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1.
Nat Rev Urol ; 17(2): 119-130, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31937919

RESUMO

Prostate cancer progression has been shown to be dependent on the development of autonomic nerves into the tumour microenvironment. Sympathetic nerves activate adrenergic neurosignalling that is necessary in early stages of tumour progression and for initiating an angiogenic switch, whereas parasympathetic nerves activate cholinergic neurosignalling resulting in tumour dissemination and metastasis. The innervation of prostate cancer seems to be initiated by neurotrophic growth factors, such as the precursor to nerve growth factor secreted by tumour cells, and the contribution of brain-derived neural progenitor cells has also been reported. Current experimental, epidemiological and clinical evidence shows the stimulatory effect of tumour innervation and neurosignalling in prostate cancer. Using nerves and neurosignalling could have value in the management of prostate cancer by predicting aggressive disease, treating localized disease through denervation and relieving cancer-associated pain in bone metastases.


Assuntos
Próstata/inervação , Neoplasias da Próstata/patologia , Microambiente Tumoral , Denervação , Humanos , Masculino , Prognóstico , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/terapia , Transdução de Sinais
2.
Andrologia ; 51(9): e13349, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31482616

RESUMO

The nitric oxide (NO) pathway plays a role in maintaining the function of the prostate. An impairment in the activity of the NO system may have an impact in the manifestation of lower urinary tract symptomatology and benign prostatic hyperplasia. Arginase enzymes (Arg) counteract the generation of NO by depleting the intracellular pool of L-arginine, known to be the substrate of the NO synthases. This study investigated the expression of arginase type I and II in the human prostate. Nondiseased prostate tissue was obtained during pelvic surgeries (prostatectomy, cystoprostatectomy). Tissue sections were exposed to antibodies directed against Arg I and II, cGMP, the phosphodiesterase 5 and nNOS. The expression of mRNA transcripts encoding for Arg I and Arg II was investigated using molecular biology. Reverse transcriptase polymerase chain reaction (RT-PCR) revealed the presence of mRNA encoding for Arg I and II, immunofluorescence specific for Arg I was seen in the stromal smooth musculature, and labelling for PDE5 and cyclic GMP was also observed. Nerve fibres containing nNOS were identified running across the smooth musculature. Immunostainings for Arg II did not yield signals. These findings are in support of the notion that, in the prostate, Arg is involved in the modulation of the activity of the NO system.


Assuntos
Arginase/metabolismo , Óxido Nítrico/metabolismo , Próstata/metabolismo , Arginase/análise , Arginase/genética , Arginina/metabolismo , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Músculo Liso/metabolismo , Fibras Nervosas/metabolismo , Óxido Nítrico Sintase Tipo I/metabolismo , Próstata/inervação , Próstata/cirurgia , Prostatectomia , RNA Mensageiro/metabolismo , Transdução de Sinais
4.
Urology ; 132: 156-160, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31306669

RESUMO

OBJECTIVE: To confirm the distribution of functional nerves involved in erectile function at the posterior of the prostate base, intraoperative nerve stimulation was performed during robot-assisted radical prostatectomy (RARP) METHODS: Several points at the posterior of the prostate and the posterolateral typical neurovascular bundle (NVB) were electrically stimulated at the level of the prostate base during RARP in patients with clinically localized prostate cancer. The prostate pedicle (PP), medial side of the PP (MPP), Denonvilliers' fascia (DF), and typical NVB were stimulated using bipolar electrodes. The changes in pressure at the middle of the urethra were measured using an inserted balloon-catheter to detect the increase in cavernosal pressure. RESULTS: Although the study included only 12 patients, each stimulation of the PP, MPP, and NVB induced evident urethral pressure responses in all patients. The median amplitude of the pressure responses was 5.49 (IQR 3.11-8.42), 6.00 (IQR 3.70-8.30), and 3.22 (IQR 2.48-7.19) cm H2O at the PP, MPP, and NVB, respectively. The amplitude of responses at the PP and MPP was not small compared with the responses at the typical NVB. Stimulations at the DF induced unstable weak urethral response alone or no response in all patients. CONCLUSION: We showed that electrostimulation of the PP and MPP increases the cavernosal pressure similar to the typical NVB stimulation. These findings indicate that maximal preservation of the tissues at the posterior area of the prostate base can contribute to optimal recovery of postoperative erectile function after nerve-sparing RARP.


Assuntos
Estimulação Elétrica , Ereção Peniana/fisiologia , Próstata/inervação , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Idoso , Humanos , Período Intraoperatório , Masculino
5.
Andrologia ; 51(8): e13302, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31074030

RESUMO

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the prostate gland inflammation characterised as genitourinary pain in the pelvic region. The rat experimental autoimmune prostatitis (EAP) was achieved to mimic CP/CPPS. The expressions of transient receptor potential vanilloid 1 (TRPV1) in the prostate, bladder and spinal dorsal root ganglion (DRG) were analysed by Western blotting. Tropomyosin receptor kinase A (TrkA) and nerve growth factor (NGF) in the DRG were also analysed by Western blotting. Measurements of inflammatory cytokines were carried out according to the instructions of the corresponding kits. The expressions of TRPV1 in the prostate, bladder and DRG in the EAP group were significantly higher than those in the control group. The expressions of NGF and TrkA in the DRG in the EAP group were significantly higher than those in the control group. The levels of serum TNF-α and IL-1ß in the EAP group were significantly higher than those in the control group. We conclude that CP/CPPS may participate in the pathological activation of neurons in the L5-S1 segment of DRG by activating NGF-TrkA pathway and cause pelvic organ cross-sensitisation by upregulating the expression of TRPV1 in the prostate, bladder and DRG.


Assuntos
Gânglios Espinais/patologia , Prostatite/patologia , Canais de Cátion TRPV/metabolismo , Animais , Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Vacina contra Difteria, Tétano e Coqueluche/imunologia , Modelos Animais de Doenças , Gânglios Espinais/citologia , Humanos , Injeções Intraperitoneais , Masculino , Fator de Crescimento Neural/metabolismo , Neurônios/patologia , Próstata/imunologia , Próstata/inervação , Próstata/patologia , Prostatite/imunologia , Ratos , Ratos Sprague-Dawley , Receptor trkA/metabolismo , Transdução de Sinais , Regulação para Cima , Bexiga Urinária/inervação , Bexiga Urinária/patologia
6.
BMC Urol ; 19(1): 41, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31133039

RESUMO

BACKGROUND: Intrafascial prostatectomy was a modified technique from the conventional nerve-sparing surgery in order to improve patients' post-surgical continence and erectile function; however, ongoing controversy exists regarding the oncological safety of this technique. In this study we aimed to provide a critical and pooled analysis based on published literatures regarding the oncological outcomes after intrafascial nerve-sparing prostatectomy. METHODS: Database searches were performed for published articles till June 2018 on PubMed. Three reviewers screened fulfilled papers and extracted data independently. Main outcome was the positive surgical margins (PSMs) rates stratified by pathological stages. We performed both one-arm and comparative meta-analysis to evaluate the oncological safety of intrafascial technique. Moreover, we built meta-regression models to assess the confounding factors. RESULTS: We retrieved a total of 117 records after electronic search, of which 21 studies were finally included in this review. There were 15 controlled studies and 6 surgical series. Our one-arm meta-analysis demonstrated that the total PSM rates after intrafascial techniques ranging from 2.2 to 35%, with a pooled rate of 14.5% on average (480 of 3151 patients, 95% confidence interval[CI]: 11.2-17.5%). Meta-regression model showed that patients' age, pT2 cancer percentage and Selection Score of Oncological Safety (SSOS) were significantly associated with total PSM rate; moreover, each 1 point of SSOS could decrease the total PSM rate by 1.3% on average. Comparative meta-analysis demonstrated that there was no significant difference between intra- and inter-fascial group regarding PSM rates. CONCLUSIONS: With stringent case selection and when performed by experienced surgeons, intrafascial prostatectomy could offer an acceptable or, at least, equivalent PSM rate compared with the conventional interfascial approach. Preoperative SSOS more than 7 points could be considered as an indication of intrafascial radical prostatectomy.


Assuntos
Próstata/inervação , Próstata/cirurgia , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Fáscia/inervação , Fasciotomia/métodos , Humanos , Masculino , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Análise de Regressão , Resultado do Tratamento
7.
Zhonghua Wai Ke Za Zhi ; 57(6): 428-433, 2019 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-31142067

RESUMO

Objective: To evaluate the effect of multimodal analgesia using periprostatic nerve block anesthesia (PNB) combined with flurbiprofen in patients undergoing transperineal template-guided prostate biopsy (TTPB). Methods: Totally 166 patients (aged (68.2±9.1) years, range: 47 to 81 years) who received TTPB from October 2017 to June 2018 at Department of Urology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University were enrolled prospectively. All the patients were randomly divided into 2 groups. The observation group (n=79) was given flurbiprofen axetil 1 mg/kg intravenously for half an hour before operation and lidocaine was used for PNB before the biopsy. The control group (n=87) was given normal saline combined with PNB. A visual analog scale (VAS) and visual numeric scale (VNS) were used to assess the patients' pain and quantify their satisfaction at two time points: VAS-1 and VNS-1: during biopsy procedure, VAS-2 and VNS-2: 30 min after the procedure. The date were compared by t test, χ(2) test, Fisher exact test and two-way repeated measures anova analysis between the 2 groups. Results: The age, total prostate volume, serum prostate-specific antigen and the number of cores were comparable among the 2 groups (P>0.05). The VAS-1 scores of the control group and the observation group were 2.8±1.7, 1.9±1.2, respectively, and the VNS-1 were 3.1±0.7, 3.4±0.3, respectively. The VAS-1 were significantly lower in observation group than in control group (F=3.904, P=0.000). Conversely, the VNS-1 were higher in observation group (F=3.526, P=0.000). At 30-minute postoperative, the VAS-2 and VNS-2 were 0.7±0.4 and 3.7±0.2 in the control group, respectively. The VAS-2 and VNS-2 were 0.6±0.5 and 3.8±0.1 in the observation group, respectively. There were no significant differences in the pain scores or the satisfaction scores between the 2 groups (F=1.429, 2.825; P=0.136, 0.083). The incidence of overall complications was 26.4% (23/87) in the control group and 25.3% (20/79) in the observation group, with no statistical difference between the 2 groups (χ(2)=0.027, P=0.869). And the complications had no statistically significant difference among the 2 groups including hematuria, urinary retention, infection, hematospermia, vascular and neurological reactions, nausea, vomiting, dizziness, headache, and respiratory depression (P>0.05). Conclusion: The multimodal analgesia induced by PNB and flurbiprofen could effectively relieve the pain for patients who received TTPB.


Assuntos
Analgésicos/uso terapêutico , Flurbiprofeno/uso terapêutico , Bloqueio Nervoso/métodos , Dor Processual/tratamento farmacológico , Próstata/patologia , Idoso , Idoso de 80 Anos ou mais , Analgesia , Anestésicos Locais/administração & dosagem , Biópsia/efeitos adversos , Quimioterapia Combinada , Humanos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Processual/etiologia , Períneo , Próstata/inervação
8.
Histochem Cell Biol ; 152(1): 35-45, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30976911

RESUMO

Prostate autonomic and sensory axons control glandular growth, fluid secretion, and smooth muscle contraction and are remodeled during cancer and inflammation. Morphogenetic signaling pathways reawakened during disease progression may drive this axon remodeling. These pathways are linked to proliferative activities in prostate cancer and benign prostate hyperplasia. However, little is known about which developmental signaling pathways guide axon investment into prostate. The first step in defining these pathways is pinpointing when axon subtypes first appear in prostate. We accomplished this by immunohistochemically mapping three axon subtypes (noradrenergic, cholinergic, and peptidergic) during fetal, neonatal, and adult stages of mouse prostate development. We devised a method for peri-prostatic axon density quantification and tested whether innervation is uniform across the proximo-distal axis of dorsal and ventral adult mouse prostate. Many axons directly interact with or innervate neuroendocrine cells in other organs, so we examined whether sensory or autonomic axons innervate neuroendocrine cells in prostate. We first detected noradrenergic, cholinergic, and peptidergic axons in prostate at embryonic day (E) 14.5. Noradrenergic and cholinergic axon densities are uniform across the proximal-distal axis of adult mouse prostate while peptidergic axons are denser in the periurethral and proximal regions. Peptidergic and cholinergic axons are closely associated with prostate neuroendocrine cells whereas noradrenergic axons are not. These results provide a foundation for understanding mouse prostatic axon development and organization and, provide strategies for quantifying axons during progression of prostate disease.


Assuntos
Axônios/metabolismo , Próstata/embriologia , Próstata/inervação , Animais , Axônios/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Próstata/citologia , Próstata/patologia
9.
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
10.
J Clin Neurosci ; 63: 213-219, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30772200

RESUMO

OBJECTIVE: To describe nerve subtypes involved by perineural invasion (PNI) in prostate cancer and their relationship with clinicopathological parameters and recurrence risk. METHODS: 141 prostatectomy specimens from men with localized prostate cancer and known perineural invasion were analyzed. Index tumor blocks were stained for perineural invasion and sympathetic/parasympathetic markers. For 98 patients with complete staining, nerves from up to three hotspot regions of intraprostatic perineural invasion were classified according to autonomic subtype and perineural invasion status. Findings were correlated with prospectively collected clinicopathological data. Biochemical recurrence predictors were tested in univariable and multivariable models. RESULTS: Most intra-prostatic nerves contained sympathetic and parasympathetic fibres, irrespective of perineural invasion status. A fraction was purely sympathetic (5% PNI, 2% non-PNI) or double-negative (non-adrenergic, non-nitrergic; 1% PNI, 1% non-PNI). Perineural invasion nerve count was associated with higher pathological stage. Although total perineural invasion or non-perineural invasion nerve count did not predict biochemical recurrence, two subtypes were found to be independent predictors: pure sympathetic non-perineural invasion nerves (HR 6.79, p = 0.03) and non-adrenergic, non-nitrergic PNI nerves (HR 10.56, p < 0.005). CONCLUSIONS: Pure sympathetic nerve density without tumour invasion and perineural invasion specifically involving non-adrenergic, non-nitrergic fibres are independent predictors of biochemical recurrence post prostatectomy, supporting a role for the autonomic nervous system in prostate cancer progression.


Assuntos
Vias Autônomas/patologia , Invasividade Neoplásica/patologia , Neoplasias da Próstata/patologia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/inervação , Próstata/patologia , Prostatectomia
11.
Prostate ; 79(6): 640-646, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30663097

RESUMO

BACKGROUND: Perineural invasion (PNI) is generally accepted as a major route of cancer dissemination in malignancies associated with highly enervated organs. However, the effect of cancer cells on vasa nervorum remains unknown. We studied this effect in locally advanced prostate cancer, a high-risk feature associated with approximately 20% of prostate cancer specific mortality. METHODS: We used immunohistochemistry for CD34, fibroblast growth factor-2 (FGF-2), FSHR, podoplanin, vascular endothelial growth factor (VEGF), and VEGFR-2 as well as histochemical methods to examine the vasa nervorum of nerves invaded by cancer cells in tissue samples from 85 patients. RESULTS: The percentage of the nerve area occupied by CD34-positive vasa nervorum endothelial cells in nerves with PNI was much higher than in nerves without PNI (7.3 ± 1.2 vs 1.9 ± 0.4; P < 0.001 and 5.8 ± 0.6 vs 1.23 ± 0.8; P < 0.001 in pT3a and pT3b prostate cancer specimens, respectively). In 19/85 of the patients the CD34-positive vasa nervorum microvessels have a thick basement membrane, similar to the vessels in diabetic microangiopathy. This subendothelial layer contains collagen fibers. Vasa nervorum endothelia and Schwann cells express FGF-2 (nuclear localization) and FSHR (plasma membrane and cytoplasmic staining). Prostate cancer cells invading nerves express VEGF, a critical cytokine in tumor angiogenesis. The vasa nervorum of prostatic nerves with PNI did not express detectable levels of VEGFR-2. No podoplanin-positive lymphatic vessels were seen in nerves. CONCLUSION: In locally advanced prostate cancer, PNI of cancer cells is associated with formation of new endoneurial capillaries and changes of vasa nervorum morphology.


Assuntos
Fator 2 de Crescimento de Fibroblastos/metabolismo , Neovascularização Patológica/metabolismo , Nervos Periféricos , Próstata , Neoplasias da Próstata , Fator A de Crescimento do Endotélio Vascular/metabolismo , Antígenos CD34/metabolismo , Humanos , Imuno-Histoquímica , Masculino , Glicoproteínas de Membrana/metabolismo , Pessoa de Meia-Idade , Invasividade Neoplásica , Nervos Periféricos/metabolismo , Nervos Periféricos/patologia , Próstata/inervação , Próstata/patologia , Neoplasias da Próstata/metabolismo , Neoplasias da Próstata/patologia , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/metabolismo
12.
Int J Cancer ; 144(12): 3099-3110, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-30537104

RESUMO

To investigate immune profile consisting of stromal PD-L1 expression, inhibitory or non-T-cell inflamed tumor microenvironment that may predict response to anti-PD-L1/PD-1 immunotherapy in prostate cancer, we validated the specificity of a PD-L1 monoclonal antibody (E1L3N) and identified PD-L1 specific expression in prostatic stromal nerve cells. PD-L1 expression was analyzed in 73 primary prostate cancers and 7 castration-resistant prostate cancers (CRPC) by immunohistochemistry (IHC) and resulting data from primary prostate cancers were correlated with tumor-associated lymphocytes (TALs), clinicopathological characteristics and clinical outcome. PD-L1 was expressed in the tumor cells in only one primary prostate cancer case and none of the CRPC. However, PD-L1 was frequently observed in the nerve branches in the tumor-associated stroma (69 of 73 cases, 94.5%), supported by colocalization with axonal marker PGP9.5. FoxP3-, CD3- and CD8-positive T lymphocytes were observed in 74.6% (47/63), 98.4% (62/63) and 100% (61/61) of the cases, respectively. The density of PD-L1+ tumor-associated nerves (TANs) was inversely correlated with that of CD8+ TALs. Higher density of PD-L1+ TANs was significantly associated with biochemical recurrence (BCR) in Kaplan-Meier survival analysis (p = 0.016). In both univariate and multivariate Cox analysis, the density of PD-L1+ TANs was independently prognostic of BCR. In conclusion, PD-L1 expression is rare in prostate tumor cells but prevalent in TANs and negatively correlated with CD8+ TALs. Neuro-immunological interaction may be a contribution to immune-suppressive microenvironment. Combinatorial treatment regimen designs to neural PD-L1 and TALs should be warranted in future clinical application of anti-PD-L1/PD-1 immunotherapy in prostate cancer.


Assuntos
Antígeno B7-H1/biossíntese , Linfócitos T CD8-Positivos/imunologia , Próstata/inervação , Neoplasias de Próstata Resistentes à Castração/imunologia , Neoplasias da Próstata/imunologia , Antígeno B7-H1/imunologia , Linfócitos T CD8-Positivos/patologia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Neoplasias de Próstata Resistentes à Castração/patologia , Neoplasias de Próstata Resistentes à Castração/cirurgia , Microambiente Tumoral/imunologia , Ubiquitina Tiolesterase
13.
BJU Int ; 123(6): 995-1004, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30091828

RESUMO

OBJECTIVE: To perform a descriptive microscopic study of prostatectomy specimens from 19 patients which anatomically characterizes the distributions of periprostatic nerve qualities, and to visualize these using diffusion tensor imaging (DTI). MATERIALS AND METHODS: Serial whole-mounted sections were stained for cholinergic (neuronal nitric oxide synthase), adrenergic (tyrosine hydroxylase) and sensory (calcitonin gene-related peptide) nerves. Extracapsular stained nerves were counted by prostate surface sector, and classified by diameter. Stain-related relative density was calculated, and distribution patterns were evaluated. To better visualize the reported neuronal structures and independently confirm our findings, nerve concordance in five male volunteers was investigated using a 3-Tesla magnetic resonance imaging-DTI system. RESULTS: At the base, cholinergic nerves were distributed from the anterolateral to posterior sectors, continuing posterolaterally (mid-section) into the posterolateral-posterior sector toward the apex. Adrenergic nerves were distributed across the anterolateral-posterior sectors at the base, with the course narrowing to the posterolateral-posterior sectors at the mid- and apical levels. Sensory fibres were found posterolaterally posteriorly at the base, continuing posterolaterally over the mid- and apical levels. Although it was not possible to determine the different nerve qualities, DTI confirmed histological findings from the base to the apex. CONCLUSIONS: Different types of nerve fibres were found to vary in distribution. When linked to possible functional aspects of the different nerve types, this morphological evidence may be of importance to further protect function after radical prostatectomy (RP). To our knowledge, this is the first time that DTI has confirmed reported histological findings in nerve-sparing RPs. DTI could be an important tool with which to correlate nerves to tumour for better preoperative planning and to incorporate imaging into treatment.


Assuntos
Imagem de Tensor de Difusão , Tecido Nervoso/diagnóstico por imagem , Próstata/diagnóstico por imagem , Próstata/inervação , Idoso , Idoso de 80 Anos ou mais , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Óxido Nítrico Sintase/metabolismo , Próstata/metabolismo , Prostatectomia , Tirosina 3-Mono-Oxigenase/metabolismo
14.
Anat Sci Int ; 94(1): 128-135, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30206773

RESUMO

Chronic testicular pain remains an important challenge for urologists. Investigation of the innervation of male gonads thus becomes essential for deepening our understanding of their regulatory roles in male reproductive physiology and pathophysiology. Studies of testicular innervation are mainly limited to the intratesticular peptidergic nerves of the testis by immunohistochemical and acetylcholinesterase histochemical investigations in some animals. Little is known about the detailed, overall distribution in general experimental animal testis. In this study, the distribution of nerves supplying the testis, epididymis and accessory sex glands of Suncus murinus was investigated by whole mount immunohistochemistry staining using a neurofilament protein antibody. Testicular nerves arose through three routes: nerves deriving from the mesenteric and renal plexuses accompanied the testicular artery, entering into the testicular hilum through the superior ligament of the testis. The nerves originating from the hypogastric plexus then ran along the internal iliac artery, deferential artery, and passed through the mesoductus deferens or mesoepididymis, innervating the cauda and corpus of the epididymis, the vas deferens and the inferior pole of the testis. The third route arose from the pelvic plexus, distributed in the seminal vesicle and the prostate. The density of nerve fibers was higher in the cauda epididymidis than in the testis, and more abundant in the vas deferens. The different origins and distribution densities of testicular nerves in S. murinus may serve different neuronal regulatory functions, and, therefore, S. murinus may be an important model animal for understanding the different characteristics of testicular pain.


Assuntos
Epididimo/inervação , Plexo Hipogástrico/anatomia & histologia , Proteínas de Neurofilamentos/análise , Musaranhos/anatomia & histologia , Testículo/inervação , Animais , Imageamento Tridimensional , Imuno-Histoquímica/métodos , Masculino , Modelos Animais , Dor/etiologia , Próstata/inervação , Glândulas Seminais/inervação , Doenças Testiculares/etiologia , Ducto Deferente/inervação
15.
Urol J ; 16(3): 260-266, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-30206921

RESUMO

PURPOSE: To investigate the impact of prostate weight on outcomes of nerve sparing laparoscopic radical prosta-tectomy (LRP) and assess its predictive value on postoperative continence and potency recovery. MATERIALS AND METHODS: We conducted a retrospective study on the clinical data of 165 patients with low risk prostate cancer (PCa) who underwent nerve sparing LRP. All the patients included had normal preoperative uri-nary and sexual function. The association of prostate weight with perioperative data was assessed using Spearman correlation coefficient. Univariate and multivariate Cox regression analyses were employed to identify prognostic predictors for continence and potency recovery. RESULTS: Increased prostate weight was significantly associated with older age, higher prostate-specific antigen (PSA), lower biopsy and pathological T stage and Gleason score, longer operative time, and higher estimated blood loss (P < .05). The continence rates at the 3rd, 6th, and 12th month after surgery were 63.6% (105/165), 87.9% (145/165), and 95.8% (158/165); and the potency rates were 44.8% (74/165), 62.4% (103/165) and 77.6% (128/165), respectively. Furthermore, multivariate Cox analysis showed that patient age (HR = 0.52, 95% CI: 0.35- 0.76) and prostate weight (HR = 0.54, 95% CI: 0.34-0.86) were independent predictors for continence recovery, while only patient age (HR = 0.66, 95% CI: 0.45-0.96) could independently predict potency recovery. CONCLUSION: Larger prostate size was correlated with older age, higher PSA, lower tumor stage and grade, longer operative time, and more intraoperative blood loss in low risk PCa patients. Increased prostate weight may inde-pendently predict poor continence recovery after nerve sparing LRP.


Assuntos
Laparoscopia , Próstata/patologia , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Idoso , Disfunção Erétil/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Tratamentos com Preservação do Órgão , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Próstata/inervação , Próstata/cirurgia , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Incontinência Urinária/epidemiologia
16.
Minerva Chir ; 74(1): 54-62, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30037175

RESUMO

Radical prostatectomy is frequently performed as a curative approach for clinically localized prostate cancer. In order to reduce the adverse effects of this operation on erectile function, preservation of neurovascular bundles was introduced as part of this operation. The decision of nerve sparing must be carefully tailored in each patient according to the stage of the disease. Patient selection has a critical importance in performing nerve sparing radical prostatectomy. In organ-confined cancers a nerve sparing surgery can be performed in the majority of the cases without jeopardizing tumor control. Individualized decision making in each case may allow more patients to receive a nerve sparing approach, and therefore, better functional outcomes. However, it continues to be difficult to predict postoperative functional outcomes accurately due to many influencing factors.


Assuntos
Tratamentos com Preservação do Órgão , Próstata/inervação , Próstata/cirurgia , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Humanos , Masculino , Fatores de Tempo , Resultado do Tratamento
17.
Zhonghua Nan Ke Xue ; 25(11): 971-977, 2019 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-32233229

RESUMO

Objective: To investigate the dynamic change in the gene expression profile of the rat BPH tissue with progressive atrophy after complete denervation. METHODS: Twelve 29-week-old male rats with spontaneous hypertension and spontaneously developed BPH were used for this study, of which 3 were included in the control (C) group and the other 9 underwent complete denervation of the prostate. At 3, 7 and 11 days after operation (the D3, D7 and D11 groups), all the rats were sacrificed and their ventral prostatic lobes harvested for histopathological examination and RNA extraction, and the RNA samples were subjected to whole genome microarray of the expression profile, followed by real-time RT-PCR validation and bioinformatics analysis. RESULTS: Progressive atrophy of the BPH tissue was observed in the rats after complete denervation. Whole genome microarray of the expression profile was successfully performed for all the samples, and its reliability validated by real-time RT-PCR of 6 differentially expressed genes selected randomly. Hierarchical clustering analysis showed 108 up-regulated and 175 down-regulated genes in the differentially expressed ones between the D3 and C groups, 462 up-regulated and 189 down-regulated in those between the D7 and C groups, and 548 up-regulated and 256 down-regulated in those between the D11 and C groups. GO functional enrichment analysis indicated that the genes in each differentially expressed gene set participated in hundreds of molecular functions, biological processes and cellular components, while pathway enrichment analysis showed their involvement in hundreds of signaling pathways, of which many were enriched simultaneously in each differentially expressed gene set and ranked as the most enriched ones, and most of the genes involved were up-regulated and related with the activation of the complement system. CONCLUSIONS: Large numbers of abnormally expressed genes are involved in the progressive atrophy of rat BPH tissue after complete denervation, and these genes participate in hundreds of molecular functions, biological progresses, cellular components and signaling pathways. Abnormal activation of the complement system may play an important role in the progressive atrophy of the BPH tissue.


Assuntos
Denervação , Próstata/inervação , Hiperplasia Prostática/genética , Hiperplasia Prostática/cirurgia , Transcriptoma , Animais , Proteínas do Sistema Complemento/genética , Perfilação da Expressão Gênica , Masculino , Análise de Sequência com Séries de Oligonucleotídeos , Ratos , Reprodutibilidade dos Testes
18.
J Clin Neurophysiol ; 35(6): 463-467, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30320663

RESUMO

PURPOSE: The occurrence of urinary incontinence and erectile dysfunction after surgical treatment for prostate cancer is a significant and lingering problem. The aim of this study is to revise and improve older techniques of intraoperative cavernous nerve mapping already in use to improve accuracy and reliability. METHODS: We prospectively studied this technique in 12 patients suffering from prostate cancer. Inhalation or intravenous anesthetic regimen was used with nondepolarizing muscle relaxants. Stimulation protocol was 30 Hz, 0.2 ms, 10 to 20 mA intensity and a maximum duration of 30 seconds. Recording was performed with a system for measuring pressure changes using a stainless steel needle electrode inside the cavernous bodies. Stimulation was systematically performed at three distinct moments during the surgery at various points. An increase or decrease in pressure of 4 cm of H20 in the cavernous bodies was considered a positive result and negative response when no changes occurred after 30 seconds of continuous stimulation. RESULTS: Of patients, 91.6% had positive responses to initial stimulation. The anesthetic regimen did not appear to significantly influence the responses in our series. CONCLUSIONS: In light of the results of this study, the stimulation of the cavernous nerves may be a viable technique in the right context, which includes good patient selection (young patients with a localized tumor and with preserved potency). The major limitation is that mapping techniques are useful to localize functional nerves, but not to monitor function in a continuous manner.


Assuntos
Disfunção Erétil/etiologia , Monitorização Neurofisiológica Intraoperatória/métodos , Próstata/inervação , Neoplasias da Próstata/cirurgia , Incontinência Urinária/etiologia , Idoso , Biofísica , Estimulação Elétrica/métodos , Lateralidade Funcional/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/cirurgia , Prostatectomia/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo
19.
Radiol Phys Technol ; 11(3): 353-359, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30078079

RESUMO

The purpose of this study was to compare diffusion tensor imaging using the local look technique and sensitivity encoding for tractography of the periprostatic neurovascular bundle. We compared the surrounding tissues of the prostate in eight healthy volunteers. The results of tractography in terms of the numbers of fibers and the fractional anisotropy map were evaluated. Distortion was evaluated using the dice similarity coefficient between isotropic diffusion images created from diffusion tensor images and T2-weighted images. The number of lines in tractography was significantly greater in diffusion tensor imaging using the local look technique (p < 0.001). Although there was no difference in image distortion of the prostate between methods, an artifact appeared in the center of the diffusion tensor image using sensitivity encoding. In conclusion, diffusion tensor imaging using the local look technique was superior to that using sensitivity encoding for tractography of the periprostatic neurovascular bundle.


Assuntos
Vasos Sanguíneos/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Imagem por Ressonância Magnética/métodos , Sistema Nervoso Periférico/diagnóstico por imagem , Próstata/irrigação sanguínea , Próstata/inervação , Adulto , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade
20.
BJU Int ; 122(5): 837-844, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30126045

RESUMO

OBJECTIVE: To show the feasibility, oncological and functional outcomes of neurovascular bundle (NVB) preservation during salvage robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS: In the present institutional review board-approved retrospective analysis, between January 2008 and March 2016, 80 patients underwent salvage RARP, performed by a single surgeon (V.P), because of local recurrence after primary treatment. These patients were categorized into two groups depending on the degree of nerve-sparing (NS) performed: a good-NS group (≥50% of NVB preservation) and a poor-NS group (<50% of NVB preservation). A standard transperitoneal six-port technique, using the DaVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), was performed, and either an anterograde or a retrograde approach was used for NVB preservation. Validated questionnaires were used preoperatively (Sexual Health Inventory for Men [SHIM] and American Urological Association scores). Potency after salvage RARP was defined as the ability to achieve a successful erection with penetration >50% of the time, while full continence after salvage RARPwas defined as 0 pads used. The Kaplan-Meier method was used for survival and predictive estimations, and regression models were used to identify the predictors of potency, continence and biochemical failure (BCF). RESULTS: The potency rate at 12 months was higher in the good-NS group (25.6% vs 4.3%; P = 0.036) regardless of previous SHIM score, and good NS tended to be predictive of potency after salvage RARP (P = 0.065). The full continence rate at 12 months and BCF rate were similar in the two groups, and non-radiation primary treatment was the only predictor of continence at 12 months after salvage RARP (P = 0.033). CONCLUSIONS: Our data support the feasibility and safety of NVB preservation for salvage RARP conducted in select patients in a high-volume institution and the subsequent better recovery of adequate erections for intercourse.


Assuntos
Tratamentos com Preservação do Órgão , Prostatectomia , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Terapia de Salvação , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/métodos , Tratamentos com Preservação do Órgão/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Próstata/inervação , Próstata/cirurgia , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Prostatectomia/estatística & dados numéricos , Neoplasias da Próstata/mortalidade , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Terapia de Salvação/efeitos adversos , Terapia de Salvação/métodos , Terapia de Salvação/estatística & dados numéricos , Resultado do Tratamento , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia
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