Selenoprotein P in seminal fluid is a novel biomarker of sperm quality.

Hepatically-derived selenoprotein P (SePP) transports selenium (Se) via blood to other tissues including the testes. Male Sepp-knockout mice are infertile. SePP-mediated Se transport to Sertoli cells is needed for supporting biosynthesis of the selenoenzyme glutathione peroxidase-4 (GPX4) in spermatozoa. GPX4 becomes a structural component of sperm midpiece during sperm maturation, and its expression correlates to semen quality. We tested whether SePP is also present in seminal plasma, potentially correlating to fertility parameters. Semen quality was assessed by sperm density, morphology and motility. SePP was measured by an immunoluminometric assay, and trace elements were determined by X-ray fluorescence spectroscopy. SePP levels were considerably lower in seminal plasma as compared to serum (0.4±0.1 mg/l vs. 3.5±1.0 mg/l); Se concentrations showed a similar but less pronounced difference (48.9±20.7 µg/l vs. 106.7±17.3 µg/l). Se and Zn correlated positively in seminal fluid but not in serum. Seminal plasma SePP concentrations were independent of serum SePP concentrations, but correlated positively to sperm density and fraction of vital sperm. SePP concentrations in seminal plasma of vasectomized men were similar to controls indicating that accessory sex glands are a testes-independent source of SePP. This notion was corroborated by histochemical analyses localizing SePP in epithelial cells of seminal vesicles. We conclude that SePP is not only involved in Se transport to testes supporting GPX4 biosynthesis but it also becomes secreted into seminal plasma, likely important to protect sperm during storage, genital tract passage and final journey.

The interplay of dyadic and individual planning of pelvic-floor exercise in prostate-cancer patients following radical prostatectomy.

This study broadens the current understanding of the role of planning by focusing on the interplay between individual and dyadic planning (i.e. making plans about the target person's behaviour together with a partner). Self-report data from N=141 prostatectomy-patients and their partners were assessed at three times within 1 year post-surgery. Direct and indirect effects of dyadic and individual planning on patients' pelvic-floor exercise (PFE) were tested. Proposed mediators were social support, social control, and action control. Cross-sectionally, the dyadic planning-PFE relationship was mediated by patients' received support and partners' provided social control. Longitudinally, mediators of dyadic planning were partners' provided social control and support. Effects of individual planning on PFE were mediated by action control at baseline only. Also, at lower levels of individual planning, patients' dyadic planning was more strongly associated with receipt of social control. Results underscore the importance of social factors in the planning process and its mechanisms in health-behaviour change.

The dual-effects model of social control revisited: relationship satisfaction as a moderator.

The dual-effects model of social control states that receiving social control leads to better health behavior, but also enhances distress in the control recipient. Associated findings, however, are inconsistent. In this study we investigated the role of relationship satisfaction as a moderator of associations of received spousal control with health behavior and affect. In a study with five waves of assessment spanning two weeks to one year following radical prostatectomy (RP), N=109 married or cohabiting prostate-cancer patients repeatedly reported on their pelvic-floor exercise (PFE) to control postsurgery urinary incontinence and affect as primary outcomes, on received PFE-specific spousal control, relationship satisfaction, and covariates. Findings from two-level hierarchical linear models with repeated assessments nested in individuals suggested significant interactions of received spousal control with relationship satisfaction predicting patients' concurrent PFE and positive affect. Patients who were happy with their relationships seemed to benefit from spousal control regarding regular PFE postsurgery while patients less satisfied with their relationships did not. In addition, the latter reported lower levels of positive affect when receiving much spousal control. Results indicate the utility of the inclusion of relationship satisfaction as a moderator of the dual-effects model of social control.

Dyadic planning of health-behavior change after prostatectomy: a randomized-controlled planning intervention.

In this study, we investigated the role of dyadic planning for health-behavior change. Dyadic planning refers to planning health-behavior change together with a partner. We assumed that dyadic planning would affect the implementation of regular pelvic-floor exercise (PFE), with other indicators of social exchange and self-regulation strategies serving as mediators. In a randomized-controlled trial at a German University Medical Center, 112 prostatectomy-patients with partners were randomly assigned to a dyadic PFE-planning condition or one of three active control conditions. Questionnaire data were assessed at multiple time points within six months post-surgery, measuring self-reported dyadic PFE-planning and pelvic-floor exercise as primary outcomes and social exchange (support, control) and a self-regulation strategy (action control) as mediating mechanisms. There were no specific intervention effects with regard to dyadic PFE-planning or pelvic-floor exercise, as two active control groups also showed increases in either of these variables. However, results suggested that patients instructed to plan dyadically still benefited from self-reported dyadic PFE-planning regarding pelvic-floor exercise. Cross-sectionally, received negative control from partners was negatively related with PFE only in control groups and individual action control mediated between self-reported dyadic PFE-planning and PFE for participants instructed to plan PFE dyadically. Longitudinally, action control mediated between self-reported dyadic PFE-planning and pelvic-floor exercise for all groups. Findings provide support for further investigation of dyadic planning in health-behavior change with short-term mediating effects of behavior-specific social exchange and long-term mediating effects of better self-regulation.

Predictors of support provision: a study with couples adapting to incontinence following radical prostatectomy.

OBJECTIVES: Four domains of predictors of support provision were tested in couples facing an illness-related stress context. Predictor domains of partners' support provision to patients adapting to incontinence following prostatectomy included stress factors, recipient factors, provider factors, and relationship factors. METHODS: Data from 109 patients and their female partners were analysed. Couples provided data on five measurement occasions from 2 weeks to 1 year postsurgery. Predictors included patient's incontinence (stress factor), patient's support mobilization, affect and general self-efficacy (recipient factors), partner's affect and general self-efficacy (provider factors), partners' average waking time spent together, both partners' relationship satisfaction and partner's received support from patient (as an indicator of reciprocal support; relationship factors). RESULTS: Provider factors were not reliably associated with support provision, neither was patient negative affect. Stress and relationship factors accounted for outcome variance in the expected directions. Among recipient factors, mobilization of support and patient self-efficacy were positively related with the outcome, whereas patient positive affect was negatively associated with support provision by partners. CONCLUSIONS: Findings on predictor domains are in line with other couple studies that used non-illness-related stress contexts. Resemblance of findings points to generalizability of predictions across stress contexts varying in content, controllability, and duration.

Impact of fast-track postoperative care on intestinal function, pain, and length of hospital stay after laparoscopic radical prostatectomy.

BACKGROUND AND PURPOSE: Postoperative recovery of intestinal function, ability to ambulate, and effective pain management are main features to establish an effective fast-track surgery model. We investigated pain scores, ambulation rate, and recovery of intestinal function in a cohort of patients who were undergoing laparoscopic radical prostatectomy (LRP). PATIENTS AND METHODS: Fifty patients who underwent LRP in our institution were randomized to receive either conventional or fast-track postoperative care. Postoperative intestinal function was quantified by clinical signs of intestinal motility. Ambulation data were collected by means of step-count devices. Pain scores were measured by a visual analog scale. Overall satisfaction and additional measures to describe patient satisfaction with the clinical course were used as quality-of-life variables. RESULTS: Fast-track patients had significantly earlier propulsive intestinal motility without increased intestinal complications. Enforced mobilization led to a significantly shorter period to first deflation/defecation. Despite significantly increased ambulation rates in the fast-track group, these patients reported significantly less pain sentience during a significantly shorter hospital stay. Overall satisfaction was significantly higher in the fast-track cohort during the hospital stay. CONCLUSION: With the implementation of fast-track concepts for LRP, patients can be discharged to home earlier with fewer complications, lower pain scores, and an overall higher satisfaction with life.

Changes in reciprocal support provision and need-based support from partners of patients undergoing radical prostatectomy.

We examined need-related and reciprocal provision of support in couples facing radical prostatectomy and its sequelae, including patients' urinary incontinence. Partners' reciprocal support provision to patients was assumed to drop from prior to until after patients' surgeries and increase again in the following months, while need-related indicators were assumed to remain unique correlates throughout. In this study of German prostatectomy patients and their partners, N = 141 couples provided data on 4 measurement occasions from presurgery to 1-year postsurgery. Need-based predictors of partners' support provision were patients' mobilized support, such as efforts to obtain advice or comfort, and degree of postsurgery incontinence. Strength of association between partner-received and provided supports served as an indicator of reciprocal support provision. Data suggested that partners' reciprocal support provision dropped significantly postsurgery and then increased again in the following months. This was true for emotional as well as instrumental reciprocal support provision. Findings also indicated that one need-based predictor of partners' support provision, patients' mobilization of support from their partners, remained a unique correlate of partners' support provision to patients. Reciprocal support provision in couples may vary during the adaptation to illness-related functional impairment and coexist with need-oriented support provision.

Validation of a postoperative prognostic model consisting of tumor microvascular invasion, size, and grade to predict disease-free and cancer-specific survival of patients with surgically resected renal cell carcinoma.

OBJECTIVES: To determine the value of microvascular invasion, tumor size, and Fuhrman grade to predict the survival of patients with surgically resected renal cell carcinoma (RCC). METHODS: A total of 771 consecutive patients (T1-4, Nx, M0) were retrospectively reviewed. For each patient with RCC, the prognostic Sao Paulo score (SPS) was calculated using the following variables: tumor size (>7 cm vs

Relationship satisfaction and erectile functions in men receiving laparoscopic radical prostatectomy: effects of provision and receipt of spousal social support.

INTRODUCTION: Prostate carcinoma ranges among the most common cancers in German men. One of its standard treatments is radical prostatectomy (RP). Postoperative comorbidities of RP include erectile dysfunctions, which may impact patients' relationship quality. Little is known, to date, about patients' and their partners' psychosocial resources that might reduce the risk of damage to relationship outcomes. Such resources include spousal social support interactions. AIM: We investigated cross-sectional and prospective relations of patient-reported and partner-reported received and provided spousal support, and patients' indicators of erectile functions and relationship satisfaction prior to and 1 year following laparoscopic radical prostatectomy. MAIN OUTCOME MEASURES: Patient-reported relationship satisfaction (Relationship Questionnaire; Fragebogen zur Partnerschaftsdiagnostik) and erectile functions (International Index of Erectile Function) were investigated as main outcomes. METHODS: One hundred thirty-nine patients and their heterosexual partners provided data prior to and 12 months after the operation. Main outcomes were patient-reported relationship satisfaction and erectile functions. In addition to several covariates, central predictors were patients' and partners' accounts of received and provided spousal support. Data were assessed using questionnaires. RESULTS: Erectile functions were associated with patients' relationship satisfaction presurgery, but not 12 months postsurgery. Patient-reported received and provided support was positively associated with relationship satisfaction at all times. Patient-reported provision of support was also related with better erectile functions prior to and postsurgery. Some of these associations could be replicated using partner accounts of respective support indicators. CONCLUSIONS: Regarding patients' relationship satisfaction and sexual functions, findings associate more consistent benefit with patients' own provision of supports when compared with their own support receipt.

Effects of received and mobilized support on recipients' and providers' self-efficacy beliefs: a 1-year follow-up study with patients receiving radical prostatectomy and their spouses.

From a proactive agentic perspective, social support is not just seen as a protective cushion against environmental demands. Rather, support may facilitate an individual's self-regulation by enhancing perceived self-efficacy (i.e., enabling hypothesis). In the present study, patient-reported indicators of mobilized and received spousal support as predictors of their own and their spouses' self-efficacy beliefs were investigated within 1 year following radical prostatectomy. During this time frame, postoperative sequelae such as urinary incontinence and erectile dysfunctions are still likely to interfere with couples' everyday activities. Seventy-two patients receiving radical prostatectomy and their spouses participated. Patients' and spouses' self-efficacy beliefs and patients' received and mobilized spousal support were assessed prior to and 12 months following surgery. Additional patient-reported covariates at 1 year post-surgery were degree of bother by urinary incontinence, overall sexual satisfaction, and relationship satisfaction. Results indicated that patients' received spousal support was associated with higher levels of patients' self-efficacy only cross-sectionally, but not longitudinally. Support mobilized by the patient prior to and 1 year after surgery, however, positively predicted spouses' levels and changes in self-efficacy. Results, thus, did not fully confirm predictions by the enabling hypothesis of social support; rather, associated aspects, such as the degree of being mobilized as a provider of support or being needed, seem to enhance agency beliefs in spouses.

Effects of provision and receipt of social support on adjustment to laparoscopic radical prostatectomy.

Radical prostatectomy has a negative impact on prostate cancer patients' health-related quality of life (HRQoL). Social support may help patients adjust to their situation after surgery. We investigated patients' accounts of received social support as well as their spouses' accounts of provided social support as predictors of patients' HRQoL 6 months after surgery. Moreover, we tested whether patients with lower HRQoL at 2 weeks after surgery had the most benefit from spousal support. A total of 77 patients (M = 61.57 years, SD = 6.03) and their spouses (M = 58.46 years, SD = 7.52) completed questionnaires at 2 weeks and 6 months after laparoscopic radical prostatectomy. Received social support, spousal provided social support, and HRQoL were assessed 2 weeks after surgery, and HRQoL was assessed again 6 months later. Patients with lower HRQoL at 2 weeks after surgery benefited more from the receipt and their partners' provision of support in terms of HRQoL 6 months later than patients with a higher HRQoL at the beginning. Assessing patients' HRQoL might be one method to identify those individuals who are in special need of support from their spouses.

Worry, desire, and sexual satisfaction and their association with severity of ED and age.

INTRODUCTION: This study evaluates worry about sexual and relationship functioning, sexual desire, and sexual satisfaction as indicators of sexual quality of life in men of different age groups suffering from mild to severe erectile dysfunction (ED). AIM: To increase insight in the mechanisms of some key indicators of sexual quality of life in different age groups. METHODS: The study sample consisted of 904 men with mild to severe ED. Mean age was 60.7 years (standard deviation [SD] = 12.4) and mean erectile function (EF) (International Index of Erectile Function [IIEF]) score was 14.5 (SD = 8.9). Multivariate analyses of variance were conducted to test the differences in outcomes among two age groups (65 65) and two levels of ED (16 16). MAIN OUTCOME MEASURES: We analyzed age, severity of ED, and interrelated indicators of sexual quality of life as worry about sexual or relationship functioning, sexual desire, and overall sexual satisfaction. Beyond, we aimed to see on which of these measures their interaction had specific independent effects. RESULTS: Younger men at a higher level of ED reported higher levels of worry about sexual and relationship functioning than older men with high ED. Older men reported slightly less sexual desire than younger men; also, more ED was associated with lower sexual desire. Finally, men with less severe ED reported higher sexual satisfaction than men with more severe ED, whereas at all levels of ED severity, older men reported more sexual satisfaction than younger men. CONCLUSIONS: Indicators of sexual quality of life among men with ED are poorer in those with more severe ED. However, younger men with severe ED worries concerning sexual functioning were more pronounced than among their older counterparts. Independent of the degree of severity of ED, older men indicated lower sexual desire but higher overall sexual satisfaction. Observed age-group differences were very small, however.

Erectile dysfunction, discrepancy between high prevalence and low utilization of treatment options: results from the 'Cottbus Survey' with 10 000 men.

OBJECTIVE: To investigate the age-stratified prevalence of erectile dysfunction (ED) and its comorbidities, and to assess the population's knowledge, utilization, and general attitude towards the treatment for ED. SUBJECTS AND METHODS: In all, 10 000 men received a 35-item questionnaire including the International Index of Erectile Function (IIEF) and sociodemographic questions regarding life style, comorbidities, quality of sexual life and knowledge or experience of ED therapy. In all, 3124 responses were included (31.2%), 2499 men lived in well established partnerships and were assessed as the basic study group. RESULTS: In the entire population the prevalence rate of ED was 40.1%. However, although known, medical treatment for ED is used only by a minority of affected men. The prevalence of ED was independently associated with age, peripheral arterial occlusive disease, hypertension, ischaemic heart disease, diabetes mellitus, and liver diseases. Correlations between sexual quality of life (QoL) and ED were statistically significant (P < 0.01) and moderate to strong (absolute values: Spearman's rho 0.35-0.76). Although 96% of the study population knew at least one phosphodiesterase type 5 (PDE5) inhibitor by name, only 53% considered taking the medication and only 9% of the men with ED had had experience with available PDE5 inhibitors. CONCLUSIONS: The sexual QoL was significantly reduced by ED. Despite high levels of awareness and general acceptance of oral medication for ED, experience with PDE5 inhibitors was low. Further investigation is required to evaluate the general impact of ED on sexual QoL and the need or wish for treatment.

Validity of the CAPRA score to predict biochemical recurrence-free survival after radical prostatectomy. Results from a european multicenter survey of 1,296 patients.

PURPOSE: The CAPRA (Cancer of the Prostate Risk Assessment) score from the University of California, San Francisco provides a new statistical model to predict recurrence-free survival and pathological tumor stage after radical prostatectomy. It was originally developed using data from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) registry. To calculate the score, which ranges from 0 to 10, 5 clinical variables are needed, ie prostate specific antigen, Gleason sum, clinical tumor grade, percentage of positive biopsies and patient age. To date, the only external validation of the CAPRA score has been conducted using the SEARCH (Shared Equal Access Regional Cancer Hospital) database. The present study uses a German database to contribute to existing validation work and to test transferability of the CAPRA score to a sample that differs fundamentally from the SEARCH sample in terms of clinical features. MATERIALS AND METHODS: Data from 1,296 German patients after radical prostatectomy were used for validation. Mean followup was 56.5 (+/-35.4) months. Accuracy of prediction of recurrence-free survival and pathological tumor stage with the CAPRA score was analyzed using Kaplan-Meier analysis, proportional hazards regression, logistic regression and graphic representation. RESULTS: For the external validation of the CAPRA score, the underlying clinical variables of our study group were unfavorable compared to the original cohort from the CaPSURE data set. The recurrence-free survival rate decreased after 3 and 5 years from 100% to 97%, respectively, in the CAPRA score 0 to 1 group, and from 44% to 31%, respectively, in the CAPRA score of 7 or higher group. The hazard ratios of a biochemical recurrence per 1-group increase were 1.50 (95% CI 1.43-1.56) for the CAPRA sum score, 1.62 (95% CI 1.53-1.71) for the 7-group CAPRA score and 3.52 (95% CI 3.00-4.12) for the 3-group CAPRA score. Concordance indices between 0.78 and 0.81 suggested good predictive accuracy. Of the 5 CAPRA constituents 4 independently predicted recurrence-free survival, ie prostate specific antigen, Gleason sum, cT stage and percent of positive biopsies. Positive margins occurred in 13.1% of patients with a CAPRA score of 0 to 1 vs 62% of patients with a score of 7 to 10 (p <0.001). Organ confined tumors were present in 97.7% of patients with a CAPRA score of 0 to 1 vs 19.3% of those with a score of 7 to 10 (p <0.001). CONCLUSIONS: Despite different clinical features in the present patient cohort and the CaPSURE data set, the accuracy of the CAPRA nomogram in predicting recurrence-free survival was high. These results underscore the effectiveness and the clinical applicability of the CAPRA score which, in addition to patient counseling, may also be used for risk stratification in clinical studies.

Predictors of spouses' provided support for patients receiving laparoscopic radical prostatectomy peri-surgery.

Close relationships are usually the most important source of social support. But even in close relationships, symptoms of distress in one or both partners may undermine support processes. Seventy-seven patients receiving laparoscopic radical prostatectomy (44-73 years) and their spouses (38-72 years) provided data 1 day prior to surgery as well as 2 days and 2 weeks post-surgery. Our assumption that the commonly found support-eroding potential of receivers' depressive symptoms would not be evident during early stages of an acute crisis situation, such as major tumor surgery, tended to be supported by the data. However, depressive symptoms and degree of patient-reported post-operative pain were associated with a delayed decrease in spousal instrumental support provision 2 weeks after surgery. Spousal depression was largely unrelated to the provision of support. The present findings hint at the limits of a loved-one's capacity to assist in times of need.

Does ultra-low-dose CT with a radiation dose equivalent to that of KUB suffice to detect renal and ureteral calculi?

The objective of this study was to evaluate the diagnostic yield of multislice CT using a radiation dose equivalent to that of conventional abdominal x-ray (KUB). One hundred forty-two patients were prospectively examined with ultrasound and a radically dose-reduced CT protocol (120 kV, 6.9 eff. mAs). Number and size of calculi, presence of urinary obstruction, and alternative diagnoses were recorded and confirmed by stone removal/discharge or by clinical and imaging follow-up. The mean effective whole-body dose was 0.5 mSv in men and 0.7 mSv in women. The sensitivity and specificity in detecting patients with calculi was 97% and 95% for CT and 67% and 90% for ultrasound. Urinary obstruction was similarly assessed, whereas CT identified significantly more alternative diagnoses than ultrasound (P<0.001). With regard to published data for standard-dose CT, the present CT protocol seems to be comparable in its diagnostic yield in assessing patients with calculi, and its radiation dose is equivalent to that of KUB.

Value of dual-phase multislice CT prior to minimally invasive therapy of iatrogenic renal injuries.

PURPOSE: To evaluate the diagnostic impact of multislice computed tomography (MSCT) in treatment planning prior to transarterial coil embolization of iatrogenic renal injuries. METHODS: Nine patients (median age 54 years, range 36-66) with iatrogenic renal vascular injury were treated with superselective coil embolization. Prior to therapy, a dual-phase (40 and 120 seconds) contrast-enhanced MSCT was applied in 6 patients. Seven patients underwent renal ultrasonography. Multiplanar reconstructions of the MSCT scans were used to affirm ongoing bleeding and to localize the bleeding site at the level of the segmental or interlobar artery. MSCT and angiographic findings were compared to evaluate the accuracy of MSCT in the detection of the bleeding source prior to therapy. RESULTS: Multiplanar reconstructions of early-phase MSCT scans allowed precise identification of the bleeding interlobar or segmental artery in all 6 cases prior to angiography. In one case, MSCT was even able to detect a source of bleeding that was not revealed by selective renal angiography. CONCLUSIONS: Multiplanar reconstructions of MSCT data demonstrate not only the presence of hematoma but also confirm ongoing bleeding and the location of the feeder artery prior to minimally invasive therapy.

Tissue engineering: creation of long-lasting blood vessels.

The construction of stable blood vessels is a fundamental challenge for tissue engineering in regenerative medicine. Although certain genes can be introduced into vascular cells to enhance their survival and proliferation, these manipulations may be oncogenic. We show here that a network of long-lasting blood vessels can be formed in mice by co-implantation of vascular endothelial cells and mesenchymal precursor cells, by-passing the need for risky genetic manipulations. These networks are stable and functional for one year in vivo.