Systematic Review of Surgical and Nonsurgical Interventions in Normal Men Complaining of Small Penis Size.

INTRODUCTION: Evidence on penile enhancement interventions is lacking. Nonetheless, many non-evidence-based solutions are readily available. AIM: To investigate enhancement and nonenhancement interventions in men without penile abnormalities seeking to increase penis size. METHODS: We performed a systematic review with no time restrictions adhering to the PRISMA guidelines. Studies with fewer than 10 cases or including men with organic penile pathologies or previous penile surgeries were excluded. MAIN OUTCOME MEASURES: When available, treatment efficacy was evaluated based on patient satisfaction, penile size increase, and complications. RESULTS: We included 17 studies, assessing a total of 21 interventions in 1,192 men screened, with 773 followed up after nonsurgical (n = 248) or surgical (n = 525) treatment. The quality of the studies was poor in terms of methodology for patient selection and outcomes assessment. The vast majority of series reported normal penile size. Among nonsurgical treatments, extenders increased flaccid length (but by <2 cm), injectables increased girth but were associated with a high complication rate, and vacuum devices did not increase size. Surgical interventions included suspensory ligament incision (the most used method; n = 12), tissue grafting (autologous, n = 2; dermal fat, n = 3, ex vivo, n = 2), flaps (n = 2), and penile disassembly (n = 1). Some men reported a significant size increase; however, complications were not infrequent, and none of the techniques was externally validated. When provided, counseling was effective, with the majority of men coming to understand that their penis was normal and unwilling to undergo any further treatment. CONCLUSION: Treatment of small penis in normal men is supported by scant, low-quality evidence. Structured counseling should be always performed, with extenders eventually used by those still seeking enhancement. Injectables and surgery should remain a last option, considered unethical outside of clinical trials. Marra G, Drury A, Tran L, et al. Systematic Review of Surgical and Nonsurgical Interventions in Normal Men Complaining of Small Penis Size. Sex Med Rev 2020;8:158-180.

The Risks of Theft and Copyright Breach from Camera Use During Scientific Presentations: It's Time for a Debate.

Photographs are frequently taken during urological presentations and distributed on social media; they may represent a breach of copyright and, in instances of clinical photographs, a breach of data protection and human rights laws. Presenters and delegates attending conferences should be advised of the conference's copyright policies. Acceptable use of camera phones during scientific presentations should be debated by the scientific community.

The effectiveness of Google GLASS as a vital signs monitor in surgery: A simulation study.

INTRODUCTION: To assess the effectiveness of the Google GLASS as a vital signs monitor in a surgical setting and identify potential uses. METHODS: This prospective, observational and comparative study recruited novice (n = 24), intermediate (n = 8) and expert urologists (n = 5). All candidates performed a procedure on the GreenLight Simulator within a simulated setting using a standard vital signs monitor and then the Google GLASS. The time taken to respond to abnormal vital signs during both sessions was recorded. A quantitative survey was used to assess the usability and acceptability of the Google GLASS surgery. RESULTS: The majority (84%) of participants responded quicker to abnormal signs with the Google GLASS compared to a standard monitor (p = 0.0267). The average simulation score during a standard-monitor and GLASS-session scored to be statistically insignificant (p = 0.253). All parameters of simulation were also similar in both sessions including average sweep speed (p = 0.594), average blood loss (p = 0.761) and average grams vaporised (p = 0.102). DISCUSSION: Surgical performance between both sessions was similar and not hampered by the use of Google GLASS. Furthermore, 81% of candidates stated the GLASS was comfortable to wear during the procedure. CONCLUSION: This study has demonstrated that head-mounted displays such as the Google GLASS are potentially useful in surgery to aid patient care without hampering the surgeons view. It is hoped that the innovation and evolution of these devices triggers the potential future application of such devices within the medical field.

Determination of optimal drug dose and light dose index to achieve minimally invasive focal ablation of localised prostate cancer using WST11-vascular-targeted photodynamic (VTP) therapy.

OBJECTIVE: To determine the optimal drug and light dose for prostate ablation using WST11 (TOOKAD Soluble) for vascular-targeted photodynamic (VTP) therapy in men with low-risk prostate cancer. PATIENTS AND METHODS: In all, 42 men with low-risk prostate cancer were enrolled in the study but two who underwent anaesthesia for the procedure did not receive the drug or light dose. Thus, 40 men received a single dose of 2, 4 or 6 mg/kg WST11 activated by 200 J/cm light at 753 nm. WST11 was given as a 10-min intravenous infusion. The light dose was delivered using cylindrical diffusing fibres within hollow plastic needles positioned in the prostate using transrectal ultrasonography (TRUS) guidance and a brachytherapy template. Magnetic resonance imaging (MRI) was used to assess treatment effect at 7 days, with assessment of urinary function (International Prostate Symptom Score [IPSS]), sexual function (International Index of Erectile Function [IIEF]) and adverse events at 7 days, 1, 3 and 6 months after VTP. TRUS-guided biopsies were taken at 6 months. RESULTS: In all, 39 of the 40 treated men completed the follow-up. The Day-7 MRI showed maximal treatment effect (95% of the planned treatment volume) in men who had a WST11 dose of 4 mg/kg, light dose of 200 J/cm and light density index (LDI) of >1. In the 12 men treated with these parameters, the negative biopsy rate was 10/12 (83%) at 6 months, compared with 10/26 (45%) for the men who had either a different drug dose (10 men) or an LDI of <1 (16). Transient urinary symptoms were seen in most of the men, with no significant difference in IPSS score between baseline and 6 months after VTP. IIEF scores were not significantly different between baseline and 6 months after VTP. CONCLUSION: Treatment with 4 mg/kg TOOKAD Soluble activated by 753 nm light at a dose of 200 J/cm and an LDI of >1 resulted in treatment effect in 95% of the planned treatment volume and a negative biopsy rate at 6 months of 10/12 men (83%).

Validation of the GreenLight™ Simulator and development of a training curriculum for photoselective vaporisation of the prostate.

OBJECTIVES: To assess face, content and construct validity, and feasibility and acceptability of the GreenLight™ Simulator as a training tool for photoselective vaporisation of the prostate (PVP), and to establish learning curves and develop an evidence-based training curriculum. SUBJECTS AND METHODS: This prospective, observational and comparative study, recruited novice (25 participants), intermediate (14) and expert-level urologists (seven) from the UK and Europe at the 28th European Association of Urological Surgeons Annual Meeting 2013. A group of novices (12 participants) performed 10 sessions of subtask training modules followed by a long operative case, whereas a second group (13) performed five sessions of a given case module. Intermediate and expert groups performed all training modules once, followed by one operative case. The outcome measures for learning curves and construct validity were time to task, coagulation time, vaporisation time, average sweep speed, average laser distance, blood loss, operative errors, and instrument cost. Face and content validity, feasibility and acceptability were addressed through a quantitative survey. RESULTS: Construct validity was demonstrated in two of five training modules (P = 0.038; P = 0.018) and in a considerable number of case metrics (P = 0.034). Learning curves were seen in all five training modules (P < 0.001) and significant reduction in case operative time (P < 0.001) and error (P = 0.017) were seen. An evidence-based training curriculum, to help trainees acquire transferable skills, was produced using the results. CONCLUSION: This study has shown the GreenLight Simulator to be a valid and useful training tool for PVP. It is hoped that by using the training curriculum for the GreenLight Simulator, novice trainees can acquire skills and knowledge to a predetermined level of proficiency.

Bone scan is of doubtful value as a first staging test in the primary presentation of prostate cancer.

Purpose. To determine whether axial MR imaging could replace bone scan as the primary staging test in newly diagnosed CaP. Material and Methods. We reviewed retrospectively all bone scans (n = 1201) performed in newly diagnosed CaP patients from 2000 to 2010 in a single tertiary academic center. We recorded patient age, ethnicity, PSA at diagnosis, TNM stage, Gleason score, alkaline phosphatase, bone scan results and axial imaging if available. Results. Mean patient age was 72 years (41-96), mean PSA and alkaline phosphatase were 268.9 ng/mL and 166 IU/L, respectively. Patients were divided in four groups according to possible bony metastases on bone scan. Group 1: Negative, no metastases demonstrated. Group 2: Positive, metastases only in pelvis and/or lumbar spine. Group 3: Positive, widespread metastases including pelvis and lumbar spine. Group 4: Positive, distant metastases without pelvic or lumbar spine abnormalities. Group 4 patients were analyzed in detail, two had possible disease that was detected only outside the pelvic and lumbar spine, unfortunately follow up images were insufficient to confirm the nature of the lesions. Conclusions. Although bone scan is a useful investigation to confirm and monitor metastasic CaP, our data suggests that axial MR imaging is an adequate primary staging study in untreated disease. Bone scan is unnecessary if CT or MRI of the pelvis and abdomen are clear of metastases.

Chronic urinary retention in men: how we define it, and how does it affect treatment outcome.

What's known on the subject? and What does the study add? Chronic urinary retention (CUR) is a poorly defined entity, as the key element of definition, significant postvoid residual urine volume (PVR), has not a worldwide and moreover evidenced-based definition. There is no agreement on which is the threshold value to define a significant PVR and different society produced guidelines with different thresholds ranging from 300 mL to 1000 mL. Diagnosis is difficult, and management has not been defined yet. There is a lack of studies on the best management of these patients, as this group of patients has always been considered at high risk of failure. Only one study compares conservative with the surgical management but it is not a randomised controlled trail. This review offers a systematic appraisal of the most recent publications on CUR. It indicates the absence of a real worldwide agreed definition, as the two keys element of it are not satisfactorily defined yet: significant PVR, is suffering from a lack of evidenced-based definition, and percussable or palpable bladder is a very nebulous concept as it is not a criteria of certainty as different individual variables affect it. This has an important effect on management which is not structured. Most of the trials involving benign prostatic hyperplasia treatments (either medical or surgical) tend to exclude this group of patients, which is a clinically important group, comprising up to a quarter of men undergoing TURP in the UK. Urinary retention describes a bladder that does not empty completely or does not empty at all. Historically, urinary retention has been classified as either acute or chronic the latter is generally classified as high pressure or low pressure according to the bladder filling pressure on urodynamic. A MEDLINE® search for articles written in English and published before January 2010 was done using a list of terms related to urinary retention: 'urinary retention', 'chronic urinary retention' and 'PVR'. Chronic urinary retention (CUR) is defined by the International Continence Society as 'a non-painful bladder, which remains palpable or percussable after the patient has passed urine'. Abrams was the first to choose a residual urine volume >300 mL to define CUR as he considered it the minimum volume at which the bladder becomes palpable suprapubically. The UK National Institute for Health and Clinical Excellence lower urinary tract symptoms (LUTS) guidelines define CUR as a postvoid residual urine volume (PVR) of >1000 mL. No studies have specifically addressed the problem of quantifying the minimum amount of urine present in the bladder to define CUR. Nor did we find any publications objectively assessing at what amount of urine a bladder can be palpable. The ability to feel a bladder may rely on variables (i.e. medical skills and patient habitus). There is a marked variability of PVR, so the test should be repeated to improve precision. As defining CUR is difficult, structured management is challenging. Nearly all prospective trials exclude men with CUR from analysis, possibly anticipating a poor outcome and a high risk of complications. However, men with CUR are a clinically important group, comprising up to 25% of men undergoing transurethral resection of the prostate. Definition of CUR is imprecise and arbitrary. Most studies seem to describe the condition as either a PVR of >300 mL in men who are voiding, or >1000 mL in men who are unable to void. This confusion leads to an inability to design and interpret studies; indeed most prospective trials simply exclude these patients. There is a clear need for internationally accepted definitions of retention to allow both treatment and reporting of outcomes in men with LUTS, and for such definitions to be used by all investigators in future trials.

180-W XPS GreenLight laser therapy for benign prostate hyperplasia: early safety, efficacy, and perioperative outcome after 201 procedures.

BACKGROUND: Photoselective vaporisation of the prostate has evolved from the GreenLight 80-W KTP powered laser to the latest 180-W XPS laser involving a MoXy fibre. OBJECTIVE: Evaluate the prevalence of perioperative complications and short-term outcome for the first time with the XPS laser in men with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE). DESIGN, SETTING, AND PARTICIPANTS: Prospective data were collected from consecutive patients at seven centres worldwide during June 2010 and March 2011. Indication for surgery was based on the European Association of Urology and the American Urological Association guidelines. Patients receiving anticoagulants or those with retention were included and analysed separately. INTERVENTION: 180-W XPS GreenLight laser prostatectomy using the MoXy fibre. MEASUREMENTS: Standard parameters associated with transurethral prostate surgery and perioperative prevalence of surgery-associated problems or complications were documented. RESULTS AND LIMITATIONS: A total of 201 patients were included in the study. Mean follow-up was 5.8 mo (standard deviation [SD]: 2.8; range: 1-12 mo). A quarter of the patients had a prostate volume≥80 ml. For prostates between 51 and 60 ml, a mean of 300 kJ (SD: 112) of energy was applied (lasing time: 35.0 min; SD: 15). Statistically significant improvements were noted in all key parameters postoperatively. The prevalence of perioperative complications was low. Limitations of the study are short duration of follow-up and limited number of available patients for the functional follow-up. CONCLUSIONS: The 180-W GreenLight XPS laser is a new effective treatment option with a low prevalence of perioperative complications for patients suffering from LUTS due to BPE.

Penile frenuloplasty: a simple and effective treatment for frenular pain or scarring.

UNLABELLED: Study Type - Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Frenuloplasty, using common plastic surgical techniques for scar lengthening, is a commonly performed operation amongst urologists for isolated frenular pathology. However, there is very little data in the urological literature regarding either technique or assessment. The only other published study was a questionnaire follow-up with a 23% response rate and the technique used was not clarified. Other studies describe expensive, rarely used procedures and are hampered by small patient numbers or short-term follow-up only. Our study validates the common practice of using plastic surgical techniques for scar lengthening. We have 100% clinical short-term follow-up (3 months) and 91% long-term follow-up (up to 10 years) showing high patient satisfaction scores and low complication and re-operation rates. This provides an evidence base from which to counsel patients who are keen for foreskin sparing surgery for frenular pathology. The extra addition of our grading system allows patients to be risk-stratified as to the risk of re-operation depending on their status at presentation and underlying pathology. OBJECTIVE: To assess the long-term patient satisfaction and outcomes for penile frenuloplasty when offered as an alternative to circumcision for frenular pain and/or scarring. PATIENTS AND METHODS: Data was prospectively collected over 10 years, for a total of 106 men. The nature of the frenular problem was graded. Techniques of V-Y plasty, Z-plasty or a combination of the two were used. All patients were reviewed at 3 months and contacted via questionnaire ≥ 1 year after surgery. The questionnaire assessed satisfaction, cosmetic appearance, pain on intercourse, need for subsequent surgery and if they would recommend the procedure to a friend. RESULTS: Follow-up was 100% (106/106) at 3 months and 91% (96/106) ≥ 1 year. Patient satisfaction and cosmesis scores both averaged 8.9/10. Need for subsequent circumcision was 8% (9/96). There were minor complications (bruising/infection/partial dehiscence) in 8% (9/96) of patients. 97% (84/87) of patients would recommend the procedure to a friend. CONCLUSIONS: Penile frenuloplasty is a safe alternative to circumcision. There are high patient satisfaction rates after surgery. Low numbers of patients require a completion circumcision after penile frenuloplasty.

Clinical and ultrasound features of segmental testicular infarction: six-year experience from a single centre.

The purpose was to analyse the aetiology and ultrasound appearances of segmental testicular infarction. Patients with focal testicular lesions underwent colour Doppler high frequency ultrasound. Segmental testicular infarction was defined as any focal area of altered reflectivity, with or without focal enlargement with absent or diminished colour Doppler flow, proven on histology or on follow-up exclusion of lesion progression. Patients were reviewed to document lesion shape, position, border definition, reflectivity and vascularity and correlated to presenting clinical symptoms and signs. Over a 6-year period 24 patients were defined as having segmental testicular infarction; median age was 37 years (range 16-82 years). All presented with a sudden onset of testicular pain. Of the patients, 14/24 (58.3%) had scrotal inflammatory disease, 5/24 (20.8%) had evidence of spermatic cord torsion, and three patients were termed idiopathic; 12/24 (50.0%) were of low reflectivity, 11/24 (45.8%) of mixed reflectivity, one of high reflectivity, 11/24 (45.8%) were wedge shaped, and 13/24 (54.2%) were round shaped. Of the patients, 8/24 (33.3%) demonstrated a mass effect, all with round-shaped lesions and with underlying epididymo-orchitis in seven. Absent colour Doppler flow was demonstrated in 20/24 (83.3%). Histology confirmed infarction in 8/24 (33.3%), and 12/24 (50.0%) had follow-up examinations without progression of the lesions. Segmental testicular infarction has characteristic ultrasound features, not always wedge-shaped, with reduced or absent vascularity of key importance. Awareness of the ultrasound features will allow for conservative management and avoid unnecessary orchidectomy.

Photoselective vaporization of the prostate with the potassium-titanyl-phosphate laser in men with prostates of >100 mL.

OBJECTIVES: To assess the efficacy of photoselective vaporization of the prostate (PVP) in men with prostates of >100 mL and causing bladder outlet obstruction (BOO), using the high-power 80 W potassium-titanyl-phosphate laser (GreenLight PV, Laserscope, San Jose, CA, USA), which offers rapid tissue ablation with minimal bleeding. PATIENTS AND METHODS: We assessed 54 consecutive patients with prostates of >100 mL (mean 135, SD 42, range 100-300) who had PVP between May 2003 and August 2005. Evaluations before PVP included urine flowmetry, the International Prostate Symptom Score (IPSS), a quality-of life (QoL) score, prostate-specific antigen (PSA) level, and prostate volume measured by transrectal ultrasonography (TRUS). RESULTS: The mean (SD, range) duration of PVP was 81.6 (22.9, 39-150) min, the mean energy used for PVP was 278 (60, 176-443) kJ and the mean duration of catheterization after PVP was 23.0 (17.1, 0-72) h. The mean (sd) maximum urinary flow rate improved from 8.0 (3.1) to 18.2 (8.1), 18.5 (9.2), 17.9 (7.8) and 19.3 (9.8) mL/s at 3, 6, 12 and 24 months, respectively. The IPSS and QoL scores showed similar improvements, and there was a statistically significant reduction in PSA level and prostate volume after PVP. There was no major complication and no patient had transurethral resection syndrome or a blood transfusion. CONCLUSIONS: The 80 W KTP laser PVP offers rapid tissue ablation in patients with BOO caused by a large prostate. The short- and medium-term outcomes show that this technique can be a viable alternative to open prostatectomy.

Ras-MEK-ERK signaling cascade regulates androgen receptor element-inducible gene transcription and DNA synthesis in prostate cancer cells.

Treatment of prostate cancer (CaP) patients frequently involves androgen ablation, but resistance often develops and androgen-insensitive tumors emerge. The molecular basis for the development of refractory CaP that grows in an androgen-independent manner is poorly understood, but alterations in growth factor signaling pathways are likely to be involved. We examined the growth factor modulation of androgen-receptor element (ARE)-inducible luciferase reporter gene activity and consequent DNA synthesis as a measure of proliferative growth in androgen-dependent LNCaP or androgen-independent PC3 or DU145 CaP cells. The synthetic androgen R1881 stimulated ARE-inducible reporter gene activity and prostate-specific antigen expression in LNCaP cells and the MEK/ERK inhibitor U0126 or the anti-androgen bicalutamide (casodex) prevented both of these responses. Activated V12-Ha-Ras expression in LNCaP cells also stimulated ARE-inducible gene transcription, and U0126 or the farnesyltransferase inhibitor FTI-277 but not bicalutamide blocked this. ARE-inducible reporter gene activity was elevated already in PC3 cells, and ERK was constitutively activated in serum-starved LNCaP or DU145 cells. U0126 inhibited each of these responses and also inhibited DNA synthesis in all 3 CaP cell lines. These results demonstrate that chronic stimulation of the Ras-MEK-ERK signaling pathway can sustain ARE-inducible gene transcription and growth of CaP cells, and suggests that components of this pathway may offer targets for cancer therapy.

Testicular calcification and microlithiasis: association with primary intra-testicular malignancy in 3,477 patients.

The prevalence of all forms of scrotal and testicular calcification and their association with testicular tumour in a symptomatic paediatric and adult population was investigated. A retrospective study of all testicular ultrasound examinations performed at a single centre over a 5-year period was undertaken. All studies were performed by experienced operators, recorded in a standard method, using high-frequency linear array transducers (> or =10 MHz). All available images (95.2%) were reviewed by experienced operators, recording the location and type of scrotal and testicular calcification according to a pre-determined schedule. A total of 3,854 studies were reviewed on 3,477 patients (age range: 1 month to 91 years). In the adult group, 3,279 examinations were analysed. Prevalence of testicular microlithiasis (TM) was 2.0%, and the prevalence of other non-microlithiasis testicular calcification (non-TM calcification) was 1.7%. Testicular tumour was associated with TM (odds ratio 9.5, P<0.001) and non-TM calcification (odds ratio 11.4, P<0.001) but not with other types of scrotal calcification. A total of 198 paediatric examinations were analysed. Prevalence of TM was 2.0% and the prevalence of non-TM calcification was 0.5%. One tumour (lymphoma) was identified, with no associated calcification. This study confirms the reported association between TM and testicular tumour and finds a previously unreported association between non-TM calcification and testicular tumour.

Basic laparoscopic surgical training: examination of a low-cost alternative.

OBJECTIVE: "Dry lab" facilities are integral to laparoscopy training, but access is often limited due to the high costs of video-laparoscopy equipment. We assessed the effectiveness of a cheap and simple training model compared to conventional video-laparoscopy for basic training using a randomised, blinded study. METHODS: Thirty-six third-year medical students without previous surgical skills were randomised into two groups: group A students were taught basic laparoscopy skills using a conventional video-laparoscopy pelvic trainer and group B students were taught similar techniques using a cardboard box with a cut-out top to allow light and visualisation. Participants in group B had one eye obscured to reduce their stereoscopic vision. After eight sessions of training amounting to 24h, the two groups were assessed by a blinded adjudicator on set tasks using both the video-laparoscopy pelvic trainer and the cardboard box. Accuracy, timing and depth perception were assessed and the results compared. RESULTS: There was no significant difference in performance scores or times between the two groups in any of the parameters when tested on the cardboard box. However, when assessed on the video trainer, the cardboard box-trained group had significantly faster times with equivalent scores in the majority of tasks. CONCLUSION: For basic laparoscopic training the cardboard box, costing nothing, is a simple and effective alternative, which can be used in conjunction with sophisticated video-laparoscopy equipment costing thousands of dollars.

Positional anatomy of vessels that may be damaged at laparoscopy: new access criteria based on CT and ultrasonography to avoid vascular injury.

BACKGROUND AND PURPOSE: To study the relations of major blood vessels (aortoiliac bifurcation and iliocaval confluence) and the inferior epigastric arteries to the umbilicus and the anterior superior iliac spine (ASIS) planes and to apply this information to define ideal, anatomically based locations for primary and secondary laparoscopic port insertions to minimize vascular injuries. MATERIALS AND METHODS: Two hundred randomly selected postcontrast CT images of the abdomen and pelvis were assessed by two radiologists. The position of the umbilicus (mobile point), ASIS (fixed point), and relations with the great vessels were measured. The angle of the umbilicus with the aortic bifurcation, theta (theta), was calculated using trigonometric principles. The position and course of the inferior epigastric arteries (IEA) was analyzed in 103 patients with color Doppler ultrasonography. RESULTS: The median distance of the aortoiliac bifurcation was 8 mm (interquartile range [IQR] 28.8 mm] and that of the iliocaval venous confluence 25 mm (IQR 32 mm) below the umbilicus. The aorta divided 48 mm (IQR 16 mm) and the iliac veins joined 33 mm (IQR 9 mm) above the ASIS plane. The angle of the umbilicus to the aortoiliac bifurcation in the sagittal plane had a range of 14 degrees to 34 degrees with a median of 21.6 degrees . The median distance from the right IEA to the midline at the umbilicus was 4.75 cm (IQR 0.7 cm), and the same distance in the ASIS plane was 4.8 cm (IQR 0.7 cm). The distance of the IEA to the midline did not exceed 6 cm in any patient on either side or in either plane. CONCLUSION: The position of the umbilicus should not be relied on for access planning. The relation between the level of the ASIS and the aortic bifurcation is more consistent. The ideal primary port entry (or Veress needle site) is at the ASIS plane in the midline, and the ideal lateral port entry is in the same plane >6 cm from the midline. If the umbilicus is to be used, a Hasson insertion is desirable, but if a Veress needle is used at the umbilicus, an angle of 45 degrees in the sagittal plane should be used.

Selenium- or quercetin-induced retardation of DNA synthesis in primary prostate cells occurs in the presence of a concomitant reduction in androgen-receptor activity.

Prostate cancer (CaP) is the most common male malignancy in the Western world. Selenium or quercetin may down-regulate prostate-cell proliferation in immortalised cells (e.g. androgen-responsive LNCaP cells). However, whether such effects are apparent in primary prostate epithelial cells (PECs) remains to be examined. Following surgical resection, primary PECs isolated from tissues (n=10 patients) were cultured in the presence or absence of selenium, selenomethionine or quercetin. Tissues from a minimum of three patients were used to generate cell preparations that were cultured independently for the purposes of the experimental analysis of each test agent. These agents were also examined in LNCaP cells. DNA synthesis was assessed by the percentage of PECs or LNCaP cells that incorporated 5-bromo-2-deoxyuridine (BrdU) into DNA. All three test agents induced a dose-related reduction in the percentage of PECs or LNCaP cells labelled with BrdU. In LNCaP cells transfected with an androgen-receptor (AR)-reporter gene coupled to luciferase, selenomethionine or quercetin reduced AR activity. Chemoprevention may retard DNA synthesis in short-term primary PECs and expression of AR-inducible elements may be a concomitant factor.

Laparoscopic partial nephrectomy with saline-irrigated KTP laser in a porcine model.

PURPOSE: To evaluate the feasibility of using the potassium titanyl phosphate (KTP) laser to perform laparoscopic partial nephrectomy in a porcine model, with saline irrigation to reduce intraoperative smoke formation. MATERIALS AND METHODS: A high-power (80 W) KTP laser was used without hilar occlusion in 14 laparoscopic partial nephrectomies in four pigs. During laser discharge, the cutting plane was irrigated continuously with saline. RESULTS: Thirteen partial nephrectomies were completed. Hemostasis was obtained without the need for any non-laser techniques. Only minimal smoke was produced, not affecting visibility or the progress of surgery. Histologic examination of the resection margin showed only minimal tissue destruction. One procedure failed because the laser fiber broke and occluded the suction during the operation. The mean partial nephrectomy time was 13.14 minutes (range 7-19 minutes) with a mean estimated blood lost of 28.57 mL (range 5-80 mL). The mean saline irrigation used for each operation was 2600 mL (range 1500-3400 mL), and the amount of saline drained out was 1700 mL (range 900-3200 mL). CONCLUSION: Laparoscopic partial nephrectomy using the 80 W KTP laser is feasible and effective in the porcine model. Saline irrigation dramatically reduces smoke formation. The technique is deserving of clinical studies after the laser-application device and suction irrigation are refined.