ABSTRACT
University of Wisconsin (UW) solution is not optimal for preservation of marginal organs. Polyethylene glycol (PEG) could improve protection. Similarly formulated solutions containing either 15 or 20 g/L PEG 20 kDa or 5, 15 and 30 g/L PEG 35 kDa were tested in vitro on kidney endothelial cells, ex vivo on preserved kidneys, and in vivo in a pig kidney autograft model. In vitro, all PEGs provided superior preservation than UW in terms of cell survival, adenosine triphosphate (ATP) production, and activation of survival pathways. Ex vivo, tissue injury was lower with PEG 20 kDa compared to UW or PEG 35 kDa. In vivo, function recovery was identical between UW and PEG 35 kDa groups, while PEG 20 kDa displayed swifter recovery. At three months, PEG 35 kDa 15 and 30 g/L animals had worse outcomes than UW, while 5 g/L PEG 35 kDa was similar. PEG 20 kDa was superior to both UW and PEG 35 kDa in terms of function and fibrosis development, with low activation of damage pathways. PEG 20 kDa at 15 g/L was superior to 20 g/L. While in vitro models did not discriminate between PEGs, in large animal models of transplantation we showed that PEG 20 kDa offers a higher level of protection than UW and that longer chains such as PEG 35 kDa must be used at low doses, such as found in Institut George Lopez (IGL1, 1g/L).
Subject(s)
Endothelial Cells/drug effects , Kidney Transplantation , Organ Preservation Solutions/pharmacology , Organ Preservation/methods , Polyethylene Glycols/pharmacology , Reperfusion Injury/surgery , Adenosine/chemistry , Adenosine/pharmacology , Adenosine Triphosphate/metabolism , Allopurinol/chemistry , Allopurinol/pharmacology , Animals , Cell Hypoxia , Disease Models, Animal , Endothelial Cells/metabolism , Endothelial Cells/pathology , Glutathione/chemistry , Glutathione/pharmacology , Insulin/chemistry , Insulin/pharmacology , Kidney/drug effects , Kidney/metabolism , Kidney/pathology , Kidney/surgery , Kidney Function Tests , Male , Molecular Weight , Organ Preservation Solutions/chemistry , Primary Cell Culture , Raffinose/chemistry , Raffinose/pharmacology , Recovery of Function/physiology , Reperfusion Injury/metabolism , Reperfusion Injury/pathology , Swine , Transplantation, AutologousABSTRACT
BACKGROUND: Even though transurethral resection of the prostate remains the gold standard treatment for lower urinary tract symptoms (LUTS) refractory to medical therapy, photoselective vaporization of the prostate (PVP) has become a popular alternative. Early PVP studies seem encouraging, but few data exist regarding the effect of PVP on sexual function at long-term follow-up. OBJECTIVE: Our aim was to evaluate the impact of PVP on erectile function (EF) at long-term follow-up in men with LUTS due to benign prostatic hyperplasia (BPH). DESIGN, SETTING, AND PARTICIPANTS: One hundred forty-nine consecutive patients who underwent a prostate vaporization with the GreenLight laser performed by a single surgeon (FB) were prospectively enrolled in this study. INTERVENTION: All patients underwent PVP with the GreenLight laser performed by one experienced surgeon. MEASUREMENTS: All patients were evaluated by International Index of Erectile Function (IIEF-5) preoperatively and at 1, 3, 6, and 12 mo and then once a year. At each visit, the questionnaires were collected, and each patient's maximum flow rate and postvoid residual volume were measured with ultrasound. Biologic data were also collected at each visit, including prostate-specific antigen, creatinine, and bacterial urine culture. RESULTS AND LIMITATIONS: One hundred forty-nine patients were enrolled in the study. Median patient age was 74 yr. Urinary function was significantly improved over baseline in both men with normal or abnormal preoperative erectile function. Energy used was 255+/-129kJ. Hospitalization stay was 2.2+/-3.1 d. Other than a temporary difference at 1 yr, IIEF-5 scores were comparable preoperatively and postoperatively if we consider all the population. However, considering patients with preoperative IIEF-5 >19, the postoperative IIEF-5 scores were significantly decreased at 6, 12, and 24 mo. CONCLUSIONS: Sexual function appears to be maintained after PVP; however, in patients with normal preoperative EF, we showed a significant decrease in EF after PVP.
