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PubMed2001

Transrectal ultrasound guided biopsy of the prostate. Do enemas decrease clinically significant complications?

PURPOSE: Transrectal ultrasound guided biopsy of the prostate is the most common modality used to diagnose prostate cancer. Although many biopsy protocols have been described, in our opinion the role of enema before biopsy has not been definitively assessed in the literature. MATERIALS AND METHODS: A retrospective review of 448 transrectal ultrasound guided biopsies was performed. All biopsies were done with the same equipment, and all patients received identical antibiotic prophylaxis with ciprofloxacin. There were 38 patients excluded from the study secondary to alternate antibiotic prophylaxis. A total of 225 patients received enemas before biopsy, while 185 did not. Clinically significant complications necessitating office visit, secondary therapy and hospitalization were evaluated. RESULTS: Overall, clinically significant complications developed in 4.4% (10 of 225) of patients who had versus 3.2% (6 of 185) of those who did not have an enema (p = 0.614). There were 2 patients in each group who underwent transurethral prostatic resection or suprapubic prostatectomy for gross hematuria and/or urinary retention after biopsy. Of the patients who received enemas 2 were hospitalized for urinary retention and complicated urinary tract infection. One patient in the group without enema was hospitalized for gross hematuria and clot urinary retention. No patients who did not receive enema preparation were hospitalized for infectious complications. CONCLUSIONS: Transrectal ultrasound guided prostate biopsy accompanied by quinolone antibiotic prophylaxis remains a relatively safe procedure. Enema before biopsy provides no clinically significant outcome advantage, and potentially increases patient cost and discomfort.

Adenocarcinoma↗
PubMed2001

Long-term treatment related complications of brachytherapy for early prostate cancer: a survey of patients previously treated.

PURPOSE: We determined long-term symptoms in patients after brachytherapy (radioactive seed implantation) for early (nonmetastatic) prostate cancer. MATERIALS AND METHODS: We performed a cross-sectional survey of 105 (80% of those contacted) men treated at least 2 years 9 months (median 5.2 years) previously with brachytherapy alone (72 patients) or brachytherapy plus external beam radiation therapy (33) at a pioneering referral center for ultrasound guided brachytherapy. RESULTS: Median patient age was 70 years at treatment and 75 years when surveyed. Bowel symptoms were uncommon (range 4% to 9%) unless patient had also received external beam radiation therapy. Urinary incontinence occurred in 45% of men, although leakage of more than a few drops, daily leakage and wearing absorptive pads occurred in 11%, 11% and 16%, respectively. Men who underwent documented transurethral prostatic resection were much more likely to report incontinence (83% versus 39%, p = 0.005) and those who underwent implantation less than 5 years earlier were less likely (33% versus 53%, respectively, p = 0.04). Complete impotence was common (50%) but impaired erections were more so (73%). Patients who received combined radiation treatment had more frequent erectile dysfunction. CONCLUSIONS: Long-term bowel symptoms are infrequent after brachytherapy alone. Urinary incontinence is common, although usually only a few drops and not daily. Erectile dysfunction, prevalent in populations of older men, was found in most men. However, because our study design precluded documenting baseline symptoms before treatment and subsequent clinical interventions, the contribution of factors other than brachytherapy is unclear. The morbidity of patients receiving more recent brachytherapy may be less.

Aged↗
PubMed2001

Prospective evaluation of the effects of prostatectomy on symptoms and quality of life.

AIMS: To evaluate prospectively urinary symptoms and quality of life before and after prostate surgery, among men who had been on a waiting list for elective transurethral prostate resection (TURP). METHODS: Face-to-face interviews with 47 men before and after prostate surgery using the urinary symptom specific American Urological Association Urinary Symptom Index (AUA-7), the Short Form 36 Health Survey (SF-36), and questions relating to the effects of urinary symptoms on men's lives and acceptable waiting times for surgery. RESULTS: The mean AUA-7 score before surgery for all participants was 22.2 (range 5-34) and after surgery improved to a mean of 7.3 (range 1-28). Men with severe urinary symptoms before surgery experienced the greatest improvement in symptoms after surgery, compared with the mild/moderate symptom group. Significant improvements occurred in three of the eight SF-36 dimensions following surgery. Acceptable waiting times for surgery differed according to the severity of mens' urinary symptoms. CONCLUSIONS: Efforts to develop methods for prioritisation of access to surgery are supported. Men with mild or moderate symptoms may reasonably delay surgery, with the expectation that, if they develop more severe symptoms, surgery will be helpful. Because of the risks as well as the benefits of prostate surgery, the use of illustrative vignettes may be useful for clinicians advising patients.

Activities of Daily Living↗
PubMed2002

Reliability and validity of the Malay version of the International Prostate Symptom Score in the Malaysian population.

PURPOSE: We validated the Malay version of the International Prostate Symptom Score in patients with and without urinary symptoms in the Malaysian population. MATERIALS AND METHODS: Validity and reliability were studied in patients with and without lower urinary tract symptoms. Reliability was evaluated using the test-retest method and internal consistency was assessed by Cronbach's alpha. Sensitivity to change was expressed as the effect size in the pre-intervention versus post-intervention score in additional patients with lower urinary tract symptoms who underwent transurethral prostate resection. RESULTS: Internal consistency was excellent. A high degree of internal consistency was observed for each of the 7 items and for the total score (Cronbach's alpha 0.53 and greater, and 0.68, respectively). The test-retest correlation coefficients of the 7 items were highly significant. The intraclass correlation coefficient was high at 0.51 and greater. There was a high degree of sensitivity and specificity to the effects of treatment. Significant change from baseline to posttreatment scores was observed in all 8 items in the treated but not in the control group. CONCLUSIONS: The Malay International Prostate Symptom Score is a suitable, reliable, valid instrument that is sensitive to clinical change in the Malaysian population.

Aged↗
PubMed2002

Hormone therapy for locally advanced prostate cancer.

PURPOSE: We assessed cause specific and all cause survival in men with locally advanced prostate cancer after hormone therapy. MATERIALS AND METHODS: Between February 1991 and November 2000, 208 men with locally advanced prostate cancer were treated with gonadal androgen ablation or gonadal androgen ablation and an antiandrogen at a single medical center. Median PSA was 46 ng./ml. (range 2 to 748). Median potential followup was 78 months (range 4 to 122) and the median observation period was 46 months (range 3 to 122). RESULTS: Of the patients 14 (7%) died of causes related to cancer and 71 (34%) died of competing co-morbid disease. Actuarial cause specific survival at 5 and 8 years was 92% and 80%, respectively. The only demographic or tumor related variable that influenced cause specific survival was Gleason score less than 8 versus 8 or greater (p = 0.02). Actuarial all cause survival at 5 and 8 years was 59% and 41%, respectively. The only variable that influenced all cause survival was a Charlson weighted co-morbidity score of less than 2 versus 2 or greater (p <0.0001). Major morbidity from the primary tumor, including bothersome obstructive voiding symptoms requiring transurethral prostate resection, ureteral obstruction or persistent hematuria, developed in 13 patients (6%), while major treatment related morbidity, including flutamide hepatotoxicity and hip fracture, developed in 4. CONCLUSIONS: Hormone therapy for locally advanced prostate cancer is associated with minimal morbidity from the primary tumor and from treatment. All cause survival parallels that reported for integrated hormone and radiation therapy.

Aged↗
PubMed2002

Relative bladder outlet obstruction.

PURPOSE: Currently bladder outlet obstruction in males is defined by the provisional International Continence Society nomogram which is partly based on expert opinion and partly on measurements before and after transurethral prostate resection. Recently there has been some interest in the development of a similar nomogram for females. MATERIALS AND METHODS: We studied the possibility of defining bladder outlet obstruction based on a sign that it causes, namely post-void residual urine. RESULTS: The probability of relative post-void residual urine exceeding 20% of bladder capacity was modeled in males and females using 1 parameter, that is URA/w20 or the ratio of the obstruction parameter urethral resistance factor (URA)-to-the bladder contractility parameter Watts factor at 20% (w20). URA/w20 represents relative bladder outlet resistance or bladder outlet resistance normalized to bladder contractility. Above a threshold of URA/w20 = 6.8 in females and 8.2 in males a relative post-void residual exceeding 20% was noted in 90% of measurements. These thresholds may be used to define relative obstruction. The provisional International Continence Society nomogram for obstruction in males was transformed into an identical nomogram for females by equating the probabilities of post-void residual urine in each gender. The latter differed from that in men, in that the lines demarcating the zones were horizontal or flow rate independent but the intercepts were approximately the same at 20 and 40 cm. water. CONCLUSIONS: Instead of defining obstruction as an absolute level of bladder outlet resistance we suggest that it is better to define it relatively, that is as a level of bladder outlet resistance that depends on bladder contractility.

Female↗
PubMed1976

The implantable artificial genitourinary sphincter in the management of total urinary incontinence.

The artificial genitourinary sphincter has been implanted in 31 patients with total urinary incontinence. Minor complications associated with implantation of this device were found to be mainly mechanical in origin, resulting in malfunction of the apparatus. Postoperative mechanical malfunction, however, was found to be correctable through a variety of secondary surgical procedures. Major complications, including infection around the prosthesis, vesical neck erosion, vesical-colic fistula, and urethral erosion, were generally associated with problems of cuff placement. In nearly all cases in which major complications occurred, it was ultimately necessary to remove the prosthesis. Overall results would indicate that patients with incontinence after transurethral prostatic resection in whom the inflatable cuff was placed around the vesical neck achieved the best results (70%). In this series of 31 patients, 68% had a normally functioning sphincter with complete correction of their urinary incontinence.

Animals↗
PubMed1992

Incidental lymphocytic prostatitis. Selective involvement with nonmalignant glands.

We documented the presence of lymphocytic prostatitis in all prostate specimens received over a 4-month period. Lymphocytic prostatitis was present in 44% of biopsy specimens (n = 77), 95% of transurethral prostatic resection specimens (n = 20), and 100% of total prostatectomy specimens (n = 9). The patchiness of the prostatitis within the prostate in part explains the lower prevalence in the biopsy specimens, which sample a much smaller portion of the gland compared with the other procedures. Lymphocytic prostatitis was seen in prostates both with and without adenocarcinoma. However, in specimens containing carcinoma, the lymphocytic aggregates rarely involved malignant glands. Instead, the aggregates were either stromal or involved nonmalignant glands either adjacent to or away from the tumor, including glands with hyperplasia, atrophy, and prostatic intraepithelial neoplasia. Even when malignant and nonmalignant glands were in close proximity, there was a sharp demarcation with respect to lymphocytic inflammation. Immunohistochemical staining with B-cell and T-cell markers disclosed that the vast majority are T lymphocytes. The localization of lymphoid aggregates to nonmalignant (including prostatic intraepithelial neoplasia) glands but not frankly neoplastic glands, suggests a selective escape of immune detection by neoplastic glands.

Adenocarcinoma↗
PubMed1992

[The intravascular transfer of glycine during percutaneous kidney surgery].

Transurethral prostatic resection using a 1.5% glycine solution causes a well known clinical and metabolic syndrome called TURP-syndrome. Recent development of percutaneous renal surgery is responsible of several similar accidents. In a prospective study of 150 patients (mean age: 35 +/- 10) subjected to a percutaneous nephrolithotomy, the natremia and the amino acid content of the plasma were measured preoperatively and immediately postoperatively by chromatography. The study shows that there is a post-nephrolithotomy syndrome in two per cent. This syndrome contains a hemodilution with hyponatremia and reabsorption of irrigation fluid. Glycolemia, serinemia and threoninemia increase significantly. These modifications have a good correlation between them except for the natremia. Variability of results in this study and in the literature is explained by difficulty and duration of surgery, volume of glycol used, increasing intrarenal pressures and sudden opening of vessels peroperatively. The gravity of post-nephrolithotomy syndrome requires to change the irrigate solute and use normal saline solution when it is possible.

Adolescent↗
PubMed2003

[Bladder calculi. Is extracorporeal shock wave lithotripsy the first choice treatment?].

OBJECTIVES: To evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) treatment of bladder stones using a retrospective study. METHODS: Between February 1991 and June 2002, 45 patients with bladder stones were treated (41 males and 4 females). Age ranged from 23 to 87 years. 63% had previous renal-ureteral lithiasis and 29% had undergone upper urinary tract ESWL. We used the Storz Modulith SL 10/SL 20. Treatments were performed using intravenous analgesia on an outpatient basis. RESULTS: 83 sessions of ESWL were performed on 53 stones. Complete fragmentation and elimination was achieved in 55% of the patients after a single session, 26.7% of the patients after 2 sessions, 6.7% after 3 sessions, 8.8% four, and 2.2% five. Mean number of shock waves was 3196.3 with an average 7-8 Kv. 8.5% had stone recurrence due to residual lithiasis, whereas 79% achieved total elimination. 13% required endoscopic procedures to evacuate stone fragments impacted in urethra. 6.6% required transurethral prostatic resection after ESWL. CONCLUSIONS: ESWL therapy is an effective option for the treatment of patients with bladder stones, non invasive, with low morbidity, without need for anesthesia, and outpatient. The effectiveness is high (79% of the patients stone free) and even higher when treating smaller stones.

Adult↗
PubMed2004

Management of hyponatremia.

Hyponatremia is an important electrolyte abnormality with the potential for significant morbidity and mortality. Common causes include medications and the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Hyponatremia can be classified according to the volume status of the patient as hypovolemic, hypervolemic, or euvolemic. Hypervolemic hyponatremia may be caused by congestive heart failure, liver cirrhosis, and renal disease. Differentiating between euvolemia and hypovolemia can be clinically difficult, but a useful investigative aid is measurement of plasma osmolality. Hyponatremia with a high plasma osmolality is caused by hyperglycemia, while a normal plasma osmolality indicates pseudohyponatremia or the post-transurethral prostatic resection syndrome. The urinary sodium concentration helps in diagnosing patients with low plasma osmolality. High urinary sodium concentration in the presence of low plasma osmolality can be caused by renal disorders, endocrine deficiencies, reset osmostat syndrome, SIADH, and medications. Low urinary sodium concentration is caused by severe burns, gastrointestinal losses, and acute water overload. Management includes instituting immediate treatment in patients with acute severe hyponatremia because of the risk of cerebral edema and hyponatremic encephalopathy. In patients with chronic hyponatremia, fluid restriction is the mainstay of treatment, with demeclocycline therapy reserved for use in persistent cases. Rapid correction should be avoided to reduce the risk of central pontine myelinolysis. Loop diuretics are useful in managing edematous hyponatremic states and chronic SIADH. In all instances, identifying the cause of hyponatremia remains an integral part of the treatment plan.

Algorithms↗
PubMed2005

[A case of an asynchronic triple tumorous disorder: a rectal adenocarcinoma, a carcinoma of the kidney and a prostatic adenocarcinoma--case report].

The authors describe occurence asynchronic tumor triplicity. In the year 1980 in 56 years old patient had histologically proven rectal adenocarcinoma and consequently was done radical Miles amputation of rectum. In December 1991 in the same patient was histologically proven well differentiated adenocarcinoma of prostate after transurethral resection of prostate. Prostate cancer was threated bilateral orchiectomy (March 1992) and consequently from April to June 1992 was done small-volume irradiation of pelvic by Betatron X-ray, box technique with dosage 70 Gy. In November 1992 there was done radical transperitoneal nephrectomy on right side for renal carcinoma. Histologically was proven moderately differentiated clear cell renal carcinoma. In August 1994 was found suspected pulmonary metastases, wich was proof on CT in the January 1995. Therapy was Imodin, Wobenzym, Vinblastin. Patient was died of generalisation renal cancer in the February 1998. The carcinoma of prostate and rectum wasn't found in the autopsy. The authors emphasize pertinence radical surgical access incuding multiplex malignant tumors and consider to carry out oncology screening in the all of patients with proven malignant tumor.

Adenocarcinoma↗
PubMed1990

Principles and clinical application of advanced urodynamic analysis of voiding function.

There are no reliable, sensitive, and specific clinical measures or symptoms from which to judge the severity of prostatic outflow obstruction. Urodynamics has developed the methodology for analyzing and measuring the mechanics of urinary tract voiding function in detail. There is a consensus in the urodynamic research community about realistic models of detrusor muscle mechanics and bladder outlet hydrodynamics, as is reflected in the very similar concepts proposed for clinical application. The pressure-flow diagram offers a simple graphical procedure for detailed assessment of the individual voiding balance. Most clinically relevant is the specific characterization of outlet function, because detrusor contraction strength cannot be pharmacologically influenced. It is difficult to accept that the best way to measure "prostatic obstruction" is symptom assessment rather than urodynamic measurement of the clearly mechanical entity "outlet obstruction". Urodynamics has evolved into scientifically accurate and specific techniques for voiding analysis. It is unreasonably to continue to use terms such as "outflow obstruction" or "weak detrusor" and all their synonyms in an undefined, speculative way. If we maintain that the clinical relevance of BPH is entirely related to outflow obstruction, then we must demonstrate obstruction objectively before surgery. If we aim at the treatment of symptoms alone, then we must become more specific in terminology and demonstrate that transurethral prostatic resection is indeed the optimum therapy for unobstructed symptomatic patients with BPH. Similarly, we must use the advanced urodynamic concepts to investigate the efficacy of newly suggested alternatives to resection such as prostatic balloon dilatation or pharmacologic therapy.

Humans↗
PubMed1992

Acid-base status following glycine absorption in transurethral surgery.

Forty patients were studied at precisely timed 10 min intervals during transurethral prostatic resection under epidural analgesia. Blood gases, serum sodium, and volumetric irrigating-fluid balance were measured. A decrease in the serum sodium level of less than 5 mmol litre-1 was recorded in 28 patients (the 'normal TUR' group). In 12 patients, the decrease was 5 mmol litre-1 or more, which corresponded to an average absorption of irrigant of 1 litre of 2.2% glycine solution (range 0.6-2.9; the 'absorption' group). Mild metabolic acidosis often developed during the operations, but this was of similar degree in the two groups. It was concluded that uptake of irrigating fluid containing glycine does not alter the acid-base status so long as the TUR syndrome does not develop.

Absorption↗
PubMed1990

[Transrectal echography of the prostate and its value in screening for prostatic carcinoma].

In order to assess the value of ultrasonography in the diagnosis of prostatic carcinoma we investigated 130 men, above the age of 50, with both ultrasound and rectal examination in a prospective study. Both investigations were performed independently from each other. When either ultrasonography or rectal examination indicated the presence of malignancy a transrectal prostatic biopsy was performed. Biopsies were taken in 72 (55%) patients. In 33 (46%) of these a carcinoma was diagnosed after histologic examination. Additional histological diagnostic data were obtained on 22 patients on whom a transurethral prostatic resection or open prostatectomy was performed. In 70% ultrasonography and rectal examination gave identical results with respect to diagnosis of carcinoma. Ten out of 33 carcinomas were detected by either ultrasound alone (n = 6) or rectal examination alone (n = 4). The advantages of ultrasound investigation include detection of non-palpable tumors, more correct staging and improved technique of ultrasound guided biopsy.

Aged↗
PubMed1985

Intraoperative anesthetic consultation.

This article deals with consultation between anesthesiologists and urologic surgeons. Some of the subjects discussed represent problems that occur commonly, such as cardiac arrhythmias and intraoperative hypertension. Other subjects, though representing less common problems, have much more serious consequences and thus should be brought to the attention of surgeons. This latter group includes malignant hyperthermia, hyponatremia during transurethral prostatic resection, and cardiac arrest.

Anesthesiology↗
PubMedDate not supplied

Preoperative mini-heparin, prostatectomy and clinical pulmonary thromboembolism.

From February 1973 through May 1977, a selected group of 131 patients undergoing prostatectomy were given preoperative mini-heparin 6--8 hours prior to surgery. There were 17 retropubic prostatectomies, 1 subtotal suprapubic prostatectomy and 113 transurethral prostatic resections. Patients ages ranged from 35 to 108 years. There were 109 cases of benign prostatic hyperplasia, 13 cases of adenocarcinoma of the prostate and 9 cases of benign prostatic hyperplasia with foci of adenocarcinoma. There was one death from massive pulmonary thromboembolism and one case of non-fatal pulmonary thromboembolism. A retrospective review of 416 prostatectomies performed during the same period of time at the same hospital, in which mini-heparin was not administered preoperatively, revealed only one case of non-fatal pulmonary thromboembolism. Our study indicates that this preoperative mini-heparin regime did not effectively reduce the morbidity and mortality associated with clinical postoperative thromboembolic phenomena. There were no important side effects, such as prolonged bleeding or drug intolerance, associated with the administration of preoperative mini-heparin.

Adenocarcinoma↗