UroToday.com - The concept behind nerve grafting is to make use of one’s own nerves, which play a minimal functional role, as conduits to promote the regrowth of new nerve fibers. In certain patients with prostate cancer, the nerves crucial for erectile function (cavernous nerves) may need to be cut in the interest of removing high-risk cancer. In these situations, the genitofemoral nerve can be interposed (grafted) as a conduit to promote regrowth of new nerve fibers. Our study examined the feasibility and success of this in patients with prostate cancer as well as those with bladder cancer, in which the prostate is also removed.

Although ours was a relatively small study, its strength lies in that we used a person independent from the surgeon who performed the surgery to assess patients on their outcomes. We found detectable rates of erectile potency in 38% of patients with a single bundle of nerves cut then grafted compared to 30% when both nerve bundles are cut and grafted. It is important to keep in mind that these patients may or may not have been using a medication that assists in erectile function such as Viagara®, Cialis (tadalafil) or Levitra (vardenafil). 

The important direction from this study is the attention it has drawn for the need to conduct a larger, randomized-controlled study to make final conclusions. Nevertheless, the study has reiterated that Urologic surgeons can perform this procedure. We recommend that the option for cavernous nerve interposition grafting should be discussed with select patients including those undergoing surgery for bladder cancer.

Written by Raj Satkunasivam, Sree Appu, Rami Al-Azab, Karen Hersey, Gina Lockwood, Joan Lipa and Neil E. Fleshner as part of Beyond the Abstract on UroToday.com

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Tadalafil may improve lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH). Researchers from Nashville, Dallas, San Antonia and Indianapolis presented these findings during the 104th Annual Scientific Meeting of the American Urological Association (AUA).

In this study, researchers randomly separated 200 men, with an age equal to or older than 40 years and at least a six month diagnosis of BPH-LUTS with an International Prostate Symptom Score (IPPS) greater than or equal to 13, into two groups taking either 20 mg of tadalafil once daily or a placebo. After 12 weeks of treatment, the men taking tadalafil experienced improved detrusor pressure at urinary flow rate, peak flow rate (Qmax), bladder capacity, post-void residual volume and bladder voiding efficiency. Relative symptom improvement in the IPSS also was significantly better in the tadalafil group. At the end of the study, the proportion of obstructed patients in the placebo group increased, while the proportion in the tadalafil group decreased.

“Dr. Dmochowski, the study author, and colleagues have added further evidence to the growing body of research that suggests that in addition to their well known effect on erectile dysfunction, PDE-5 inhibitors may be able to help with management of bladder outlet symptoms as well. This is an exciting concept for men’s health,” said Anthony Y. Smith, MD, an AUA spokesman.

Dmochowski, R; Roehrborn, C; Kraus, S; Klise, S. Changes in bladder outlet obstruction index in men with signs and symptoms of benign prostatic hyperplasia treated with tadalafil. J Urol, suppl. 2009: 181, 4, abstract 1924.

Source:
Lacey Dean

American Urological Association

Statins, drugs widely prescribed to lower cholesterol, may have protective effects on prostate health. This large Mayo Clinic cohort study looked at three different aspects of urological health — prostate cancer, erectile dysfunction and prostate enlargement. Initial research results are being presented April 25-30, 2009, at the American Urological Association (AUA) meeting in Chicago.

These Mayo Clinic study findings came from data in the Olmsted County Study of Urinary Health Status among Men, a large cohort study of men living in Olmsted County, Minn. This study has followed 2,447 men ages 40 to 79 from 1990 to the present to assess various urologic outcomes among aging men.

“One of the major advantages of this large cohort study is that the men have participated in this study for over 15 years. Because of this, we have the ability to look at associations between statin use, how long statins were used and multiple aspects of urologic function,” says Jennifer St. Sauver, Ph.D., Mayo Clinic epidemiologist and study author.

Three significant abstracts are being presented at the AUA meeting:

Statins May Reduce Risk of Prostate Cancer (April 26, 3:30-5:30 p.m. CDT)

In the first study, researchers followed the 2,447 men for over 15 years and discovered that men taking statins were less likely to develop prostate cancer, compared to men who did not take statins.

Of the statin users, 38 (6 percent) were diagnosed with prostate cancer. Comparatively, non-statin users were three times more likely to develop prostate cancer, suggesting statin use may prevent development of prostate cancer.

“In recent years, it has been suggested that statin medications may prevent development of cancer. However, until now, there has been limited evidence to support this theory,” says Rodney Breau, M.D., a Mayo Clinic urologic oncology fellow who led the study. “Our research provides evidence that statin use is associated with a threefold reduced risk of being diagnosed with prostate cancer.”

Statin medications are currently used to lower cholesterol or to help prevent heart attack and stroke in high-risk patients. In the laboratory setting, researchers have observed that statin medications prevent cancer cells from dividing and, in fact, may cause some cancer cells to die.

“In the United States, one in six men will develop prostate cancer; however, far more will develop heart disease,” says Jeffrey Karnes, M.D., Mayo Clinic urologist and senior author on the study. “I tell my patients to take care of their heart - because what’s good for the heart is also good for the prostate.”

The investigators emphasize that these results are preliminary. To determine if statins are protective for prostate cancer, randomized controlled trials are necessary, says Dr. Karnes.

Statin Use May Protect Against Erectile Dysfunction (April 27, 10:30 a.m.-12:30 p.m. CDT)

Hyperlipidemia, high cholesterol and other risk factors for heart disease have been shown to put men at risk for erectile dysfunction (ED). With this in mind, Mayo Clinic researchers studied 1,480 men from the Olmsted County cohort to determine if men who used statins were less likely to develop erectile dysfunction, compared to men who did not use statins.

Overall, statin use was not significantly associated with a decreased risk of developing ED. However, statins were associated with a decreased risk of ED among older men (>60 years). Men in this age category who used statins were less likely to develop ED, compared to older men who did not use statins. Additionally, men who took statins for a longer time were more protected against developing ED. For example, men who took statins for nearly nine years or more were 64 percent less likely to develop ED, while men who took statins for less than three years had about the same risk of developing ED. compared to men who did not take statins.

“Protection of vascular health remains an important concomitant of preserving erectile health. Our data suggest that longer use of statins may result in the lowest risk of erectile dysfunction,” says Ajay Nehra, M.D. , Mayo Clinic urologist and senior study author.

ED is common, and prevalence increases with age. It affects 5 to 10 percent of men at age 40. By age 70, from 40 to 60 percent of men have the condition.

Statin Use May Prevent Prostate Enlargement (April 28, 1:00-3:00 p.m. CDT)

Benign prostatic enlargement affects one in four men ages 40 to 50 and almost half of 70- to 80-year-old men. The condition is most often diagnosed when men visit their physicians due to urinary problems prompted by prostate enlargement. Mayo Clinic researchers have found that taking statins may prevent or delay benign prostatic enlargement.

Of the 2,447 men studied, 729 (30 percent) were statin users; researchers found that statin users were 63 percent less likely to develop lower urinary tract problems and 57 percent less likely to develop an enlarged prostate.

“Statins have been shown to have anti-inflammatory effects, and previous research suggests inflammation may be associated with benign prostate disease,” says Dr. St. Sauver. “This study suggests that men’s urinary health could be improved by taking statin medications.”

Further Study Needed

The researchers note that further studies, particularly clinical trials, are necessary to determine whether taking statins might prevent development of this common condition.

“If you are taking a statin for a heart condition or to lower cholesterol, these studies suggest that statins could have other benefits,” says Dr. St. Sauver. “However, it’s very clear we need more information before men are advised to start taking statins for their urological health.”

Source:
Traci Klein

Mayo Clinic

Men taking generic drugs may be more likely to have less effective results and more adverse events than if they were using branded medications, according to new data from researchers in New York. Researchers presented a study at the 104th Annual Scientific Meeting of the American Urological Association (AUA) showing that generic substitutes for alpha blockers and 5-alpha reductase inhibitors (5-ARIs), two classes of medications used to treat lower urinary tract symptoms (LUTS) in men, are less effective than their branded counterparts.

Over eight weeks, the study tested 212 men taking branded alpha blockers or 5ARIs with an average age of 64, who were switched to generic alternatives by their primary care physician or due to insurance coverage. The researchers measured the efficacy of the medications using several parameters, including the International Prostate Symptom Score (IPSS), peak flow rate (Qmax), post-void residual urine (PVR), voiding diary information, International Index of Erectile Function (IIEF), ejaculatory function and the prevalence of adverse events.

In the men who were switched to generic medications, the IPSS and PVR rates increased and Qmax decreased. In addition, the men experienced several new side effects, including dizziness (4.6 percent), nasal congestion (3.2 percent) and ejaculatory dysfunction (3.6 percent) for those switching alpha blockers, and ejaculatory dysfunction (4.7 percent) and erectile dysfunction (5.8 percent) for those switching to generic 5-ARIs.

“This preliminary study shows that some generics are not as effective as their branded counterparts and that men should consult a physician if a generic alternative is not providing results. Given that this is an early study, interpretation should be cautious as patients were not blinded as to which medication they were receiving and there may be a bias against generic medications on the part of patients,” said Kevin McVary, MD, an AUA spokesman. “Often, men switch because of cost or insurance company regulations; but, it is important to ensure efficacy and consider potential side effects prior to switching medications. A physician should be able to monitor the patient and may recommend switching back to the branded medication if efficacy decreases or side effects increase while taking a generic medication.”

Kaplan, S; Chung, D; Sandhu, J; Te, A. Generic substitutes are neither as safe nor effective as branded medications: experience in men treated for lower urinary tract symptoms (LUTS). J Urol, suppl. 2009: 181, 4, abstract 1799

Source:
Lacey Dean

American Urological Association