Jeffrey S. Palmer

SURFACTANT ADMINISTRATION REDUCES TESTICULAR ISCHEMIA-REPERFUSION INJURY

PURPOSEnThe mechanism of testicular ischemia-reperfusion injury has not been well delineated. We determined the efficacy of a biocompatible surfactant (tetronic 1107) to reduce tissue injury and evaluated cell membrane integrity as reflected by calcium ion permeability in an in vivo animal model of testicular ischemia-reperfusion.nnnMATERIALS AND METHODSnThree groups of male Sprague-Dawley rats (6 per group) were studied. Group 1 was the nonoperative control, and groups 2 and 3 underwent 4 hours of unilateral testicular ischemia followed by 4 hours of reperfusion. Ten minutes after reperfusion 0.4 ml. saline was administered intravenously to group 2 and 180 mg./kg. surfactant tetronic 1107 to group 3. 99mTechnetium pyrophosphate was used to monitor calcium ion uptake by the ipsilateral and contralateral testicles. Both testicles were also examined histologically.nnnRESULTSnThe surfactant treated animals had markedly diminished hemorrhagic discoloration and vascular congestion compared to saline treated animals. These results were confirmed microscopically with improved nuclear chromicity and disarray of germ cell layers of the seminiferous tubules. The surfactant treated group also had a statistically significant (p <0.05) reduction in radiotracer uptake compared to the saline treated animals, confirming a reduction in calcium ion permeability.nnnCONCLUSIONSnThe results of this study suggest that tetronic 1107 is effective in reducing tissue damage in a testicular ischemia-reperfusion animal model.

Same day surgery for radical retropubic prostatectomy: Is it an attainable goal?*

OBJECTIVESnEconomic forces are stimulating a re-evaluation of various management strategies. Recent critical pathways for radical prostatectomy have resulted in reduced length of stay to as low as 2.9 days.nnnMETHODSnThe time in the operating room and recovery room, average blood loss, length of hospitalization, patient charges, and estimated hospital costs were compared for 20 patients undergoing radical prostatectomy up to 1 year before and for 27 men after initiation of a critical pathway. Under the protocol, patients receive an education booklet and preoperative teaching in preparation for early discharge and an epidural for anesthesia. An anonymous questionnaire was mailed to all patients treated by the pathway after catheter removal.nnnRESULTSnThe new pathway resulted in a significant reduction in average time in the operating room (3.7 +/- 0.4 hours versus 4.9 +/- 1.2 hours), estimated blood loss (1204 +/- 527 cc versus 1948 +/- 740 cc), and length of hospitalization (1.7 +/- 0.6 days versus 4.6 +/- 1.5 days). In addition, patient charges and hospital costs were reduced by 32% and 35%, respectively. Thirty-seven percent of the study group was discharged after 1 night compared with 0% in the group treated before the pathway was initiated. Forty-one percent of the study group was not transfused and did not donate blood. Outcome surveys completed by 25 of 27 study patients revealed an overall satisfaction of 96% with 0 of 10 patients who were discharged after one night indicating they would have preferred to be hospitalized longer.nnnCONCLUSIONSnConventional management of men undergoing radical prostatectomy can be safely modified while preserving patient satisfaction without increasing morbidity. Avoiding peripheral narcotics and emphasizing preoperative teaching has enabled us to reduce length of stay greatly, with same day discharge now an attainable goal.

A Platelet Activating Factor Antagonist Attenuates the Effects of Testicular Ischemia

PURPOSEnPlatelet activating factor, a biochemical marker and lipid mediator of ischemic injury, has been demonstrated in several organ systems. The objective of this study was to investigate the possible role of platelet activating factor in testicular ischemic injury.nnnMATERIALS AND METHODSnFive groups of 6 male Sprague-Dawley rats were studied, including group 1-nonoperated controls, group 2-sham operated controls, group 3-those that underwent administration of 10 micrograms./kg. exogenous platelet activating factor into the left testicular artery, group 4-those that underwent 4 hours of testicular ischemia and group 5-those that received pretreatment with 0.4 mg./kg. of the platelet activating factor antagonist CV-6209 intravenously before 4 hours of testicular ischemia. Ipsilateral and contralateral testes were examined histologically and seminiferous tubular diameters were measured.nnnRESULTSnExogenous platelet activating factor administration in group 3 and 4 hours of ischemia in group 4 resulted in a similar extent of histological degeneration of the experimental testicle. Pretreatment with CV-6209 in group 5 resulted in a marked decrease in hemorrhagic discoloration, vascular congestion and histological changes noted with ischemia in group 4.nnnCONCLUSIONSnThe results of this study suggest that platelet activating factor has a biochemical role in tissue injury associated with testicular ischemia. Also, administration of a platelet activating factor antagonist before the ischemic event decreases seminiferous tubule degeneration.

Comparison of Blood Flow and Histological Changes in Rat Models of Testicular Ischemia

PURPOSEnOur aim was to quantify objectively the degree of vascular insufficiency produced by twisting versus clamping the spermatic cord, and determine the contribution of the vasal vessels to these changes using the laser Doppler flowmeter.nnnMATERIALS AND METHODSnThree groups of 12 male Sprague-Dawley rats each were studied. Group 1 underwent 720-degree torsion of the spermatic cord, group 2 underwent vascular clamping of the spermatic cord with 1 clamp, excluding the anatomically separate vasal vessels, and group 3 underwent vascular clamping of the entire spermatic cord and vasal vessels with 2 clamps. Blood flow and histological changes were determined.nnnRESULTSnVascular clamping of the spermatic cord in groups 2 and 3 resulted in a significant decrease in testicular blood flow compared to 720-degree torsion (p < 0.05). These flow changes correlated with more severe and reproducible gross changes, and histological features of seminiferous tubule degeneration compared to spermatic cord twisting.nnnCONCLUSIONSnIn the rat clamping the spermatic cord is a more severe and reproducible model of testicular torsion than 720-degree torsion. The contribution of the vasal vessels to the decrease in blood flow and resulting histological degeneration after testicular ischemia is negligible in the rat.

DEFINING THE ROLE OF SURVEILLANCE IN THE MANAGEMENT OF LOCALIZED PROSTATE CANCER

With the dramatic increase in the detection of prostate cancer in the last 5 years, there has been an enormous challenge for physicians to recommend the best therapy for patients with localized prostate cancer. This challenge, however, has been difficult to meet because of the absence of well-conducted comparative trials. Because the primary goal of the urologist has been to cure prostate cancer and prolong life, the concept of surveillance therapy seems to be quite inappropriate; however, few other diseases have treatments that can so negatively impact on a mans daily quality of life. In addition, the natural history of this cancer, in contrast to many others, does not invariably lead to metastasis or death during the normal life span of most patients. Therefore, in contrast to physicians, many men may wish to maximize their quality of life rather than their duration of survival. This choice depends on the probability of good and bad outcomes that are possible with each treatment option. Ultimately, it is the patients choice to make with help and unbiased guidance from the physician.

Duplicated seminal vesicle.

We report a case of complete, unilateral seminal vesicle duplication without concomitant reproductive duct or renal anomalies encountered during radical retropubic prostatectomy. We also discuss the possible embryologic origin of this anomaly and the clinical implications.

Possible mechanisms for epididymal sparing during testicular ischemia.

OBJECTIVESnAlthough extensive research has been conducted on the normal anatomy and physiology of the epididymis, the effects of ischemia on the organ have not been primarily investigated. The aim of the present study was to investigate the macroscopic and microscopic effects of prolonged ischemia on the epididymis and the factors that may contribute to its resistance to ischemia.nnnMETHODSnSix groups of male Sprague-Dawley rats (6 rats/group) were studied. Groups 1, 2, and 3 underwent a sham operation of 4, 8, and 12 hours, respectively, and groups 4, 5, and 6 underwent 4, 8, and 12 hours of ischemia, respectively. The ipsilateral testes and epididymides were monitored throughout the experiment. At the conclusion of the experiment, bilateral orchiectomy was performed, and structures were histologically evaluated.nnnRESULTSnThere were no abnormal macroscopic findings of the bilateral epididymides of groups 1, 2, and 3 or of the contralateral, control epididymides of groups 4, 5, and 6. Macroscopically, there was a direct correlation between the length of ischemia and the degree of hemorrhagic discoloration of the proximal caput. The degree of hemorrhagic infiltration noted microscopically was consistent with the macroscopic observations. The epithelia of the ischemic epididymides remained intact with numerous microvilli.nnnCONCLUSIONSnThe results of this study suggest that the epithelium of the epididymis is relatively resistant to ischemic damage compared with the gonad during testicular ischemia.

A simple technique to identify catheter balloon defects

Catheter drainage is essential after radical prostatectomy. If the catheter balloon is defective or damaged, deflation may lead to inadvertent catheter displacement. Subsequent attempts to replace the catheter may be difficult and risk damage to the vesicourethral anastomosis. Catheter balloon damage usually occurs during vesicourethral anastomotic suture placement. Testing the catheter balloon with saline after suture placement will detect most leaks but occasionally a small leak will not be noticed and the damage will not be recognized until the catheter has fallen out. We describe a simple technique to identify catheter balloon defects that helps eliminate inadvertent catheter displacement following radical prostatectomy by detecting small balloon injuries which otherwise might not be recognized.