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Journal of Endourology | 2009

Functional and Oncologic Outcomes Comparing Interfascial and Intrafascial Nerve Sparing in Robot-Assisted Laparoscopic Radical Prostatectomies

Lindsay Potdevin; Matt Ercolani; Jeongyun Jeong; Isaac Yi Kim

INTRODUCTION The impact of intrafascial versus interfascial nerve sparing during radical prostatectomy on oncologic and postoperative outcome is still controversial. This manuscript compares the outcomes of intrafascial versus interfascial techniques of nerve sparing used during robot-assisted laparoscopic radical prostatectomy (RALRP) at our institution. MATERIALS AND METHODS Of the 171 patients who underwent RALRP at our institution from January 2006 through December 2007, the charts of 147 patients who underwent bilateral nerve sparing procedure were reviewed retrospectively. During the study period, the preferred technique of nerve sparing at our institution changed from the conventional interfascial approach to athermal intrafascial robotic (AIR) approach. The rates of positive surgical margins (+SMs), continence, and potency were measured. RESULTS Perioperative characteristics and complication rates were similar between the two groups. Continence rates at 1, 3, and 6 months increased from 27.3%, 68.8%, and 93.5%, respectively, after the interfascial procedure to 68.6%, 84.3%, and 92.9% after the AIR procedure. Potency rates at 3, 6, and 9 months in the interfascial group were 16.7%, 43.8%, and 66.7%, respectively, whereas in the AIR group they improved to 24.2%, 81.8%, and 90.9%. The rates of +SMs in pT2 disease were 5.88% in the interfascial group and 7.55% in the AIR group (not significant), whereas in pT3, +SMs were 22.2% in the interfascial group and 41.18% in the AIR group (p < 0.05). CONCLUSION AIR technique greatly improved potency rate and shortened the time to return of continence following RALRP. This improved outcome, though, was achieved at the price of higher +SM rates in patients with pT3 disease.


Urologic Oncology-seminars and Original Investigations | 2013

Pathologic implications of prostatic anterior fat pad

Jeongyun Jeong; Eun Yong Choi; Dong I. Kang; Matt Ercolani; Dong Hyeon Lee; Wun-Jae Kim; Isaac Yi Kim

OBJECTIVE Lymph node status has significant pathologic implications in patients with prostate cancer. In this study, we have performed pathologic analysis of prostatic anterior fat pad (PAFP) excised during robot-assisted radical prostatectomy (RARP) to investigate the potential role of AFP on pathologic staging of prostate cancer. METHODS A total of 258 consecutive patients underwent PAFP excision during RARP between July 2007 and June 2009. PAFP was removed and submitted en bloc to the pathology department and evaluated for the presence of lymphoid tissue and metastatic prostate cancer. Retrospective chart review was performed for all patients. RESULTS Of the 258 patients, 30 (11.6%) had 1 or 2 PAFP lymph nodes and 228 (88.4%) men showed no lymphoid tissue in their PAFPs. Preoperatively, mean PSA level was higher in the former group. There were no significant pathologic differences between the 2 groups. Among the 30 patients with PAFP lymph nodes, 3 were positive for metastatic prostate cancer. All 3 of these patients had high-risk features preoperatively. In 1 patient, the pelvic lymph nodes were negative for metastatic prostate cancer. At 2-year follow-up, PSA level of this patient was undetectable. CONCLUSIONS Herein, we demonstrated that the PAFP contained lymph nodes in over 11% of the patients undergoing RARP at our institution. Prostate cancer was upstaged in 1 patient as a result of PAFP excision. Since this patient is free of biochemical recurrence at 2 years, routine excision and pathologic analysis of PAFP should be considered in prostate cancer patients undergoing radical prostatectomy.


Journal of Endourology | 2010

Clavien Classification of Complications After the Initial Series of Robot-Assisted Radical Prostatectomy: The Cancer Institute of New Jersey/Robert Wood Johnson Medical School Experience

Jeongyun Jeong; Eun Yong Choi; Isaac Yi Kim

PURPOSE To study the safety and feasibility of robot-assisted radical prostatectomy (RARP) for the surgical management of localized prostate cancer, we analyzed perioperative parameters and the pattern of complications in our patients who underwent RARP. PATIENTS AND METHODS After the performance of more than 600 RARP over a 4-year period by a single surgeon using the daVinci® robot system at the Cancer Institute of New Jersey/Robert Wood Johnson Medical School, we reviewed the medical records of the first 200 patients retrospectively. All patients were divided into four groups according to the order of case numbers to compare intergroup differences in preoperative characteristics and perioperative parameters. Perioperative complications were determined in all patients, and complications were classified according to the Clavien classification system. RESULTS The mean operative time was 212 minutes, and the mean blood loss was 189 mL. The mean length of hospital stay was 1.13 days. Overall, 12% (24 men) experienced various perioperative complications among the 200 patients. Of the total 24 patients, 5 (20.8%) men experienced intraoperative complications, and 19 (79.2%) men showed postoperative complications. Rectal injury occurred in two (8.3%) men, and the injury was repaired primarily using two-layer suture techniques without any sequelae. Three (12.5%) patients had femoral neuropathy, and urinary retention developed in 7 (25.0%) patients. Among our 200 patients, no transfusion was needed intraoperatively and postoperatively. There were nine (4.5%) patients in the Clavien grade I complications category, and another 9 (4.5%) men were classified as grade II complications. Six (3.0%) men had grade IIIb complications, and there were no grade IV or V complications. CONCLUSIONS In our initial series of RARP procedures, we experienced low morbidity, with the overall complication rate of 12%. After implementing minor modifications, most of the early complications were prevented. Rectal injuries, if recognized intraoperatively, can be repaired primarily.


Molecular and Cellular Biochemistry | 2012

CREBZF, a novel Smad8-binding protein

Jae-Ho Lee; Geun Taek Lee; Seok Joo Kwon; Jeongyun Jeong; Yun-Sok Ha; Wun-Jae Kim; Isaac Yi Kim

Smads are the secondary messengers of the transforming growth factor-β (TGF-β) signaling pathway. TGF-β receptors phosphorylate the Receptor Smads (R-Smads) upon ligand binding; activated R-Smads translocate to the nucleus and function as transcription factors. Among the R-Smads, Smads 1, 5, and 8 mainly mediate signals in the bone morphogenetic proteins (BMPs) pathways, while Smads 2/3 mediate TGF-β signaling. The regulation of Smads in the TGF-β signal pathway has been well defined, but the relationship of Smads 1, 5, and 8 to the BMP pathways has been relatively understudied. To understand the specific regulation of BMP mediating Smads, we performed yeast two-hybrid screening using the Mad homology 2(MH2) domain of Smad8 as bait. In this screening, novel Smad-binding protein, CREBZF—a basic region–leucine zipper (bZIP) transcription factor—was identified. The interaction of CREBZF and Smads 1, 5, and 8 was confirmed by immunoprecipitation in a human prostate cancer cell line. Overexpression of CREBZF inhibited the promoter activity of BMP response element and abolished the cell growth inhibition induced by BMP-6. Thus, CREBZF inhibits the function of BMP-6 by interacting with Smads. The identification of this novel Smads-binding protein, among others will help us understand the modulation of BMP-signaling pathways.


Asian Journal of Andrology | 2011

Pathological findings following radical prostatectomy in patients who are candidates for active surveillance: impact of varying PSA levels

Dong Il Kang; Thomas L. Jang; Jeongyun Jeong; Eun Young Choi; Kelly Johnson; Dong Hyeon Lee; Wun-Jae Kim; Isaac Yi Kim

Active surveillance is an acceptable treatment option in men with a low-risk prostate cancer. In the present study, we have retrospectively reviewed the outcomes of 509 men who fit the criteria for active surveillance but selected radical prostatectomy. Then, the impact of varying prostate-specific antigen (PSA) levels on the risk of upstaging and upgrading in these patients was assessed. Pathological characteristics of patients who fulfilled the inclusion criteria under three active surveillance criteria--those of the University of California-San Francisco, the National Cancer Institute and the European Association of Urology--were examined. The proportion of men who were deemed candidates for active surveillance but were subsequently upstaged or upgraded was determined. Of 509 patients, 186 (36.5%), 132 (25.9%) and 88 (17.3%) men fulfilled the active surveillance criteria, respectively. Upgrading (Gleason scores 7-10) ranged from 32.8% to 38.6%, while upstaging (≥pT3) ranged from 10.2% to 12.5%, depending on the three active surveillance criteria. After a median follow-up of 24 months, three patients developed a biochemical recurrence. When the impact of varying PSA levels was examined using a test for trend analysis in the context of PSA for each protocol, rates of upstaging were lower in men with PSA <4 ng ml(-1). However, there was no impact of varying PSA levels on upgrading. In conclusion, commonly used active surveillance protocols carry the risks of upgrading and upstaging. More reliable and accurate markers are needed to better stratify the risks of men who are appropriate candidates for active surveillance.


International Journal of Urology | 2011

Impact of robot-assisted radical prostatectomy on health-related quality of life in patients with lower urinary tract symptoms

Eun Yong Choi; Jeongyun Jeong; Dong Il Kang; Kelly Johnson; Matt Ercolani; Thomas L. Jang; Dong Hyeon Lee; Wun-Jae Kim; Isaac Yi Kim

Objective:  Lower urinary tract symptoms (LUTS) are a common complaint in patients with prostate cancer. We attempted to elucidate the effect of robot‐assisted radical prostatectomy (RARP) on patients having different preoperative LUTS severity through analysis of postoperative health‐related quality of life.


Korean Journal of Urology | 2010

Bone morphogenetic protein signaling: implications in urology.

Jeongyun Jeong; Dong Il Kang; Geun Taek Lee; Isaac Yi Kim

The bone morphogenetic proteins (BMPs), as members of the transforming growth factor-β (TGF-β) superfamily, not only control bone formation, but also regulate multiple key steps during embryonic development and differentiation. Furthermore, BMPs play critical roles in maintaining the homeostasis of the cardiovascular, pulmonary, reproductive, urogenital, and nervous systems in adult life. Like all members of the TGF-β superfamily, BMP signaling is mediated through a heteromeric complex of type I and type II transmembrane serine/threonine kinase receptors. The subsequent signal transduction cascade includes either the canonical Smad-dependent or non-canonical Smad-independent pathways. Reflecting the critical function of BMPs, BMP signaling is tightly regulated at multiple steps by various mechanisms including extracellular endogenous antagonists, neutralizing antibodies/extracellular soluble receptor domains, small molecule inhibitors, cytoplasmic inhibitory Smads, and transcriptional co-repressors. Recently, dorsomorphin, the first small molecule inhibitor of BMP signaling, was identified and suggested as a useful tool for dissecting the mechanisms of signaling pathways and for developing novel therapeutics for diverse human diseases that are related to the BMP signaling pathways. In this article, we discuss various mechanisms involved in regulating BMP signaling pathways and their implications for urology.


Journal of Robotic Surgery | 2011

Impact of Partin nomogram on presurgical planning: intrafascial versus interfascial nerve sparing during robot-assisted radical prostatectomy

Jeongyun Jeong; Eun Yong Choi; Dong Il Kang; Dong-Hyeon Lee; Isaac Yi Kim


Journal of Robotic Surgery | 2010

Early assessment of patient satisfaction and health-related quality of life following robot-assisted radical prostatectomy

Eun Yong Choi; Jeongyun Jeong; Dong Il Kang; Kelly Johnson; Thomas L. Jang; Isaac Yi Kim


The Journal of Urology | 2010

291 STAGING IMPLICATIONS OF ANTERIOR PROSTATIC FAT PAD EXCISION DURING ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

Jeongyun Jeong; Shilpa Lamba; Eun Yong Choi; Dong Il Kang; Isaac Yi Kim

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Wun-Jae Kim

Chungbuk National University

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Thomas L. Jang

Memorial Sloan Kettering Cancer Center

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Eun Young Choi

Seoul National University

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