Urinary incontinence and neuropathy after radical prostatectomy: diagnosis and treatment.

INTRODUCTION AND OBJECTIVE: The urinary incontinence after radical prostatectomy is secondary to neuropathy with various degrees from neurapraxia to neurotmesis. We propose to apply therapeutic and rehabilitative models appropriate to the diagnosis and to evaluate the results. MATERIALS AND METHODS: We examined 79 homogeneous patients with urinary incontinence after radical prostatectomy. After having defined the diagnosis by a urodynamic examination, the study of pudendal nerve somatosensory-evoked potentials (SEPs) and perineal electromyography (EMG), patients were divided into four groups (A; B; C; D) and submitted to different clinical drug protocols and rehabilitation. After 3 months, patients were reevaluated. RESULTS: Twenty-eight patients with idiopathic overactive bladder (Group A) have been treated with anticholinergics: two unchanged (7%); 14 improved (50%); and 12 recovered (43%). Sixteen patients with overactive bladder and sphincter incompetence (Group B) have practiced physiokinesis therapy (FKT) of pelvic floor and anticholinergic therapy: one unchanged (6%); eight improved (50%); and seven recovered (44%). Fourteen patients with perineal incompetence to continence (Group C) have been treated with FES, FKT of pelvic floor, and Biofeedback: three patients were unchanged (21%); five improved (36%); and six recovered (43%). Twenty-one patients with sphincter denervation (Group D) performed FES, FKT of pelvic floor, and Biofeedback: 16 unchanged (76%); five improved (24%); and zero recovered (0%). Of these 16 patients, six non-responders have placed a transobturator tape (TOT) sling and four an artificial sphincter. CONCLUSIONS: A therapy adherent to the diagnosis increases success rate.

[Urinary incontinence after radical prostatectomy. Neurophysiological and urodynamic diagnosis]. / L'incontinenza urinaria dopo prostatectomia radicale. Diagnosi urodinamica e neurofisiologica.

OBJECTIVES: Urinary incontinence after radical prostatectomy presents different clinical features. We propose to clarify the etiology and the therapeutic approaches. METHODS: 51 patients with urinary incontinence after radical prostatectomy underwent urodynamics, perineal EMG, perineal EMG frequency analysis and study of computerized sensory pudendal somatosensory evoked potentials. RESULTS: 18 patients (35%) were suffering from urinary incontinence secondary to overactive bladder, 14 patients (28%) had both an overactive bladder and a sphincter failure associated with Wallerian degenerative axonal neuropathy or segmental demyelination, 3 patients (6%) showed no significant urodynamics alterations but had signs of an incompetent sphincter neurapraxia, while 16 patients (31%) had urinary incontinence secondary to a degenerative neuropathy. CONCLUSIONS: Urinary incontinence after radical prostatectomy shows an etiologic diversification and therefore requires different therapeutic approaches

Curcumin and the cellular stress response in free radical-related diseases.

Free radicals play a main pathogenic role in several human diseases such as neurodegenerative disorders, diabetes, and cancer. Although there has been progress in treatment of these diseases, the development of important side effects may complicate the therapeutic course. Curcumin, a well known spice commonly used in India to make foods colored and flavored, is also used in traditional medicine to treat mild or moderate human diseases. In the recent years, a growing body of literature has unraveled the antioxidant, anticarcinogenic, and antinfectious activity of curcumin based on the ability of this compound to regulate a number of cellular signal transduction pathways. These promising data obtained in vitro are now being translated to the clinic and more than ten clinical trials are currently ongoing worldwide. This review outlines the biological activities of curcumin and discusses its potential use in the prevention and treatment of human diseases.

Practical approaches to investigate redox regulation of heat shock protein expression and intracellular glutathione redox state.

The products of vitagenes such as heat shock protein 32 (Hsp32, heme oxygenase 1) and Hsp70, the family of inducible cytoprotective proteins regulated by the Keap1/Nrf2/ARE pathway, and small molecule antioxidants such as glutathione provide the cell with powerful means to counteract and survive various conditions of stress. Among these protective systems, the heat shock proteins represent a highly conserved and robust way for preservation of correct protein conformation, recovery of damaged proteins, and cell survival. Their regulation is dependent on the redox status of the cell, thus redox regulation is rapidly evolving as an important metabolic modulator of cellular functions, and is being increasingly implicated in many chronic inflammatory and degenerative diseases. Protein thiols play a key role in redox sensing, and regulation of cellular redox state is crucial mediator of multiple metabolic, signalling and transcriptional processes in the brain. Nitric oxide, and reactive nitrogen species induce the transcription of vitagenes and Keap1/Nrf2/ARE-dependent genes whose functional products protect against a wide array of subsequent challenges. Emerging interest is now focusing on exogenous small molecules that are capable of activating these systems as a novel target to minimize deleterious consequences associated with free radical-induced cell damage, such as during neurodegeneration. This chapter describes methods that can be used to assess the expression of heat shock proteins and the cellular glutathione redox status and discusses their relevance to mechanisms modulating the onset and progression of neurodegenerative diseases.