Significance of nuclear factor - kappa beta activation on prostate needle biopsy samples in the evaluation of Gleason score 6 prostatic carcinoma indolence.

Background The goal of our study was to find out whether the immunohistochemical expression of nuclear factor-kappa beta (NF-κB) p65 in biopsy samples with Gleason score 3 + 3 = 6 (GS 6) can be a negative predictive factor for Prostate cancer (PCa) indolence. Patients and methods Study was conducted on a retrospective cohort of 123 PCa patients with initial total PSA ≤ 10 ng/ml, number of needle biopsy specimens ≥ 8, GS 6 on biopsy and T1/T2 estimated clinical stage who underwent laparoscopic radical prostatectomy and whose archived formalin-fixed and paraffin-embedded (FFPE) prostate needle biopsy specimens were used for additional immunohistochemistry staining for detection of NF-κB p65. Both cytoplasmic and nuclear NF-κB p65 expression in biopsy cores with PCa were correlated with postoperative pathological stage, positive surgical margins, GS and biochemical progression of disease. Results After follow-up of 66 months, biochemical progression (PSA ≥ 0.2 ng/ml) occurred in 6 (5.1%) patients, 3 (50%) with GS 6 and 3 (50%) with GS 7 after radical prostatectomy. Both cytoplasmic and nuclear NF-κB p65 expressions were not significantly associated with pathological stage, positive surgical margin and postoperative GS. Patients with positive cytoplasmic NF-kB reaction had significantly more frequent biochemical progression than those with negative cytoplasmic NF-kB reaction with PSA 0.2 ng/ml as cutoff point (p = 0.015) and a trend towards more biochemical progression with PSA ≥ 0.05 ng/ml as cutoff point (p = 0.068). Conclusions Cytoplasmic expression of NF-κB is associated with more biochemical progression and might be an independent prognostic factor for recurrence-free survival (RFS), but further studies including larger patient cohorts are needed to confirm these initial results.

Tissue ischemia due to CO2 pressure during laparoscopic radical prostatectomy.

Laparoscopic radical prostatectomy is nowadays one of the most frequently performed urological surgical procedures. For insufflation in laparoscopic radical prostatectomy (LRP) CO2 is used, with the pressure in the operative region between 12 and 15 mm Hg. At the microcirculation level, the pressure is lower, which raises the possibility of ischemic tissue damage during the procedure. The activity of glutathione peroxidase (GSH-px), superoxide dismutase (SOD) and catalase (CAT) was measured at the beginning and immediately after the end of the surgery in 44 patients who underwent LRP and in 11 who underwent retropubic radical prostatectomy (RRP). Capillary endothelial damage was assessed by applying immunohistochemical and morphometric methods to tissue samples from the urinary bladder neck, which contains all layers of the bladder wall. Measurement of the enzyme activity showed no significant increase of GSH-px (p-0.431), SOD (p-0.220) and CAT (p-0.434) levels. Neither immunohistochemical analysis of the bladder neck capillaries with i-nitric oxide synthase (i-NOS) nor morphometric analysis showed signs of endothelial ischemic damage.

Is laparoscopic nephropexy improving the quality of life.

Short- and long-term effectiveness of laparoscopic nephropexy was evaluated in patients with symptomatic nephroptosis especially quality of life of the patients and repositioning of the ptotic kidney. In 87 patients with symptomatic nephroptosis laparoscopic nephropexy was performed from 1994 to 2003. In 86 patients trans-abdominal approach was used and retroperitoneal in one patient. Visual pain scale was used for pain evaluation before surgery and six month after surgery. At the same period creatinine serum concentration, urine examination, i.v. urography and ultrasound in supine and erect position was made. There was statistical significant decrease of pain from 6.5 +/- 1.055 (SD) to 2.4 +/- 1.577 (SD) (p = 0.000), according to visual scale, and decrease of urinary tract infections (p = 0.000) in patients after laparoscopic nephropexy. Average operative time was 45.9 +/- 8 (SD) min., and hospital stay 3.4 +/- 0.7 (SD) days. Reposition of the kidney was successful in 70 of 80 patients. Laparoscopic nephropexy importantly improved the quality of life in patients with symptomatic nephroptosis. Surgical procedure was safe and successful in most of the patients.

Laparoscopic radical prostatectomy--analysis of our first 100 consecutive cases.

The aim of this study was retrospective study of our first 100 consecutive cases of prostatic cancer, operated by laparoscopic approach and comparison with 100 cases of open retropubic radical prostatectomy (RRP) at our department, focusing on operative data and morbidity. From June 1999 to August 2003 we have performed first consecutive 100 laparoscopic radical prostatectomies (LRP), all according to Montsouris technique. In this study we have compared the results with 100 patients who underwent from May 1997 to August 2003 open RRP. Mean operative time was shorter after RRP (155 vs. 234 min, p = 0.018). Mean blood loss was significantly lower in LRP group (446 vs. 710 ml, p < 0.001). Mean catheter duration time (6.4 vs. 10 days, p < 0.001) and hospital stay (8.6 vs. 11 days, p < 0.001) were significantly shorter in LRP group. There was no statistically significant difference in complication rate in both groups (p = 0.139). Laparoscopic radical prostatectomy is a safe procedure for the patient and complications do not appear more often than in the open operation. In LRP we detected shorter mean catheter duration time, shorter hospital stay and less blood loss. This procedure demands perfect knowledge of the laparoscopic operative technique and due to long-term learning curve, the procedure could be done only in particular centers, where exist suitable equipment and also experienced operators in laparoscopic technique.