Juan I. Martínez-Salamanca

Cancer control and the preservation of neurovascular tissue: How to meet competing goals during robotic radical prostatectomy

Study Type – Therapy (case series) 
Level of Evidence 4

Current role of penile implants for erectile dysfunction.

Purpose of review The purpose of this review is to appraise new developments and publications in the field of penile prosthetic surgery. Urologists dealing with erectile dysfunction need to recognize the value of penile prosthetic surgery as a very efficacious treatment for this common condition. This type of surgery is needed in a considerable proportion of patients with erectile dysfunction so this review is timely and relevant. Recent findings The main themes in the literature covered include risk factors for infection of penile prostheses, its prevention with the use of hydrophilic and antibiotic-coated prostheses, particularly in re-operations, and its management with the new rescue procedures. Surgical tips for prosthetic surgery are also reviewed as well as clinical outcomes and factors influencing them. Summary Of all the invasive treatments currently available, placement of a penile prosthesis is one of the most successful, giving high levels of satisfaction. With the aid of new technical advances, the risk of infection - the most feared complication - can be minimized so prosthetic surgery may play a major role in the treatment of erectile dysfunction.

Eficacia limitada del uso de agente inyectable permanente en el tratamiento de la incontinencia urinaria de esfuerzo tras prostatectomía radical

Resumen es: OBJETIVO: No existen datos suficientes en relacion a la eficacia del tratamiento de la incontinencia urinaria de esfuerzo (IUE) despues de prostatectomia...

Nitrergic Function Is Lost but Endothelial Function Is Preserved in the Corpus Cavernosum and Penile Resistance Arteries of Men after Radical Prostatectomy

INTRODUCTION Radical prostatectomy (RP) frequently results in erectile dysfunction (ED). It has been hypothesized that alterations of cavernosal tissue subsequent to RP contribute to ED but functional evaluation of the impact of RP on human erectile structures is lacking. AIM This study aims to evaluate endothelial function of human corpus cavernosum (HCC) and human penile resistance arteries (HPRA) and neurogenic responses of HCC from patients with ED secondary to RP (ED-RP). METHODS HCC strips and HPRA were obtained from organ donors without history of ED (No-ED) and patients with ED who were segregated depending on ED etiology: ED-RP or vasculogenic (ED-VASC). Functional evaluation of HCC and HPRA was performed in organ chambers and wire myographs, respectively. Histological evaluation of cavernosal tissue consisted of trichrome staining for fibrosis quantification and TUNEL assay for determination of apoptosis. MAIN OUTCOME MEASURES Endothelium-dependent and endothelium-independent relaxation, electrical field stimulation (EFS)-induced neurogenic contraction and relaxation, and cavernosal fibrosis and apoptosis. RESULTS Endothelium-dependent relaxations were significantly impaired in HCC and HPRA from ED-VASC patients while these responses in ED-PR patients were not different to No-ED. Similarly, sildenafil-induced relaxations were reduced in HCC and HPRA from ED-VASC but were preserved in ED-RP. Adrenergic contractions induced by EFS in HCC were potentiated in both ED-RP and ED-VASC. EFS-induced nitrergic relaxation was significantly reduced in HCC from ED-VASC but was almost abolished in ED-RP. Fibrous tissue content and cavernosal apoptosis in HCC from ED-RP were not significantly different from No-ED. CONCLUSIONS Endothelial function and cavernosal sensitivity to phosphodiesterase type 5 inhibitors are preserved in erectile tissue from ED-RP while a marked imbalance in neurogenic modulation of cavernosal tone favoring adrenergic contractile responses over nitrergic relaxation is manifested. Fibrotic and apoptotic processes in cavernosal tissue are not specifically associated to ED-RP. These evidences could help to retarget therapeutic strategies in the management of ED after RP.

Inflatable Penile Prosthesis Implantation Without Corporeal Dilation: A Cavernous Tissue Sparing Technique

PURPOSE We compared the advantages and disadvantages of initial penile implantation with vs without prior dilation of the corpora cavernosa. MATERIALS AND METHODS Patients implanted for the first time with a 700CX or an antibiotic coated 700CX InhibiZone 3-piece prosthesis by a single surgeon during January 2005 to December 2006 were included in the study. They were randomized to penile implantation without (group 1) or with (group 2) penile dilation. Postoperative pain was measured on the day after surgery and at day 7 postoperatively. Perioperative and postoperative complications were recorded. Residual erectile activity without prosthesis inflation was evaluated using the International Index of Erectile Function at 3-month intervals for 9 months. Patients recorded penile length and girth during maximum sexual stimulation during this time. RESULTS A total of 100 patients were included in the study. Intraoperative complications occurred in 2 group 1 and 3 group 2 patients. Postoperatively complication rates and types were similar in the 2 groups. Pain was significantly greater in group 2 (p <0.01). Immediately postoperatively, and at 3 and 6 months penile length was significantly greater in group 1 than in group 2 (p <0.05). Mean International Index of Erectile Function scores were higher in group 1 (12, range 10 to 14 vs 7, range 6 to 8). CONCLUSIONS Results suggest that penile dilation is not necessary in primary implantation cases.

Análisis crítico comparativo de prostatectomía radical abierta retropubica, laparoscópica y robótica: resultados de continencia urinaria y función sexual (Parte II)

Resumen es: Objetivo: La prostatectomia radical es un procedimiento ampliamente aceptado y consolidado como tratamiento del cancer de prostata clinicamente localizad...

Análisis crítico comparativo de prostatectomía radical abierta, laparoscópica y robótica: resultados de morbilidad perioperatoria y control oncológico (Parte I)

Resumen es: Objetivo: El tratamiento quirurgico del cancer de prostata clinicamente localizado ha demostrado ser una opcion excelente en lo que ha resultados oncolog...

Improving surgical outcomes in renal cell carcinoma involving the inferior vena cava.

Radical nephrectomy with tumor thrombectomy remains the mainstay of treatment in renal cell carcinoma with inferior vena cava extension. Despite the rapid improvements experienced in perioperative care in recent years, this intervention still often results in significant morbidity and mortality. A deeper understanding of salient features of this complex operation provides a valuable insight into the clinical mechanisms underlying the variations observed in surgical outcomes. The ‘operation profile’ serves not only as a basis for making an adequate prognostic assessment, but also creates a platform from which ‘innovative’ strategies for improving quality and safety can be made. The present review aims to set a ‘profile’ for radical nephrectomy and tumor thrombectomy, and to propose a number of strategies that may reduce the complication rates of this intervention.

Second Prize: Pelvic Neuroanatomy and Innovative Approaches to Minimize Nerve Damage and Maximize Cancer Control in Patients Undergoing Robot-Assisted Radical Prostatectomy

Robot-assisted radical prostatectomy is an option for surgical management of clinically localized prostate cancer. There have been theoretical concerns, however, regarding lack of anatomic data with specific relevance to robot-assisted prostatectomy, use of thermal or electrical energy during nerve sparing, and lack of tactile feedback. To address these concerns, we have revisited anatomic foundations and have incorporated a few modifications and strategies in the technique of robot-assisted prostatectomy to maximize cancer control, preserve neurovascular tissue, and emulate time-tested steps of anatomic radical prostatectomy. We present our findings about neural anatomy, modified technique, and oncologic and functional outcomes from patients who have undergone this procedure at our institution.

Evidencia Científica actual sobre la utilidad del Ultrasonido de Alta Intensidad (HIFU) en el tratamiento del Adenocarcinoma Prostático

Resumen Objetivo Evaluar en la literatura especifica existente la evidencia cientifica sobre la utilizacion del Ultrasonido de Alta Intensidad (HIFU) en el tratamiento del adenocarcinoma prostatico (Cap). Metodo Se revisa la literatura a traves de tres bases de datos: PubMed, Cochrane Library, HTA database. Se seleccionaron varios articulos teniendo en cuenta el numero de casos, los criterios de inclusion de los pacientes, el tiempo de seguimiento. Intentamos evaluar la mejor evidencia disponible llevando a cabo una revision sistematica de la eficacia clinica y del coste-efectividad del HIFU en el tratamiento del Cap. Analizamos supervivencia global, supervivencia libre de enfermedad y calidad de vida, incluyendo complicaciones, efectos adversos y aceptacion de la tecnica. Resultados Los trabajos disponibles se centran en dos indicaciones principales: la aplicacion del HIFU como primer escalon terapeutico y como terapia de rescate en recidivas post-radioterapia. Encontramos una gran dificultad para extraer conclusiones sobre los beneficios relativos del HIFU: ausencia de media o alta evidencia y falta de comparaciones de esta terapia emergente con los tratamientos estandar. En cuanto a resultados sobre coste-efectividad tampoco objetivamos datos que nos permitieran extraer evidencia cientifica de calidad media/alta sobre la tecnica. La mayoria de trabajos ofrecian disparidad en la definicion de supervivencia libre de enfermedad (SLE), lo que dificulta la interpretacion de resultados y la extraccion de conclusiones. Los criterios de inclusion fueron tambien heterogeneos entre los diversos autores. Conclusiones Actualmente la evidencia cientifica sobre la utilidad del HIFU en el tratamiento del adenocarcinoma prostatico es de calidad baja. Entre los aspectos a destacar tenemos en cuenta su capacidad de destruccion tumoral local tanto en los casos sin terapia previa como en las recidivas post-radioterapia. No se pueden extraer, sin embargo, conclusiones a medio y largo plazo por la falta de ensayos clinicos randomizados y controlados con seguimiento suficiente para medir beneficios en terminos de supervivencia global y calidad de vida (balance efectos adversos/beneficios), la ausencia de comparaciones con las terapias estandar asi como la heterogeneidad de criterios de definicion de la SLE.