Does perineural invasion on prostate biopsy predict adverse prostatectomy outcomes?

Abstract

Straddle injuries are not to be confused with the stenoses that occur from pelvic fracture. With pelvic fracture, the injury is a distraction injury where there is disruption of the urethra and corpus spongiosum at the level of the membranous -bulbar junction or the membranous and the prostate. Here there is no real spongiosum fibrosis and "urethral stricture" -but scar tissue that fills the gap. Primary realignment is the preferred management of such injuries because it a distraction injury and not a stricture. Historically, the outcomes of primary realignment are a reduction in urethral stricture by 50%, while the rates of erectile dysfunction and incontinence are the same as a suprapubic tube. Furthermore, the eventual stricture that does occur is often shorter and more amenable to urethrotomy.From the above abstracts, I think the conclusion that straddle injuries should be managed by suprapubic tube alone, as the best management that should be followed. Intuitively, we would assume that the Denis Browne principle would apply here and stenting would promote epithelialization. However, until a randomized prospective trial takes pace -and I doubt that any such study will be done soon -we should resist the temptation to primarily realign the urethra. As to urethral penetrating urethral injuries from low velocity gunshot wounds (no delayed ischemia or blast effect) the site of injury is typically short. A short area of injury can be bridged by adequate mobilization and natural elasticity of the urethra, particularly in the bulbar urethra. In the penile urethra, over mobilization and an anastomosis on tension may result in chordee or stricture failure. Primary realignment of a short penile urethral injury is not the first treatment of choice -but rather surgical exploration and primary repair. When the defect is too long (more than 1 cm or so), urethral marsupialization and a two stage repair (in the method of Johansson) is probable best. Objective: To determine the relationship between perineural invasion (PNI) on prostate biopsy and radical prostatectomy (RP) outcomes in a contemporary RP series, as there is conflicting evidence on the prognostic significance of PNI in prostate needle biopsy specimens. Dr. Steven B. Brandes