Deborah D. Ricker

Patient-reported urinary continence and sexual function after anatomic radical prostatectomy

OBJECTIVES After radical prostatectomy, the rates for recovery of urinary continence and sexual function reported by experienced surgeons are much higher than the patient-reported outcomes from other centers. It is uncertain whether this represents differences in surgical technique or in the collection of data. This study was performed to determine patient-reported rates of continence and potency after radical prostatectomy performed by an experienced surgeon at a high-volume referral center for the treatment of localized prostate cancer. METHODS Sixty-four men with localized prostate cancer who were potent preoperatively and who had sexual partners underwent anatomic radical prostatectomy between March 1997 and January 1998. A validated disease-targeted quality-of-life survey that assesses function and bother in two organ systems (urinary and sexual) was administered preoperatively and at 3, 6, 12, and 18 months postoperatively. RESULTS Urinary continence, which was defined as wearing no pads, gradually improved during the first 12 months after surgery, and at 1 2 and 18 months, 93% of the patients were dry. Throughout the study, 93% to 98% of the patients characterized their urinary bother as none or small. Potency, defined as the ability to have unassisted intercourse with or without the use of sildenafil, improved gradually, and by 18 months, 86% of patients were potent and 84% considered sexual bother as none or small. Although one third of patients at 18 months were using sildenafil intermittently, only 2 patients were not able to have intercourse without its use. CONCLUSIONS Patient-reported rates of continence and potency after radical prostatectomy performed by an experienced surgeon are high.

Characterization and localization of nitric oxide synthase in the human prostate

OBJECTIVES To characterize nitric oxide synthase (NOS), which catalyzes nitric oxide (NO) production, in the human prostate using biochemical and immunohistochemical techniques. METHODS NOS catalytic assay and NOS immunohistochemistry were performed on histologically verified nonmalignant prostate tissue obtained from the peripheral and transition zones of seven radical prostatectomy specimens. RESULTS Biochemical analysis revealed NOS activity in the human prostate, with a greater amount in the peripheral zone than in the transition zone (P < 0.01). In both prostate zones, NOS was immunohistochemically localized to nerve fibers and ganglia coursing throughout the smooth musculature of the stroma and to subepithelial nerve plexuses. NOS immunoreactivity was also localized to glandular epithelium. CONCLUSIONS The presence, activity, and distribution of NOS were described in two regions of the human prostate. The present evidence implicates NO in the automatic innervation and physiology of the human prostate. It is proposed that NO may modulate smooth muscle tone and secretory functions in the human prostate, although functional studies are needed to support these hypotheses.

The effects of platelet-activating factor on the motility of human spermatozoa.

Our laboratory has recently detected the presence of platelet-activating factor (PAF)-like activity in human spermatozoa. To gain further insight into the role of PAF on the male reproductive system, this study, using videomicroscopy, evaluated the effects of synthetic PAF on the motility of human spermatozoa. Treatment of 20 human semen samples with 3.69 × (10 −7 to 3.69 × 10 −13 M PAF resulted in statistically significant increases in motility. Treatment of spermatozoa with lyso-PAF (the biologically inactive form of PAF) showed no change in motility. Treatment of spermatozoa with PAF in severely asthenozoospermic males may be of therapeutic value.

Platelet activating factor enhances in vitro fertilization of rabbit oocytes

Capacitation of spermatozoa is essential for fertilization. Rabbit spermatozoa are particularly difficult to capacitate in vitro and require treatment with high-ionic-strength Bracketts defined medium. Spermatozoa treated with platelet activating factor had significantly higher fertilization rates when compared with nontreated (fresh, twice washed) spermatozoa (63% vs 34%). Fertilization rates of spermatozoa treated with platelet activating factor, although higher than those of high-ionic-strength capacitated spermatozoa, were not significantly different (63% vs 57%). Spermatozoa treated with lyso-platelet activating factor, the biologically inactive form of platelet activating factor, were noted to have fertilization rates similar to those of the untreated (noncapacitated) group. These data show that synthetic platelet activating factor treatment of uncapacitated spermatozoa induces fertilization of rabbit oocytes in vitro in a manner similar to that for spermatozoa capacitated by high-ionic-strength media and significantly higher than that for untreated spermatozoa or after treatment with the biologically inactive form of platelet activating factor (lyso-platelet activating factor).

Effects of platelet activating factor on mouse oocyte fertilization in vitro.

Platelet activating factor is rapidly gaining acceptance as a potent mediator in many reproductive processes. This study presents data that indicate a direct role of platelet activating factor in fertilization. Platelet activating factor was shown to significantly increase (p less than 0.001) the fertilization rate of mouse oocytes in vitro. Furthermore, CV3988, an inhibitor of platelet activating factor, was noted to significantly decrease in vitro fertilization rates at 10(-5) and 10(-4) mol/L concentrations.

Treatment of Sperm with High-Ionic Strength Medium Increases Microsurgical Fertilization Rates of Rabbit Oocytes Fertilized by Subzonal Placement of Sperm

This study was conducted to investigate the requirement for sperm processing in microsurgical subzonal placement of sperm in rabbit oocytes. Fertilization rates with standard in vitro fertilization and microsurgical subzonal sperm placement were found to be similar (56 and 55%) when sperm treated with high-ionic strength Bracketts defined inedium to initiate capacitation were used. Statistically significant reductions in fertilization rates for both standard in vitro fertilization and subzonal placement were noted when twice-washed spermatozoa were used. Initiation of capacitation of spermatozoa results in higher fertilization results even when the zona pellucida is bypassed during fertilization.

The effects of platelet activating factor on the motility of human spermatozoa

Our laboratory has recently detected the presence of platelet-activating factor (PAF)-like activity in human spermatozoa. To gain further insight into the role of PAF on the male reproductive system, this study, using videomicroscopy, evaluated the effects of synthetic PAF on the motility of human spermatozoa. Treatment of 20 human semen samples with 3.69 x 10(-7) to 3.69 x 10(-13) M PAF resulted in statistically significant increases in motility. Treatment of spermatozoa with lyso-PAF (the biologically inactive form of PAF) showed no change in motility. Treatment of spermatozoa with PAF in severely asthenozoospermic males may be of therapeutic value.

The effect of androgen on nitric oxide synthase in the male reproductive tract of the rat**Supported by United States Public Health Service grants HD30137 and DK19300–18 and training grant H32–6647, Bethesda, Maryland.††Presented at the Conjoint Meeting of The American Fertility Society and the Canadian Fertility and Andrology Society, Montreal, Quebec, Canada, October 11 to 14, 1993.

OBJECTIVE To determine if nitric oxide synthase activity within the male reproductive tract is regulated by androgen. DESIGN Nitric oxide synthase activity was measured in the reproductive organs of three groups of mature rats: unoperated controls, 1-week castrates, and 1-week castrates given T capsules at the time of surgery. The presence of nitric oxide synthase activity was confirmed by using the nitric oxide synthase-specific inhibitor N-nitro-L-arginine methyl ester (L-NAME). RESULTS After castration, nitric oxide synthase activity was significantly reduced by 88%, 73%, and 54% in the caput, corpus, and cauda epididymidis, respectively. In the penis, nitric oxide synthase activity decreased 45% and nitric oxide synthase protein decreased 57% after castration. In the seminal vesicle and lateral prostate, nitric oxide synthase activity increased significantly after castration from nondetectable levels in controls. Nitric oxide synthase activity in the coagulating gland and ventral and dorsal prostate did not change after castration. The changes in nitric oxide synthase activity in all organs after castration were prevented by T replacement. Additionally, the activity measured in every organ in all three treatment groups was > 90% inhibited by L-NAME. CONCLUSION These data demonstrate that androgen differentially affects nitric oxide synthase activity in the male reproductive tract. To the best of our knowledge this is the first time that nitric oxide synthase activity has been shown to be influenced by androgen in any tissue.

The presence of platelet-activating factor-like activity in human spermatozoa**Presented at the 44th Annual Meeting of The American Fertility Society, Atlanta, Georgia, October 10 to 13, 1988.

Evidence is provided for the existence of platelet-activating factor (PAF)-like activity in the lipid extracts of human spermatozoa. The PAF content of human spermatozoa based on [3H]-serotonin release from washed rabbit platelets was noted to be 1.45 pmol/10(8) sperm cells in highly purified motile spermatozoa. No PAF activity was associated with the seminal fluid. Platelet-activating factor content of spermatozoa may be related to its fertility potential.