Continence, potency and oncological outcomes after robotic-assisted radical prostatectomy: early trifecta results of a high-volume surgeon

OBJECTIVE center dot To evaluate early trifecta outcomes after robotic-assisted radical prostatectomy (RARP) performed by a high-volume surgeon. PATIENTS AND METHODS center dot We evaluated prospectively 1100 consecutive patients who underwent RARP performed by one surgeon. In all, 541 men were considered potent before RARP; of these 404 underwent bilateral full nerve sparing and were included in this analysis. center dot Baseline and postoperative urinary and sexual functions were assessed using self-administered validated questionnaires. center dot Postoperative continence was defined as the use of no pads; potency was defined as the ability to achieve and maintain satisfactory erections for sexual intercourse > 50% of times, with or without the use of oral phosphodiesterase type 5 inhibitors; Biochemical recurrence (BCR) was defined as two consecutive PSA levels of > 0.2 ng/mL after RARP. center dot Results were compared between three age groups: Group 1, < 55 years, Group 2, 56-65 years and Group 3, > 65 years. RESULTS center dot The trifecta rates at 6 weeks, 3, 6, 12, and 18 months after RARP were 42.8%, 65.3%, 80.3%, 86% and 91%, respectively. center dot There were no statistically significant differences in the continence and BCR-free rates between the three age groups at all postoperative intervals analysed. center dot Nevertheless, younger men had higher potency rates and shorter time to recovery of sexual function when compared with older men at 6 weeks, 3, 6 and 12 months after RARP (P < 0.01 at all time points). center dot Similarly, younger men also had a shorter time to achieving the trifecta and had higher trifecta rates at 6 weeks, 3 and 6 months after RARP compared with older men (P < 0.01 at all time points). CONCLUSION center dot RARP offers excellent short-term trifecta outcomes when performed by an experienced surgeon. center dot Younger men had a shorter time to achieving the trifecta and higher overall trifecta rates when compared with older men at 6 weeks, 3 and 6 months after RARP.

Genetics and race variability of the lucerne - Colletotrichum trifolii pathosystem in Australia

The Australian-bred lucerne cultivars, Trifecta and Sequel, were found to possess useful levels of resistance to both Colletotrichum trifolii races 1 and 2. Race 2 has only been previously observed in the United States and surveys did not reveal its presence in Australia. Multilocus fingerprinting using random amplified polymorphic DNA (RAPDs) analysis revealed low diversity (<10% dissimilarity) within Australian C. trifolii collections, and between the Australian race 1 isolates and a US race 2 isolate. Studies on the inheritance of resistance to C. trifolii race 1 in individual clones from Trifecta and Sequel revealed the presence of 2 different genetic mechanisms. One inheritance was for resistance as a recessive trait, and the other indicated that resistance was dominant. The recessive system has never been previously reported, whereas in the US, 2 completely dominant and independent tetrasomic genes Anl and Ant have been reported to condition C. trifolii resistance. It was not possible to fit the observed segregations from our studies to a single-gene model. In contrast to US studies, clones of cv. Sequel exhibiting the recessive resistance reacted differently to spray and stem injection with C. trifolii inoculum, being resistant to the former and susceptible to the latter, providing additional evidence for the presence of a different genetic mechanism conditioning resistance to those previously reported in the US. As C. trifolii is one of the most serious diseases of lucerne worldwide, the future development of molecular markers closely linked to the dominant and recessive resistances identified in these studies, and the relationships between these resistances and Anl and Ans as determined by genetic mapping, appear to be useful areas of future study.

Pentafecta: A New Concept for Reporting Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy

Background: Widespread use of prostate-specific antigen screening has resulted in younger and healthier men being diagnosed with prostate cancer. Their demands and expectations of surgical intervention are much higher and cannot be adequately addressed with the classic trifecta outcome measures. Objective: A new and more comprehensive method for reporting outcomes after radical prostatectomy, the pentafecta, is proposed. Design, setting, and participants: From January 2008 through September 2009, details of 1111 consecutive patients who underwent robot-assisted radical prostatectomy performed by a single surgeon were retrospectively analyzed. Of 626 potent men, 332 who underwent bilateral nerve sparing and who had 1 yr of follow-up were included in the study group. Measurements: In addition to the traditional trifecta outcomes, two perioperative variables were included in the pentafecta: no postoperative complications and negative surgical margins. Patients who attained the trifecta and concurrently the two additional outcomes were considered as having achieved the pentafecta. A logistic regression model was created to evaluate independent factors for achieving the pentafecta. Results and limitations: Continence, potency, biochemical recurrence-free survival, and trifecta rates at 12 mo were 96.4%, 89.8%, 96.4%, and 83.1%, respectively. With regard to the perioperative outcomes, 93.4% had no postoperative complication and 90.7% had negative surgical margins. The pentafecta rate at 12 mo was 70.8%. On multivariable analysis, patient age (p = 0.001) was confirmed as the only factor independently associated with the pentafecta. Conclusions: A more comprehensive approach for reporting prostate surgery outcomes, the pentafecta, is being proposed. We believe that pentafecta outcomes more accurately represent patients` expectations after minimally invasive surgery for prostate cancer. This approach may be beneficial and may be used when counseling patients with clinically localized disease. (C) 2011 European Association of Urology. Published by Elsevier B. V. All rights reserved.

Avaliação do Potencial para Ensilagem de Cultivares de Alfafa (Medicago sativa L.)

The objective of this trial was to study the ensilage potential of alfalfa (Medicago sativa L,.). The material used in the evaluation was harvested from an experiment in a complete randomized blocks design with three replicates, with seventeen alfalfa cultivars, Criouil, Florida 77, P555, P581, Moapa, Gilboa, 34 Linea, C/W 8754, C/W 4468, C/W 86, C/W 8746, Hunter Field, Trifecta, Sequel, CUF 101, Aurora e Siriver, during three years. The harvest used for the determinations was collected at 30(th) day of plants development and the material was submitted to two treatments: no wilting - Fresh alfalfa frozen immediately after harvest; wilting fresh alfalfa exposed to sun by three hours to get 35% DM. The dry matter content (DM), water soluble carbohydrates (WSC) and buffer capacity (BC) were evaluated in rhp forages Wilting increased the dry matter content (39,98%), however there were not differences among cultivars. The same occurred for the WSC content, with interaction among cultivars and treatments. The alfalfa cultivars, when submitted to effective wilting practice, presented appropriated characteristics of dry matter and water-soluble carbohydrates for ensilage. Wilting had no effect on alfalfa buffer capacity.

Produção e Distribuição de Matéria Seca e Composição Bromatológica de Cultivares de Alfafa (Medicago sativa L.)

The objective of this research was to evaluate dry matter production (DMP), seasonal distribution (SD) and chemical composition of crude protein (CP), neutral detergent fiber (NDF) and acid detergent fiber (ADF) of seventeen alfalfa cultivates: Creole, Florida 77, P555, P581, Moapa, Gilboa, 34 Linea, C/W 8754, C/W 4468, C/W 86, C/W 8746, Hunter Field, Trifecta, Sequel, CUF 101, Aurora e Siriver. A complete randomized blocks experimental design, with three replicates in a split plot on time scheme, was used. For DMP and SD, the cultivates were in the main plot and cuts in the subplots. For chemical composition, cultivates were also the main plots, and seasons of the year, summer and winter, the subplots. There were no differences among cultivates for the annual average dry matter production (12,08 t/[ha.year]) and SD (35% in the winter). There were differences in the chemical composition, among cultivates for CP and significant interaction among cultivates and the seasons of year for NDF and ADF. All cultivates showed similar potential production and seasonal distribution of dry matter. The alfalfa quality in the winter was better than in the summer.