Introduction: To evaluate the incidence and risk factors for postoperative inguinal hernia (IH) after robot-assisted radical prostatectomy (RARP) and to assess whether a newly developed prevention technique reduces the incidence of IH after RARP. Methods: We included 161 consecutive patients (322 groins) who underwent RARP between September 2011 and October 2013. The prevention technique was as follows: (1) sufficient incision of peritoneum around the internal inguinal ring; (2) separation of spermatic vessels; (3) dissection of vas deferens. Results: Postoperative IH occurred in 14 cases (19.4%) occurring in the observation group compared to 2 cases (2.2%) in the prevention group. Patent processus vaginalis (PPV) was the only risk factor. Time-to-event analysis demonstrated a significant decrease in IH incidence in the IH prevention group (p = 0.005). Conclusion: Our data reveal a higher incidence of IH after RARP, with the existence of PPV as the only identified risk factor. Our simple IH-prevention technique, which does not involve the use of artificial materials, appears safe and effective.
The neuropeptide precursor ProGRP is a distinct serum marker that is useful to know the NE milieu and provides prognostic information in patients with advanced prostate cancer. Standard therapy for metastatic prostate cancer may make progress when further studies will clarify the causative link between serum ProGRP level and androgen-independent disease progression.
The clinical results demonstrated the existence of a regulatory mechanism for GRP, which to date had only been observed in cell lines. These findings suggest that GRP is a growth factor potentially upregulated by androgen but that does not rely principally on androgen modulation. The large overlap in levels of ProGRP among the groups limits the use of this value as a monitoring tool. Measurement of ProGRP, however, does have potential as an independent parameter to evaluate androgen-independent progression and to facilitate a new therapeutic strategy that may compensate for current limitations of diagnosis based on PSA alone.
A 69-year-old man with dif®culty urinating and severe back pain was referred to our department. A physical examination showed a huge prostate and`stony' hard induration palpable in its entirety. Laboratory examinations showed a slightly high serum alkaline phosphatase (ALP) level, but the PSA (2.1 ng/mL) and PAP values were within the normal range. A biopsy specimen from the prostate was identi®ed as moderately to poorly differentiated adenocarcinoma with focal neuroendocrine differentiation (Fig. 1a); immunohistochemical staining was partly positive for PSA in the moderately differentiated component, and positive with chromogranin A (CgA) in the poorly differentiated component, but negative with neurone-speci®c enolase (NSE). The bone scintigram showed multiple bone metastasis, and abdominopelvic CT revealed multiple lymph node metastasis. The level of progastrin-releasing peptide (ProGRP) was up to 737.4 pg/mL (standard value <46.0 pg/mL). Accordingly, disease activity was evaluated in relation to levels of ProGRP and ALP, and clinical images. The patient was treated with hormonal therapy (LHRH analogue and¯utamide) and periodic combination chemotherapy based on cisplatin and adriamycin. The hormonal/chemotherapy was effective in controlling the cancer progression for the ®rst 7 months, but thereafter progression increased, accompanied by high levels of serum ProGRP (Fig. 2) while PSA levels remained a b Fig.
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