Reinier-Jacques Opsomer

ADJUVANT RADIATION THERAPY DOES NOT CAUSE URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY: RESULTS OF A PROSPECTIVE RANDOMIZED STUDY

PURPOSE We analyzed the potential influence of adjuvant radiotherapy on urinary continence after radical prostatectomy. MATERIALS AND METHODS A total of 100 patients with N0M0 prostate cancer randomized in a prospective study on postoperative radiotherapy for locally advanced disease (positive surgical margin, capsular perforation and/or seminal vesicle infiltration) were studied. Objective pad weighing tests corroborated by direct personal interviews were used to evaluate urinary continence at regular postoperative intervals. RESULTS Of the patients 48 received 60 Gy. external radiotherapy with 18 MV photon beams between 12 and 16 weeks postoperatively, and 52 were followed expectantly. Risk factors were similar in both groups. With a mean followup of 24 months, no difference in complete urinary continence was observed. Of the irradiated group 77% and of the surveillance group 83% were totally dry. The fate of the bladder neck had no significant influence on final continence status, although there was a trend for faster recovery when the bladder neck was preserved. CONCLUSIONS In this prospective randomized study 60 Gy. external radiation therapy administered between 3 and 4 months after radical prostatectomy for pathologically locally advanced prostate cancer had no significant influence on urinary continence.

Neuromagnetic somatosensory homunculus: A non-invasive approach in humans

The somatosensory homunculus has been identified during stimulation of median (at wrist and elbow), femoral, tibial and pudendal nerves of the left hemibody via the neuromagnetic imaging technique. The somatic representations of different body districts have been localized in the somatosensory cortex, by means of an equivalent dipole localization algorhythm. Dipole locations agree with the well-known somatotopic organization obtained with invasive techniques. The proposed method is, therefore, an important investigating tool for studies on normal and diseased subjects.

Endoureteropyelotomy: Percutaneous Treatment of Ureteropelvic Junction Obstruction

A total of 47 percutaneous operations (endoureteropyelotomy) was performed for treatment of 41 congenital and 6 secondary cases of ureteropelvic junction obstruction between September 1983 and April 1988. Evaluation was available in 39 cases with a followup of 4 to 56 months (mean 16 months). Good results were obtained in 28 of 39 cases (72 per cent) and there were 3 failures (8 per cent). Eight patients (20 per cent) were symptomatically improved but they had residual obstruction on a diuretic study. Only 1 multioperated patient with a good early postoperative result has shown radiological deterioration at 1 year. Complications were managed conservatively, except for 1 case of intravascular coagulopathy. Endoureteropyelotomy is an effective alternative treatment for ureteropelvic junction obstruction but further evaluation definitely is warranted to define better its indications and risk factors.

Assessing the risk of unsuspected prostate cancer in patients with benign prostatic hypertrophy: a 13-year retrospective study of the incidence and natural history of T1a-T1b prostate cancers.

To determine the incidence and natural history of stage T1a‐T1b prostate cancer in patients undergoing surgery for benign prostatic hypertrophy (BPH), and thus evaluate the effect that recent medical and ‘minimally invasive’ treatments (which provide no prostate sample for pathological examination) might have on the percentage of patients with unsuspected prostate cancer.

Sudomotor skin responses following nerve and brain stimulation

A comparative evaluation of sudomotor innervation to the limbs and perineum was made using electrical stimulation of the median nerve at the wrist and transcranial magnetic stimulation of the brain. Sympathetic skin responses (SSRs) were recorded from the palms (SSR-1), the soles (SSR-2) and the perineum (SSR-3). Normative data in 25 volunteers showed the following latencies in seconds: [table: see text].

Sympathetic skin responses from the limbs and the genitalia: Normative study and contribution to the evaluation of neurourological disorders

The autonomic innervation of the limbs and the genitalia was studied by means of electrical stimulation of the median nerve at the wrist and the dorsal nerve of the penis/clitoris and recording of sympathetic skin responses from the hand, the foot, and the perineum. In males, the response was also recorded from the penile shaft following median nerve stimulation. Normative data were obtained from 40 healthy volunteers (20 men and 20 women). The clinical contribution of these tests was investigated in a series of 42 patients referred to our laboratory for urinary and/or sexual disorders. Sympathetic skin responses are helpful in the evaluation of sexual impotence and of disorders affecting the pelvic floor as well as of well-known neuropathies.

Treatment of Advanced Carcinoma of the Prostate With a Depot Luteinizing Hormone-releasing Hormone Analogue (ICI-118630)

We treated 37 patients with newly diagnosed advanced prostatic cancer with monthly injections of a long acting depot preparation of a luteinizing hormone-releasing hormone superagonist. Serum testosterone levels were reduced to and maintained within the castrate range, even in cases of objective progression. The partial objective regression rate was 43 per cent, with 36 per cent of the patients having objectively stable disease and 21 per cent having objective progression. The subjective improvement rate was 67 per cent. The addition of a short course of diethylstilbestrol at the initiation of therapy appeared to shorten the delay for the subjective improvement. Patient acceptance was excellent and side effects were minimal. Depot luteinizing hormone-releasing hormone analogues, alone or in combination, may well become a preferred alternative treatment for patients with advanced prostatic cancer.

Do seminal or prostatic secretions play a role in local recurrence after radical prostatectomy for localized prostate cancer

Neoplastic cellular contamination of the surgical bed may be responsible for late local failure after radical prostatectomy. Cytology analysis of the seminal and prostatic fluid collected intraoperatively was undertaken in 30 patients. Neoplastic cells were found in 2 patients both with seminal vesicle involvement. Although it is difficult to admit that tumor spillage during surgery would be a major cause of local recurrence, the presence of tumor cells in the ejaculate may be diagnostic of seminal vesicle invasion. All patients with pathologic stage T2 had a negative cytologic finding.

Leydig Cell Tumor: Estradiol Level at Different Locations

The authors report on estradiol levels at different locations in a patient with a Leydig cell tumor. The highest value was found in the testicular vein. The estradiol level was, however, ten times higher in the peritesticular vaginal fluid than in the peripheral veins.

Muscle regeneration after endoureteropyelotomy

Three specimens of ureteropelvic junction, obtained at dismembered pyeloplasty after successful endoureteropyelotomy, were studied. In the regenerative tissue, numerous cells were found with morphological, immunohistochemical and ultrastructural characteristics of mature smooth muscle cells; no regeneration of bundle arrangement was observed.