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Herbert Lepor - One of the best experts on this subject based on the ideXlab platform.
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THE NEW YORK UNIVERSITY NERVE SPARING ALGORITHM DECREASES THE RATE OF POSITIVE SURGICAL MARGINS FOLLOWING Radical Retropubic Prostatectomy
2016Co-Authors: Jonathan Melamed, Herbert Lepor, Ojas Shah, David A. RobbinsAbstract:Purpose: We developed an algorithm that prospectively defines when to excise the neurovas-cular bundles during Radical Retropubic Prostatectomy with the goal of maximizing the perfor-mance of nerve sparing procedures while minimizing positive surgical margins. Materials and Methods: From January 1 to December 31, 2000 a single surgeon performed 272 Radical Retropubic prostatectomies and 263 were performed from January 1 to December 31, 2001. A single pathologist analyzed all specimens with positive margins. There were no prospectively defined criteria to guide decisions regarding excision of the neurovascular bundles in the 2000 study cohort. Gleason score, percent tumor volume and perineural invasion were independently analyzed in the biopsy specimens according to the site of origin (right versus left side) for the 2001 group only. The ipsilateral neurovascular bundle was excised for Gleason 6 or less tumors when there were 50 % or greater tumor volume in the biopsy specimen and perineural invasion, for Gleason 7 tumors when there was 30 % or greater tumor volume, or perineural invasion and for Gleason 8 to 10 tumors when there was 10 % or greater tumor volume, or perineural invasion. Results: There were no statistically significant differences between the 2000 and 2001 group
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factors predicting preservation of erectile function in men undergoing open Radical Retropubic Prostatectomy
The Journal of Urology, 2008Co-Authors: Tracy Marien, Alexander Sankin, Herbert LeporAbstract:Purpose: The development of erectile dysfunction represents a major concern for potent men with localized prostate cancer undergoing open Radical Retropubic Prostatectomy. We identified factors predicting the preservation of erectile function in men undergoing open Radical Retropubic Prostatectomy.Materials and Methods: Between October 2000 and September 2005 a total of 1,110 men underwent open Radical Retropubic Prostatectomy by a single surgeon. The UCLA-PCI was self-administered at baseline, and at 3, 6, 12 and 24 months postoperatively. The 728 (66%) men who responded that they engaged in sexual intercourse with or without taking phosphodiesterase type 5 inhibitors in the month before surgery and who were not dependent on intracavernous injections, intraurethral suppositories, vacuum devices or penile prostheses were considered potent. Followup was available for 659 men. Of the evaluable men 25 received salvage radiation therapy, adjuvant chemotherapy or hormonal therapy and were excluded from the stu...
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inguinal hernias in men undergoing open Radical Retropubic Prostatectomy
Urology, 2007Co-Authors: Herbert Lepor, David RobbinsAbstract:Objectives To determine the incidence of inguinal hernias in men undergoing open Radical Retropubic Prostatectomy (RRP). Methods The incidence of preoperative and postProstatectomy inguinal hernias were determined by a retrospective chart review and questionnaire survey of 1130 consecutive men who underwent open RRP by a single surgeon from October 2000 to October 2005. A preoperative inguinal hernia was diagnosed by the physical examination or abdominal computed tomography findings. The incidence of new postoperative hernias was ascertained by the patients' responses to a survey indicating the development of a new groin bulge or hernia. Results Of the 1130 patients, 146 (13%) had a preoperative inguinal hernia. Increasing age and lower body mass index were significantly associated with the detection of a preoperative inguinal hernia. The sensitivity of detecting an inguinal hernia by physical examination and routine abdominal computed tomography preoperatively was 96.3% and 42.5%, respectively. Also, 8% of men developed a new hernia. Conclusions Although abdominal computed tomography can identify inguinal hernias in men undergoing open RRP, the test's sensitivity is inferior to that of a simple physical examination. All candidates for open RRP should undergo a careful physical examination to identify asymptomatic inguinal hernias. Our findings suggest that the previously reported high incidence of symptomatic inguinal hernias that developed after open RRP can be explained by a failure to diagnose preexisting inguinal hernias and the development of new hernias.
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the impact of open Radical Retropubic Prostatectomy on continence and lower urinary tract symptoms a prospective assessment using validated self administered outcome instruments
The Journal of Urology, 2004Co-Authors: Herbert Lepor, Ledia KaciAbstract:ABSTRACTPurpose: We determined the impact of Radical Retropubic Prostatectomy on continence and lower urinary tract symptoms (LUTS).Materials and Methods: Between October 2000 and August 2002, 500 men with clinically localized prostate cancer underwent Radical Retropubic Prostatectomy by a single surgeon, and completed the UCLA Prostate Cancer Index and American Urological Association (AUA) symptom index at baseline, 3, 6, 12 and 24 months after Radical Prostatectomy. Univariate analysis was performed to identify factors predisposing the early return of continence.Results: A total of 100%, 98.3%, 97.1%, 94.2% and 98.6% of patients filled out the UCLA Prostate Cancer Index and AUA symptom index at baseline, and 3, 6, 12 and 24 months, respectively. Based on protective pad requirement or frequency of incontinence 100%, 90.9%, 87.2%, 92.1% and 98.5% vs 98.8%, 80.6%, 91.2%, 95.2% and 98.5% of men were continent at baseline, 3, 6, 12 and 24 months after surgery, respectively. Age, severity of lower urinary tra...
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influence of body weight and prostate volume on intraoperative perioperative and postoperative outcomes after Radical Retropubic Prostatectomy
Urology, 2003Co-Authors: Elias I Hsu, Eugene K Hong, Herbert LeporAbstract:Abstract Objectives To determine the influence of body weight and prostate volume on surgical outcomes after Radical Retropubic Prostatectomy. Methods Between January 1994 and July 2000, 1024 men underwent Radical Retropubic Prostatectomy by a single surgeon. Information was collected on body weight, prostate volume, operative time, estimated blood loss, allogenic transfusion rate, intraoperative complications, perioperative complications, postoperative complications, surgical margin status, and length of hospital stay. Postoperative continence and erectile function were assessed from self-administered questionnaires. Results Body weight was not significantly related to operative time (P = 0.09), estimated blood loss (P = 0.12), allogenic transfusion rate (P = 0.49), intraoperative complications (P = 0.37), perioperative complications (P = 0.84), postoperative complications (P = 0.44), positive margin rate (P = 0.07), length of hospital stay (P = 0.27), postoperative continence (P = 0.72), or postoperative erectile function (P = 0.92). The prostate volume was significantly and directly related to the estimated blood loss (P = 0.02), allogenic transfusion rate (P = 0.01), and length of hospital stay (P = 0.01). The prostate volume was significantly and inversely related to the positive surgical margin rate (P = 0.03). The prostate volume was not significantly related to the operative time (P = 0.12), intraoperative complications (P = 0.68), perioperative complications (P = 0.73), postoperative complications (P = 0.14), postoperative continence (P = 0.23), or postoperative erectile function (P = 0.90). Conclusions No clinically relevant risks were associated with increasing body weight. Intraoperative bleeding resulting in higher transfusion rates represented the only clinically significant outcome that was adversely impacted by prostate volume. In the hands of experienced surgeons, Radical Retropubic Prostatectomy can be performed in heavy men and in men with large prostates with excellent outcomes.
Vincenzo Gentile - One of the best experts on this subject based on the ideXlab platform.
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use of 3d t2 weighted mr sequences for the assessment of neurovascular bundle changes after nerve sparing Radical Retropubic Prostatectomy rrp a potential diagnostic tool for optimal management of erectile dysfunction after rrp
The Journal of Sexual Medicine, 2009Co-Authors: Alessandro Sciarra, Valeria Panebianco, Danilo Lisi, Stefano Salciccia, R Passariello, Andrea Alfarone, Alessandro Gentilucci, Vincenzo GentileAbstract:ABSTRACT Introduction Erectile dysfunction (ED) is one of the complications after Radical Retropubic Prostatectomy (RRP), and recovery of erectile function is quantitatively related to the preservation of the neurovascular bundles (NVBs). Aim The aim of our study was to assess, in patients submitted to a nerve-sparing RRP, the capability of a dedicated 3D isotropic magnetic resonance imaging (MRI) T2-weighted sequence in the depiction of postsurgical changes of NVB formation. Methods Fifty-three consecutive patients underwent a bilateral nerve-sparing RRP. Two postoperative magnetic resonance (MR) examinations and International Index of Erectile Function Five-Item (IIEF-5) questionnaire were carried out at 6 and 12 months. Morphological imaging of the postProstatectomy fossa was performed by first acquiring turbo spin echo T2-weighted sequences in the axial and coronal planes and then with 3D T2-weighted isotropic sequence on axial plane. Image findings were scored using a relative 5-point classification (0 = normal; I = mild; II = mild to moderate; III = moderate; IV = severe alterations) and correlated with postoperative IIEF-5 score questionnaire. Main Outcome Measures The degree of association between the alteration score values obtained by postoperative MR morphologic evaluation for MR sequence and IIEF-5 score. Results Image interpretation was performed by two radiologists, that scoring MR alterations by the use of axial and multiplanar reconstruction 3D T2 isotropic sequence. The radiologists placed 43.30% of patients in class 0 (23/53 normal or quite normal), 32.00% in class I (17/53 mild), 11.40% in class II (6/53 mild to moderate), 7.50% in class III (4/53 moderate), and 5.70% in class IV (3/53 severe). In all cases, the correlation and regression analyses between the 3D T2 isotropic sequence and IIEF-5 score, resulted in higher coefficient values (rho = 0.45; P = 0.0010). Conclusion The MRI protocol and NVB change classification score proposed in this study would represent an additional tool in the postoperative phase of those patients with ED. Sciarra A, Panebianco V, Salciccia S, Alfarone A, Gentilucci A, Lisi D, Passariello R, and Gentile V. Use of 3D T2-weighted MR sequences for the assessment of neurovascular bundle changes after nerve-sparing Radical Retropubic Prostatectomy (RRP): A potential diagnostic tool for optimal management of erectile dysfunction after RRP. J Sex Med 2009;6:1430–1437.
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2d and 3d t2 weighted mr sequences for the assessment of neurovascular bundle changes after nerve sparing Radical Retropubic Prostatectomy with erectile function correlation
European Radiology, 2009Co-Authors: Valeria Panebianco, Vincenzo Gentile, Alessandro Sciarra, Marcello Osimani, Danilo Lisi, Mauro Ciccariello, Stefano Salciccia, Franco Di Silverio, R PassarielloAbstract:The aim of this study was to assess the capability of a 3D isotropic MRI T2-weighted sequence (3D T2 ISO) in the depiction of changes of neurovascular bundles (NVBs) after bilateral nerve-sparing Radical Retropubic Prostatectomy (RRP). Furthermore, our aim was also to introduce a new MRI classification score of the NVB alteration patterns using the International Index Erectile Function Five-Item (IIEF-5) score as standard of reference. Fifty-three consecutive patients were postoperatively submitted to two MR examinations, including both 2D TSE T2-weighted (2D T2) and 3D T2 ISO sequences. Image findings were scored using a relative five-point classification and correlated with the postoperative IIEF-5 score. Radiologists attributed 13.2% of patients to class 0, 11.3% to class I, 34% to class II, 24.5% to class III, and 16.9% to class IV. With 3D T2 ISO images, the same radiologists determined 43.3% class 0, 32% class I, 11.4% class II, 7.5% class III, and 5.7% class IV. In all cases, the correlation and regression analysis between the 3D T2 ISO and IIEF-5 score resulted in higher coefficients values. The 3D sequence correlated most closely with patients' grading of erectile function.
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use of local hyperthermia as prophylaxis of fibrosis and modification in penile length following Radical Retropubic Prostatectomy
International Journal of Hyperthermia, 2005Co-Authors: G Perugia, M Liberti, Patrizio Vicini, F Colistro, Vincenzo GentileAbstract:Objective: The aim of the study was to evaluate the effectiveness of local hyperthermia in reducing possible penile shortening following Radical Retropubic Prostatectomy.Patients and methods: The study population comprised 40 patients, aged 52–74 years, submitted to Radical Retropubic Prostatectomy. Patients were divided into two groups of 20. In Group A, patients were submitted to local hyperthermia 3 weeks after surgery, three times a week, with treatment lasting 30 min. Patients received a total of 10 applications, which reached a local temperature of 39–40°C. A second cycle was repeated after 1 month. In Group B, patients were submitted only to post-operative follow-up once a month. Penile length was measured in all patients both before and 3 months after surgery in the ‘stretching phase’ from the pubo-penile junction to the tip of the glans.Results: In Group A patients (hyperthermia treatment), no variation in penile length was observed in 16 cases (80%), while the reduction ranged from 0.5–1.5 cm in...
William J Catalona - One of the best experts on this subject based on the ideXlab platform.
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cancer progression and survival rates following anatomical Radical Retropubic Prostatectomy in 3 478 consecutive patients long term results
The Journal of Urology, 2004Co-Authors: Kimberly A Roehl, Christian G Ramos, Jo Ann V Antenor, William J CatalonaAbstract:ABSTRACTPurpose: We updated a long-term cancer control outcome in a large anatomical Radical Retropubic Prostatectomy (RRP) series. We also evaluated the perioperative parameters that predict cance...
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cancer recurrence and survival rates after anatomic Radical Retropubic Prostatectomy for prostate cancer intermediate term results
The Journal of Urology, 1998Co-Authors: William J Catalona, Deborah S SmithAbstract:AbstractPurpose: We evaluate cancer recurrence and survival rates following anatomic Radical Retropubic Prostatectomy.Materials and Methods: From 1983 through August 1997, 1 surgeon performed anatomic Radical Retropubic Prostatectomy in 1,778 men (mean age plus or minus standard deviation 63 +/− 7), using a unilateral or bilateral nerve sparing modification when feasible (93%). Postoperative adjuvant radiation therapy (mean dose 60 Gy.) was given to 4% of patients because of adverse pathological findings. Patients were followed with semiannual prostate specific antigen (PSA) tests and annual digital rectal examinations. Followup PSA 0.3 ng./ml. or greater was considered evidence of cancer recurrence. We used Kaplan-Meier product limit estimates to calculate 7-year cancer recurrence-free probabilities, prostate cancer specific survival and all cause survival (overall, and stratified by age, preoperative PSA, tumor grade and tumor stage). We used multivariate Cox proportional hazards models to determine cli...
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5 year tumor recurrence rates after anatomical Radical Retropubic Prostatectomy for prostate cancer
The Journal of Urology, 1994Co-Authors: William J Catalona, Deborah S SmithAbstract:AbstractThe new anatomical approach to Radical Retropubic Prostatectomy with its nerve sparing option allows for preservation of erections, improved urinary continence, decreased blood loss, and lower operative mortality and morbidity rates. We sought to evaluate cancer control with this operation by determining the 5-year tumor recurrence rates using detectable serum prostate specific antigen levels as a criterion for tumor recurrence in a series of 925 consecutive men with clinical stage T1 or T2 prostate cancer. Overall, the 5-year probability of nonprogression was 78% (95% confidence limits 74 to 82%). The 5-year nonprogression rate was higher in patients whose tumors were not palpable (90% for impalpable tumors detected through transurethral resection of the prostate, 97% for impalpable prostate specific antigen detected tumors and 74% for palpable tumors). Nonprogression correlated with pathological tumor stage (91% for organ confined disease, 74% for positive margins or microscopic capsular perfora...
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5 year tumor recurrence rates after anatomical Radical Retropubic Prostatectomy for prostate cancer
The Journal of Urology, 1994Co-Authors: William J Catalona, Deborah S SmithAbstract:The new anatomical approach to Radical Retropubic Prostatectomy with its nerve sparing option allows for preservation of erections, improved urinary continence, decreased blood loss, and lower operative mortality and morbidity rates. We sought to evaluate cancer control with this operation by determining the 5-year tumor recurrence rates using detectable serum prostate specific antigen levels as a criterion for tumor recurrence in a series of 925 consecutive men with clinical stage T1 or T2 prostate cancer. Overall, the 5-year probability of nonprogression was 78% (95% confidence limits 74 to 82%). The 5-year nonprogression rate was higher in patients whose tumors were not palpable (90% for impalpable tumors detected through transurethral resection of the prostate, 97% for impalpable prostate specific antigen detected tumors and 74% for palpable tumors). Nonprogression correlated with pathological tumor stage (91% for organ confined disease, 74% for positive margins or microscopic capsular perforation, 32% for seminal vesical invasion and virtually nil for lymph node metastases) and tumor grade (89% for well, 78% for moderately and 51% for poorly differentiated tumors). We conclude that anatomical Radical Prostatectomy achieves excellent cancer control for patients with organ confined prostate cancer.
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return of erections and urinary continence following nerve sparing Radical Retropubic Prostatectomy
The Journal of Urology, 1993Co-Authors: William J Catalona, Joseph W BaslerAbstract:AbstractWe evaluated recovery of erections and urinary continence following anatomical Radical Retropubic Prostatectomy in a series of 784 consecutive patients with clinical stage A or B prostate cancer. Nerve sparing Radical Prostatectomy was performed in men deemed appropriate candidates. Recovery of erections sufficient for intercourse and urinary continence were analyzed controlling for patient age, pathological tumor stage and the performance of unilateral or bilateral nerve sparing surgery in men followed for a minimum of 18 months. Erections were regained in 149 of 236 preoperatively potent men (63%) treated with bilateral and 24 of 59 (41%) treated with unilateral nerve sparing surgery. Recovery of erections correlated with patient age and pathological tumor stage in patients treated with bilateral nerve sparing surgery. Continence was regained in 409 of 435 patients (94%) and did not correlate with patient age, tumor stage or nerve sparing surgery. Anatomical Radical Retropubic Prostatectomy can ...
Patrick C. Walsh - One of the best experts on this subject based on the ideXlab platform.
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high anterior release of the levator fascia improves sexual function following open Radical Retropubic Prostatectomy
The Journal of Urology, 2008Co-Authors: Matthew E Nielsen, Penny Marschke, Edward M Schaeffer, Patrick C. WalshAbstract:Purpose: Recent anatomical studies have shown that branches of the cavernous nerves running adjacent to the prostate at the apex travel more anteriorly than previously recognized. Outcomes of robot assisted Radical Prostatectomy suggest improved postoperative sexual outcomes following high anterior release of the levator fascia. We prospectively evaluated the effect of high anterior release on oncological and sexual function outcomes following open Radical Retropubic Prostatectomy.Materials and Methods: A total of 167 patients with clinically localized prostate cancer with a preoperative Sexual Health Inventory for Men score of greater than 21 underwent Radical Retropubic Prostatectomy with bilateral nerve sparing and selective high anterior release, as performed by a single surgeon. Data on postoperative sexual function were collected by an independent third party. Sexual function outcomes at 12 months were defined as 1) a Sexual Health Inventory for Men score of 16 or greater and/or a satisfaction score...
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systematic detection and repair of subclinical inguinal hernias at Radical Retropubic Prostatectomy
Urology, 2005Co-Authors: Matthew E Nielsen, Patrick C. WalshAbstract:Abstract Objectives Inguinal hernias occur in 15% of men within 1 to 2 years after Radical Retropubic Prostatectomy (RRP). This suggests that many of these hernias may have been present at surgery, but not diagnosed. Beginning in September 2001, all patients undergoing RRP were carefully examined intraoperatively for the presence of a hernia or a dilated internal inguinal ring. In this study we define the frequency of inguinal hernias detected at RRP and the durability of repair. Methods Between September 2001 and December 2004, 430 patients underwent RRP by one surgeon. Hernias, detected in 142 men (33%), were repaired preperitoneally: direct hernias were repaired with mesh and indirect hernias with 2-0 Prolene suture. The patients were followed up for an average of 19 months (range 9 to 36). Information on postoperative hernia status was available for 315 men (73.3%). Results Of the 430 patients, 142 (33%) had hernias repaired at RRP. Of these hernias, 32% were right sided, 28% left sided, and 40% bilateral; 34% were direct hernias and 66% indirect. Of the 142 patients who underwent intraoperative hernia repair, 95 (67%) had follow-up data, and 5 (5.3%) of that group developed a hernia postoperatively. None of the hernias repaired at RRP recurred. Recurrent hernias on the side of the repair occurred in 3.1%. Conclusions Incidental inguinal hernias were commonly found (33%) at RRP. Two thirds of the defects detected were indirect. Clinical recurrence after repair was rare.
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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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effect of methylprednisolone on return of sexual function after nerve sparing Radical Retropubic Prostatectomy
Urology, 2004Co-Authors: Kellogg J Parsons, Penny Marschke, Patricia Maples, Patrick C. WalshAbstract:Abstract Objectives To determine whether postoperative methylprednisolone improves the recovery of sexual function after nerve-sparing Radical Retropubic Prostatectomy. Methods We randomized men undergoing bilateral nerve-sparing Radical Retropubic Prostatectomy by a single surgeon to receive 6 days of placebo or methylprednisolone beginning on postoperative day 1. At 3, 6, and 12 months postoperatively, we assessed potency with the abbreviated International Index of Erectile Function questionnaire and urinary continence with participant-reported pad use. We used the chi-square test, Fisher’s exact test, and the two-sample t test with equal variances for comparisons between study groups. Results No operative complications occurred and 70 (100%) of 70 participants experienced normal wound healing. The odds of being potent for participants who received methylprednisolone (n = 34) compared with those who received placebo (n = 36) did not significantly differ at 3 (odds ratio 0.29, 95% confidence interval 0.08 to 1.05), 6 (odds ratio 0.63, 95% confidence interval 0.17 to 2.4), or 12 (odds ratio 1.18, 95% confidence interval 0.29 to 4.8) months. The mean International Index of Erectile Function scores did not significantly differ at 3 ( P = 0.08), 6 ( P = 0.50), or 12 ( P = 0.71) months. At 12 months, 74% of the methylprednisolone and 71% of the placebo participants were potent ( P = 0.8). The proportions of participants who were continent did not differ significantly at 3 ( P = 0.89), 6 ( P = 0.25), or 12 ( P = 0.49) months. At 12 months, 96% of the methylprednisolone and 100% of the placebo participants were continent. Conclusions At doses sufficient to produce a systemic anti-inflammatory effect, postoperative methylprednisolone was not associated with improved potency at up to 12 months after bilateral nerve-sparing Radical Retropubic Prostatectomy in men 40 to 60 years old.
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preservation of accessory pudendal arteries during Radical Retropubic Prostatectomy surgical technique and results
Urology, 2004Co-Authors: Craig G Rogers, Bruce P Trock, Patrick C. WalshAbstract:Abstract Introduction Our institution previously described a surgical technique for preservation of accessory pudendal arteries at Radical Retropubic Prostatectomy. Since then, we have expanded our experience. We now report our refinements in the surgical technique, illustrated with video, and the influence of accessory artery preservation on the recovery of sexual function after Radical Retropubic Prostatectomy (RRP). Technical considerations Between 1987 and 2003, 2399 potent men underwent RRP. Of the 2399 men, 84 (4%) were identified with accessory pudendal arteries. Of the 84 men, 52, who underwent bilateral nerve-sparing surgery, were available for evaluation. We identified a control population, without accessory pudendal arteries, who were matched for age, stage, and neurovascular bundle status. Potency was defined as the ability to achieve unassisted intercourse with or without the use of sildenafil. In a Cox proportional hazards model, the effect of artery preservation increased the likelihood of potency more than twofold (relative risk 2.65; 95% confidence interval 1.11 to 6.32; P = 0.028). Kaplan-Meier analysis showed a significantly shorter median time to regain potency among those with artery preservation, 6 versus 12 months ( P = 0.020). Conclusions Preservation of accessory pudendal arteries may favorably influence the recovery of sexual function and interval to recovery after RRP.
R Passariello - One of the best experts on this subject based on the ideXlab platform.
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use of 3d t2 weighted mr sequences for the assessment of neurovascular bundle changes after nerve sparing Radical Retropubic Prostatectomy rrp a potential diagnostic tool for optimal management of erectile dysfunction after rrp
The Journal of Sexual Medicine, 2009Co-Authors: Alessandro Sciarra, Valeria Panebianco, Danilo Lisi, Stefano Salciccia, R Passariello, Andrea Alfarone, Alessandro Gentilucci, Vincenzo GentileAbstract:ABSTRACT Introduction Erectile dysfunction (ED) is one of the complications after Radical Retropubic Prostatectomy (RRP), and recovery of erectile function is quantitatively related to the preservation of the neurovascular bundles (NVBs). Aim The aim of our study was to assess, in patients submitted to a nerve-sparing RRP, the capability of a dedicated 3D isotropic magnetic resonance imaging (MRI) T2-weighted sequence in the depiction of postsurgical changes of NVB formation. Methods Fifty-three consecutive patients underwent a bilateral nerve-sparing RRP. Two postoperative magnetic resonance (MR) examinations and International Index of Erectile Function Five-Item (IIEF-5) questionnaire were carried out at 6 and 12 months. Morphological imaging of the postProstatectomy fossa was performed by first acquiring turbo spin echo T2-weighted sequences in the axial and coronal planes and then with 3D T2-weighted isotropic sequence on axial plane. Image findings were scored using a relative 5-point classification (0 = normal; I = mild; II = mild to moderate; III = moderate; IV = severe alterations) and correlated with postoperative IIEF-5 score questionnaire. Main Outcome Measures The degree of association between the alteration score values obtained by postoperative MR morphologic evaluation for MR sequence and IIEF-5 score. Results Image interpretation was performed by two radiologists, that scoring MR alterations by the use of axial and multiplanar reconstruction 3D T2 isotropic sequence. The radiologists placed 43.30% of patients in class 0 (23/53 normal or quite normal), 32.00% in class I (17/53 mild), 11.40% in class II (6/53 mild to moderate), 7.50% in class III (4/53 moderate), and 5.70% in class IV (3/53 severe). In all cases, the correlation and regression analyses between the 3D T2 isotropic sequence and IIEF-5 score, resulted in higher coefficient values (rho = 0.45; P = 0.0010). Conclusion The MRI protocol and NVB change classification score proposed in this study would represent an additional tool in the postoperative phase of those patients with ED. Sciarra A, Panebianco V, Salciccia S, Alfarone A, Gentilucci A, Lisi D, Passariello R, and Gentile V. Use of 3D T2-weighted MR sequences for the assessment of neurovascular bundle changes after nerve-sparing Radical Retropubic Prostatectomy (RRP): A potential diagnostic tool for optimal management of erectile dysfunction after RRP. J Sex Med 2009;6:1430–1437.
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2d and 3d t2 weighted mr sequences for the assessment of neurovascular bundle changes after nerve sparing Radical Retropubic Prostatectomy with erectile function correlation
European Radiology, 2009Co-Authors: Valeria Panebianco, Vincenzo Gentile, Alessandro Sciarra, Marcello Osimani, Danilo Lisi, Mauro Ciccariello, Stefano Salciccia, Franco Di Silverio, R PassarielloAbstract:The aim of this study was to assess the capability of a 3D isotropic MRI T2-weighted sequence (3D T2 ISO) in the depiction of changes of neurovascular bundles (NVBs) after bilateral nerve-sparing Radical Retropubic Prostatectomy (RRP). Furthermore, our aim was also to introduce a new MRI classification score of the NVB alteration patterns using the International Index Erectile Function Five-Item (IIEF-5) score as standard of reference. Fifty-three consecutive patients were postoperatively submitted to two MR examinations, including both 2D TSE T2-weighted (2D T2) and 3D T2 ISO sequences. Image findings were scored using a relative five-point classification and correlated with the postoperative IIEF-5 score. Radiologists attributed 13.2% of patients to class 0, 11.3% to class I, 34% to class II, 24.5% to class III, and 16.9% to class IV. With 3D T2 ISO images, the same radiologists determined 43.3% class 0, 32% class I, 11.4% class II, 7.5% class III, and 5.7% class IV. In all cases, the correlation and regression analysis between the 3D T2 ISO and IIEF-5 score resulted in higher coefficients values. The 3D sequence correlated most closely with patients' grading of erectile function.
