Association between benign prostate enlargement-related storage and voiding symptoms and systolic blood pressure: a single-center cross-sectional study

ABSTRACT BACKGROUND: Lower urinary tract symptoms significantly worsen quality of life. The hypothesis that they might lead to serious systolic blood pressure alterations through inducing sympathetic nervous activity has not been studied so far. OBJECTIVES: To investigate the relationship between benign prostate enlargement-related storage and voiding symptoms and systolic blood pressure. DESIGN AND SETTING: Cross-sectional single-center study on data from a hospital patient record system. METHODS: We evaluated the medical records of all consecutive patients with benign prostate enlargement-related lower urinary tract symptoms admitted between January 2012 and December 2017. Storage and voiding symptoms were assessed separately. International Prostate Symptom Score, uroflowmetry, postvoiding residual urine volume and systolic blood pressure were recorded. Pearson correlation and linear regression analysis were used. RESULTS: Positive correlations were found between systolic blood pressure and all of the storage symptoms. Among these, urgency had the most significant effect. There were 166 patients (41.4%) with urgency for urination, which increased mean systolic blood pressure from 124.88 mmHg (average value in elevated blood pressure group) to 132.28 mmHg (average value in stage-1 hypertension group). Hesitancy in urinating and feeling of incomplete bladder emptying had weak positive correlations with systolic blood pressure. There was a negative correlation between systolic blood pressure and intermittency of urination. CONCLUSIONS: With increasing numbers of urine storage symptoms, systolic blood pressure also increases, while the opposite occurs for voiding symptoms in patients with benign prostate enlargement. We conjecture that storage symptoms may lead to this increase through inducing sympathetic hyperactivity. Further prospective studies with larger groups are needed to confirm these findings.

Association between benign prostate enlargement-related storage and voiding symptoms and systolic blood pressure: a single-center cross-sectional study.

BACKGROUND: Lower urinary tract symptoms significantly worsen quality of life. The hypothesis that they might lead to serious systolic blood pressure alterations through inducing sympathetic nervous activity has not been studied so far. OBJECTIVES: To investigate the relationship between benign prostate enlargement-related storage and voiding symptoms and systolic blood pressure. DESIGN AND SETTING: Cross-sectional single-center study on data from a hospital patient record system. METHODS: We evaluated the medical records of all consecutive patients with benign prostate enlargement-related lower urinary tract symptoms admitted between January 2012 and December 2017. Storage and voiding symptoms were assessed separately. International Prostate Symptom Score, uroflowmetry, postvoiding residual urine volume and systolic blood pressure were recorded. Pearson correlation and linear regression analysis were used. RESULTS: Positive correlations were found between systolic blood pressure and all of the storage symptoms. Among these, urgency had the most significant effect. There were 166 patients (41.4%) with urgency for urination, which increased mean systolic blood pressure from 124.88 mmHg (average value in elevated blood pressure group) to 132.28 mmHg (average value in stage-1 hypertension group). Hesitancy in urinating and feeling of incomplete bladder emptying had weak positive correlations with systolic blood pressure. There was a negative correlation between systolic blood pressure and intermittency of urination. CONCLUSIONS: With increasing numbers of urine storage symptoms, systolic blood pressure also increases, while the opposite occurs for voiding symptoms in patients with benign prostate enlargement. We conjecture that storage symptoms may lead to this increase through inducing sympathetic hyperactivity. Further prospective studies with larger groups are needed to confirm these findings.

External Validation of the Cancer of the Prostate Risk Assessment Postsurgical Score for Prediction of Disease Recurrence after Radical Prostatectomy.

Objective. The cancer of the prostate risk assessment (CAPRA-S) postsurgical score predicts recurrence, metastasis, and cancer-specific survival after radical prostatectomy (RP). We evaluated the relation between CAPRA-S score and biochemical recurrence (BCR) in prostate cancer after RP in our clinic. Materials and Methods. This study was performed on 203 patients with prostate carcinoma who underwent open RP and regional lymph node dissection in our clinic between 2008 and 2013. We calculated the CAPRA-S scores including prostate-specific antigen (PSA) at diagnosis, pathology Gleason score, surgical margin, seminal vesicle invasion, extracapsular extension, and lymph node involvement. The patients were divided into 3 risk groups (low, intermediate, and high risk) according to risk scores. Results. Recurrence occurred in 17.8% of the patients (36 patients out of 203 patients) with a median of 11.7-month follow-up. The average recurrence-free survival time is 44.6 months. Surgical margin invasion and seminal vesicle invasion significantly correlated with BCR especially in high risk group (11 and 13 of 15 patients, p < 0.05, resp.). Conclusion. CAPRA-S score can be easily calculated and it is useful in clinical practice in order to timely propose adjuvant therapies after surgery.

Metachronous bilateral granulocytic sarcoma of the testis in a young adult: a report of an unusual entity.

Granulocytic sarcomas are rare tumors composed of neoplastic blood cells, typically occurring during the course of acute nonlymphoblastic leukemia or before its onset. We present a case of a 23-year-old young adult man with metachronous granulocytic sarcoma of the testis without hematologic manifestations who was diagnosed with granulocytic sarcoma (GS). The patient was treated with right orchiectomy but relapsed with a left testicular mass 16 months later when a left orchiectomy was performed. The patient has been free of disease for 13 months following the left orchiectomy. This case highlights a rare hematologic cancer that urologists and pathologists should be aware of since it can present as a testicular mass. Only 3 cases of testicular GS without an associated hematologic disorder have been described. To the best of our knowledge, our patient is the first reported case in the English literature of metachronous GS of the testis with no evidence of hematologic disorder.

Synchronous bladder and prostate cancers in the specimens of radical cystoprostatectomy: a multicenter retrospective analysis.

The purpose of this study was to evaluate the features of prostate cancer that have been incidentally detected in radical cystoprostatectomy specimens of bladder cancer patients. The researchers of the current study retrospectively evaluated the data from 119 men who underwent radical cystoprostatectomy at four referral institutions in Ankara, Turkey. Of the 21 prostate cancer patients, 17 (81%) were aged ≥ 60 years; 10 (47.6%) had clinically significant diseases; three had a Gleason score of 6, three had a Gleason score of 7, three had a Gleason score of 8, one had a positive surgical margin along with extracapsular invasion of the tumor and a high Gleason score, and three patients had a tumor volume of ≥ 0.5 cm(3), of which two also had a high Gleason score. Patients were followed-up for a mean of 29 ± 10.2 months; the overall survival was 96.6% (n = 115) during that period. Preoperative digital rectal examination and prostate-specific antigen values did not differ between the benign and prostate cancer groups. There was no survival advantage in the insignificant prostate cancer and benign prostate groups. No additional benefit for predicting prostate cancer was found with digital rectal examination and prostate-specific antigen tests, although some clinicians advised such. In patients aged < 60 years, organ-sparing cystectomy seems reasonable. In prostate-sparing surgery, candidates who are aged >60 years, the preoperative work-up may routinely include prostate biopsy, especially the apex. Preoperative findings of multifocality of bladder cancers and the presence of carcinoma in situ have the risk of prostatic involvement.

Preparation and characterization of papaverine-loaded poly[(r)-3-hydroxybutyrate] membranes to be used in the prevention of vasospasm.

The objective of this study is the preparation and characterization of poly[(R)-3-hydroxybutyrate] (PHB) membrane loaded with a vasodialative agent (i.e., papaverine hydrochloride) as a blood vessel coverage strip to be used in the prevention of undesired vascular vasospasm. Papaverine-loaded PHB membranes were especially designed to act locally and provide an efficient, long term, and sustained prevention of vasospasm at the site of the newly created vascular anastomosis without any systemic vasodilation effect of the papaverine, which may be life-threatening for the patient. The membranes were prepared by gelation of PHB followed by solvent casting. PHB membranes were characterized in terms of morphology, chemical structure, swelling behavior, in vitro drug release, degradation, and blood compatibility studies as in vitro coagulation tests. Activated partial thromboplastin time, prothrombin time, and fibrinogen concentration were measured by blood coagulation assays. Investigated and evaluated parameters for in vitro drug release, degradation, and in vitro coagulation studies were the concentration of PHB and drug content. Similar effective parameters were used for swelling behavior studies (i.e., concentration of PHB and drug content). Drug release, swelling behavior, degradation, and in vitro coagulation of the membranes were found to be influenced by these parameters. Obtained results showed that papaverine-loaded PHB membranes provide an efficient and advantegous means for the prevention of vasospasm during vascular anastomosis as a local application.

Protective effects of tadalafil on experimental spinal cord injury in rats.

Tadalafil is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5). Nitric oxide (NO) functions as a retrograde neurotransmitter in the spinal cord, and postsynaptic structures respond to NO by producing cGMP. The concentrations of cGMP in the spinal cord are controlled by the actions of PDE. The aim of the study was to evaluate and compare the effects of the use of both methylprednisolone and tadalafil on serum and tissue concentrations of NO, malondialdehyde (MDA) levels, superoxide dismutase (SOD) activity, and tissue glutathione peroxidase (GSH-Px) activity in rats with spinal cord injury (SCI). SCI was induced in Wistar albino rats by dropping a 10 g rod from a 5.0 cm height at T8-10. The 28 rats were randomly divided into four equal groups: tadalafil, methylprednisolone, non-treatment and sham groups. Rats were neurologically tested at 24 hours after trauma. At the end of the experiment, blood samples were collected and spinal cord tissue samples were harvested for biochemical evaluation. The tissue level of NO was increased in the tadalafil group compared with the non-treatment and methylprednisolone groups (p<0.05). The tissue levels of SOD and GSH-Px did not differ between the groups. Serum levels of NO were higher in the tadalafil group than in the non-treatment group (p<0.05). The increase in serum SOD levels was greater in the tadalafil group than the methylprednisolone group. Serum MDA levels in the tadalafil and methylprednisolone groups tended to be lower than in the non-treatment group (p>0.05). Tissue MDA levels in the tadalafil and methylprednisolone groups tended to be lower than in the non-treatment group and sham groups (p>0.05). Although there was no difference in neurological outcome scores between the tadalafil, methylprednisolone and non-treatment groups (p>0.05), the animals in the tadalafil and methylprednisolone groups tended to have better scores than the non-treatment group. Thus, tadalafil appears to be beneficial in reducing the effects of injury to the spinal cord by increasing tissue levels of NO and serum activity of SOD.

Hereditary behavior of varicocele.

The inheritance of varicoceles and the potential transmission to first-degree relatives has rarely been investigated. In the present study, we examined the first-degree relatives of men with known varicocele to reveal the familial risk for varicocele. Of the patients with clinical varicocele who presented with infertility, testicular pain, or asymmetrical swelling of the scrotum between June 1, 2008 and May 31, 2009, 49 agreed to have their available first-degree relatives contacted for screening of varicoceles (n = 66). A cohort of 100 consecutive men who applied to the department of internal medicine between 2008 and 2009 for checkup procedure without a history of subfertility or a varicocele were used as a control population. Of the 92 first-degree relatives contacted, 66 (71.7%) decided to participate in this study. Of these 66 men, 21 (33.9%) had a palpable varicocele on physical examination. Compared with a control population (12%), the prevalence of palpable varicocele in the first-degree relatives of patients with known varicocele (33.9%) was approximately 3-fold greater (P < .005). Among the first-degree relatives, 4 (21.1%) of 19 fathers and 17 (36.2%) of 47 brothers had palpable varicocele. As a conclusion, a significant increase in varicocele prevalence is present in the first-degree relatives of men with known varicoceles. Patients should be counseled about this increased risk in male relatives of patients.

Augmented reality: a new tool to improve surgical accuracy during laparoscopic partial nephrectomy? Preliminary in vitro and in vivo results.

BACKGROUND: Use of an augmented reality (AR)-based soft tissue navigation system in urologic laparoscopic surgery is an evolving technique. OBJECTIVE: To evaluate a novel soft tissue navigation system developed to enhance the surgeon's perception and to provide decision-making guidance directly before initiation of kidney resection for laparoscopic partial nephrectomy (LPN). DESIGN, SETTING, AND PARTICIPANTS: Custom-designed navigation aids, a mobile C-arm capable of cone-beam imaging, and a standard personal computer were used. The feasibility and reproducibility of inside-out tracking principles were evaluated in a porcine model with an artificially created intraparenchymal tumor in vitro. The same algorithm was then incorporated into clinical practice during LPN. INTERVENTIONS: Evaluation of a fully automated inside-out tracking system was repeated in exactly the same way for 10 different porcine renal units. Additionally, 10 patients underwent retroperitoneal LPNs under manual AR guidance by one surgeon. MEASUREMENTS: The navigation errors and image-acquisition times were determined in vitro. The mean operative time, time to locate the tumor, and positive surgical margin were assessed in vivo. RESULTS AND LIMITATIONS: The system was able to navigate and superpose the virtually created images and real-time images with an error margin of only 0.5 mm, and fully automated initial image acquisition took 40 ms. The mean operative time was 165 min (range: 135-195 min), and mean time to locate the tumor was 20 min (range: 13-27 min). None of the cases required conversion to open surgery. Definitive histology revealed tumor-free margins in all 10 cases. CONCLUSIONS: This novel AR tracking system proved to be functional with a reasonable margin of error and image-to-image registration time. Mounting the pre- or intraoperative imaging properties on real-time videoendoscopic images in a real-time manner will simplify and increase the precision of laparoscopic procedures.

Robotic and imaging in urological surgery.

PURPOSE OF REVIEW: New imaging modalities and tissue navigation systems, which are adoptable to minimally invasive robotic urological surgical systems and prone to make the procedures more precise and easy, are reviewed. RECENT FINDINGS: Image-guided surgery as the general name of combining information of imaging modalities with real-time surgery has already found a place in open and minimally invasive procedures. Soft tissue navigation is a complex type of computer-assisted surgery for soft tissue interventions. Robotic surgery has advantages of superior degrees of freedom and three-dimensional stereotactic user interface. A combination of surgical robotics with image-assisted surgery and soft tissue navigation may offer advantages of more precise anatomical target localization and dissection with minimal damage to the tissue. Solving the problem of organ shift and as a result, unpredictable changing of intraoperative anatomy soft tissue navigation has the potential to increase the precision of minimally invasive robotic surgery. SUMMARY: Apart from less invasiveness, the concomitant use of minimal invasive robotic systems with soft tissue navigation enhances surgical precision. However, at present, abdominal navigation systems are in experimental use and not perfect enough for daily surgical routine.