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Charles B Brendler

Publications and source records attributed to Charles B Brendler.

16 recordsLinked to original sources
PubMed2007

Laparoscopic ice slurry coolant for renal hypothermia.

PURPOSE: We assessed the safety and efficacy of microparticulate ice slurry for laparoscopic hypothermia during renal ischemia in a single kidney porcine model. MATERIALS AND METHODS: A total of 18 farm pigs were randomized to 3 groups of 6 each. All groups underwent initial right laparoscopic nephrectomy, followed by 1 of 3 procedures on the left kidney. Group 1 underwent 90-minute hilar clamping under warm ischemia, group 2 underwent 90-minute hilar clamping under cold ischemia using laparoscopically delivered microparticulate ice slurry and control group 3 underwent hilar dissection, no clamping and no microparticulate ice slurry. Body and renal cortical temperatures were measured. Serum creatinine and the glomerular filtration rate were assessed preoperatively, and on postoperative days 1, 3, 8 and 15. RESULTS: Average time to achieve a renal temperature of 20C or less was 9.7 minutes and it remained constant during the 90-minute cold ischemia time. Mean serum creatinine was significantly higher in the warm ischemia group than in the cold ischemia and control groups on postoperative days 1 and 3. Additionally, mean serum creatinine in the cold ischemia and control groups was similar at all time points. The mean glomerular filtration rate was significantly lower in the warm ischemia group than in the cold ischemia and control groups on postoperative days 1, 3 and 8. The mean glomerular filtration rate in the cold ischemia group was lower than in the control group on postoperative day 1, while it was similar on postoperative days 3, 8 and 15. CONCLUSIONS: In the porcine model laparoscopic renal hypothermia achieved with microparticulate ice slurry was safe and efficient. It significantly decreased renal dysfunction secondary to an ischemic insult with no adverse effects or complications associated with microparticulate ice slurry use.

Animals↗
PubMed2007

Dietary fatty acids correlate with prostate cancer biopsy grade and volume in Jamaican men.

PURPOSE: Jamaica has the highest incidence of prostate cancer in the world. Dietary fat is associated with prostate cancer. The Omega6 polyunsaturated fatty acids have been shown to stimulate prostate carcinogenesis and the Jamaican diet is rich in linoleic acid. We hypothesized positive correlations between Omega6 polyunsaturated fatty acid, prostate specific antigen and prostate biopsy pathology. MATERIALS AND METHODS: A total of 148 men were enrolled in Kingston, Jamaica. Serum prostate specific antigen and erythrocyte membrane polyunsaturated fatty acids were analyzed. Men with prostate specific antigen 2.6 ng/ml or greater underwent biopsy. Histopathological and statistical analyses were performed on available data. RESULTS: Of the 54 men who underwent biopsy 24 had prostate cancer, 17 had a Gleason score of 7 or greater and 11 had a tumor volume of 50% or greater. There were significant positive correlations between linoleic acid and Gleason score (p = 0.009), and the linoleic acid-to-docosahexaenoic acid (Omega3) ratio and tumor volume (p = 0.03). There was a significant negative correlation between the arachidonic acid (Omega6)-to-docosapentanoic acid (Omega3) ratio and Gleason score (p = 0.04). Statistical correlations between prostate specific antigen and polyunsaturated fatty acids were inconsistent. CONCLUSIONS: The positive correlations between linoleic acid and Gleason score, and the linoleic acid-to-docosahexaenoic acid ratio and tumor volume support studies showing that Omega6 polyunsaturated fatty acids stimulate and Omega3 polyunsaturated fatty acids inhibit prostate cancer growth. The negative correlation between the arachidonic acid-to-docosapentanoic acid ratio and Gleason score supports studies that demonstrate increased metabolism of arachidonic acid in prostate cancer to form carcinogenic metabolites, namely prostaglandin E2. Our findings support the association between dietary fatty acids and prostate cancer, and they warrant further dietary and tissue studies in high risk populations.

Aged↗
PubMed2006

Robotic-assisted laparoscopic prostatectomy in overweight and obese patients.

OBJECTIVES: To assess outcomes of robotic laparoscopic radical prostatectomy (RLRP) in overweight and obese patients, defined as those with a body mass index (BMI) of 25 to 30 kg/m2 and greater than 30 kg/m2, respectively. METHODS: This was a nonrandomized study evaluating all of our RLRP patients. Patients were divided into three groups: BMI of 25 kg/m2 or less (group 1), BMI greater than 25 kg/m2 and less than 30 kg/m2 (group 2), and BMI of 30 kg/m2 or more (group 3). Patients were evaluated prospectively with the validated Rand 36-Item Health Survey (version 2) and with the University of California, Los Angeles Prostate Cancer Index questionnaire. RESULTS: Between February 2003 and November 2004, 150 RLRPs were performed at our center. Average follow-up was 8 months. Groups 1, 2, and 3 had 39, 65, and 46 patients, respectively. Average BMIs for all three groups were statistically different (P < 0.01). When compared with group 1, open conversion rates, hospital stay, positive margin, and complication rates were not statistically different for groups 2 or 3. Operative time (P < 0.004) and estimated blood loss (P < 0.03), however, were statistically greater for group 3 compared with group 1. Transfusion rate was highest in group 2 (P = 0.04 compared with group 1). Prostate weights were also statistically greater in groups 2 (P = 0.003) and 3 (P = 0.02) compared with group 1. Overall, BMI did not increase perioperative and postoperative morbidity. CONCLUSIONS: Robotic laparoscopic radical prostatectomy is safe in overweight and obese patients and might be the surgical management of choice in this subset of patients. Further long-term follow-up with more patients is required to verify this initial observation.

Adult↗
PubMed2006

Robotic-assisted laparoscopic prostatectomy: first 100 patients with one year of follow-up.

OBJECTIVES: To report our initial experience of 100 patients with robotic-assisted laparoscopic radical prostatectomy. Continued technological advances have expanded our armamentarium of minimally invasive devices and techniques to offer our patients. Robotic-assisted laparoscopic radical prostatectomy has been adopted at many centers. METHODS: This was a nonrandomized prospective study evaluating our initial 100 patients who underwent robotic-assisted laparoscopic radical prostatectomy. The follow-up data were obtained prospectively using the validated Rand 36-item health survey, version 2, and the University of California, Los Angeles, Prostate Cancer Index preoperatively and at 1, 3, 6, and 12 months postoperatively. Patients who required open conversion were excluded from the outcome analysis. Patients who received a sural nerve graft were excluded from the operative analysis. RESULTS: The average age and body mass index of all patients were 58.4 years (range 42 to 70) and 28.5 kg/m2 (range 18.1 to 50.6), respectively, with a median follow-up of 12 months. The average prostate-specific antigen level was 6.07 ng/mL. Seven patients required conversion to an open technique, and four underwent sural nerve grafting. The positive surgical margin rate was 16% (15 of 92). Using the Rand 36-item health survey, version 2, and the University of California, Los Angeles, Prostate Cancer Index health surveys, the average percentage of return to baseline urinary function was 52%, 70%, 79%, and 84% at 1, 3, 6, and 12 months, respectively. The overall average percentage of return to baseline sexual function was 51%, 58%, 66%, and 80% at 1, 3, 6, and 12 months, respectively. CONCLUSIONS: Robotic-assisted laparoscopic radical prostatectomy is a safe and efficient method for achieving prostate cancer control even during the initial learning curve for this procedure.

Adult↗
PubMed2006

Impact of surgical margin status on long-term cancer control after radical prostatectomy.

OBJECTIVE: To determine whether previously described technical modifications that significantly decreased the positive surgical margin (PSM) rate have translated into improved long-term cancer control, as SM status is generally recognized as an independent risk factor for biochemical recurrence (BR) after radical retropubic prostatectomy (RRP), and is the only factor that can be modified by surgical technique. PATIENTS AND METHODS: Between March 1994 and December 2004, 996 consecutive patients had RRP as the sole treatment for clinically localized prostate cancer. The surgery was done by one surgeon (C.B.B.) and the data were prospectively reviewed. RESULTS: The overall PSM rate was 8.8%; the PSM rate by pathological stage was 1.7%, 24.2% and 27.1% for men with pT2, pT3a and pT3b disease, respectively (P < 0.001). In all, 968 of 996 (97.2%) patients were available for the follow-up (mean 6.4 years); 69 of 883 (7.8%) with negative SMs (NSMs) developed BR, vs 29 of 85 (34%) with PSMs (P < 0.001). The actuarial 5- and 10-year biochemical disease-free survival was 92.1% and 89.6%, and 70.6% and 59.9%, for patients with NSM and PSM, respectively (P < 0.001). On multivariate analysis, PSM, pathological stage and Gleason grade were the strongest predictors of BR (P < 0.001). The preoperative prostate-specific antigen level, and clinical stage T1c and T2a disease were not associated with recurrence. The hazard ratio (95% confidence interval) for BR in patients with PSMs was 3.27 (2.1-5.1). CONCLUSIONS: RRP including the previously described surgical modifications not only decreased the PSM rate but also resulted in excellent long-term cancer control. The importance of meticulous surgical technique in RRP cannot be overemphasised.

Adult↗
PubMed2006

Surgical modifications in bladder neck reconstruction and vesicourethral anastomosis during radical retropubic prostatectomy to reduce bladder neck contractures.

PURPOSE: We describe surgical modifications in radical retropubic prostatectomy (RRP) which have significantly reduced the incidence of bladder neck contractures (BNC). MATERIALS AND METHODS: Between March 1994-July 2005, 977 men underwent a RRP by a single surgeon. Group I comprised 548 patients operated upon July 1994-December 1999, without the modifications described below. Group II comprised 429 men operated upon January 2000-December 2004, with the following surgical modifications: 1) reconstruction of the bladder neck (BN) to a diameter of 28 French; 2) placement of the posterior (6 o'clock) vesicourethral suture on mild traction before placing this suture into the bladder, allowing inspection and, if necessary, replacement of any of the previously placed sutures; 3) bladder displacement when tying the vesicourethral sutures which allows the sutures to be tied under direct vision and prevents incorporation of extraneous tissue. Data were retrospectively analyzed. RESULTS: Demographic data were comparable between groups. In group I, 31/548 (5.7%) developed a BNC compared to 1/429 (0.2%) in Group II, p < 0.001. Urinary continence (no pads/maximum of one light pad for security in 24 hours) at 12 months in the 32 patients who developed a BNC was worse when compared to patients who did not develop a BNC (58% versus 80%, p = 0.003). After excluding the patients who developed a BNC, continence rates were comparable between both groups. The positive margin rate at the BN was not adversely affected by these modifications. CONCLUSIONS: Simple, easily applied modifications to the management of the BN and vesicourethral anastomosis can substantially reduce the incidence of BNC.

Adenocarcinoma↗
PubMed2005

Modified clipless antegrade nerve preservation in robotic-assisted laparoscopic radical prostatectomy with validated sexual function evaluation.

INTRODUCTION: We present our technique for clipless antegrade neurovascular bundle preservation during robotic laparoscopic radical prostatectomy, along with short-term follow-up of our patients' sexual function. TECHNICAL CONSIDERATIONS: Using the da Vinci three-arm robotic system, we performed robotic laparoscopic radical prostatectomy using a transperitoneal approach in an antegrade fashion. After division of the bladder neck, the posterior plane of the prostate was developed distally toward the apex of the prostate in the midline. This plane was then developed completely, releasing the vascular pedicles and neurovascular bundles in a medial to lateral direction, with occasional use of bipolar cautery and without the use of clips or monopolar cautery. Patients with a minimal follow-up of 3 months who did not require open conversion were included in this study. A total of 56 patients met these inclusion criteria between February 2003 and May 2004, with a mean follow-up of 6 months. Patients were given the validated Rand Medical Outcomes Study 36-Item Health Survey, version 2, with the University of California, Los Angeles, Prostate Cancer Index preoperatively and at 1, 3, 6, and 12 months postoperatively. The overall score for both unilateral and bilateral nerve-sparing groups was 35.0, 39.7, 49.4, and 49.6 at 1, 3, 6, and 12 months postoperatively, respectively. These coincided with a return to baseline potency rate of 47%, 54%, 66%, and 69% at 1, 3, 6, and 12 months, respectively. CONCLUSIONS: Antegrade dissection of the neurovascular bundle, avoiding the use of clips or monopolar cautery during robotic laparoscopic radical prostatectomy, may result in early return of sexual function and overall outcome similar to that after radical retropubic prostatectomy.

Adult↗
PubMed2005

Simplifying laparoscopic partial nephrectomy: technical considerations for reproducible outcomes.

OBJECTIVES: To present our technique, modifications, and experience of laparoscopic partial nephrectomy (LPN). Nephron-sparing surgery is an increasingly accepted treatment for selected T1a kidney tumors. Because of the more complex surgical technique involved, LPN is evolving more slowly than laparoscopic radical nephrectomy. METHODS: The data of 41 consecutive patients with T1a tumors who had undergone LPN from October 2002 to March 2004 were retrospectively reviewed. Four main considerations in our surgical technique were consistently used: (a) LPN was performed in the transperitoneal approach, (b) a suture traction system was placed on the kidney when tumor visualization was challenging, (c) sutures and bolsters were preloaded on the abdominal wall, and (d) hemostasis and closure of the renal defect was performed using Lapra-Ty clips, eliminating knot-tying. RESULTS: The mean patient age was 63.1 years. The mean warm ischemia time was 29.7 minutes, and the mean surgical time was 226.5 minutes. In 26 of 41 patients, the collecting system was entered and repaired. The median estimated blood loss was 150 mL, with a mean tumor size of 2.2 cm. Three cases were converted to open surgery. Five complications (13.2%) occurred. The median hospital stay was 2 days. Of the 41 specimens, 11 were benign. All surgical margins were negative. The mean follow-up was 7.5 months. CONCLUSIONS: Although technically challenging, LPN is emerging as an alternative to open partial nephrectomy. With several easily applied technical considerations, we have simplified LPN, making the procedure more efficient. We believe that the technical considerations we describe can increase the feasibility and ease of LPN for Stage T1a exophytic renal tumors.

Adult↗
PubMed2005

Early release of the neurovascular bundles and optical loupe magnification lead to improved and earlier return of potency following radical retropubic prostatectomy.

PURPOSE: Since 1999 we have made 2 modifications in the nerve sparing approach to radical retropubic prostatectomy (RRP), namely early release of the neurovascular bundles (NVBs) before division of the posterior membranous urethra and the use of 2.5x optical loupe magnification during NVB preservation. We retrospectively reviewed our results. MATERIALS AND METHODS: Between January 1998 and August 2003, 507 men underwent RRP for prostate cancer. All surgeries were performed by a single surgeon (CBB). Bilateral nerve sparing procedures were performed in 313 men. Modifications were introduced sequentially to the surgical technique and potency rates were compared to those of patients operated on before these modifications. Patients were divided into groups based on the technique of nerve sparing as group 1 (standard release of the NVB), group 2 (early release of the NVB) and group 3 (early release with loupe magnification). All patients were followed for a minimum of 5 months. Postoperative potency rates were compared among the 3 groups. RESULTS: Mean followup was 15.9 months. Mean patient age was 56.2 years. The overall potency rate among groups 1, 2 and 3 was 40.5%, 54.8% and 66.1%, respectively. Mean time to potency was 10.7, 8.5 and 2.0 months, respectively. Significant differences were found in the overall potency rate among all groups (p <0.05). Mean time to potency was significantly improved between groups 1 and 3 (p <0.05) and between groups 2 and 3 (p <0.05). CONCLUSIONS: Minor modifications in nerve sparing technique lead to improved postoperative potency rates and decreased time to potency in men undergoing RRP.

Aged↗
PubMed2005

Intra-operative prostate examination: predictive value and effect on margin status.

OBJECTIVE: To evaluate the ability of intra-operative prostate examination (IOPE) to predict extraprostatic extension (EPE) and its effect on margin status in the region of the neurovascular bundle (NVB) when combined with wide excision. PATIENTS AND METHODS: We retrospectively reviewed 403 patients with clinical stage T1c prostate adenocarcinoma undergoing radical retropubic prostatectomy (RRP). All patients had IOPE during RRP, and those with palpable abnormalities in the region of the NVB underwent wide excision. Pathological outcomes were analysed. RESULTS: Of 403 patients, 49 (12%) had a palpable abnormality in the region of the NVB. After wide excision, 18 (37%) of these 49 patients were found to have EPE at the site of the palpable abnormality; with wide excision of the NVB, only one of these 18 patients (6%) had a corresponding positive surgical margin (PSM). In 354 patients with a normal IOPE and who underwent bilateral NVB preservation, 30 were found to have EPE in the region of the NVB. The PSM rate in this subset was 23% (seven of 30). The positive predictive value of IOPE for detecting EPE was 37%. CONCLUSION: IOPE detects abnormalities in 12% of patients with preoperative stage T1c prostate cancer. Although the predictive value of this test is limited, IOPE may decrease PSMs in a subset of patients with EPE in the region of the NVB. The present study reaffirms the value of IOPE for assessing the risk of extraprostatic disease, and for guiding surgical management.

Adenocarcinoma↗
PubMed2004

Minor modifications in apical dissection of radical retropubic prostatectomy in patients with clinical stage T2 prostate cancer reduce positive surgical margin incidence.

OBJECTIVES: To describe modifications in the apical dissection of radical retropubic prostatectomy (RRP) in men with palpable disease that reduce the incidence of positive apical surgical margins. Positive surgical margins occur in up to 45% of patients undergoing RRP, even in contemporary series. The apex is the most common site of positive margins, and patients with palpable (clinical Stage T2) disease are more likely to have positive surgical margins than patients with nonpalpable (clinical Stage T1c) disease. METHODS: Ninety-five men, 48 to 77 years old (mean age 59.6) with clinical Stage T2 tumors underwent RRP between October 1998 and May 2001. Surgical modifications included identification of the prostatic urethral junction by dissection of the levator ani muscle from the prostate and partial transection of the puboprostatic ligaments; variable division of the membranous urethra 1 to 3 mm distal to the prostatic urethral junction; division of prostatic ischial ligaments before dividing the catheter and posterior membranous urethra; and division of the neurovascular bundle at the urogenital diaphragm before liberating the prostate from the rectum. RESULTS: Positive surgical margins occurred in only 8 (8.4%) of 95 patients, even though tumor extended beyond the prostatic capsule in 55% of cases. Only 2 (2.1%) of the 95 patients had isolated positive apical surgical margins. Urinary continence was not adversely affected by these modifications. CONCLUSIONS: Easily applied modifications in the apical dissection of RRP significantly reduce the incidence of positive apical margins in patients with clinical Stage T2 prostate cancer.

Adenocarcinoma↗
PubMed2004

Renal tolerance to prolonged warm ischemia time in a laparoscopic versus open surgery porcine model.

PURPOSE: To our knowledge the effects of renal warm ischemia (WI) during laparoscopic vs open surgery have not been investigated. Decreased renal blood flow during pneumoperitoneum may precondition the kidney to tolerate longer WI time. Traditionally 30 minutes has defined the limit of renal WI time in open surgery. However, recent reports show renal function recovery at WI times of 45 to 120 minutes. We assessed renal function recovery after prolonged WI during laparoscopic vs open surgery in a solitary kidney porcine model. MATERIALS AND METHODS: A total of 32 female farm pigs underwent right laparoscopic nephrectomy to create a single kidney model. At 12 days later the animals were randomized into open and laparoscopic groups, each with 4 subgroups, namely 30, 60 and 90 minutes of WI, and a 90-minute control. Serum creatinine and the glomerular filtration rate were assessed preoperatively and on postoperative days 1, 3, 8 and 15. RESULTS: There was no statistical difference in renal function between the laparoscopic and open groups. Although the early decrease in renal function (72 hours) was highest in the 60 and 90-minute WI groups, by postoperative day 15 this difference was not statistically significant. Postoperative day 15 glomerular filtration rate and serum creatinine values were not significantly different from baseline in any of the WI groups. CONCLUSIONS: We found no difference in renal function recovery when comparing laparoscopic and open WI. Although WI up to 90 minutes resulted in initial renal dysfunction, by 2 weeks postoperatively function normalized. Our results indicate that in a single kidney porcine model the renal unit can fully recover from WI times of up to 90 minutes.

Animals↗
PubMed2004

Adjunctive therapy for men with high risk localized and locally advanced prostate cancer: targeting disseminated tumor cells.

PURPOSE: Our research into the pathophysiology of micrometastatic dissemination and cancer recurrence has resulted in the initiation of a clinical trial for men with clinically localized and locally advanced disease. MATERIALS AND METHODS: We describe the development of this trial, which exploits anti-angiogenesis therapy, and delineate how our understanding of prostate cancer metastasis influenced its design. RESULTS: Prostate cancer is a heterogeneous disease. Although many men can be cured with local therapy, a large majority with clinically localized disease will experience a relapse usually at a distant site. This result is most likely due to micrometastatic dissemination early in the disease process. Therefore, successful contemporary treatment of many men with prostate cancer should include a combination of local and systemic therapies. Fortunately, cellular, molecular and genetic features that may predict which men are most in need of this therapeutic approach are being identified and characterized. This insight not only supports the rationale for a combination therapeutic approach to prostate cancer management, but will help identify the pathways and agents that provide the most promising targets for intervention. CONCLUSIONS: Despite advances in prevention and early detection, refinements in surgical technique, and improvements in radiation and systemic therapies, the ability to cure all men with prostate cancer remains unattainable. The continuing challenge is the successful eradication of recurrent and metastatic disease.

Angiogenesis Inhibitors↗