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Background: Aim of the current study is to describe our technique of hydrodissection (HD) of the retroprostatic space (RPS) performed between the Denonvillier's fascia (DF) and prostatic capsule (PC) and to evaluate its impact on the outcomes of nerve-sparing robot-assisted radical prostatectomy (nsRALP) during the learning-curve period.Methods: This randomized study enrolled 25 consecutive male patients with indication of nsRALP. The HD and the subsequent dissection of the seminal vesicles (SVs) and RPS was performed by a resident in learning curve for RALP; the residual portion of RALP was performed by an expert. The perioperative, oncologic and functional outcomes of 2 groups of patients (Group A: nsRALP after HD of the RPS and Group B: standard nsRALP without HD) were compared. Two analyses were performed, considering a per-protocol (PP) population regarding only randomized patients with correct HD and an Intention-To-Treat (ITT) population regarding all randomized patients.Results: In 4/14 (29%) of patients of Group A the injected fluid was not intraoperatively identified in the expected plane. The groups were statistically homogeneous in relation to the baseline variables. A statistically significant difference was observed between the SVs/RPS dissection time and the SVs-related estimated blood loss in both analyses. A significantly higher rate of dry patients was observed in group A at 1 month after nsRALP. A statistically significant correlation was observed between the effective time of dissection of the SVs and the postoperative IIEF-5 drop.Conclusions: The transrectal ultrasound-guided transperineal HD seems useful for the preliminary development of the RPS during the learning curve period of nsRALP. It seems associated with less time and blood loss for the dissection of the SVs and RPS. Studies on larger cohorts are needed to draw more robust conclusions. [ABSTRACT FROM AUTHOR]

Metabolism processes reflect the health state of human body. On this basis it is possible to look at the human body as a biosystem transfer function having as inputs the sources originated from environmental and as outputs the metabolic fluids of the body. The chemical composition of these fluids depends on the specific interactions inside the body. A particular pathological state could modify the chemical fingerprint of some sources like skin emissions, breath, urine. In this work the authors have analysed the fingerprint of patients affected by prostate cancer of urine headspace by means of a gas sensors array. This work follows a pilot study performed on behalf of authors in which a characterization of these patterns has been preliminarily investigated. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To test high-intensity focused ultrasound (HIFU) as salvage first-line treatment for palpable, TRUS-evidenced, biopsy-proven locally recurrent prostate cancer (CaP) after radical prostatectomy (RP). Materials and methods: Nineteen patients with palpable, TRUS-evidenced, biopsy-proven local recurrence of CaP after RP, unwilling to undergo salvage radiotherapy (SRT), underwent HIFU as a single-session procedure. Pre-, intra-, and postoperative data including early and late complications, and oncologic outcomes (PSA nadir, biochemical recurrence (BCR)-free survival, and need of secondary adjuvant treatment) were prospectively evaluated. Success was defined as PSA nadir ≤0.1 ng/ml obtained within 3 months from HIFU. In case of PSA nadir >0.1 ng/ml or PSA increase ≥1 ng/ml above the PSA nadir, a biopsy of the treated lesion was performed, and if negative, maximum androgen blockade (MAB) was adopted. In case of positive biopsy, RT was performed. Failure was defined as use of secondary adjuvant treatment (MAB or RT). Results: Median follow-up was 48 months. All cases were performed as overnight procedure. No case of urethrorectal fistula or anastomotic stricture was observed. Two cases of acute urinary retention were resolved with prolonged urethral catheterization. Four cases of stress urinary incontinence were observed; 2 (mild incontinence) were resolved after pelvic floor exercises within 6 months, while 2 cases of severe incontinence required surgical minimally invasive treatment;17/19 patients (89,5%) were classified as success. Two patients failed to show a PSA nadir <0.1 ng/ml. During follow-up, 8/17 patients (47%) were classified as failure, with consequent total rate of failures 10/19 (52.6%). A statistically significant difference was observed in pre-HIFU median PSA (2 vs. 5.45 ng/ml, respectively, P = 0.013) and Gleason score of the RP specimen (P = 0.01) between the success and failure group. Conclusions: Salvage first-line HIFU for palpable, TRUS-evidenced, biopsy-proven local recurrence of CaP is a feasible, minimally invasive day-case procedure, with an acceptable morbidity profile. It seems to have a good cancer control in the short- and mid-term. Patients with lower pre-HIFU PSA level and favorable pathologic Gleason score presented better oncologic outcomes. A prospective randomized trial with an adequate recruitment and follow-up is necessary to confirm our preliminary oncologic results. [Copyright &y& Elsevier]

Abstract: Objectives: To evaluate the prevalence and short-term follow-up of focal proliferative atrophy lesions, either with or without the presence of inflammation (PIA/PA), and its correlation with the PSA levels, focusing on the prostate biopsy cores that test negative for prostate adenocarcinoma (PCa). Methods: Five hundred fifty consecutive patients who had undergone a transrectal ultrasound-guided transperineal prostate biopsy were evaluated retrospectively for the presence and follow-up of focal proliferative atrophy lesions. PIA/PA were defined according to De Marzo. The prevalence of atrophy in PCa and negative biopsy cores was compared by means of χ2. After logarithmic transformations of the PSA values, t-test and ANOVA were applied for the comparison of the means. Incidence of newly diagnosed PCa during follow-up (mean 33.7 months) in patients with or without focal proliferative atrophy was compared by means of χ2. Results: A focal atrophic lesion resulted in 161/339 negative biopsies. PIA was observed in 93/161 patients (57.8%), while PA was observed in the remaining 68/161 (42.2%). Among the negative biopsy cases, the difference in PSA values were not statistically significant according to the presence or absence of atrophy (P = 0.120). The group of negative biopsies with PIA was similar in terms of PSA characteristics with the benign (PA P = 0.738; non-atrophy P = 0.342), and cancer subgroups (P = 0.094); 245/339 (72.3%) patients were successfully followed-up. Biopsy was repeated in 24/71 (33.8%) patients with PIA, in 14/50 (28%) with PA and in 27/124 (21.7%) with no atrophy lesions at initial biopsy. The incidence of newly diagnosed PCa in the 3 groups was not statistically different (χ2, P = 0.81). Conclusions: Focal proliferative atrophy lesions are a common finding in biopsy specimens negative for PCa. Patients with negative biopsy associated with PIA presented similar PSA characteristics as patients with biopsy-proven PCa. However, the incidence of PCa at short-term follow-up did not differ significantly between patients with PIA, PA, or no atrophic lesions at initial biopsy. Based on our findings, early repeat biopsy does not seem to be necessary after an initial diagnosis of PIA/PA, although a longer follow-up is mandatory for definitive conclusions. [Copyright &y& Elsevier]

Abstract: Background: Puboprostatic ligament preservation has been proposed as a method to accelerate continence recovery after radical prostatectomy (RP). However, these ligaments present anatomic continuity with the bladder, and there must be interruption at some point to expose the prostatourethral junction. Objectives: To describe the surgical steps of pubovesical complex (PVC)–sparing robot-assisted laparoscopic RP (RALP) and present the preliminary results of our technique. Design, setting, and participants: Thirty PVC-sparing RALP procedures were performed in patients <60 yr with clinically localised prostate cancer between 2007 and 2009 by the same surgeon. Surgical procedure: The principles of bladder neck preservation, tension and energy-free dissection of the bundles as well as seminal vesicle sparing are applied. Ventrally, a plane of dissection is developed between the detrusor apron and the prostate. The soft connective tissue between Santorini''s plexus and the prostate is blandly dissected, leaving the plexus intact and in place. Measurements: The rates and location of positive surgical margins (PSM) as well as functional outcomes are presented. Results and limitations: Three of 30 patients (10%) had a PSM (two apical margins and one on the left posterolateral side). At catheter removal, 24 of 30 patients (80%) were dry (0 pads), and 6 of 30 patients (20%) needed one security pad. After 3 mo, 22 of 30 patients (73%) presented an International Index of Erectile Function score >17 (with or without phosphodiesterase type 5 inhibitors). Thirteen of 22 potent patients had an Erection Hardness Score of 3, and 9 of 22 patients had a score of 4. Small sample size, low mean age of enrolled patients (52 yr), and the absence of diseases that could impair the continence and potency recovery are some of the limitations of the study. Moreover, it is difficult to quantify the effect of each applied continence-sparing technique. Conclusions: The holistic preservation of the PVC during RALP is technically feasible. It leads towards an absolute preservation of the periprostatic anatomy that may enhance early functional outcomes. Further studies are needed to confirm our results. [Copyright &y& Elsevier]

The Rh ··· M ··· Cu bonding orbital of heterotrimetallic RhMCu represents a 7c-2e bond. TDDFT studies of the electronic spectra showed that the main band of the electronic spectrum is assigned to the ν (Rh→M) electron transfer transition. The correlations of Δδ (P) and 1 J (Rh-P) for phosphite complexes, with respect to QALE model electronic parameters χ d , π p and E ar , has succeeded in the assessment of the σ and π effects on NMR spectral parameters. [Display omitted] • The Rh ··· M ··· Cu bonding orbital of heterotrimetallic RhMCu represents a 7c-2e bond. • The main band of the UV-vis spectra is assigned to ν (Rh → Mo/W) transition. • ν (Rh → Mo/W) is a well defined electronic parameter for phosphites. The synthesis and characterization of the monoanionic heterotrimetallic (d 8 ··· d 0 ··· d 10) complexes [L 2 Rh(μ-S) 2 M(μ-S) 2 CuCl]− (L = P(OPh) 3 , P(O- o -Tol) 3 (P(O- o -CH 3 C 6 H 4) 3), P(OMe) 3 , P(OEt) 3 , P(O i Pr) 3 ; L 2 = COD (1,5-cyclooctadiene), cis -dppen (cis -Ph 2 PCH = CHPPh 2); M = Mo, W) is presented. The complex (NEt 4)[(cis -dppen)Rh(μ-S) 2 W(μ-S) 2 CuCl] was characterized by X-ray diffraction analysis. The detailed DFT study of the electronic structure of the complexes with P(OMe) 3 and COD ligands has revealed the existence of extended electron delocalization over the atom-sharing (spiro) four-membered rings system Rh(μ-S) 2 M(μ-S) 2 Cu and the possibility of electronic communication between the terminal metal centers. The electronic spectra of the complexes with P(OMe) 3 ligands were studied with TDDFT calculations and the main absorption band in the visible region was assigned to ν (Rh → Mo/W) electron transfer transition. The ν (Rh → Mo/W) transition was found to correlate linearly with Tolman's electronic parameter of the phosphite ligands, making it an electronic parameter for the ligands studied. Finally, the study of the dependence of Δδ(31P) and 1 J (Rh-P) of the phosphite complexes, with respect to the QALE model electronic parameters χ d , π p and E ar , has succeeded in the assessment of the σ and π effects on these NMR spectral parameters. [ABSTRACT FROM AUTHOR]