A three-centre experience of orthotopic neobladder reconstruction after radical cystectomy: revisiting the initial experience, and results in 104 patients.

OBJECTIVE: To assess, in a retrospective three-centre series, a second analysis of the initial experience and results of patients undergoing radical cystectomy (RC) and orthotopic neobladder reconstruction (ONR) after an additional 4 years of follow-up. PATIENTS AND METHODS: The medical records of 104 suitable consecutive patients undergoing RC and ONR between June 1994 and April 2003 were reviewed retrospectively. The complications, mortality, continence and cancer control rates were all recorded. RESULTS: The median (range) follow-up was 88 (52-156) months; 90 patients had reconstruction with a 'Studer' neobladder, 12 with a Hautmann W pouch and 2 with a 'T pouch' ileal neobladder. There were 24 early complications, and one death after surgery. There were 32 late complications. The daytime continence rate was 98% and the nocturnal continence rate was 76%. Ten patients required intermittent self-catheterization (ISC). In all, 30 patients had local and/or distant recurrences, all of whom died. Seven patients died from other causes. CONCLUSIONS: ONR provides excellent long-term continence rates and both acceptable complication and mortality rates. Suitable patients undergoing RC should be offered ONR.

Brachytherapy for prostate cancer: is the pretreatment prostate volume important?

OBJECTIVE: To prospectively determine the effect of prostate volume on lower urinary tract symptoms (LUTS) in terms of changes in the International Prostate Symptom Score (IPSS), and to determine whether prostate volume affects the retention rate after brachytherapy, as there is concern that patients with larger prostates might develop more troublesome LUTS after brachytherapy. PATIENTS AND METHODS: We prospectively identified 100 consecutive patients who had brachytherapy for prostate cancer, using a real-time three-dimensional seed implantation technique, at one institution. At each follow-up review the IPSS was recorded. To determine the effect of prostate volume on the IPSS after treatment the patients were divided into two groups according to prostate volume at brachytherapy (<50 and >or=50 mL). RESULTS: The median patient age was 62 years, the overall median prostate volume was 42 mL and the median intraoperative D90 was 190 Gy. The pretreatment IPSS was 4 and 8 for the <50 and >or=50 mL groups, respectively, and at 3 months after brachytherapy the median IPSS increased to 18 and 20 for the two groups, respectively. Eleven patients went into acute retention of urine after brachytherapy (six in the >or=50 mL group). CONCLUSIONS: This study shows that patients with prostates of >or=50 mL have an IPSS comparable with those who have prostates of <50 mL. Large prostates should not be considered an exclusion criterion when an intraoperative planning technique is used for brachytherapy.

Buerger's disease presenting as a testicular mass: A rare presentation of an uncommon disease.

Thromboangiitis obliterans is an uncommon nonatherosclerotic segmental inflammatory disease that predominantly affects the small and medium-sized arteries and veins of the distal extremities. It was first described in 1879 and is also known as Buerger's disease. Buerger's usually begins with ischemia of small vessels producing digital infarcts and may progress to more proximal arteries and veins, producing claudication of the feet, legs, hands, or arms. Tobacco smoking is essential to the initiation and the progression of disease and it typically occurs in males under the age of 45 years. Although Buerger's most commonly affects the arms, hands, legs, and feet, it has also been reported in other vascular beds including cerebral, coronary, renal, mesenteric, and pulmonary arteries. There are also a small number of cases involving the male genitalia. To our knowledge, there has only been one English case of Buerger's involving the testis, published in 1940. Here, we present a new case of Buerger's presenting as a testicular mass in a 17-year-old cannabis smoker.

The effect of nephroureterectomy on glomerular filtration rate.

OBJECTIVE: To determine the effect of nephroureterectomy (NU) on the glomerular filtration rate (GFR), and to determine whether the estimated GFR after NU is influenced by age and other factors associated with renal impairment. PATIENTS AND METHODS: We retrospectively identified 131 patients who had had a NU at either of two UK institutions. Their serum creatinine levels were recorded before and after NU, along with comorbidity data, and from this their GFR before and after NU was estimated using the Modification of Diet in Renal Disease Study Group equation. RESULTS: At a median follow-up of 5 years there was an 18% deterioration in estimated GFR in the 131 patients. The percentage deterioration in estimated GFR was greater in those aged >or= 70 years than in those aged <70 years (20% vs 15% deterioration). Those with more risk factors for renal impairment had a greater percentage deterioration in estimated GFR than those with no such risk factors. CONCLUSIONS: This study shows that NU has a profound effect on future estimated GFR, an effect that is further compounded in those with risk factors for renal impairment. This study therefore provides both the patient and the urologist with an idea of potential future renal function after NU and contributes greatly to preoperative counselling.

A three-centre experience of orthotopic neobladder reconstruction after radical cystectomy: initial results.

OBJECTIVE: To assess, in a retrospective three-centre series, the initial experience and results of patients undergoing radical cystectomy and orthotopic neobladder reconstruction. PATIENTS AND METHODS: The medical records were retrospectively reviewed for 104 suitable consecutive patients undergoing radical cystectomy and orthotopic neobladder reconstruction between June 1994 and April 2003. The initial histology, operating times, transfusion rates, complications, mortality rates, continence rates, potency rates, and cancer control rates were recorded. RESULTS: The median (range) follow-up was 48 (6-113) months; 90 patients had a reconstruction with a 'Studer' neobladder, 12 with a 'Hautmann W pouch' and two with a 'T pouch' ileal neobladder. There were 24 early complications, and in eight patients re-operation was required; there was one death after surgery. There were 14 late complications and 10 patients required re-operation. The daytime continence rate was 99% and the nocturnal continence rate 78%. Five patients required intermittent self-catheterization. Twenty-two patients died from local and/or distant recurrences, and four from other causes. CONCLUSIONS: Orthotopic neobladder reconstruction provides excellent continence rates, and both acceptable complication and mortality rates. Suitable patients undergoing radical cystectomy should be offered orthotopic neobladder reconstruction.