Evaluation of prostaglandin E2 and E-series prostaglandin receptor in patients with interstitial cystitis.

PURPOSE: We evaluated PGE2 and EP receptor in patients with interstitial cystitis. MATERIALS AND METHODS: Enrolled in the study were 20 female patients with interstitial cystitis (11 with and 9 without Hunner lesions), 9 female controls with another urological disease who needed a cystoscopic procedure and 10 normal volunteers. In all participants we determined O'Leary-Sant symptom and problem scores, and obtained voluntary urine specimens for PGE2 analysis. Using anesthesia the bladder was distended by saline in stepwise fashion from 100 ml to maximum capacity in patients with interstitial cystitis. Each time the infused saline was retrieved for PGE2 analysis. We also measured PGE2 and the expression of EP receptor mRNA in bladder biopsy tissue in patients with interstitial cystitis. RESULTS: Symptom and problem indexes in patients with interstitial cystitis and Hunner lesions were significantly higher than in patients with interstitial cystitis without Hunner lesions. Urinary PGE2 in patients with interstitial cystitis and Hunner lesions was significantly higher than in patients with interstitial cystitis without lesions, controls and normal volunteers. PGE2 in retrieved saline in patients with interstitial cystitis and Hunner lesions increased depending on infusion volume but not in patients with interstitial cystitis without lesions. PGE2 content in bladder biopsy tissue was significantly higher in patients with interstitial cystitis and Hunner lesions than in controls. In patients with interstitial cystitis and Hunner lesions the expression of EP1 and EP2 mRNA was significantly higher than in controls. CONCLUSIONS: Our study showed increased PGE2 production and mRNA expression of EP1 and EP2 receptors in the bladder in patients with interstitial cystitis and Hunner lesions. Further studies are warranted to explore the pathophysiological and therapeutic implications.

[Transrectal biopsy of the prostate for the detection of non-palpable prostate cancer: a comparison of 6 versus 12 core biopsy].

PURPOSE: Several studies suggest that extended transrectal prostate biopsy more than 6 core may improve the cancer detection rate. We compared 6 and 12 core biopsies to determine the impact on cancer detection and complication rate. PATIENTS AND METHODS: We retrospectively evaluated 150 patients who underwent transrectal ultrasound guided prostate biopsy between January 1999 and December 2003. Patients who were suspected to have prostate cancer on digital rectal examination and/or who had a history of previous prostate biopsy were excluded. Sextant biopsy was performed in 52 patients (6 core group) and 12 core biopsy was performed in 98 patients (12 core group). The cancer detection rate and post-biopsy complication rate were estimated. RESULTS: There was no significant difference in the overall cancer detection rate between 6 and 12 core groups (17 of 52 men or 32.7% versus 35 of 98 men or 35.7%). In addition, even if calculated the cancer detection rate stratified according to a PSA of 0 to 4.0, 4.1 to 10.0 and greater than 10.0 ng/ml, there was no significant difference between both groups. There was also insignificant difference of complication rate between both groups. CONCLUSIONS: The results of our study showed that there was no significant difference in cancer detection and complication rate between both groups.

An alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate glutamate-receptor antagonist can inhibit premicturition contractions in rats with bladder outlet obstruction.

OBJECTIVE: To explore the possible involvement of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA) glutamate-receptors in bladder dysfunction associated with bladder outlet obstruction (BOO), as detrusor overactivity (DO) is common in men with benign prostatic hyperplasia. MATERIALS AND METHODS: Proposed mechanisms of DO include the myogenic or neurogenic theory, and the autonomous bladder hypothesis. In rats, BOO produces premicturition contractions (PMCs) that are assumed to be a consequence of inappropriate non-micturition activity during the filling phase. Using pharmacology, we explored the cause of PMCs to provide new insights into DO in humans. BOO was created in female Wistar rats; 6 weeks after obstruction we evaluated them using conscious-filling cystometry. A specific AMPA receptor antagonist, 1-(4'-aminophenyl)- 3,5-dihydro-7,8-dimethoxy-4H-2,3-benzodiazepin-4-one (CFM-2) was administered intravenously (i.v.) (0.003-3 mg/kg) or intrathecally (i.t.) (0.01-10 microg). RESULTS: The i.v. administration of CFM-2 in rats with BOO significantly decreased the threshold pressure and micturition pressure. The most remarkable findings were that i.v. administration of CFM-2 in rats with BOO significantly and dose-dependently decreased the amplitude and number of PMCs. The highest dose of CFM-2 almost completely eliminated PMCs. The i.t. administration of CFM-2 had no significant effect on PMCs. CONCLUSION: AMPA receptors have never been suggested as a neural mechanism of bladder dysfunction associated with BOO. Although PMCs in rats with BOO have been assumed to be mainly of myogenic origin, PMCs were suppressed by the i.v. administration of CFM-2. Thus, we think that PMCs have neurogenic components that are linked with AMPA receptors. In the present study, i.v. but not i.t. administration of CFM-2 suppressed PMCs, suggesting peripheral and/or supraspinal sites of inhibitory action of CFM-2 on PMCs.

Long-term patient reported outcome of urinary symptoms after hypospadias surgery: norm related study in adolescents.

PURPOSE: Although there are some reports of the functional outcome after hypospadias surgery, long-term patient reported data on urinary symptoms are sparse. We evaluated the long-term outcome of urinary control in patients with hypospadias who were operated in childhood. MATERIALS AND METHODS: A detailed questionnaire was mailed to 33 patients with hypospadias who were between 18 and 26 years old and had undergone the first operation at age 6 years or younger, and to 50 age matched controls. RESULTS: A total of 22 patients (66.7%) and 38 controls (76.0%) returned the questionnaire. Mean age was 20.6 years in the hypospadias group and 21.0 years in the control group. Of the 22 patients 8 had mild and 11 had severe hypospadias, while severity was unknown in 3. Straight direction of the urinary stream was noted at a similar rate in the hypospadias and control groups (77% and 71%, respectively). Regarding the urinary stream, no subjects in either group reported it as bad or very bad. Of the hypospadias group 95% of subjects and 89% of controls reported mild or no urinary frequency bother. The incidence of individuals who always or mainly voided while standing was similar in the hypospadias and control groups (91% and 84%, respectively). However, 32% of subjects in the hypospadias group reported moderate or severe terminal dribbling, in contrast to only 3% of controls. When subjects with mild and severe hypospadias were compared, 4 of 11 (36%) with severe hypospadias needed to squeeze the urethra after voiding to eliminate residual urine in the urethra, whereas none with mild hypospadias needed to squeeze the urethra. CONCLUSIONS: Although patients with hypospadias mostly have good urinary control, terminal dribbling is not uncommon, especially in those with severe hypospadias.

Long-term cosmetic and sexual outcome of hypospadias surgery: norm related study in adolescence.

PURPOSE: Even if performed early in life, hypospadias surgery may have a significant impact on self-esteem and sexual behavior in adolescence. We evaluated the long-term cosmetic and sexual outcomes of hypospadias surgery performed in childhood. MATERIALS AND METHODS: A detailed questionnaire was mailed to 33 patients with hypospadias who were 18 to 26 years old and had undergone the first operation at age 6 years or younger. It was also mailed to 50 age matched controls. RESULTS: A total of 22 patients (66.7%) and 38 controls (76.0%) returned the questionnaire. Mean age in the hypospadias and control groups was 20.6 and 21.0 years, respectively. Eight of the 22 patients had mild hypospadias and 11 had severe hypospadias. Severity was unknown in 3 patients. Age at the first and final operations was 31 to 75 (mean 46) and 35 to 81 months (mean 53). The number of operation was 1 in 10 patients, 2 in 10 and 3 in 2. The rate of dissatisfaction with penile appearance was slightly higher in the hypospadias group than in the control group (40.9% vs 34.2%). The single reason for dissatisfaction in the hypospadias group was inadequate penile size, whereas in the control group penile size, phimosis and curvature were the major reasons for dissatisfaction (69.2%, 46.2% and 23.1%, respectively). Experience with masturbation (100% and 97.4%) and sexual intercourse (52.4% and 55.3%), and mean age at first masturbation (13.4 and 13.0 years) and first sexual intercourse (16.6 and 17.3 years) were similar in the hypospadias and control groups, respectively. CONCLUSIONS: Although patients with hypospadias had a slightly higher rate of dissatisfaction with penile size, their sexual behavior was not different from that in control subjects.

Laparoscopic removal of a retroperitoneal extralobar pulmonary sequestration in an adult.

A 41-year-old male patient presented with dull left flank pain. A computed tomography (CT) showed a subdiaphragmatic retroperitoneal extra-adrenal mass. A magnetic resonance image demonstrated it was hypointense on T1 weighted and hyperintense on T2. Serum analyses for adrenal hormones revealed no abnormality. [I131]metaiodo-benzylguanidene scintigraphy showed no abnormal uptake. The patient underwent laparoscopic removal to manage the symptoms and to make a pathological diagnosis, which was an extralobar pulmonary sequestration. Another congenital lung malformation was not detected on chest CT scan. The symptom was relieved postoperatively.

Brain activation during detrusor overactivity in patients with Parkinson's disease: a positron emission tomography study.

PURPOSE: Patients with Parkinson's disease often have urine storage symptoms, such as urinary urgency, frequency and incontinence, which are induced by detrusor overactivity. However, little is known of the mechanisms inducing detrusor overactivity in this disease. We have previously examined the human brain response to bladder filling in healthy male volunteers using positron emission tomography. We hypothesized that brain activation patterns in response to bladder filling would be different in patients with Parkinson's disease. MATERIALS AND METHODS: Nine male patients with Parkinson's disease were catheterized via the urethra for bladder filling and intravesical pressure monitoring. We performed positron emission tomography, consisting of tasks 1 and 2. For task 1 the bladder was maintained empty via the urethral catheter. For task 2 room temperature water was dripped for bladder filling until the onset of detrusor overactivity. Data acquisition for task 2 was done during detrusor overactivity. Data on each scan were summed on a computer and further analyzed using a statistical parametric mapping procedure. RESULTS: Significant brain activation during detrusor overactivity was found in the periaqueductal gray, supplementary motor area, cerebellar vermis, insula, putamen and thalamus. The most prominent activation was found in the cerebellum. The pons was not activated during detrusor overactivity. CONCLUSIONS: Alteration in brain activation sites in response to bladder filling may be related to the pathophysiology of detrusor overactivity in patients with Parkinson's disease.

Differences in tumor core distribution between palpable and nonpalpable prostate tumors in patients diagnosed using extensive transperineal ultrasound-guided template prostate biopsy.

BACKGROUND: The authors performed extensive transperineal ultrasound-guided template prostate biopsies to investigate carcinoma core distribution. METHODS: Between August 2000 and May 2004, 371 men underwent template biopsies. Three hundred twelve patients had not undergone a previous biopsy (first group) and 59 had undergone previous transrectal sextant biopsies (repeat group). Of the 312 patients in the first group, 236 had normal digital rectal examination (DRE) findings (DRE- first group) and 76 patients had an abnormal DRE (DRE+ first group). A mean of 20.1 biopsy cores (range, 9-38 cores) was taken from the entire prostate. The region > 2.0 cm from the rectal face of the prostate was defined as the anterior region and the remaining area was defined as the posterior region. RESULTS: In the DRE- first group, the carcinoma core rate (number of tumor cores/number of biopsy cores) in the anterior region (7.2%) did not differ from that of the posterior region (7.3%) (P = 0.9635). However, in the DRE+ first group, the carcinoma core rate in the posterior region (22.0%) was found to be higher than in the anterior region (13.2%) (P < 0.0001). In the repeat group, the carcinoma core rate in the posterior region (3.1%) was significantly (P = 0.0008) lower than that exhibited in the anterior region (7.2%). CONCLUSIONS: The results of the current study suggest that nonpalpable prostate carcinoma is distributed equally within the entire prostate, although palpable carcinoma is distributed mainly in the posterior region and many of the tumor foci in the anterior region may be missed by a transrectal sextant biopsy. The examination of radical prostatectomy specimens is required to prove these results.

Difference of cancer core distribution between first and repeat biopsy: In patients diagnosed by extensive transperineal ultrasound guided template prostate biopsy.

BACKGROUND: We performed extensive transperineal ultrasound guided template prostate biopsy and evaluated cancer core distribution. METHODS: From August 2000 to May 2002, 113 men with prostate specific antigen levels between 4.0 and 10.0 ng/ml underwent template biopsy. Eighty-six had no previous biopsy (first group) and 27 had previous transrectal sextant biopsies (repeat group). A mean of 18.4 biopsy cores were taken. We defined the region over 2 cm from the rectal face of the prostate as the anterior region and the other as the posterior. RESULTS: Cancer was detected in 49 of 113 (43%) men. Forty-two were in the first group and seven in the repeat group. In the first group, the cancer core rate (cancer core number/biopsy core number) in the anterior region (7.0%) had no difference from that in the posterior region (8.6%) (P = 0.7111). But in the repeat group, the cancer core rate in the anterior region (4.6%) was higher than in the posterior (1.5%) (P < 0.0001). CONCLUSIONS: These results suggest that transrectal sextant biopsies miss more cancers in the anterior region than in the posterior. We believe template technique has an advantage to be able to detect cancer equally in the anterior and posterior.