HOUSTON -- (September 24, 2009) -- Men who have undergone prostate cancer surgery have a new option for managing incontinence – a common side effect and significant quality-of-life issue some men face after surgery, said a urologist from Baylor College of Medicine.

"After surgery, some prostate cancer patients will remain focused on the aftermath," said Dr. Mohit Khera, an assistant professor in the Scott Department of Urology at BCM. "They may become distressed and embarrassed when dealing with incontinence or the loss of their bladder control."

Aid for bladder function, control

But Khera said a new sling device can help these men better manage their bladder function and control after surgery. Prostate cancer affects one in six men in the United States. Surgery is the most common treatment and may be followed by radiation or hormone therapy.

Incontinence occurs when the muscles that support the bladder or control the release of urine are weakened. Muscles at the end of the urethra (the pathway from which urine exits the body) undergo pressure that they cannot sustain, causing early release.

In prostate cancer surgery patients, the urethral muscles are weakened by the removal of the prostate gland and subsequent injury to the surrounding urethral muscle.

Sling compresses urethra

To fit patients with the sling, doctors make a small incision under the scrotum. The sling has four "arms" that go through the patient's tissue, heal and "scar" into place.

The sling lifts and compresses the urethra, said Khera. It brings the urethra and bladder back into their natural position and helps with bladder control.

"The sling serves as a hammock for the urethra," said Khera. "It is made of polypropylene mesh and does not require any additional hardware or artificial materials. It's very natural."

Patients go home the day of surgery. They will have a catheter for one to two days and should be back to full activity in four weeks, Khera said.

Alternate devices

Alternate treatments are more invasive and may be less tolerable to some patients, Khera said. They include silicone rubber-made sphincters which require hospitalizations and abdominal surgeries. An inflatable device fits the urethra and controls bladder function and pressure.

"We are making significant advances in improvement of quality of life following prostate cancer surgery," said Khera.

Erectile dysfunction is also a common condition caused by removal of the prostate gland. Khera leads an erectile preservation program at BCM that rehabilitates and treats men before and after surgery.

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HOUSTON -- (September 24, 2009) -- Dr. Brendan Lee of Baylor College of Medicine plans to use a $2.3 million "transformative" grant from the National Institutes of Health to elucidate the relationship between nitric oxide – a crucial molecule in cellular metabolism – and the enzyme argininosuccinic acid lyase, which he hypothesizes may play an important role in many common diseases associated with alterations in this biological chemical.

"The transformative nature of this is that it looks at control and regulation of nitric oxide in a different way – from the level of the enzyme that is responsible for production of arginine, the precursor of nitric oxide," said Lee, a professor of molecular and human genetics at BCM. "It could transform how we treat nitric oxide-related diseases."

Important implications

The findings could have implications for many diseases, including those of the heart and blood vessels, nerves and brain as well as metabolic disease like diabetes.

In a letter telling Lee of the award, Dr. Francis Collins, director of the NIH, wrote: "As you know, this program, funded through the Office of the NIH Director and the Common Fund, is intended to support research that has the potential to transform the way we think about and conduct science, so the recipients represent an elite few with truly bold ideas. Competition for the awards was fierce, and standards very high."

Different look at nitric oxide

"The basis for this grant stems from our observations of patients who had rare disorders of the urea cycle," said Lee. (The urea cycle involves the breakdown of waste proteins in the cell, a critical element for healthy life.) "Many patients had problems that could not be explained by high levels of ammonia alone (resulting from degradation of cellular waste). "Until now, most work on nitric oxide metabolism has focused on nitric oxide synthase, the enzyme that makes nitric oxide. This work will look at a different way in which nitric oxide is controlled."

Lee is one of 42 scientists nationwide to receive a grant through the NIH Transformative R01 Program, funded through the office of Collins.

Dr. Susan Rosenberg, professor of molecular and human genetics at BCM, received a five-year, $2.5 million NIH director’s Pioneer Award granted under the same program. Collins announced the awards simultaneously at a ceremony at the NIH Sept. 24.

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HOUSTON -- (September 23, 2009) -- Dr. H. David Shine, associate professor of neurosurgery at Baylor College of Medicine, was installed as president of the International Society for Neurochemistry at the group's 22nd biennial meeting in Busan, South Korea.

Shine, who also holds appointments in the department of neuroscience, molecular and cellular biology and the Center for Cell and Gene Therapy at BCM, will hold the presidency for two years. His research focuses on molecular neurobiology, nervous system regeneration and gene therapy of the nervous system.

The International Society of Neurochemistry is a professional society of molecular and cellular neuroscientists with world-wide membership.

In addition to its biennial meeting the society publishes the Journal of Neurochemistry, supports meetings of its regional sister societies and special conferences and symposia, and provides financial support for investigators in economically deprived and developing countries.

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HOUSTON -- (September 23, 2009) -- Medical and nursing school leaders should hold curricula for complementary and alternative medicine programs at their schools to the same standards they use for any courses at their institutions, but a survey of such offerings indicates that they are not, said experts from Baylor College of Medicine in a report that appears in the current issue of Academic Medicine.

Dr. Donald Marcus, professor emeritus of medicine at BCM, and Dr. Laurence McCullough, professor in the BCM Center for Ethics and Health Policy, evaluated curricula at the 15 institutions that received National Institutes of Health National Center for Complementary and Alternative Medicine grants to integrate evidence-based information about complementary and alternative medicine into the educational program. The study examined the web sites of the 15 awardees and reviewed the educational material for four popular therapies – herbal remedies, chiropractic, acupuncture and homeopathy – and compared them to evidence-based medicine guidelines.

Eliminate outdated information

"The review of alternative medicine curricula demonstrated that the information presented on complementary and alternative medicine was based on a poor standard of evidence that would not be acceptable for conventional therapies," said Marcus. "The evidence is of poor quality and out–of-date compared to the materials used to teach conventional therapies."

Marcus said that by presenting complementary and alternative medicine with poor quality evidence, the programs could encourage the use of ineffective and potentially dangerous therapies.

Ethical obligation

Marcus and McCullough suggested that the medical and nursing schools:

• Appoint faculty committees to review the educational materials and therapies provided by integrative medicine programs.
• Hold such programs to the same standard of evidence used for conventional treatments.
• Provide ongoing oversight of integrative medicine education programs.

"We need to identify the best evidence for these therapies," said Marcus. "We have an educational and ethical obligation to provide the best education to students and health professionals."

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HOUSTON -- (September 23, 2009) -- For more than a decade, obstetrician-gynecologists have given pregnant women facing premature birth steroids to hasten the development of their newborn's lungs. Now a study appearing online in the Proceedings of the National Academy of Sciences involving a "mystery" gene called Erk3 explains the success of that therapy.

"When we generated newborn mice lacking the gene for Erk3 (extracellular signal-related kinase 3), they were growth-restricted and died of acute respiratory failure within the first 24 hours of life," said Dr. Kjersti Aagaard-Tillery, assistant professor of obstetrics and gynecology at Baylor College of Medicine and a senior author of the report. "When we completed our microscopic and histological studies, it appeared that the lung architecture had developed normally with the correct number of lobes but the saccular structures (or 'air sacs') were immature and underdeveloped."

Type II pneumocytes

She said further analyses led the research team to conclude that the cells responsible for final functional maturation (type II pneumocytes) had not developed normally and contained more glycogen than normal animals. The glycogen replaces surfactant, a substance essential for normal breathing.

"It looked akin to what we see in growth-restricted and premature human infants," Aagaard-Tillery said.

When compared to babies who are not growth-restricted but born at the same gestation, these infants fare poorly, she said.

When she and her colleagues from Canada sought to treat the mice, they turned to the steroids commonly used in treating mothers anticipating premature birth or growth restricted babies.

"We found we could correct the lung defect in terms of the cellular anatomy," she said. "After the steroids, we could see no evidence of delayed lung maturation and the glycogen content in the type II pneumoctyes normalized. In other words, giving the mice steroids in the pregnancy overcame the genetic defect in their babies' lungs. It's the first time we have shown that we can correct the phenotypic (visible symptoms) result of a gene deletion by administering a maternal drug in its commonly used clinical form."

However, while the lung cells appeared mature, the infant mice still lacked the drive to breathe and died, although later than would have happened without treatment. This was again similar to the clinical situation in humans, where premature babies from mothers given a single course of steroids before 34 weeks of pregnancy fare better.

Erk3

"Our current efforts in the laboratory are focused on finding out precisely which molecular pathways in the lung are affected by the steroids, and how it is that we can restore normal lung development but the neonates will still experience respiratory failure," she said.

She also wants to find out where Erk3 fits in determining fetal growth and how that meshes with the effect of a protein called insulin-like growth factor 2 in determining a newborns size.

"This shows us the beginnings of the science behind what we have done clinically for over a decade," said Aagaard-Tillery. "Ultimately, these mice provide us with the tools to figure out why giving the pregnant mothers steroids will benefit their premature and growth-restricted babies. Continuing this work will give us more clues that we can use to further improve outcomes for these babies."

Others who took part in this work include Sonia Klinger, Benjamin Turgeon, Kim Lévesque and Sylvain Meloche of the University of Montreal in Montreal, Quebec, Canada, and Geoffrey A. Wood of the University of Guelph in Guelph, Ontario, Canada.

Funding for this work came from the Canadian Institutes for Health Research and the NIH Directors New Innovator Award.

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