A. Keszthelyi

Analysis of Risk Factors for Urinary Incontinence after Radical Prostatectomy

Introduction: Our aim was to identify the independent risk factors associated with urinary incontinence after radical retropubic prostatectomy (RRP). Materials and Methods: Using univariate and multivariate analyses, we examined several pre- and perioperative factors. One hundred and sixty-six patients were divided into three groups: patients who were immediately continent after catheter removal (group I), patients who became continent later (group II) and incontinent patients (group III). Results: There were 34 patients (20.5%) in group I, 111 (66.9%) in group II, and 21 (12.6%) in group III. The multivariate analysis between the continent and incontinent patients proved that the postoperatively measured total length of the posterior urethra (strongly associated with length of the sphincter, length of the urethral stump and the presence of anastomotic stricture) was the independent risk factor for permanent incontinence or delayed continence following RRP. The age of patients per se represented a risk factor only for delayed continence, but not for permanent incontinence. Conclusions: Postoperatively measured shorter posterior urethral length results in an increased risk of urinary incontinence and delays continence after RRP. It seems that older age only delays reaching continence.

Bladder augmentation with detubularized intestinal segment

The authors report on 9 cases of bladder augmentation with detubularized intestinal segments. The capacity of the contracted bladder was increased in 4 cases; care was taken to prevent the development of an hour-glass bladder. In a young female patien a caecal-ileal segment was applied so that in case of a possible future pregnancy the measentery should not hinder the growth of the uterus. In 4 cases hypertonic neurogenic bladders were augmented with intestinal segments, thus the further destruction of the kidneys could be avoided. In one case the reflux was hindered by a Kock valve, but stagnation developed above the valve, therefore it was eliminated and replaced by a 15 cm intestinal segment. In one case the uninhibited neurogenic bladder was augmented, the resistance of the urethra increased as a result of which the patient stated dry between self-catheterizations. Attention is called upon the metabolic disturbances and increased risk of infection following intestinal implantations.

Changes of protein expression in prostate cancer having lost its androgen sensitivity

ObjectiveThe majority of prostate cancers require androgen hormones for growth, and androgen ablation is an important part of the systemic treatment of advanced prostate cancer. Nevertheless, most of these cancers eventually relapse as they become less sensitive to androgen ablation and anti-androgen treatment. Elucidating the molecular events that are responsible for the conversion of androgen-sensitive cancers to androgen-refractory tumors may reveal new therapeutic opportunities.MethodsIn the present study, we investigated nine androgen-sensitive and nine androgen-refractory prostate cancer samples to evaluate the expression levels of 10 selected proteins that have been implicated in oncogenesis and cancer progression.ResultsOur immunohistochemical data show that three of the investigated proteins (i.e., minichromosome maintenance-2, methylguanine-DNA methyltransferase, and androgen receptor) are expressed at significantly different levels in the androgen-refractory cancer samples than in the androgen-sensitive tumors, whereas the expression levels of the seven other studied proteins (i.e., β-catenin, p27, p21, p16, Ki67, hypoxia-inducible factor 1 alpha, and geminin) are not significantly different regarding the two groups.ConclusionsOur data suggest that the increased expression of minichromosome maintenance-2 and decreased expression of methylguanine-DNA methyltransferase related to androgen receptor are indicative of the androgen-refractory stage in prostate cancer. Further studies are required to determine whether these expression changes play a causative role in the transition of androgen-sensitive to androgen-refractory prostate cancer.

Voiding Symptoms and Urodynamic Findings in Patients with Modified Ileal Neobladde

The aim of our study was to find the cause of urinary incontinence and voiding dysfunction in patients undergoing radical cystectomy and orthotopic bladder replacement with modified ileal neobladder (Reddy). Twenty-eight incontinent patients (operated on between 1988 and 2004) were involved in our examination. Based on the complaints of the patients, continence status was evaluated and divided into two groups: group I: partially incontinent (only night-time incontinence) n = 11 (39.3%) and group II: totally incontinent (night-time and daytime incontinence) n = 17 (60.7%). Detailed urodynamic examination (enterocystometry and urethral pressure profile) in addition to involuntary neobladder contractions and capacity detection were carried out on all patients. Furthermore resting pressure and maximal voluntary contraction ability of the sphincter were determined and statistically analyzed in both groups. Significant difference was noticed in resting pressure and maximal voluntary contraction ability of the sphincter among the partially incontinent and totally incontinent patients. Frequency, intensity and duration of involuntary neobladder contractions also showed significant differences between the two groups. Incontinence of neobladder depends not only on the destruction of resting and contraction capability of the urethral sphincter, but also on the presence or absence of involuntary contractions in the wall of the neobladder and decreased capacity of the neobladder.

Prevention and treatment of erectile dysfunction after radical prostatectomy

Radical prostatectomy is the curative surgical management of organ confined prostate cancer. Erectile dysfunction may follow surgery as the most common complication decreasing the quality of life of the patient. Thanks to spreading PSA screening probability increases to detect prostate cancer in its early stage and so the expected number of surgery is increasing, too. Higher number of operation as well as surgery more frequently performed in younger age calls the attention to the importance of erectile dysfunction and its management. Nowadays the physiology of erectile dysfunction due to radical prostatectomy has been revealed, and as a consequence, the nerve sparing surgery for its prevention is already known. The paper presents the different kind of possible invasive and non-invasive treatments of erectile dysfunction, and surveys their history and effectiveness. The erectile function of patients who underwent radical prostatectomy between 1998 and 2007 at the Department of Urology and Uro-oncological Centre was assessed by IIEF- and MMM questionnaire and letters with questions of habit of medicine taking. The results show that 59% of patients who desire sexual activity are capable of it spontaneously or with medical management.

A merevedési zavar megelozése és kezelé sének lehetoségei radikális prostatectomia után

Radical prostatectomy is the curative surgical management of organ confined prostate cancer. Erectile dysfunction may follow surgery as the most common complication decreasing the quality of life of the patient. Thanks to spreading PSA screening probability increases to detect prostate cancer in its early stage and so the expected number of surgery is increasing, too. Higher number of operation as well as surgery more frequently performed in younger age calls the attention to the importance of erectile dysfunction and its management. Nowadays the physiology of erectile dysfunction due to radical prostatectomy has been revealed, and as a consequence, the nerve sparing surgery for its prevention is already known. The paper presents the different kind of possible invasive and non-invasive treatments of erectile dysfunction, and surveys their history and effectiveness. The erectile function of patients who underwent radical prostatectomy between 1998 and 2007 at the Department of Urology and Uro-oncological Centre was assessed by IIEF- and MMM questionnaire and letters with questions of habit of medicine taking. The results show that 59% of patients who desire sexual activity are capable of it spontaneously or with medical management.

Prevention and managment possibilities of erectile dysfunction after radical prostatectomy

Radical prostatectomy is the curative surgical management of organ confined prostate cancer. Erectile dysfunction may follow surgery as the most common complication decreasing the quality of life of the patient. Thanks to spreading PSA screening probability increases to detect prostate cancer in its early stage and so the expected number of surgery is increasing, too. Higher number of operation as well as surgery more frequently performed in younger age calls the attention to the importance of erectile dysfunction and its management. Nowadays the physiology of erectile dysfunction due to radical prostatectomy has been revealed, and as a consequence, the nerve sparing surgery for its prevention is already known. The paper presents the different kind of possible invasive and non-invasive treatments of erectile dysfunction, and surveys their history and effectiveness. The erectile function of patients who underwent radical prostatectomy between 1998 and 2007 at the Department of Urology and Uro-oncological Centre was assessed by IIEF- and MMM questionnaire and letters with questions of habit of medicine taking. The results show that 59% of patients who desire sexual activity are capable of it spontaneously or with medical management.