Document Detail


The application of regional hypothermia using transrectal cooling during radical prostatectomy: mitigation of surgical inflammatory damage to preserve continence.
MedLine Citation:
PMID:  23153199     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Preservation of continence and sexual function continues to be a formidable quality-of-life issue regarding outcomes after radical prostatectomy. There is little argument that physical preservation of the nerves and sphincters is a critical component to achieving success in these domains. Previously demonstrated factors such as advancing age, deteriorating physical health status, and subnormal baseline potency negatively impact outcomes. Our hypothesis, however, has been that inflammatory response to surgery has a large impact on surgical outcomes of prostatectomy. Trauma-induced inflammation could account for variation in recovery despite nearly identical surgery on many patients, especially in high-volume surgeons. In other words, we suggest and maintain that younger and healthier patients tolerate and/or recover better from the trauma/inflammation of surgery. Those who do not recover as well may have altered inflammatory response to injury. A common response to decrease inflammation in response to physical injury would be as simple as to cool the injury with ice. Previous neurologic studies have suggested that using ice during surgical intervention can reduce the inflammatory damage. Therefore, we applied this concept that preemptive hypothermia could reduce inflammation to the robot-assisted prostatectomy procedure to potentially lead to improved continence and potency outcomes. In 2009, we introduced the concept of regional hypothermia via an endorectal cooling balloon during robot-assisted radical prostatectomy (RARP). We have published our single institution data demonstrating a significant reduction of overall incontinence. Defining continence as zero-pads, our overall 1-year incontinence has been reduced by 70% (from 13% to 4%). Severe incontinence, defined as two or more pads, was likewise reduced by 70% (from 2.9% to 0.9%). Regional hypothermia used during the time of surgery represents a novel strategy for minimizing inflammation and subsequent muscle and nerve damage in RARP.
Authors:
Michael A Liss; Douglas Skarecky; Blanca Morales; Thomas E Ahlering
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-11-15
Journal Detail:
Title:  Journal of endourology / Endourological Society     Volume:  26     ISSN:  1557-900X     ISO Abbreviation:  J. Endourol.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-12     Completed Date:  2013-05-15     Revised Date:  2013-12-04    
Medline Journal Info:
Nlm Unique ID:  8807503     Medline TA:  J Endourol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1553-7     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Catheterization
Cold Temperature*
Cystectomy
Humans
Hypothermia, Induced*
Inflammation / prevention & control*
Male
Prostatectomy / adverse effects*,  methods*
Rectum / surgery*
Urinary Incontinence / etiology*
Grant Support
ID/Acronym/Agency:
P30 CA062203/CA/NCI NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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