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Jonathan I. Epstein - One of the best experts on this subject based on the ideXlab platform.
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radical retropubic prostatectomy how often do experienced surgeons have positive surgical margins when there is extraprostatic extension in the region of the Neurovascular Bundle
The Journal of Urology, 2005Co-Authors: David J Hernandez, Jonathan I. Epstein, Bruce J Trock, Toyonori Tsuzuki, Ballentine H Carter, Patrick C. WalshAbstract:ABSTRACTPurpose:: We determined the frequency of positive surgical margins (PSMs) in patients with extraprostatic extension (EPE) in the region of the Neurovascular Bundle (NVB) who underwent open radical retropubic prostatectomy by 2 experienced surgeons.Materials and Methods:: A total of 204 men with EPE in the region of the NVB underwent surgery by 2 experienced surgeons. The frequency of PSMs in the area of the NVB as well as the nerve sparing status of each lobe of the prostate were determined through a retrospective investigation of the pathology database as well as the physician’s database. The recovery of sexual function was determined and compared to controls.Results:: The age, clinical stage, biopsy Gleason sum and serum prostate specific antigen of the patients operated on by surgeons 1 and 2 were similar. Surgeon 1 widely excised at least 1 Neurovascular Bundle in 16% of the patients and surgeon 2 in 63%. The overall frequency of PSMs at the NVB was 5.9% for surgeon 1 and 5.8% for surgeon 2. O...
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Excision of the Neurovascular Bundle at radical prostatectomy in cases with perineural invasion on needle biopsy
Urology, 1999Co-Authors: G. Frank Holmes, Patrick C. Walsh, Charles R. Pound, Jonathan I. EpsteinAbstract:Abstract Objectives. To assess, in a group of patients who had undergone radical prostatectomy and who were likely to have extraprostatic extension of their tumors based on the previous finding of perineural invasion on needle biopsy, how effective excision of the Neurovascular Bundle was in reducing the number of positive margins and increasing the potential cure rate. Methods. Eighty radical prostatectomy cases from our institution that had perineural invasion on prostate needle biopsy were retrospectively studied to determine the presence and location of extraprostatic extension, positive margins, and seminal vesicle or lymph node involvement, whether the Neurovascular Bundle had been excised, and whether tumor was present in the Bundle region. Results. In 14 (17.5%) of 80 cases, excising the Neurovascular Bundle led to a situation in which there was tumor in the Neurovascular Bundle, all the surgical margins of resection were negative for tumor, and there was no seminal vesicle or lymph node involvement. The remaining cases were equally divided between (a) less aggressive tumors that were organ-confined or had only focal extraprostatic extension with no tumor in the Neurovascular Bundle and (b) more aggressive tumors that had positive margins or involvement of the seminal vesicles or lymph nodes. Within the latter group, however, there were 9 patients (11.3% of all 80 cases) with negative seminal vesicles and lymph nodes in whom excision of the Neurovascular Bundle at least reduced the extent of positive margins. Most of the positive margins in patients with tumor in the Neurovascular Bundle occurred outside the Bundle region, and in this study, none of the cases with positive surgical margins were the sole result of failure to excise the Neurovascular Bundle. Conclusions. When perineural invasion is seen on needle biopsy, the morbidity of resecting one or both Neurovascular Bundles, which in some cases could turn out to be unnecessary, must be weighed against the benefit of reducing the incidence of positive margins (17.5% of our cases) or decreasing the extent of positive margins (11.3% of our cases).
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Extended Followup of the Influence of Wide Excision of the Neurovascular Bundle(s) on Prognosis in Men with Clinically Localized Prostate Cancer and Extensive Capsular Perforation
The Journal of urology, 1996Co-Authors: Robert C. Smith, Jonathan I. Epstein, Alan W. Partin, Charles B. BrendlerAbstract:AbstractPurpose: The effect of wide excision of the Neurovascular Bundles on disease-free survival was determined in men with clinically localized prostate cancer and pathological evidence of extensive capsular perforation in the region of the Neurovascular Bundle.Materials and Methods: We previously analyzed 107 men with clinically localized prostate cancer and pathological evidence of extensive capsular perforation in the region of the Neurovascular Bundles. Wide excision of the Neurovascular Bundle on the sides of palpable induration resulted in negative surgical margins in 58 percent of patients compared to only 45 percent in whom the Neurovascular Bundles were left intact (p = 0.03). At a mean followup of 20 months, median interval to disease recurrence as defined by a measurable PSA level was 33 months in patients whose Neurovascular Bundle(s) were widely excised versus 22 months in those whose Neurovascular Bundle(s) were left intact (p = 0.03). However, by 43 months 75 percent of the patients in b...
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Influence of Wide Excision of the Neurovascular Bundle(s) on Prognosis in Men with Clinically Localized Prostate Cancer with Established Capsular Penetration
The Journal of urology, 1993Co-Authors: Alan W. Partin, Jonathan I. Epstein, R. Neill Borland, Charles B. BrendlerAbstract:AbstractWe analyzed 107 men with clinically localized prostate cancer who had pathologically established capsular penetration in the region of the Neurovascular Bundles to determine the effect of wide excision of the Neurovascular Bundle(s) on disease-free survival. In 38 patients established capsular penetration was not suspected clinically and the Neurovascular Bundle(s) were preserved. In 69 patients established capsular penetration was suspected, and 1 or both Neurovascular Bundles were excised widely with the prostate. Disease-free survival was defined by an undetectable serum prostate specific antigen (PSA) level postoperatively. Wide excision of the Neurovascular Bundle(s) resulted in negative surgical margins in 40 of 69 patients (58%) compared to only 17 of 38 (45%) in whom the Neurovascular Bundle(s) was left intact (p = 0.03). Median interval to disease recurrence, as defined by a measurable serum PSA level, was 22 months in the group in whom the Neurovascular Bundles were preserved versus 33 m...
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invasion of the Neurovascular Bundle by prostate cancer evaluation with mr imaging
Radiology, 1991Co-Authors: Clare M Tempany, Patrick C. Walsh, Jonathan I. Epstein, Alain Rahmouni, Elias A ZerhouniAbstract:Preservation of the Neurovascular Bundle (NVB) and potency without compromising tumor control are current objectives of radical retropubic prostatectomy as treatment for prostate cancer, but preoperative determination of whether cancer has invaded the NVB can be difficult. The use of conventional body-coil magnetic resonance (MR) imaging to make this preoperative determination was evaluated in 50 patients with biopsy-proved cancer. All patients underwent radical retropubic prostatectomy after MR imaging. MR imaging, surgical, and pathologic data were correlated relative to tumor location and volume, Gleason grade, presence of capsular penetration, and depth of NVB invasion. The sensitivity of MR imaging for invasion was 68%, specificity was 59%, and overall accuracy was 64%. Results of this study indicate that MR imaging can help identify the NVB and predict invasion of the NVB by tumor, but the usefulness of the technique is limited by the lack of spatial resolution associated with use of the whole-body coil.
William P Cooney - One of the best experts on this subject based on the ideXlab platform.
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the ulnar Neurovascular Bundle at the wrist a technical note on endoscopic carpal tunnel release
Journal of Hand Surgery (European Volume), 1994Co-Authors: Tyson K Cobb, Stephen W Carmichael, William P CooneyAbstract:The boundaries of Guyon's canal have recently been redefined by a series of anatomical dissections. These showed that the confines of this space do not extend from the pisiform to the hook of the hamate, as currently accepted. The fascial roof extends radial to the hook of the hamate, which allows the ulnar Neurovascular Bundle to course radial to the hamate hook. The position of the ulnar nerve and artery is of particular significance for endoscopic carpal tunnel release. Most endoscopic devices are designed to divide the flexor retinaculum just to the radial aspect of the hamate hook. Utilizing cross-sectional analysis of nine cadaver specimens, we found the ulnar artery to course radial to the hamate hook in five and palmar to it in four. Therefore, the ulnar artery may be at greater risk of injury during endoscopic procedures than previously recognized.
Charles B. Brendler - One of the best experts on this subject based on the ideXlab platform.
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Extended Followup of the Influence of Wide Excision of the Neurovascular Bundle(s) on Prognosis in Men with Clinically Localized Prostate Cancer and Extensive Capsular Perforation
The Journal of urology, 1996Co-Authors: Robert C. Smith, Jonathan I. Epstein, Alan W. Partin, Charles B. BrendlerAbstract:AbstractPurpose: The effect of wide excision of the Neurovascular Bundles on disease-free survival was determined in men with clinically localized prostate cancer and pathological evidence of extensive capsular perforation in the region of the Neurovascular Bundle.Materials and Methods: We previously analyzed 107 men with clinically localized prostate cancer and pathological evidence of extensive capsular perforation in the region of the Neurovascular Bundles. Wide excision of the Neurovascular Bundle on the sides of palpable induration resulted in negative surgical margins in 58 percent of patients compared to only 45 percent in whom the Neurovascular Bundles were left intact (p = 0.03). At a mean followup of 20 months, median interval to disease recurrence as defined by a measurable PSA level was 33 months in patients whose Neurovascular Bundle(s) were widely excised versus 22 months in those whose Neurovascular Bundle(s) were left intact (p = 0.03). However, by 43 months 75 percent of the patients in b...
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Influence of Wide Excision of the Neurovascular Bundle(s) on Prognosis in Men with Clinically Localized Prostate Cancer with Established Capsular Penetration
The Journal of urology, 1993Co-Authors: Alan W. Partin, Jonathan I. Epstein, R. Neill Borland, Charles B. BrendlerAbstract:AbstractWe analyzed 107 men with clinically localized prostate cancer who had pathologically established capsular penetration in the region of the Neurovascular Bundles to determine the effect of wide excision of the Neurovascular Bundle(s) on disease-free survival. In 38 patients established capsular penetration was not suspected clinically and the Neurovascular Bundle(s) were preserved. In 69 patients established capsular penetration was suspected, and 1 or both Neurovascular Bundles were excised widely with the prostate. Disease-free survival was defined by an undetectable serum prostate specific antigen (PSA) level postoperatively. Wide excision of the Neurovascular Bundle(s) resulted in negative surgical margins in 40 of 69 patients (58%) compared to only 17 of 38 (45%) in whom the Neurovascular Bundle(s) was left intact (p = 0.03). Median interval to disease recurrence, as defined by a measurable serum PSA level, was 22 months in the group in whom the Neurovascular Bundles were preserved versus 33 m...
Andrew B Rosenkrantz - One of the best experts on this subject based on the ideXlab platform.
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zoomed echo planar diffusion tensor imaging for mr tractography of the prostate gland Neurovascular Bundle without an endorectal coil a feasibility study
Abdominal Radiology, 2016Co-Authors: Justin M Ream, Christopher Glielmi, Mariana Lazar, Naomi Campbell, Josef Pfeuffer, Rainer Schneider, Andrew B RosenkrantzAbstract:Purpose The purpose of this study was to assess the feasibility of zoomed echo-planar imaging (EPI) diffusion tensor imaging (DTI) with 2-channel parallel transmission (pTx) for MR tractography of the periprostatic Neurovascular Bundle (NVB) without an endorectal coil, and to compare its performance to that of conventionally acquired DTI.
Tyson K Cobb - One of the best experts on this subject based on the ideXlab platform.
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the ulnar Neurovascular Bundle at the wrist a technical note on endoscopic carpal tunnel release
Journal of Hand Surgery (European Volume), 1994Co-Authors: Tyson K Cobb, Stephen W Carmichael, William P CooneyAbstract:The boundaries of Guyon's canal have recently been redefined by a series of anatomical dissections. These showed that the confines of this space do not extend from the pisiform to the hook of the hamate, as currently accepted. The fascial roof extends radial to the hook of the hamate, which allows the ulnar Neurovascular Bundle to course radial to the hamate hook. The position of the ulnar nerve and artery is of particular significance for endoscopic carpal tunnel release. Most endoscopic devices are designed to divide the flexor retinaculum just to the radial aspect of the hamate hook. Utilizing cross-sectional analysis of nine cadaver specimens, we found the ulnar artery to course radial to the hamate hook in five and palmar to it in four. Therefore, the ulnar artery may be at greater risk of injury during endoscopic procedures than previously recognized.