.

BACKGROUND: The significance of lymphovascular invasion (LVI) remains controversial, and the association of LVI with biochemical relapse was investigated in men treated with radical prostatectomy according to pathological results. METHODS: Data from 1268 patients undergoing radical prostatectomy between 2000 and 2009 were retrospectively reviewed. Clinicopathological variables were compared between LVI-negative and LVI-positive patients. Multivariate analyses by Cox proportional hazard model and Kaplan-Meier method were performed to identify risk factors for biochemical relapse in all patients, patients with pT2N0 and pT2N0 negative resection margin (RM). RESULTS: LVI information was available in 1160 cases, and LVI was seen in 121 cases (10.4%). Clinicopathological variables were significantly worse in LVI-positive patients than in LVI-negative patients. On multivariate analyses, PSA⩾10 ng ml(-1), pathological Gleason score ⩾8, pathological T stage ⩾3, lymph node metastasis, positive RM and LVI were independent predictors for biochemical relapse in all patients. In patients with pT2N0, PSA⩾10 ng ml(-1), pathological Gleason score ⩾8, positive RM and LVI were independent predictors for biochemical relapse. In patients with pT2N0 negative RM, LVI and pathological Gleason score ⩾8 were independent predictors for biochemical relapse (LVI; hazard ratio 3.809, 95% confidence interval 1.900-7.635, P-value<0.001, Gleason score ⩾8; hazard ratio 2.189, 95% confidence interval 1.199-3.999, P-value=0.011). With a median follow-up of 50 months, 5-year biochemical relapse-free survival in patients with pT2N0 negative RM was 95.7% in those with negative LVI in comparison to 85.3% in those with positive LVI (P<0.001, log rank). CONCLUSIONS: LVI was consistently a significant predictor for biochemical relapse after radical prostatectomy in not only all patients but also in patients with pT2N0 and pT2N0 negative RM. These results strongly support the significance of LVI as a predictor for biochemical relapse.

Impact of body mass index on clinicopathological outcome and biochemical recurrence after radical prostatectomy.

BACKGROUND: Accumulating evidence suggests that obesity is associated with tumor progression in prostate cancer (PCa) patients after radical prostatectomy (RP). We conducted a retrospective multicenter study to determine the effect of body mass index (BMI) on the clinicopathological characteristics and biochemical recurrence of PCa in Japanese men who underwent RP. METHODS: The medical records of 1257 men with PCa treated by RP without neoadjuvant therapy at four medical institutes between 2001 and 2009 were retrospectively reviewed. Patients were categorized into four groups using the World Health Organization (WHO) BMI classification and BMI quartiles. Associations of the various BMI categories with clinicopathological characteristics and biochemical recurrences were statistically evaluated. Biochemical recurrence was defined as a PSA level of >0.2 ng ml(-1). RESULTS: Of the 1257 patients, 230 (18.3%) experienced biochemical recurrence during the median follow-up period of 49 months. The median BMI was 23.8 kg m(-2), and 1.4% patients were underweight, 65.4% were of normal weight, 30.9% were overweight and 2.4% were obese (WHO classification). Preoperative PSA levels and PSA density (PSAD) tended to decrease as BMI increased. Pathological characteristics did not differ significantly among BMI categories. As per the WHO classification and quartile categories, biochemical recurrence rate was comparable among the BMI groups. After adjusting for other pre- and postoperative covariables, multivariate Cox proportional hazards analysis revealed that a high BMI did not have an independent impact on biochemical recurrence-free survival. CONCLUSIONS: Underweight Japanese PCa patients treated by RP had higher preoperative PSA levels and PSAD. High BMI was not associated with adverse pathological findings or increased biochemical recurrence rate in Japanese PCa patients treated with RP. Racial differences may exist in the relationship between obesity and outcomes of RP in PCa patients.

Intraoperative electrical stimulation of the pelvic splanchnic nerves during nerve-sparing radical hysterectomy.

OBJECTIVES: This study sought to determine whether intraoperative electrical stimulation (IES) of pelvic splanchnic nerves (PSNs) while monitoring bladder contraction was useful to predict postoperative bladder function during conventional nerve-sparing radical hysterectomy. METHODS: Seventeen patients with stage Ib or IIa cervical cancer underwent conventional radical hysterectomy. IES was performed in all cases, stimulating the roots of PSN, the posterior sheath of the vesicouterine ligament (PVL) and the dorsal area of the ligament. After resection of the uterus, the PSN roots were stimulated again. Bladder function was evaluated by urodynamic study (UDS) preoperatively and 3 months after surgery. RESULTS: The results of IES were consistent with bladder function evaluated by postoperative UDS. In 13 of 17 cases, an increased intravesical pressure was observed with IES of the PSN roots after uterus resection. Nine of 13 cases showed marked detrusor contraction with UDS 3 months after surgery and were able to void without using abdominal pressure except in one case. In the remaining 4 of 17 cases, no response could be detected to IES on either side. Three cases voided using abdominal pressure and one used clean intermittent self-catheterization without spontaneous voiding. CONCLUSIONS: IES while monitoring intravesical pressure during radical hysterectomy represents a technically simple and useful procedure for the prediction of postoperative bladder function.

[Bulbocavernosus reflex induced by bladder filling in a neurogenic bladder patient due to spinal arteriovenous malformation. A case report].

A 59-year-old man with spinal arteriovenous malformation at L-1 level was referred to our clinic for urinary retardation and urinary protraction. Bulbocavernosus reflex (BCR) was performed at empty bladder and at the storage phase during cystometry. BCR was evoked by compressing the glans penis. The evoked reflexes were examined by palpatating the contractile responses of the bulbocavernosus muscle and bipolar surface electrodes on each side of para-perineal raphe. Evoked response of BCR couldn't be detected at empty bladder, but obvious responses of BCR were detected at about 300 ml bladder filled. For further evaluation, a concentric needle electrode was inserted into the periurethral striated muscle to examine the evoked potential of BCR. The responses were unstable at empty bladder, but stable evoked potentials were obtained at storage phase. BCR performed only at empty bladder may cause false negative result.

[Improved gastric patch method for esophagocardioplasty in esophageal achalasia].

We performed esophagocardioplasty with the gastric patch (original GP) as the treatment of first choice in patients with esophageal achalasia. However, postoperative reflux esophagitis occurred in many due to secretory dysfunction of the gastric mucosa implanted in the mediastinum. We therefore developed two modifications of the gastric patch technique (GP II and GP III) which do not involve implantation of the gastric mucosa in the esophagus. Twenty-three patients have undergone the modified GP II procedure in our institution. Postoperative changes in the esophagus were examined fluoroscopically, and it was found that esophageal diameter increased from an average 2.9 +/- 0.6 cm to 5.2 +/- 1.0 cm at an average follow-up of 7.1 months (p < 0.01). All 23 patients experienced amelioration of symptoms, even though some reddening was still present in the lower esophagus, with a maximum follow-up of 8 years. Based on these results, the modified GP procedures are an acceptable open surgery modality for esophagocardioplasty in esophageal achalasia.

[Electromyographic study of the striated urethral sphincter by using the bulbocavernosus reflex: study on change of sacral reflex activity caused by bladder filling].

PURPOSE: The change of sacral reflex activity of the striated urethral sphincter in the urine storage phase is investigated using evoked potential reaction of the bulbocavernosus reflex (BCR). METHODS: Eleven normal male subjects and 13 male patients with neurogenic bladder due to suprasacral (C3-C7) spinal cord injury (SCI patients) were investigated. Within the SCI patients, five were complete SCI and 8 were incomplete SCI. BCR was elicited by electrical stimulation of dorsal nerve of the penis, and the evoked potential of the BCR was recorded with a concentric needle electrode from the periurethral striated muscle. BCR was performed both at empty and at filled bladder respectively, and changes of the amplitudes (AMP) were examined. Moreover, the changes of AMP affected by bladder filling were compared between the normal subjects and the SCI patients. RESULTS: In both the normal subjects and the SCI patients, AMP increased at the filled bladder as compared with that of the empty bladder. In addition, the change of AMP was statistically bigger in the SCI patients (a ratio of amplitude at filled bladder/amplitude at empty bladder: 4.73 +/- 3.90) than in the normal subjects (the ratio: 1.32 +/- 0.44). CONCLUSION: Sacral reflex activity was accelerated by bladder filling in both the normal subjects and SCI patients. And the acceleration in the SCI patients was more remarkable than that in the normal subjects. In addition to the conventional evaluation of the integrity of sacral reflex arc by BCR examination, the observation of changes of BCR affected by bladder filling may provide the information for the continuity of sacral segment and supraspinal micturition center.

[Urinary disturbance in olivopontocerebellar atrophy (OPCA)--changes during the progression of the disease].

PURPOSE: Among spinocerebellar degeneration, syndromes categorized as multiple system atrophy (MSA) are commonly associated with neurogenic bladder, and urinary disturbances change with the disease progression. Accordingly, the changes in the urodynamic findings during the progression of the disease have been studied in the case of Olivopontocerebellar atrophy (OPCA) and OPCA type of MSA. METHODS: Urodynamic study (UDS) was performed more than twice in eight patients (5 males, 3 females, age 48-76, mean 55.0). The interval range between the first examination and follow up examination was 9-93 months (mean 42.4). UDS included cystogram, intravenous pyelography, residual urine volume, cystometry, urethral pressure profilometry, and external sphincter electromyography. RESULTS: The bladder was deformed in almost all patients with the progression of the disease, but the upper urinary tract was properly preserved. Residual urine volume tended to increase, and residual urine rate worsened significantly. The stable detrusor activity seemed to become overactive accompanied by detorusor hyperreflexia, and finally seemed to be acontractile. The normal sphincter activity seemed to become overactive accompanied by detrusor-sphincter dyssynergia, and finally complete relaxation could't be observed. CONCLUSION: These results suggest that urinary disturbance deteriorates together with other neuropathies as the disease progresses in OPCA. These patients should be continuously observed along with proper urinary management depending on the disease progression.

[Electromyographic study of the striated urethral sphincter by using the bulbocavernosus reflex: study of the normal voluntary voiding and the involuntary sphincter relaxation].

PURPOSE: The aim of this study was to investigate the sacral reflex activity at the striated urethral sphincter relaxation by evoking the potential of the bulbocavernosus reflex (BCR). METHODS: 17 normal male subjects were investigated. BCR was elicited by electrical stimulation of dorsal nerve of the penis, and the evoked potential of the BCR (BCR-EP) was recorded by a concentric needle electrode at the periurethral striated muscle. In normal subjects BCR was performed at rest and during voluntary voiding. In 8 of the normal subjects electrical stimulation was increased gradually during voluntary voiding, and changes of BCR-EP were studied. 3 male patients with neurogenic bladder suffering from urinary incontinence caused by involuntary sphincter relaxation (IVSR) were also investigated. In these patients with neurogenic bladder, BCR was performed at rest and during voluntary voiding as well as during involuntary voiding. RESULTS: In the normal subjects stable BCR-EP was elicited at rest and disappeared during voluntary voiding. But a gradually increased larger stimulation clearly demonstrated BCR-EP during voluntary voiding. In 3 patients with neurogenic bladder, stable ECR-EP was elicited at rest. During involuntary voiding caused by IVSR obvious BCR-EP was also elicited, but its amplitude was slightly less than the amplitude of BCR-EP at rest. During voluntary voiding in 2 of the 3 patients BCR-EP was recognized but the amplitude was much less, and in the third patient BCR-EP could not be recognized. CONCLUSION: BCR-EP was suppressed during voluntary voiding in normal subjects, but insufficiently suppressed in the patients with neurogenic bladder. In these patients BCR-EP during voluntary voiding was suppressed more distinctly than BCR-EP during involuntary voiding due to IVSR. In urodynamic study, the detrusor contraction and the sphincter relaxation were common phenomenon in both voluntary voiding and involuntary voiding, but the difference in the degree of the BCR suppression depended on whether micturition was voluntary or involuntary. It was suggested that the measurement of BCR-EP could distinguish involuntary voiding caused by pathological urethral sphincter relaxation from voluntary voiding.

Somatosensory evoked magnetic fields elicited by dorsal penile, posterior tibial and median nerve stimulation.

The aim of this study is to localize the primary sensory cortex of urogenital organs in the human brain. Using a newly developed MRI-linked magnetoencephalography system, we measured somatosensory evoked magnetic fields (SEFs) for unilateral stimuli on the dorsal penile nerve (DPN), posterior tibial nerve (PTN) and median nerve (MN). In five healthy male subjects, SEFs were clearly observed. Peak latency of the first cortical components were 63.8 +/- 9.2 ms for DPN, 39.8 +/- 3.0 ms for PTN and 20.7 +/- 0.7 ms for MN stimuli. Peak amplitude of the first cortical components were 63.1 +/- 10.8 fT for DPN, 160.2 +/- 50.1 fT for PTN and 335.2 +/- 70.3 fT for MN stimuli. Isofield map for the peak latencies indicated a single dipolar pattern for DPN as well as for PTN and MN stimuli. Using a single current dipole model, all SEF sources were localized on the contralateral central sulcus to the stimuli, indicating the primary sensory cortex. The DPN sources were localized on the interhemispheric surfaces, corresponding to previous speculations by direct cerebral stimulation. This non-invasive SEF technique promises further brain functional mapping for the urogenital organs.

The effect of magmatic activity on hydrothermal venting along the superfast-spreading East pacific rise.

A survey of hydrothermal activity along the superfast-spreading (approximately 150 millimeters per year) East Pacific Rise shows that hydrothermal plumes overlay approximately 60 percent of the ridge crest between 13 degrees 50' and 18 degrees 40'S, a plume abundance nearly twice that known from any other rige portion of comparable length. Plumes were most abundant where the axial cross section is inflated and an axial magma chamber is present. Plumes with high ratios of volatile ((3)He, CH(4), and H(2)S) to nonvolatile (Mn and Fe) species marked where hydrothermal circulation has been perturbed by recent magmatic activity. The high proportion of volatile-rich plumes observed implies that such episodes are more frequent here than on slower spreading ridges.