Impact of benign prostatic hyperplasia surgery on erectile function.

AIM: We evaluate the prevalence of erectile dysfunction (ED) prior to surgery for benign prostatic hyperplasia (BPH) and changes produced after surgical intervention. PATIENTS AND METHODS: This prospective study included 128 patients treated surgically for BPH. The prevalence of ED was determined before and after surgery according to the International Index of Erectile Function (IIEF). The influence of different clinical variables on erectile function (EF) improvement or deterioration after surgery was determined using uni- and multivariate analyses. RESULTS: Mean IIEF score before surgery was 20.5 +/- 7.6. Overall, ED was absent in 32% of patients, mild in 42%, moderate in 13.3%, and severe in 12.5%. Mean IIEF score following surgery was 21.5 +/- 7.4 (p = n.s.). After surgery EF improved in 26.6% (34/128) of patients and worsened in 18.8% (24/128) (p < 0.05). Analysing the subset of patients with presurgical ED, 39% reported improvement and 21.1% reported worsening of EF postoperatively. None of the variables analyzed showed a significant relationship with improvement or worsening of EF. Only age was related to worsening EF in the subgroup of non-ED patients. CONCLUSIONS: There is a high prevalence of ED amongst candidates for BPH surgery. Although the risk of worsening EF exists postsurgically, an important percentage of ED patients will improve.

Percentage of cancer in prostate biopsies as prognostic factor for staging and postoperative biochemical failure after radical prostatectomy.

OBJECTIVE: To assess if the percentage of cancer in prostate needle biopsies provides independent prognostic information for predicting pathological stage and/or biochemical relapse after radical prostatectomy. METHODS: One hundred and forty prostate cancer patients who underwent radical prostatectomy were evaluated. Preoperative parameters analyzed were patient age, PSA, clinical stage, and the information obtained from sextant biopsies (Gleason score, maximum percentage of cancer in a core, percentage of tissue with cancer in all biopsies and the number of cores positive for cancer). Univariate and multivariate analyses (logistic regression) for the dependent variables (prostate cancer, organ-confined and biochemical relapse) were performed. RESULTS: The tumor was organ-confined in 73.6% of patients. In those patients studied for disease progression (n = 126), no biochemical recurrence was observed in 76.2%. In the multivariate analysis for organ-confined disease, the total percentage of biopsy tissue with cancer, the preoperative PSA level, the Gleason score and the clinical stage were the most accurate predictive factors of pathological stage. The multivariate analysis for the study of biochemical failure indicated that only the total percentage of biopsy tissue with cancer, the preoperative PSA level and the Gleason score were independent predictive factors. According to the logistic regression analysis for disease recurrence, 3 risk groups could be identified: low risk (less than 10% probability of disease progression), intermediate risk (30%) and high risk (more than 70%). CONCLUSIONS: The percentage of cancer in prostate biopsy provides independent prognostic information for predicting pathological stage and the risk of biochemical failure after radical prostatectomy.

[Comparative study of P 53, Bcl-2, and C-erbB-2 expression in low-grade papillary bladder tumors]. / Estudio comparativo de la expresión de p53, Bcl-2 y C-erbB-2 en neoplasias papilares vesicales de bajo grado.

OBJECTIVE: To study the prognostic value of p53, bcl-2 and c-erbB-2 immunoexpression in predicting tumor relapses in low-grade papillary bladder neoplasms. METHODS: In all patients a complete transurethral resection of the lesion was performed. All the material was formalin-fixed and paraffin-embedded. At the immunohistochemical level, the following monoclonal antibodies were utilized: p53 (clone DO7), bcl-2 (clone 124) and c-erbB-2 (clone CB11). In order to predict tumor relapses during follow-up, a study of specificity, sensitivity and predictive positive value (PVP) and negative was designed. In univariate statistical studies, the following tests were utilized: Chi-square, Kaplan-Meier estimates and Cox logistic regression. RESULTS: Mean follow-up was 76.6 months (38 to 168). In recurrence prediction, p53 expression showed a high specificity (99%) as well as a high PPV (96%). Regarding bcl-2 and c-erbB-2 immunoexpression, both specificity (65% and 72%) and PPV (61% and 72%) were also high, although these percentages were lower than those obtained for p53 expression. The combined analysis of p53 and bcl-2 indicated that bcl-2 immunoexpression in non-basal cells of the urothelium could be independent of p53, although the number of cases showing this particular expression pattern is not high enough to perform an accurate statistical analysis. Otherwise, histologic grade demonstrated higher sensitivity (64%) and lower specificity (40%) than the immunohistochemical markers. In univariate studies, p53 showed an intense statistical correlation with relapse-free interval (RFI) and prediction of tumor recurrences during follow-up (p < 0.001), whereas the expression of bcl-2 (p = 0.065) was nearly correlated with RFI (p = 0.065). In contrast, expression of c-erbB-2 did not show statistical correlation (p = 0.112). CONCLUSIONS: In our study, individual and combined analysis of p53 and bcl-2 immunoexpression have demonstrated to be useful in predicting tumor recurrences and RFI in low-grade bladder lesions.

Estudio comparativo de la expresión de P53, Bcl-2 y C-erbB-2 en neoplasias papilares vesicales de bajo grado / Comparative sutdy of P53, Bcl-2, and C-erb-carousel expression in low-grade papillary bladder tumors

OBJETIVOS: Estudiar el valor pronóstico de la expresión inmunohistoquímica de p53, bcl-2 y cerbB-2 en la predicción de recidivas tumorales en neoplasias vesicales papilares de bajo grado histológico. MÉTODOS: En todos los pacientes se realizó la resección transuretral completa de la lesión. El material se fijó posteriormente en formaldehído y fue incluido en parafina. Para el estudio inmunohistoquímico se utilizaron los siguientes anticuerpos monoclonales: p53 (clon DO7), bcl-2 (clon 124) y c-erbB-2 (clon CB11). En relación con la predicción de recidivas tumorales se analizaron sensibilidad, especificidad y valor predictivo positivo (VPP) y negativo. Para el estudio estadístico univariante se utilizaron las pruebas de la Chi-cuadrado, Kaplan-Meier y regresión logística de Cox. RESULTADOS: El seguimiento medio de los pacientes fue de 76,6 meses (38-168 meses). La expresión de la proteína p53 mostró una elevada especificidad (99 por ciento) y elevado VPP (96 por ciento) en relación con la predicción de recidivas tumorales. En cuanto a la expresión de bcl-2 y c-erbB-2, los valores de especificidad (65 por ciento y 72 por ciento) y VPP (61 por ciento y 72 por ciento) fueron también elevados, aunque menores que los obtenidos con p53. El análisis conjunto de la expresión de p53 y bcl-2 indicó que la expresión de bcl-2 en las capas no basales del urotelio podría ser independiente de la expresión p53, aunque el número de casos que muestran este tipo de expresión es muy reducido para un correcto análisis estadístico. Por su parte, el grado histológico mostró mayor sensibilidad (64 por ciento) y menor especificidad (40 por ciento) que los marcadores inmunohistoquímicos estudiados. En el estudio univariante, la expresión de p53 demostró una intensa asociación estadística con el intervalo libre de enfermedad (ILE) y con la predicción de recidivas tumorales (p<0,001), mientras que la expresión de bcl-2 muestra tendencia a la asociación (p=0,065). Por el contrario, la expresión de c-erbB-2 no estaba correlacionada (p=0,112). CONCLUSIONES: El análisis individual y conjunto de la expresión inmunohistoquímica de p53 y bcl-2 en neoplasias vesicalesuroteliales de bajo grado histológico ha demostrado en nuestro estudio utilidad en la predicción de recidivas tumorales y del ILE (AU)

[Efficacy and safety of sildenafil in patients with erectile dysfunction and hypertension. Prognostic factors]. / Eficacia y seguridad del sildenafilo en pacientes con disfunción eréctil e hipertensión arterial. Factores pronósticos de respuesta.

BACKGROUND: Our purpose was to assess the efficacy and safety of sildenafil as a treatment for erectile dysfunction in hypertensive patients, and to investigate those factors associated with a treatment failure. PATIENTS AND METHOD: Open, prospective study including 114 patients suffering from erectile dysfunction plus arterial hypertension who were evaluated by anamnesis, physical examination, blood tests including glycemia and lipidic and hormonal profiles, penile colour Doppler ultrasonography after intracavernosal prostaglandin E1 (PGE1) injection, and the Sexual Health Inventory for Men (SHIM). Efficacy of sildenafil was assessed by administering again the SHIM and by means of a global assessment questionnaire. Side effects were also recorded. Factors influencing treatment outcome were evaluated by univariate and multivariate statistical analysis. RESULTS: Overall, sildenafil was effective in 59.2% of 103 eligible patients. Efficacy in patients with psychogenic erectile dysfunction was 75%, whereas in those with an organic etiology, the efficacy was 50.7%. Age, diabetes mellitus, nocturnal penile tumescence, response to intracavernosal PGE1 injection and erectile dysfunction severity (defined by the SHIM basal score) significantly influenced treatment response (p < 0.05) after an univariate analysis. The multivariate analysis, however, selected only diabetes mellitus and severity of erectile dysfunction as the prognostic factors. No severe side effects were noticed. CONCLUSIONS: Sildenafil is a rather effective and well-tolerated treatment for erectile dysfunction in hypertensive patients. Baseline severity of erectile dysfunction and diabetes mellitus represent the prognostic factors most significantly associated with treatment outcome.