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Preoperative pain as a risk factor for chronic post-surgical pain - six month follow-up after radical prostatectomy.

Background: Chronic post‐surgical pain (CPSP) by definition develops for the first time after surgery and is not related to any preoperative pain. Preoperative pain is assumed to be a major risk factor for CPSP. Prospective studies to endorse this assumption are missing.

Risk factors for acute and chronic postoperative pain in patients with benign and malignant renal disease after nephrectomy.

Aims: This longitudinal study was performed in order to analyze the incidence of and perioperative risk factors for the development of chronic postsurgical pain (CPSP) in patients after nephrectomy.

Prevalence, severity, and chronicity of pain and general health-related quality of life in patients with localized prostate cancer.

Aims: To analyze the prevalence and the severity spectrum of pain and its relationships to health‐related quality of life and the bio‐psycho‐social consequences of pain among patients scheduled for radical prostatectomy.

Chronic pain and disability after pelvic and acetabular fractures--assessment with the Mainz Pain Staging System.

BACKGROUND Chronic posttraumatic pelvic pain (PPP) after pelvic ring fractures impacts negatively on quality of life issues. This study aimed to more clearly identify and quantify the problem. METHODS For this cross-sectional study, patients were examined 52 (median) months after pelvic fractures. The following parameters were measured: pain chronicity (Mainz Pain Staging System [MPSS]), pain intensity (Numeric Rating Scale, 0-10), pelvic fracture outcome scores (Majeed, Pohlemann, and Bürk), pain severity (Chronic Pain Grading Questionnaire), pain-related interference with activities of daily living (Chronic Pain Grading Questionnaire), low back pain-related disability (Oswestry score), neuropathic pain (painDETECT), physical functioning (Short Form-12), and medical comorbidities (Weighted Illness Check List-20). Psychological distress was evaluated for anxiety and depression (Hospital Anxiety and Depression Scale) and mental quality of life (Short Form-12). RESULTS Sixty-nine patients had a total of 49 pelvic and 41 acetabular fractures; 70% underwent osteosynthesis. The prevalence of PPP was 64%. Prevalence weighted with the dysfunctional pain chronicity stages MPSS II and III was 48%. Patients with pelvic fracture types (AO classification) A, B, and C had PPP prevalences of 38%, 67%, and 90%, respectively. Pain chronicity stages (MPSS) were moderately to strongly correlated with pelvic pain intensity (r = 0.57), the three pelvic fracture outcome scores (r = -0.78 to -0.90), pain-related interference (r = 0.72), Oswestry score (r = 0.68), nerve injury and neuropathic pain (r = 0.52), reduced physical (r = -0.72) and mental functioning (r = -0.58), trauma-related comorbidity (r = 0.53), anxiety (r = 0.51), and depression (r = 0.67). CONCLUSION This study demonstrated that the intensity and prevalence of PPP are high even some 4 years after injury. The validated instruments MPSS (measuring pain chronicity) and Oswestry disability score proved to be appropriate for classifying outcome after pelvic ring fractures.

Preoperative chronic pain in radical prostatectomy patients: preliminary evidence for enhanced susceptibility to surgically induced pain.

Background and objective The aim of the study was to examine a possible relationship between the extent of preoperative chronic pain and the development of moderate-to-severe acute postoperative pain. Methods Eighty-four patients scheduled for radical prostatectomy were studied. Pain intensities after mobilization during the first 3 postoperative days were added to yield a total pain score (total pain score after mobilization, range 0–30). Pain was considered as moderate to severe at a total pain score after mobilization of 12 or higher. The preoperative severity of chronic pain disorders was measured using the Mainz Pain Staging System (I–III). Further possible preoperative risk factors for the development of intense postoperative pain that were examined included pain intensity, pain in the urological site, psychological distress (Hospital Anxiety and Depression Scale) and health-related quality of life (Short Form-12). Results Patients with moderate-to-severe preoperative chronic pain and those with higher Mainz Pain Staging System stages were significantly (P < 0.001) more likely to develop moderate-to-severe postoperative pain. Anxiety and depression scores as well as physical health (Short Form-12) were significantly associated with a total pain score after mobilization of at least 12. The development of postoperative pain was independent of the presence of preoperative pain in the urological site. Conclusion This study demonstrated that higher degrees of preoperative chronic pain were associated with the development of more intense pain after radical prostatectomy. Preoperative psychological distress and reduced physical health were associated with a marked increase in postoperative pain intensity.

Distribution of EphB4 and EphrinB2 in normal and malignant urogenital tissue

OBJECTIVE Ephrin (Eph) receptors are receptor tyrosine kinases; both EphrinB2, as a ligand, and EphB4, as a receptor, are involved in angiogenesis. EphrinB2 is expressed on arteries and EphB4, a specific receptor for EphrinB2, is expressed on veins. It is unknown whether involvement of arteries and veins in tumor angiogenesis is distinctive. Here we investigated their distribution in normal and malignant tissue of the urogenital tract. MATERIALS AND METHODS Five-micrometer-thick paraffin sections from nontumoral and tumoral tissues of kidney (n = 12), bladder (n = 33), and prostate (n = 20) were immunoreacted with antisera against EphB4 and EphrinB2 using the avidin-biotin-peroxidase complex technique. Comparisons of EphB4 and EphrinB2 stained arterial and venous vessels in the nontumoral and tumoral sections were evaluated in a semiquantitative analysis as frequency of the vessels in a predetermined tumor area counted under light microscopy. RESULTS Expression of EphrinB2 in arterial and EphB4 in venous endothelium was significantly greater in tumoral sections compared with nontumoral sections. No statistically significant correlation in comparing the labeling patterns for EphrinB2 with the labeling patterns for EphB4 was observed in nontumoral as well as tumoral sections. CONCLUSIONS The high expression of EphrinB2 in arterial and EphB4 in venous endothelium of urogenital tract tumors might contribute to their involvement in the progression of tumor angiogenesis. The relation between arteries and veins in the normal and tumor tissues is unchanged.

CMDX©-based single source information system for simplified quality management and clinical research in prostate cancer

BackgroundHistopathological evaluation of prostatectomy specimens is crucial to decision-making and prediction of patient outcomes in prostate cancer (PCa). Topographical information regarding PCa extension and positive surgical margins (PSM) is essential for clinical routines, quality assessment, and research. However, local hospital information systems (HIS) often do not support the documentation of such information. Therefore, we investigated the feasibility of integrating a cMDX-based pathology report including topographical information into the clinical routine with the aims of obtaining data, performing analysis and generating heat maps in a timely manner, while avoiding data redundancy.MethodsWe analyzed the workflow of the histopathological evaluation documentation process. We then developed a concept for a pathology report based on a cMDX data model facilitating the topographical documentation of PCa and PSM; the cMDX SSIS is implemented within the HIS of University Hospital Muenster. We then generated a heat map of PCa extension and PSM using the data. Data quality was assessed by measuring the data completeness of reports for all cases, as well as the source-to-database error. We also conducted a prospective study to compare our proposed method with recent retrospective and paper-based studies according to the time required for data analysis.ResultsWe identified 30 input fields that were applied to the cMDX-based data model and the electronic report was integrated into the clinical workflow. Between 2010 and 2011, a total of 259 reports were generated with 100% data completeness and a source-to-database error of 10.3 per 10,000 fields. These reports were directly reused for data analysis, and a heat map based on the data was generated. PCa was mostly localized in the peripheral zone of the prostate. The mean relative tumor volume was 16.6%. The most PSM were localized in the apical region of the prostate. In the retrospective study, 1623 paper-based reports were transferred to cMDX reports; this process took 15 ± 2 minutes per report. In a paper-based study, the analysis data preparation required 45 ± 5 minutes per report.ConclusionscMDX SSIS can be integrated into the local HIS and provides clinical routine data and timely heat maps for quality assessment and research purposes.

Linkage of Data from Diverse Data Sources (LDS): A Data Combination Model Provides Clinical Data of Corresponding Specimens in Biobanking Information System

To provide sufficient clinical data for corresponding specimens from diverse databases established before the implementation of biobanks for research purposes with respect to data privacy regulations. For this purpose, we developed a data model called “linkage of data from diverse data sources (LDS)”. The data model was developed to merge clinical data from an existing local database with biospecimen repository data in our serum bank for uro-oncology. This concept combines two data models based on XML: the first stores information required to connect multiple data sources and retrieve clinical data, and the second provides a data architecture to acquire clinical and repository data. All data were anonymized and encrypted using the Advanced Encryption Standard. X.509 certificates were applied to secure data access. Furthermore, we tested the feasibility of implementing these models in the information management system for biobanking. The data concept can provide clinical and repository data of biospecimens. Only authorized receivers can access these data. Sensitive and personal data are not accessible by the data receivers. The data receiver cannot backtrack to the individual donor using the data model. The acquired data can be converted into a text file format supported by familiar statistical software. Supplementary tools were implemented to generate and view XML documents based on these data models. This data model provides an effective approach to distribute clinical and repository data from different data sources to enable data analysis compliant with data privacy regulations.

Postoperative Schmerztherapie nach radikaler Prostatektomie mit oder ohne epiduraler Analgesie

Epidural analgesia for postoperative pain treatment is favored, for example, within the scope of so-called fast-track surgery, especially abdominal surgery. To improve pain care for our urological patients, we examined the quality of postoperative pain therapy with and without epidural analgesia after radical prostatectomy. After the investigation was approved by the local ethics committee, patients were questioned in detail about the pain they experienced for 7 days after radical prostatectomy. For all 7 postoperative observation days, significantly less pain was measured for patients receiving epidural analgesia compared with patients without epidural analgesia. This could be shown for the average and strongest pain intensity at rest as well as for pain during mobilization. Patients with epidural analgesia were discharged, on average, 1 day earlier. After radical prostatectomy, postoperative pain therapy with epidural analgesia seems to offer advantages with regard to the quality of analgesia and the average length of hospital stay.

Management of a ureteroarterial fistula

Ureteroarterial fistulae are rare after vascular surgery with only 16 cases being reported in the literature. We report a 65-year-old woman who presented with massive gross hematuria following endostenting of an iliac aneurysm. Cystoscopy demonstrated ejaculation of blood from the left orifice and angiography revealed an ureteroiliac fistula between the left ureter and the common iliac artery. Following placement of a vascular endoprosthesis and a double J stent gross hematuria developed. This case highlights the diagnosis and therapeutic approach in patients with suspected ureteroarterial fistula.