A side-specific nomogram for extraprostatic extension may reduce the positive surgical margin rate in radical prostatectomy.

PURPOSE: Nomograms predicting side-specific extraprostatic extension (EPE) may be applied to reduce positive surgical margin (PSM) rates in patients planned for radical prostatectomy (RP). This study evaluates the impact of implementing an externally validated nomogram for side-specific EPE on PSM rate and degree of nerve-sparing. METHODS: In patients planned for RP, the side-specific nomogram predictions (based on MRI, ISUP grade group, and PSA density), with an advised threshold of 20% for safe nerve-sparing, were presented preoperatively to the urological surgeon. The surgeon completed a survey before RP about the planning with respect to side-specific nerve-sparing and change of management due to the result of the nomogram. PSM rates and degree of nerve-sparing were compared to a retrospective control group treated in the months prior to the introduction of the nomogram. RESULTS: A total of 100 patients were included, 50 patients in both groups representing 200 prostate lobes. Of the patients, 37% had histologically confirmed EPE, and 40% a PSM. In 12% of the 100 lobes planned after nomogram presentation, a change in management due to the nomogram was reported. A per-prostate lobe analysis of all the lobes showed comparable rates of full nerve-sparing (45% vs. 30%; p = 0.083) and lower rates of PSM on the lobes with histological EPE (45% vs. 85%; p < 0.05) in the intervention (nomogram) group versus the control group. CONCLUSION: Implementing a predictive nomogram for side-specific EPE in the surgical planning for nerve-sparing leads to lower rates PSM on the side of the histological EPE without compromising nerve-sparing.

Urethral reconstruction of critical defects in rabbits using molecularly defined tubular type I collagen biomatrices: key issues in growth factor addition.

Tubular type I collagen biomatrices with and without growth factors (GFs) were constructed and evaluated in a rabbit model for critical urethral defects. Porous tubular biomatrices with an inner diameter of 3 mm were prepared using highly purified collagen fibrils and were crosslinked with or without heparin. Heparinized biomatrices were supplemented with the heparin-binding GFs vascular endothelial GF, fibroblast GF-2, and heparin-binding epidermal GF. Biomatrices with and without GFs were used to replace a critical 1 cm urethral segment in rabbits (n = 32). All animals showed normal urination without urinary retention. General histology and immunohistology of graft areas (2, 4, 12, and 24 weeks after implantation) indicated that all biomatrices were replaced by urethra-like structures with normal appearing cytokeratin-positive urothelium surrounded by vascularized tissue. The GF-containing biomatrices showed an increase in extracellular matrix deposition, neovascularization, urothelium, glands, granulocytes, and fibroblasts, compared with biomatrices without GF. GFs substantially improved molecular features of healing but failed to be superior in functional outcome. Retrograde urethrography indicated a normal urethral caliber in case of biomatrices without GF, but a relative narrowing of the urethra at 2 weeks postsurgery and diverticula after 4 weeks in case of biomatrices with GF. In conclusion, tubular acellular type I collagen biomatrices were successful in repairing urethral lesions in artificial urethral defects, and inclusion of GF has a profound effect on regenerative processes.

Long-term outcome of different types of 1-stage hypospadias repair.

PURPOSE: We evaluated the outcome of postpubertal patients who underwent 1-stage hypospadias repair before onset of puberty with at least 10 years of followup. MATERIALS AND METHODS: A total of 2,053 patients underwent surgical repair of hypospadias between January 1981 and May 2004 at our hospital. We evaluated patients who are now at least 18 years old and who underwent 1-stage hypospadias repair. Data were collected in regard to familial incidence, age at operation, operative technique, complications and followup of at least 10 years. Evaluation was subdivided based on operative procedure. RESULTS: A total of 126 patients were included in the study. The familial incidence was 7.9% of cases and an associated undescended testis was seen in 9.5%. There were 62 cases with no complications. At least 1 complication was seen in 64 cases, including infection in 3, tissue necrosis in the operative area in 3, wound dehiscence in 6, fistula in 29, meatal stenosis in 15, urethral stenosis in 10, cosmetic dissatisfaction in 16 and other in 2. CONCLUSIONS: Even in the hands of the experienced pediatric urologists the complication rate after hypospadias repair remains high, with an average of 54% at long-term followup. Our results clearly showed that additional complications can present after long-term followup (a first complication can present after more than 5 years with the longest interval being 14 years). Therefore, final outcome of hypospadias surgery can only be evaluated once the patient has reached adulthood. The results seem to depend on the severity of the abnormality, reflected in the complication distribution rather than operative technique.