849 RARP AND LOCALIZED HYPOTHERMIA'S IMPACT ON CONTINENCE AND INFLAMMATORY RESPONSE

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You have accessJournal of UrologyTechnology & Instruments: Robotics: Benign & Malignant Disease (I)1 Apr 2013849 RARP AND LOCALIZED HYPOTHERMIA'S IMPACT ON CONTINENCE AND INFLAMMATORY RESPONSE Blanca Morales, Ha Lan Tran, Philip Carpenter, Navneet Narula, Douglas Skarecky, and Thomas Ahlering Blanca MoralesBlanca Morales Orange, CA More articles by this author , Ha Lan TranHa Lan Tran Orange, CA More articles by this author , Philip CarpenterPhilip Carpenter Orange, CA More articles by this author , Navneet NarulaNavneet Narula New York, NY More articles by this author , Douglas SkareckyDouglas Skarecky Orange, CA More articles by this author , and Thomas AhleringThomas Ahlering Orange, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.417AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The hypothesized mechanism for age-related improved continence from regional hypothermia during prostatectomy (Urology 2009. Apr;73(4):691-6) is reduction of localized trauma and inflammation. Localized neutrophil (PMN) counts are a reliable measure of inflammatory reaction within 30 minutes of surgical trauma to tissues. METHODS Using archived pathology slides of prostatectomy specimens, we blindly counted peri-prostatic PMNs in men undergoing RARP n=35 vs RARP with hypothermia (hRARP, n=36). An experienced pathologist blindly selected sites from posterolateral peri-prostatic tissue with the greatest population of PMNs for enumeration. PMNs from five high-powered fields were used to obtain mean counts for analysis by the Student's T-Test. RESULTS The Control and hRARP groups had comparable demographic factors and specimen characteristics (p >0.05): age (62.8 v. 60.5), pre-op PSA (5.5 vs. 4.6), AUA (8.4 v. 8.9), Bother (1.4 v. 1.8), IIEF-5 (20.1 v. 20.1), and BMI (26.3 v. 26.9), prostate weight (56.8 v. 56.1), and Gleason Score (6.7 v. 6.6). Pre and postoperative blood neutrophil counts were equivalent for both groups. Fig. 1 depicts a scatter plot demonstrating that PMN counts increased with age in all men even though they encountered similar surgical trauma regardless of age. Overall the mean number of PMNs was reduced ∼50% for hRARP versus controls (p= 0.003). Fig. 2 shows that as men age, the impact of hypothermia appears to be markedly greater. The median time to 0-pad continence was significantly shorter for hRARP (26 v. 69 days) as compared to controls (p= 0.008). CONCLUSIONS This blinded pathological study provides evidence supporting anti-inflammation as one of the effects of hypothermia on prostate tissue during RARP. Among controls, localized inflammation increased with advancing age given the same amount of trauma. Lastly, hypothermia treated men experienced improved time to continence compared to controls. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e349 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Blanca Morales Orange, CA More articles by this author Ha Lan Tran Orange, CA More articles by this author Philip Carpenter Orange, CA More articles by this author Navneet Narula New York, NY More articles by this author Douglas Skarecky Orange, CA More articles by this author Thomas Ahlering Orange, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...