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CMH Abstracts
13OW RELEVANT IS THE EXPERIENCE OF THE UROLOGIST INRANSRECTAL ULTRASOUND FOR AN ACCURATE PREOPERA-IVE STAGING OF PROSTATE CANCER?
. Bannowsky ∗, A. Probst, L. Bäurle, T. Loch
Department of Urology, Ev.-Luth. Diakonissen Hospital, Flensburg, Germany-mail address: [email protected] (A. Bannowsky).
ackground: The aim of the study was to compare preoperative transrectal ultra-ound (TRUS) findings with the final histopathological stage after radical prosta-ectomy and the dependence to the experience of the physician to determine thealue of TRUS in preoperative staging of prostate cancer.
ethods: The evaluation was performed as a prospective study. In 300 radicalrostatectomy specimens the histopathological and ultrasound findings wereorrelated. The TRUS was performed by 20 physicians. Experience levels wereifined as follows: group 1= less than one year of TRUS experience, group=between 1 and 3 years, group 3=between 3 and 5 years, group 4=morehan 5 years. The mean age of the patients was 66.7 years (52—81 years) andll patients underwent radical retropubic prostatectomy. The distribution of theistopathological results showed: pT2a (n = 78; 26%), pT2b (n = 128; 42.7%), pT3an=55; 18.3%), pT3b (n = 36; 12%), pT4 (n = 3, 1%).
esults: Overall organ-confined prostate cancer (T2a/b) was correctly identifiedith TRUS in 81% and capsular penetration (T3/T4) in 37%. Sensitivity of TRUS
n organ-confined prostate cancer was 0.81, specificity 0.43 and the positive pre-ictive value 0.76. Sensitivity, specificity and positive predictive value (PPV) ofRUS for stage T3 were 0.37, 0.87 and 0.56 respectively. Concerning the iden-ification of the tumor site, the correspondence of the TRUS results with theinal histology was 56%. Statistical evaluation of sensitivity, specificity and PPV inomparison to the experience levels showed significant difference between theroups (gp1: Sens.: 0.90, spec.: 0.23, PPV: 0.70; gp2: 0.81, 0.36, 0.67; gp3: 0.79,.41, 0.76; gp4: 0.91, 0.45, 0.83) (p<0.05).
onclusion: Overall these results show a high sensitivity for organ-confinedumors but a low sensitivity in T3 stage and low specificity in organ-confinedumors due to the results of the unexperienced groups. The evaluation showedsignificant correlation between the staging quality and the experience level
f the physicians. Education and training in TRUS is highly recommended asong as the optimal preoperative staging is still under debate and the benefitf additional staging by MRI is not firmly established yet.
oi:10.1016/j.jomh.2009.08.015
14IEL ‘‘CONCEPT’’ AND LONG TERM RESULTS OF LOW-DOSEILDENAFIL FOR REHABILITATION OF ERECTILE FUNCTIONFTER NERVE-SPARING RADICAL PROSTATECTOMY — AWO YEAR FOLLOW-UP
. Bannowsky1,∗, H. Schulze2, C. van der Horst2, S. Hautmann2, K.-P.ünemann2
Ev.-Luth. Diakonissen Hospital, Department of Urology, Flensburg, Germany, 2 Universityospital Schleswig-Holstein, Campus Kiel, Department of Urology, Kiel, Germany-mail address: [email protected] (A. Bannowsky).
ackground: Several treatment regimens for rehabilitation of erectile functionfter nerve-sparing radical prostatectomy (nsRP) are currently discussed. In pre-ious prospective studies we showed nocturnal penile tumescense and rigidityNPTR) in 95% of the patients in the early phase after nsRP.
ethods: 43 sexual active patients were operated by nerve-sparing retropubicadical prostatectomy. All patients completed an IIEF-5 questionnaire concerningrectile function preoperatively. A measurement of NPTR (Rigi-Scan®) was car-ied out in the following night after catheter removal. 23 patients with preservedocturnal erections detected during NPTR-recordings received sildenafil 25mg/dt night. A control of 18 patients underwent follow up without PDE-5-inhibitors.IEF-5 questionnaire was performed 6, 12, 24, 36, 52, 78 and 104 weeks afterperation.
esults: 41 of 43 patients (95%) showed 1-5 erections during the first night afteratheter removal. In the group of daily sildenafil the IIEF-5 score decreased fromreoperative 21.2 mean score to 3.6 at 6 weeks, 3.9 at 12 weeks, 6.1 at 24 weeks,0.4 at 36 weeks, 14.5 at 52 weeks, 19.4 at 78 weeks and 21.0 mean score at 104eeks after prostatectomy. In the control group preoperative IIEF-5 mean score1.2 decreased to 3.8 at 6 weeks, 3.9 at 12 weeks, 5.3 at 24 weeks, 6.1 at 36eeks, 9.3 at 52 weeks, 13.4 at 78 weeks and 14.8 at 104 weeks. Statistical eval-ation showed a significant difference in IIEF-5 score and time to recovery ofrectile function (p<0.05).
onclusion: The measurement of NPTR after nsRP showed erectile functionven at the ‘‘first’’ night after catheter removal. In case of early penile erectionshe cavernous nerve was well preserved during surgery providing good neuronalntegrity. Daily low dose PDE-5 inhibitors lead to a significant improvement ofecovery of erectile function and is supportive to the organic rehabilitation.
oi:10.1016/j.jomh.2009.08.016
CalsN
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32 jmh Vol. 6, No. 3, pp. 229–275, September 2009
15HY MEN DIE AND SUFFER MORE THAN WOMEN
ames Achanyi-Fontem
Douala, Littoral Region, Cameroon-mail address: [email protected], http://cameroonlink.blogspot.com.
omen’s health has always an important part of national priority in most countries of theorld, but unfortunately no counselling centres or offices for men’s health exist in more thanalf the number of countries. It is within this frame work that one can rightly point out thaten are silently suffering through what can be described as a serious health crisis making them
o die and suffer more than women. In most societies, lifestyle is used to explain the differencesn longevity between men and women.Looking at the gender perspective, the mere suggestion that men need their own health
ounselling centres or health clinics or that men must advocate for their rights like a victimizedinority would not rankle women’s health advocates, though some politicians are reluctant to
ake men’s health on as a cause, for fear of alienating women.Scientists have admitted that apart from the exception of Alzheimer’s disease, that takes the
ives of more women than men, men die of just about every one of the leading causes of deatht younger ages than women, from lung cancer to influenza and pneumonia, chronic liver dis-ase, diabetes, sickle cell disorder and AIDS. Topping the list for both sexes is heart disease.Cancer also strikes men disproportionately: one in three women at some point in life; one in
wo men. In part, that is a result of the fact that more men than women smoke, and possiblyf occupational exposures.On the other hand, men’s vulnerability appears to start quite early. More male foetuses are
onceived, but they are at greater risk of stillbirth and miscarriage, scientists find. Even asnfants, mortality is higher among newborn boys and premature baby boys.Behaviour also plays a role in some of the extra deaths and illnesses among men: they tend
o be more aggressive than women and to take more risks. Men smoke at higher rates thanomen, drink more alcohol and are less likely to wear seat belts or use sunscreen. Men alsouffer more accidental deaths and serious injuries and are more likely to die of injuries and carccidents. They are three times as likely to be victims of murder, four times as likely to commituicide and, as teenagers, 11 times as likely to drown.Some experts think that depression also contributes to these reckless and self-destructive
ehaviours, but that just as heart disease was initially defined by men’s experiences and there-ore ignored or missed in women, depression may have been framed by women’s experiencesnd therefore may be missed and go untreated in men.As a result, even though more baby boys are born, among people in their mid-30 s, women
utnumber men. Among people aged 100, women outnumber men by 8 to one. During aesearch study carried out by Dr. Legato, he tried asked a number of questions, which tried tolarify analysis of male vulnerability like: ‘‘Why are there more miscarriages of boy foetuses?hat is it about the sexing of the foetus that makes a male more vulnerable? What makesboy less mature in terms of lung function after he’s born? And what is this propensity for
isk-taking?’’One theory is that males are vulnerable because of their chromosomal makeup, he explains:here women have two X chromosomes, men have an X chromosome and a Y chromosome. ‘Ìt
s said that even before implantation in the wall of the uterus, the newly fertilized XX entityas a leg up,’’ Dr. Legato adds, ‘‘because it can use that extra X to combat mutations in the chro-osome that might be lethal or detrimental. And that might be a reason why females have aore sturdy constitution.’’Scientists and advocates who are concerned about men’s health are encouraging men them-
elves to take the first steps by accepting responsibility for their health status, seeking preven-ive care and making changes in habits, if necessary. New drugs for erectile dysfunction haveelped bring men into doctors’ offices in recent years, experts say, but that is not enough.Dr. Ken Goldberg, an urologist and the author of ‘‘How Men Can Live as Long as Women,’’
ays in his work that ‘‘Men need to take as good care of their bodies as they do of their carsnd trucks’’. Men should stop thinking that they are bulletproof and invincible. For more, clickn http://cameroonlink.blogspot.com.
oi:10.1016/j.jomh.2009.08.017
16EN’S HEALTH IN SIBERIA
. Kulchavenya1,∗ , M. Romanovskyi 1, A. Neimark2
Urogenital Dpt of Novosibirsk Research TB Institute, Novosibirsk, Russian Federation, 2 Dpt of Urol-gy and Nefrology Altay Medical University, Novosibirsk, Russian Federation-mail addresses: ekaterina [email protected], [email protected] (E. Kulchavenya).
ackground: To obtain a greater understanding of sexual status, behaviour and habitsmong men in Siberia to offer special approach of treatment for sexual dysfunction.
ethods: A population-based study was conducted among men in Siberia. 1280 menage 20 - 64 years) filled in special detailed questionnaire on sexual health. At 52 amongf a cohort the level of testosterone was estimated.
esults: 23% of the respondents were healthy; others had one or more chronic dis-ases. 84% were rare consumer of the alcohol, and 9% never did consume it. Only 29%ere non-smokers, others smoked - from «sometimes» (29%) up to «more than one packer day» (16%). 42% used to exercises, 4% did it rarely, and 54% of the men were notngaged in sports at all.In 3% of the boys the first coitus was in 14 years; the latest debut of sexual life was
n 24 years old (1% of the respondents). 81% men had only one constant sexual partner.The self-estimation of the erection has appeared is low. Only each third man (33%)
stimated their erection as «excellent», 27% considered it as «good», 20% - ‘‘middle’’, 13%‘‘poor’’ and 7% - ‘‘very poor’’. Exactly the same prorportion was revealed in the self-stimation of life success, career etc. 33% men counted their life success as «excellent»,7% thought it was «good», 20% - ‘‘middle’’, 13% - ‘‘poor’’ and 7% - ‘‘very poor’’.Half of men in group, where the level of testosterone in plasma was estimated, were
ypogonadal. The men with androgen deficiency in 5-7 times more often were smokersnd consumers of alcohol. They had reported worse sexual function also they were lessuccessful in their job, than men with normal testosterone.12 patients were treated with i.m. injections of testosterone undecanoate ‘‘Nebido’’
000mg every 12 weeks. Nebido has been proved very effective in this group: libido andexual function improved, mood was positively influenced, self-estimation of total suc-ess was high.
onclusion: In Siberia a status of sexual health of the men is quite satisfactory aswhole. We have revealed high direct correlation between level of the erection and
ife success. It is the additional evidence that erectile dysfunction is both medical andocial problem. Siberians more often and in more young age have androgen deficiency;ebido is high effective in these patients.
oi:10.1016/j.jomh.2009.08.018
