Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.630
Filtrar
1.
Nat Rev Urol ; 17(3): 177-188, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32086498

RESUMO

The practice of radical prostatectomy for treating prostate cancer has evolved remarkably since its general introduction around 1900. Initially described using a perineal approach, the procedure was later popularized using a retropubic one, after it was first described as such in 1948. The open surgical method has now largely been abandoned in favour of the minimally invasive robot-assisted method, which was first described in 2000. Until 1980, the procedure was hazardous, often accompanied by massive blood loss and poor outcomes. For patients in whom surgery is indicated, prostatectomy is increasingly being used as the first step in a multitherapeutic approach in advanced local, and even early metastatic, disease. However, contemporary molecular insights have enabled many men to safely avoid surgical intervention when the disease is phenotypically indolent and use of active surveillance programmes continues to expand worldwide. In 2020, surgery is not recommended in those men with low-grade, low-volume Gleason 6 prostate cancer; previously these men - a large cohort of ~40% of men with newly diagnosed prostate cancer - were offered surgery in large numbers, with little clinical benefit and considerable adverse effects. Radical prostatectomy is appropriate for men with intermediate-risk and high-risk disease (Gleason score 7-9 or Grade Groups 2-5) in whom radical prostatectomy prevents further metastatic seeding of potentially lethal clones of prostate cancer cells. Small series have suggested that it might be appropriate to offer radical prostatectomy to men presenting with small metastatic burden (nodal and or bone) as part of a multimodal therapeutic approach. Furthermore, surgical treatment of prostate cancer has been reported in cohorts of octogenarian men in good health with minimal comorbidities, when 20 years ago such men were rarely treated surgically even when diagnosed with localized high-risk disease. As medical therapies for prostate cancer continue to increase, the use of surgery might seem to be less relevant; however, the changing demographics of prostate cancer means that radical prostatectomy remains an important and useful option in many men, with a changing indication.


Assuntos
Próstata/cirurgia , Prostatectomia/história , Neoplasias da Próstata/história , Procedimentos Cirúrgicos Robóticos/história , História do Século XX , História do Século XXI , Humanos , Excisão de Linfonodo/história , Excisão de Linfonodo/tendências , Masculino , Próstata/anatomia & histologia , Próstata/patologia , Prostatectomia/métodos , Prostatectomia/tendências , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos
2.
Urology ; 136: 190-195, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31730940

RESUMO

OBJECTIVE: To provide the anatomy of the puboprostatic ligament and related structures to save urogenital competence after prostatectomy. MATERIALS AND METHODS: Pelvic areas of 31 adult cadavers were dissected to figure out the shape, number, and location of the puboprostatic ligaments. RESULTS: The puboprostatic ligament was the most important support structure between the pubic bone and prostate gland. Puboprostatic ligaments were bilaterally single (61.3%), bilaterally double (19.4%), or mixed (19.4%). Ligaments were mostly I-shaped (53.8%). If ligaments had extra attachment to or from the arcuate line, the ligaments were λ-shaped (36.3%), or Y-shaped (8.8%). In one case, the ligament had a central fusion with an irregular shape. I-shaped puboprostatic ligaments were observed more frequently in specimens with double ligaments, while λ-shaped puboprostatic ligaments were observed more frequently in the cases with single ligaments. The average distance between both puboprostatic ligaments was 8.1 mm at the pubic site and 14.2 mm at the prostate site. The distance was narrower when the specimen had double puboprostatic ligaments on both sides. The neurovascular bundle ran beneath the puboprostatic ligament. If the ligament was the λ-shaped type, the neurovascular bundle frequently pierced the lateral band of the ligament. CONCLUSION: Puboprostatic ligaments hold and stabilize the prostate against the pubic bone. It is believed that a pelvis with bilateral, double puboprostatic ligaments would have advantages in urogenital competence. The morphologic data of the shape, multiplicity, and location of the PPLs would help to make a plan to approach the prostate.


Assuntos
Ligamentos/anatomia & histologia , Próstata/anatomia & histologia , Prostatectomia/métodos , Osso Púbico/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Humanos , Masculino , Pessoa de Meia-Idade
3.
Khirurgiia (Mosk) ; (3): 111-120, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30938366

RESUMO

Robot-assisted operations as widely used in urology, gynecology, general and cardiovascular surgery are considered by many experts as a new 'gold standard' of surgical treatment of various diseases in developed countries. Robot-assisted radical prostatectomy for prostate cancer is the most common robotic procedure. Better functional outcomes of robot-assisted radical prostatectomy are due to another (new) understanding of pelvic surgical anatomy, new approach implying dissection and preservation of external urethral sphincter and neurovascular structures. Prostate neuroanatomy, various approaches to preserve neurovascular structures and own experience of nerve-sparing robot-assisted radical prostatectomy with functional results are reviewed in the article.


Assuntos
Próstata/inervação , Próstata/cirurgia , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Dissecação/métodos , Humanos , Masculino , Pelve/anatomia & histologia , Pelve/inervação , Pelve/cirurgia , Próstata/anatomia & histologia , Resultado do Tratamento , Uretra/anatomia & histologia , Uretra/cirurgia
5.
Med Phys ; 46(7): 3078-3090, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31002381

RESUMO

PURPOSE: Accurate regional segmentation of the prostate boundaries on magnetic resonance (MR) images is a fundamental requirement before automated prostate cancer diagnosis can be achieved. In this paper, we describe a novel methodology to segment prostate whole gland (WG), central gland (CG), and peripheral zone (PZ), where PZ + CG = WG, from T2W and apparent diffusion coefficient (ADC) map prostate MR images. METHODS: We designed two similar models each made up of two U-Nets to delineate the WG, CG, and PZ from T2W and ADC map MR images, separately. The U-Net, which is a modified version of a fully convolutional neural network, includes contracting and expanding paths with convolutional, pooling, and upsampling layers. Pooling and upsampling layers help to capture and localize image features with a high spatial consistency. We used a dataset consisting of 225 patients (combining 153 and 72 patients with and without clinically significant prostate cancer) imaged with multiparametric MRI at 3 Tesla. RESULTS AND CONCLUSION: Our proposed model for prostate zonal segmentation from T2W was trained and tested using 1154 and 1587 slices of 100 and 125 patients, respectively. Median of Dice similarity coefficient (DSC) on test dataset for prostate WG, CG, and PZ were 95.33 ± 7.77%, 93.75 ± 8.91%, and 86.78 ± 3.72%, respectively. Designed model for regional prostate delineation from ADC map images was trained and validated using 812 and 917 slices from 100 and 125 patients. This model yielded a median DSC of 92.09 ± 8.89%, 89.89 ± 10.69%, and 86.1 ± 9.56% for prostate WG, CG, and PZ on test samples, respectively. Further investigation indicated that the proposed algorithm reported high DSC for prostate WG segmentation from both T2W and ADC map MR images irrespective of WG size. In addition, segmentation accuracy in terms of DSC does not significantly vary among patients with or without significant tumors. SIGNIFICANCE: We describe a method for automated prostate zonal segmentation using T2W and ADC map MR images independent of prostate size and the presence or absence of tumor. Our results are important in terms of clinical perspective as fully automated methods for ADC map images, which are considered as one of the most important sequences for prostate cancer detection in the PZ and CG, have not been reported previously.


Assuntos
Imagem de Difusão por Ressonância Magnética , Processamento de Imagem Assistida por Computador/métodos , Próstata/anatomia & histologia , Próstata/diagnóstico por imagem , Automação , Humanos , Masculino
6.
Prog Urol ; 29(5): 263-269, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30948187

RESUMO

INTRODUCTION: Prostatic arterial embolization (PAE) is an experimental therapy for benign prostatic hyperplasia. Its feasibility is based on the knowledge of the pelvic arterial anatomy, and more specifically the prostate. The aim of this study was to describe the prostatic arterial supply: origins, distribution and variability. MATERIAL AND METHODS: We reviewed retrospectively, with two radiologists, 40 arteriographies of patients who underwent PAE in our center. With these observations of 80 hemipelvics, we described the number of prostatic arteries, their origins, their distributions and eventually their anastomoses with other pelvic arteries. RESULTS: There was one prostatic artery in 70% of the cases. It came from a common trunk for the prostate and the bladder in 55% of the cases, from the obturator artery in 17.5% of the cases, from the pudendal artery in 25% of the cases, from the intern iliac artery in 1% of the cases, and from the superior gluteal artery in 1% of the cases. The prostatic artery splitted in two branches (medial and lateral), with no anastomoses in 37% of the cases. Anastomoses with penile and rectal arteries were observed in 29% of the cases. CONCLUSIONS: For our 40 patients, we observed many variations of arterial prostatic anatomy. We proposed a classification in order to increase security and efficacy of PAE, and it should be validated with more patients. LEVEL OF EVIDENCE: 2.


Assuntos
Artérias/anatomia & histologia , Artérias/patologia , Embolização Terapêutica/métodos , Próstata/anatomia & histologia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Artérias/diagnóstico por imagem , Artérias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Próstata/patologia , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/patologia , Estudos Retrospectivos
7.
J Appl Clin Med Phys ; 20(4): 10-17, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30821881

RESUMO

PURPOSE: With the move towards magnetic resonance imaging (MRI) as a primary treatment planning modality option for men with prostate cancer, it becomes critical to quantify the potential uncertainties introduced for MR-only planning. This work characterized geometric and dosimetric intra-fractional changes between the prostate, seminal vesicles (SVs), and organs at risk (OARs) in response to bladder filling conditions. MATERIALS AND METHODS: T2-weighted and mDixon sequences (3-4 time points/subject, at 1, 1.5 and 3.0 T with totally 34 evaluable time points) were acquired in nine subjects using a fixed bladder filling protocol (bladder void, 20 oz water consumed pre-imaging, 10 oz mid-session). Using mDixon images, Magnetic Resonance for Calculating Attenuation (MR-CAT) synthetic computed tomography (CT) images were generated by classifying voxels as muscle, adipose, spongy, and compact bone and by assignment of bulk Hounsfield Unit values. Organs including the prostate, SVs, bladder, and rectum were delineated on the T2 images at each time point by one physician. The displacement of the prostate and SVs was assessed based on the shift of the center of mass of the delineated organs from the reference state (fullest bladder). Changes in dose plans at different bladder states were assessed based on volumetric modulated arc radiotherapy (VMAT) plans generated for the reference state. RESULTS: Bladder volume reduction of 70 ± 14% from the final to initial time point (relative to the final volume) was observed in the subject population. In the empty bladder condition, the dose delivered to 95% of the planning target volume (PTV) (D95%) reduced significantly for all cases (11.53 ± 6.00%) likely due to anterior shifts of prostate/SVs relative to full bladder conditions. D15% to the bladder increased consistently in all subjects (42.27 ± 40.52%). Changes in D15% to the rectum were patient-specific, ranging from -23.93% to 22.28% (-0.76 ± 15.30%). CONCLUSIONS: Variations in the bladder and rectal volume can significantly dislocate the prostate and OARs, which can negatively impact the dose delivered to these organs. This warrants proper preparation of patients during treatment and imaging sessions, especially when imaging required longer scan times such as MR protocols.


Assuntos
Imagem por Ressonância Magnética/métodos , Órgãos em Risco/efeitos da radiação , Próstata/anatomia & histologia , Neoplasias da Próstata/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Adulto , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Próstata/efeitos da radiação , Radiometria/métodos , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos
8.
J Med Radiat Sci ; 66(2): 81-90, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30737908

RESUMO

INTRODUCTION: In Ghana, trans-abdominal ultrasonography is the main sonographic method of prostatic volume evaluation. The examinations are done when the patient's bladder is full. However, the delay and the discomforting experiences associated with a full bladder have been well documented. In an attempt to investigate other less discomforting options, this study was undertaken to determine if sonographic transabdominal prostatic evaluations performed at urinary bladder volumes of 50-99 mL differ significantly to evaluations done at volumes of 100-199, 200-299 and 300-399 mL. METHODS: A prostatic study of adult patients was undertaken in Accra, from 2014 to 2015. Using an ultrasound machine, 79 sets of prostatic measurements were recorded at a urinary bladder volume of 50-99 mL (V1 as our reference volume), and at least one of three other urinary bladder volumes (V2 = 100-199 mL, V3 = 200-299 mL and V4 = 300-399 mL), in 66 males. Twelve of the participants had multiple sets of prostate volume measurements. SPSS was used to analyse the data. T-test, Bland-Altman plots and linear regression were used to compare and test for the existence of proportional biases in measurements. RESULTS: There was a statistically significant difference in prostatic volumes recorded at V1 and V2 (P = 0.017). However, the prostatic volume differences recorded for V1/V3, and V1/V4 groups of data were all not statistically significant (P > 0.05). The limits of agreement for the set of measurements spread from approximately -29 to +18 mL for V1/V2, -48 to +36 mL for V1/V3 and -12 to +12 mL for V1/V4 variables. There was no proportional bias in the V1/V2 (P = 0.55) and V1/V4 (P = 0.463) measurements. CONCLUSION: Urinary bladder volume of 50-99 mL produces prostatic volume measurements comparable to volumes measured in patients with a full (300-399 mL), or nearly full urinary bladder (200-299 mL). A urinary bladder volume of 50-99 mL may therefore be adequate for scanning the prostate gland, and is likely to be tolerated much better by patients.


Assuntos
Abdome , Próstata/anatomia & histologia , Próstata/diagnóstico por imagem , Bexiga Urinária/anatomia & histologia , Adulto , Humanos , Masculino , Tamanho do Órgão , Próstata/patologia , Ultrassonografia , Bexiga Urinária/patologia
9.
Pharm Biol ; 57(1): 90-98, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30724641

RESUMO

CONTEXT: Lespedeza cuneata G. Don (Fabaceae), has been used as a traditional treatment of various diseases. There is a report L. cuneata effects on hormone replacement therapy for endocrine-related disease. However, studies related to benign prostatic hyperplasia (BPH) have not been investigated. OBJECTIVE: The effects of L. cuneata aqueous extract (LCW) on testosterone-induced prostatic hyperplasia (TPH) were examined. MATERIALS AND METHODS: Male Wistar rats (10 weeks, 330-350 g) were randomly divided to 6 groups (n = 6): Control group; TPH group (3 mg/kg, s.c, daily); TPH + LCW (25, 50, 100 mg/kg); TPH + Finasteride 10 mg/kg for 6 weeks. At the end of treatment, histological change of prostate, serum dihydrotestosterone (DHT) level, mRNA expression of 5α-reductase, inflammatory factors, proliferating cell nuclear antigen (PCNA) and fibroblast growth factor-2 (FGF-2) in prostate were examined. Then, LCW was treated with BPH-1, a human BPH cell line, at 25, 50, 100 µg/mL for 24 h and examine mRNA level of androgen receptor (AR) and prostate-specific antigen (PSA). In addition, the content of vicenin-2 was analyzed. RESULTS: LCW treatment of TPH inhibited serum DHT levels by 54.5, 51.2 and 54.1% and mRNA expression of 5α-reductase were inhibited 54.3, 61.3 and 73.6%, respectively. In addition, mRNA expression of inflammatory factors, PCNA and FGF-2 were decreased in the prostate of rats. Also, LCW attenuated mRNA level of AR and PSA in BPH-1 cell. The content of vicenin-2 in the LCW was analyzed to 0.89 mg/g. DISCUSSION AND CONCLUSIONS: Based on the results, LCW is a potential pharmacological candidate for the treatment of prostatic hyperplasia.


Assuntos
Lespedeza/química , Extratos Vegetais/farmacologia , Hiperplasia Prostática/tratamento farmacológico , 3-Oxo-5-alfa-Esteroide 4-Desidrogenase/metabolismo , Animais , Citocinas/metabolismo , Di-Hidrotestosterona/antagonistas & inibidores , Di-Hidrotestosterona/sangue , Di-Hidrotestosterona/farmacologia , Finasterida/farmacologia , Masculino , Tamanho do Órgão/efeitos dos fármacos , Antígeno Nuclear de Célula em Proliferação/metabolismo , Próstata/anatomia & histologia , Próstata/efeitos dos fármacos , Antígeno Prostático Específico/metabolismo , Hiperplasia Prostática/sangue , Hiperplasia Prostática/induzido quimicamente , Hiperplasia Prostática/patologia , Ratos , Ratos Wistar , Receptores Androgênicos/metabolismo , Testosterona/administração & dosagem
10.
BMC Vet Res ; 15(1): 49, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717756

RESUMO

BACKGROUND: Prostatic diseases are common and mostly associated with enlargement of the accessory gland. Thus, determining the prostate size has become a main criterion for evaluating prostate health status. Computed tomography (CT) is recommended as a beneficial tool for evaluating prostate size, morphology and surrounding tissues. The purpose of this study was to establish an accurate procedure for volume estimation and afterwards evaluate the prostate volume in CT. Data of 95 dogs were analysed (58 male intact, 37 male neutered) using the slice addition technique with the Amira program. Accuracy of volumetric measurements by CT was validated by comparing them with those of phantoms of known volume. Patients were grouped according to age (< 4 yrs., 4-8 yrs., > 8 yrs) and prostate morphology in CT (H = homogeneous, I = inhomogeneous, C = cystic). The length of the sixth lumbar vertebra was measured to relate prostate volume to body size. This ratio was generated to compare prostate volume between the groups, irrespective of body size (ratio volume = Rv). RESULTS: A high correlation between the CT-derived and phantom volume was found. Overall, the mean prostate volume was 58.6 cm3. The mean ratio volume was 1.3 in intact male dogs, this being significantly higher than in neutered dogs (0.7). The lowest ratio volume values were found in group H for intact (Rv = 0.9) and neutered dogs (Rv = 0.6), followed by group I (intact: Rv = 1.1; neutered: Rv = 0.7) and C (intact: Rv = 1.4; neutered: Rv = 0.8). The length of the sixth lumbar vertebra was well correlated with the prostate volume (intact: r = 0.63, p < 0.001; neutered: r = 0.48, p = 0.003), while age exhibited a correlation only in intact dogs (r = 0.52, p < 0.001). CONCLUSION: The present study is pioneering in applying a slice addition technique to volumetric measurements of the prostate gland in CT, resulting in a highly precise method. Volumetric measurements of the canine prostate gland in CT images provide information about the prostate structure, castration status, age and body size of the patients. Therefore, prostate volume is a relevant parameter for evaluating prostate health status.


Assuntos
Cães/anatomia & histologia , Próstata/diagnóstico por imagem , Animais , Vértebras Lombares/anatomia & histologia , Vértebras Lombares/diagnóstico por imagem , Masculino , Tamanho do Órgão , Imagens de Fantasmas/veterinária , Próstata/anatomia & histologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Software , Tomografia Computadorizada por Raios X/veterinária
11.
Acta Oncol ; 58(7): 1029-1035, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30761939

RESUMO

Background: To evaluate the occurrence of erectile dysfunction at 3 years (3yED) after prostate brachytherapy (BT) and to predict 3yED after treatment based on patients and treatments characteristics. Material and methods: From September 2007 to July 2015, 117 men with mild or no ED [International Index of Erectile Function (IIEF-5) > 16] underwent 125Iodine real-time ultrasound-guided low-dose rate BT to a total dose of 160 Gy for low-risk or favorable intermediate-risk prostate adenocarcinoma, and were followed prospectively during 3 years. Median age was 63 years (51-79). The post-implant dosimetric parameters on the postoperative computer tomography were derived from the dose-volume histogram of the prostate and the penile bulb (PB), crura, neurovascular bundles (NVBs) and internal pudendal arteries (IPAs). Potential clinical confounding factors were collected. Additionally, anatomical indexes reflecting the prostate anatomical location within the pelvis were studied. These variables were compared between patients with and without 3yED. 3yED was defined as an IIEF-5 score change to the lower category between baseline, with or without medication. Results: The 3yED rate was 59% (62% maintained an IIEF-5 > 16). On multivariate analysis, prostate D90% (p > .5) and pretreatment characteristics including age (p > .5), pre-implant potency (p > .5), diabetes (p = .08) and high cardiovascular risk rates (p = .1) did not influence the occurrence of 3yED. Only the PB dose especially the D10% > 51 Gy was associated with 3yED (p = .005). Conversely, dose to the crura, IPAs or NVBs did not seem to impact the erectile function. The prostate position, especially the apex location varied significantly between potent and impotent patients and 3yED was significantly associated with close position of the prostate apex to PB (p = .008). Conclusion: The most predictive factor of 3yED was the dose to the PB. This may be explained by variation in individual patients' anatomy and this could allow for the development of better strategies to prevent ED.


Assuntos
Adenocarcinoma/radioterapia , Braquiterapia/efeitos adversos , Disfunção Erétil/epidemiologia , Neoplasias da Próstata/radioterapia , Lesões por Radiação/epidemiologia , Idoso , Variação Anatômica , Braquiterapia/métodos , Relação Dose-Resposta à Radiação , Disfunção Erétil/etiologia , Seguimentos , Humanos , Radioisótopos do Iodo/administração & dosagem , Radioisótopos do Iodo/efeitos adversos , Masculino , Pessoa de Meia-Idade , Órgãos em Risco/anatomia & histologia , Órgãos em Risco/efeitos da radiação , Pênis/anatomia & histologia , Pênis/efeitos da radiação , Estudos Prospectivos , Próstata/anatomia & histologia , Lesões por Radiação/etiologia , Dosagem Radioterapêutica , Tomografia Computadorizada por Raios X
12.
Medicine (Baltimore) ; 98(3): e13897, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30653095

RESUMO

To analyze whether different volumes of tissue resected during transurethral resection of the prostate (TURP) would associate with the subsequent development of prostate cancer.This population-based retrospective cohort study recruited 49,206 patients with benign prostate hyperplasia (BPH) undergoing TURP between 2005 and 2012. Patients were recruited from the Taiwan National Health Insurance Research Database. Patients were separated into three groups, based on different volumes of tissue resected during TURP (5-15 g, 15-50 g, >50 g).Of the 49,206 patients, 633 patients were diagnosed with new onset of prostate cancer following TURP. Older age was a risk factor contributing to the onset of prostate cancer (P = .0196) and different volumes of tissue resected were significantly related to the incidence of postoperative prostate cancer (P = .0399). The group of patients with a smaller volume of prostate resected had a higher risk of prostate cancer with a hazard ratio (HR) of 1.221 (95% confidence interval [CI]: 1.035, 1.440; P = .0179). However, the risk in the group of patients with a larger volume of prostrate resected was not significantly different, with an HR of 1.277 (95% CI: 0.981, 1662; P = .0690). The incidence of prostate cancer in Taiwanese males over 30 years of age has previously been reported to be 0.0560%; the mean incidence was 0.2282% in our present study.This study shows that BPH patients who had a smaller volume of tissue resected during TURP show a higher incidence of prostate cancer postoperatively. Currently, no clear mechanism is shown to demonstrate the relationship between resected prostate weight and the incidence of tumors. Patients with a larger prostate volume might have lower urinary tract symptoms earlier and then seek professional help. It is possible that surgical procedures might remove the potentially carcinogenic prostate tissue and thus reduce the risk of an aggressive tumor developing in the future.


Assuntos
Próstata/anatomia & histologia , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Neoplasias da Próstata/patologia , Ressecção Transuretral da Próstata/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Humanos , Incidência , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/fisiologia , Período Pós-Operatório , Próstata/patologia , Hiperplasia Prostática/patologia , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/etiologia , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Ressecção Transuretral da Próstata/métodos , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos/tendências
13.
Reprod Fertil Dev ; 31(5): 875-887, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30694739

RESUMO

Sperm banking and AI could benefit endangered African wild dog conservation. However, it is unclear whether their dominance hierarchy causes a decrease in reproductive and sperm quality parameters in subordinate males that typically do not breed. In this study, we investigated the effect of social rank on male reproductive parameters, including faecal androgen and glucocorticoid metabolite concentrations, prostate and testes volume, preputial gland size, semen collection success and sperm quality. Samples were obtained from captive males (prebreeding season: n=12 from four packs; breeding season: n=24 from seven packs) that were classified as alpha (dominant), beta or gamma (subordinates) based on the frequency of dominant versus submissive behaviours. In the prebreeding season, semen was successfully collected from all alpha but only half the subordinate males, with urine contamination (associated with lower rank) significantly reducing total and progressive motility, sperm motility index, normal sperm morphology and acrosome integrity. The breeding season was associated with a significant increase in faecal androgens, prostate and testis volume, as well as progressive motility and the total number of spermatozoa ejaculated. However, with the exception of prostate volume (mean±s.e.m: 12.5±4.5, 7.1±1.0 and 7.3±1.0cm3 in alpha, beta and gamma males respectively; P=0.035), all other reproductive and sperm quality parameters did not differ between males of each social rank. In conclusion, reproductive suppression of subordinate males appears to be behaviourally mediated, because males of all social ranks produce semen of similar quality, making them suitable candidates for sperm banking, particularly during the breeding season when sperm quality improves.


Assuntos
Hierarquia Social , Reprodução/fisiologia , Motilidade Espermática/fisiologia , Espermatozoides/fisiologia , Androgênios/análise , Animais , Canidae , Forma Celular/fisiologia , Fezes/química , Masculino , Tamanho do Órgão/fisiologia , Próstata/anatomia & histologia , Estações do Ano , Análise do Sêmen/veterinária , Contagem de Espermatozoides/veterinária , Espermatozoides/citologia , Testículo/anatomia & histologia
14.
Minerva Chir ; 74(1): 63-77, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30037176

RESUMO

Urinary incontinence after radical prostatectomy (RP) is still an issue and may compromise patient quality of life and psychosocial behavior, regardless of oncologic outcomes. As this condition usually resolves by the end of the first postoperative year, many surgeons focused their attention on "early" return of urinary continence (UC). The aim of this non-systematic review is to present an overview of the current knowledge on the anatomy and the surgical techniques addressed to early functional recovery of continence after RP. The available literature data suggest that the preservation of bladder neck, pubo-prostatic ligaments, endopelvic fascia and vesico-urethral complex may play a role in recovery of early UC. Similarly, bladder neck reconstruction, anterior and/or posterior myo-fascio-ligamentous support to the anastomosis and tension-free watertight vesico-urethral anastomosis can improve early UC recovery post RP. More recently surgical approaches (i.e. Retzius-sparing technique) seem to add a piece in the jigsaw in the scenario of the early recovery of UC. Notwithstanding the efforts of the surgeons, more evidence from randomized studies is required to prove benefits of the different approaches and the "ideal" RP is far to be standardized.


Assuntos
Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Recuperação de Função Fisiológica , Micção/fisiologia , Humanos , Masculino , Complicações Pós-Operatórias/prevenção & controle , Próstata/anatomia & histologia , Próstata/cirurgia , Fatores de Tempo , Incontinência Urinária/prevenção & controle
15.
Strahlenther Onkol ; 195(2): 121-130, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30140944

RESUMO

BACKGROUND AND PURPOSE: The aim of this study was to evaluate an automatic multi-atlas-based segmentation method for generating prostate, peripheral (PZ), and transition zone (TZ) contours on MRIs with and without fat saturation (±FS), and compare MRIs from different vendor MRI systems. METHODS: T2-weighted (T2) and fat-saturated (T2FS) MRIs were acquired on 3T GE (GE, Waukesha, WI, USA) and Siemens (Erlangen, Germany) systems. Manual prostate and PZ contours were used to create atlas libraries. As a test MRI is entered, the procedure for atlas segmentation automatically identifies the atlas subjects that best match the test subject, followed by a normalized intensity-based free-form deformable registration. The contours are transformed to the test subject, and Dice similarity coefficients (DSC) and Hausdorff distances between atlas-generated and manual contours were used to assess performance. RESULTS: Three atlases were generated based on GE_T2 (n = 30), GE_T2FS (n = 30), and Siem_T2FS (n = 31). When test images matched the contrast and vendor of the atlas, DSCs of 0.81 and 0.83 for T2 ± FS were obtained (baseline performance). Atlases performed with higher accuracy when segmenting (i) T2FS vs. T2 images, likely due to a superior contrast between prostate vs. surrounding tissue; (ii) prostate vs. zonal anatomy; (iii) in the mid-gland vs. base and apex. Atlases performance declined when tested with images with differing contrast and MRI vendor. Conversely, combined atlases showed similar performance to baseline. CONCLUSION: The MRI atlas-based segmentation method achieved good results for prostate, PZ, and TZ compared to expert contoured volumes. Combined atlases performed similarly to matching atlas and scan type. The technique is fast, fully automatic, and implemented on commercially available clinical platform.


Assuntos
Anatomia Artística , Atlas como Assunto , Comércio , Interpretação de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Próstata/anatomia & histologia , Próstata/diagnóstico por imagem , Humanos , Aumento da Imagem/métodos , Imagem por Ressonância Magnética/instrumentação , Masculino , Sensibilidade e Especificidade
16.
World J Urol ; 37(5): 799-804, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30191394

RESUMO

PURPOSE: With the rapidly expanding anatomical and technical knowledge surrounding nervesparing radical prostatectomy (NSRP), anatomical and operative textbooks have failed to keep pace with the literature. A surgical skill laboratory (SSL) was designed to educate urology trainees on surgical anatomy and techniques for NSRP. The objective was to assess the validity of a SSL program. METHODS: A low-fidelity, anatomically accurate prostate model with its appropriate fascial coverings and location of the neurovascular bundle was created. Participants were surveyed prior to a SSL workshop for their knowledge of NSRP focusing on clinical and anatomical considerations. An interactive 2-h tutorial and workshop was then undertaken outlining the clinical and anatomical nuances for NSRP, with participants then practising an intra and inter-fascial NSRP on the model. Participants were resurveyed immediately after the workshop and at 6 months. RESULTS: Thirty participants completed the NSRP workshop. Significant differences (p < 0.0001) in anatomical and clinical knowledge were noted after the workshop with improvements for both junior and senior trainees. The knowledge was retained at 6 months following the workshop. CONCLUSIONS: A low-fidelity bench-top model is a feasible and reproducible technique for improving the understanding of periprostatic anatomy and the different surgical approaches for NSRP. The SSL is useful and knowledge gained appears to be retained by workshop participants. SSL workshops are a valid hands-on approach to teaching surgical skills and should remain an integral part of urology training.


Assuntos
Prostatectomia/educação , Neoplasias da Próstata/cirurgia , Urologia/educação , Competência Clínica , Educação , Humanos , Masculino , Tratamentos com Preservação do Órgão , Nervos Periféricos/anatomia & histologia , Próstata/anatomia & histologia , Próstata/cirurgia , Prostatectomia/métodos , Treinamento por Simulação
17.
Minim Invasive Ther Allied Technol ; 28(4): 220-226, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30293473

RESUMO

Introduction: In this study we evaluate the influence of longitudinal and transverse length of prostate size measured on the magnetic resonance imaging (MRI) scan on the overall outcomes of HoLEP. Material and methods: The patients were divided into two groups based on the shape of the prostate. Group 1 had a longitudinal shape with a longitudinal diameter greater than the transverse diameter, whereas group 2 had an oval shape with a transverse diameter greater than the longitudinal diameter. The pre-operative, peri-operative and the one-month post-operative data along with the urinary parameters were then evaluated. Results: The two groups were comparable with regard to their pre-operative values. While the median lobe enucleation time and morcellation time showed no difference, group 1 showed a significantly shorter (p < 0.01) operative time for lateral lobe enucleation, lower laser energy usage and better enucleation efficiency. However, there was no difference in the median lobe enucleation time, morcellation time, haemoglobin drop, duration of urethral catheterization and hospital stay. The groups were also comparable with regard to the improvement in urinary parameters and complications. Conclusion: Prostate shape plays a significant role in the surgical treatment of BPH.


Assuntos
Terapia a Laser/métodos , Morcelação/métodos , Duração da Cirurgia , Próstata/anatomia & histologia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Cateterismo Urinário/métodos , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Resultado do Tratamento
18.
Prostate ; 79(2): 183-194, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30298636

RESUMO

BACKGROUND: Serum folate concentrations in the United States have risen since dietary folic acid fortification was first mandated in 1998. Although maternal folic acid offers protection against neural tube defects in conceptuses, its impact on other organ systems and life stages have not been fully examined. Here, we used a mouse model to investigate the impact of a Folic acid (FA) enriched diet on prostate homeostasis and response to androgen deprivation. METHODS: Male mice were fed a control diet (4 mg FA/kg feed) or a folic acid supplemented diet (24 mg FA/kg feed) beginning at conception and continuing through early adulthood, when mice were castrated. RESULTS: We made the surprising observation that dietary FA supplementation confers partial resistance to castration-mediated prostate involution. At 3, 10, and 14 days post-castration, FA enriched diet fed mice had larger prostates as assessed by wet weight, taller prostatic luminal epithelial cells, and more abundant RNAs encoding prostate secretory proteins than castrated control diet fed mice. Diet did not significantly affect prostate weights of intact mice or serum testosterone concentrations of castrated mice. RNA-Seq analysis revealed that the FA enriched diet was associated with a unique prostate gene expression signature, affecting several signaling and metabolic pathways. CONCLUSIONS: Continuous exposure to a FA enriched diet slows prostate involution in response to androgen deprivation. Prostates from FA diet mice have increased secretory gene expression and increased luminal cell heights. The influence of dietary FA supplementation on the prostate response to androgen deprivation raises a future need to consider how dietary folic acid supplementation affects efficacy of androgen-reducing therapies for treating prostate disease.


Assuntos
Androgênios/deficiência , Ácido Fólico/administração & dosagem , Próstata/efeitos dos fármacos , Androgênios/sangue , Animais , Castração , Suplementos Nutricionais , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Próstata/anatomia & histologia , Próstata/fisiologia , Receptores Androgênicos/biossíntese , Testosterona/sangue
19.
Cell Rep ; 25(12): 3530-3542.e5, 2018 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-30566875

RESUMO

A comprehensive cellular anatomy of normal human prostate is essential for solving the cellular origins of benign prostatic hyperplasia and prostate cancer. The tools used to analyze the contribution of individual cell types are not robust. We provide a cellular atlas of the young adult human prostate and prostatic urethra using an iterative process of single-cell RNA sequencing (scRNA-seq) and flow cytometry on ∼98,000 cells taken from different anatomical regions. Immunohistochemistry with newly derived cell type-specific markers revealed the distribution of each epithelial and stromal cell type on whole mounts, revising our understanding of zonal anatomy. Based on discovered cell surface markers, flow cytometry antibody panels were designed to improve the purification of each cell type, with each gate confirmed by scRNA-seq. The molecular classification, anatomical distribution, and purification tools for each cell type in the human prostate create a powerful resource for experimental design in human prostate disease.


Assuntos
Próstata/anatomia & histologia , Próstata/citologia , Uretra/anatomia & histologia , Uretra/citologia , Adulto , Células Epiteliais/citologia , Humanos , Masculino , Análise de Sequência de RNA , Análise de Célula Única , Células Estromais/citologia
20.
J. Health NPEPS ; 3(2): 380-391, Julho-Dezembro. 2018. ilus
Artigo em Inglês | LILACS | ID: biblio-980857

RESUMO

Objective: to verify selenium effectiveness in maintenance of prostate tissue architecture. Method: experimental study using 20 adult 90-day-old male rats divided into the following groups: TG, 05 animals that received injectable testosterone; TSG, 05 animals that received injectable testosterone and weekly doses of selenium by gavage; CG1, 05 intact animals; CG2, 05 animals that received saline injection and saline by gavage. Results: characteristic architecture was found in tissue samples from animals of CG with cubic/prismatic secretory epithelium surrounded by fibro-muscular stroma. Animals of TG showed an increase in prostatic epithelium height, increase in the number of blood vessels in stroma and presence of proliferative lesions. Proliferative lesions were also found in tissue samples from animals of TSG, besides having improve in epithelial height, as seen in TG. Conclusion: it is concluded that selenium at this concentration has no effectiveness in modulating morphology of prostatic tissue of adult rats.(AU)


Objetivo: verificar la eficacia del selenio en mantener la morfología tisular. Método: estudio experimental, utilizando 20 ratones machos adultos (5 animales/grupo), divididos en: TG, recibieron testosterona inyectable; TSG, recibieron testosterona inyectable y dosis semanales de selenio por gavado; CG1, animales intactos; CG2, recibieron solución salina inyectable y por gavado. Resultados: una arquitectura característica fue encontrada en las muestras tisulares de los animales del CG, con epitelio cúbico/prismático envuelto por estroma fibro-muscular. En los animales del TG la próstata presentó un epitelio con células más altas, un aparente aumento en el número de vasos sanguíneos estromais, además de la presencia de lesiones proliferativas. También se encontraron lesiones proliferativas en las muestras tisulares de los animales del TSG, además de presentar mayor altura del epitelio, como vistas en TG. Conclusión: se concluye así que el Selenio, en esta concentración, parece no ser eficaz en la protección contra las modificaciones promovidas por la administración de T exógena en ratas adultas.(AU)


Objetivo: verificar a eficácia do selênio na manutenção da morfologia tecidual prostática. Métodos: estudo experimental, utilizando 20 ratos machos adultos, divididos em: TG, 05 animais que receberam testosterona injetável; TSG, 05 animais que receberam testosterona injetável e doses semanais de selênio por gavagem; CG1, 05 animais intactos; CG2, com 05 animais que receberam solução salina injetável e por gavagem. Resultados: uma arquitetura característica foi encontrada nas amostras teciduais dos animais do CG, com epitélio cúbico/prismático envolvido por estroma fibro-muscular. Nos animais do TG a próstata apresentou um epitélio com células mais altas, um aparente aumento no número de vasos sanguíneos no estroma, além da presença de lesões proliferativas. Também foram encontradas lesões proliferativas nas amostras teciduais dos animais do TSG, além de apresentarem maior altura do epitélio, como vistas no TG. Conclusão: conclui-se assim, que o Selênio, nesta concentração, parece não ser eficaz na proteção contra as modificações promovidas pela administração de T exógena em ratos adultos.(AU)


Assuntos
Animais , Ratos , Próstata/anatomia & histologia , Testosterona/administração & dosagem , Compostos de Selênio/administração & dosagem , Epidemiologia Experimental , Ratos Wistar
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA