Treatment of malakoplakia with trimethoprim-sulfamethoxazole.

A case is described of malakoplakia involving the urinary tract and retroperitoneum with recalcitrant infection due to Escherichia coli which was not responsive to seemingly appropriate antibiotics and surgery for drainage, but which subsequently responded to treatment with trimethoprim-sulfamethoxazole. It is speculated that this drug combination may be helpful because of the ability of trimethoprim to enhance the killing of viable undigested microorganisms inside malakoplakic macrophages.

Survival with localized carcinoma: radical prostatectomy vs radiation therapy.

The charts of all patients receiving radical surgery and radiation therapy for cancer localized to the prostate in the years 1950 to 1977 in the State of Connecticut were reviewed. Long-term survival rates at ten and fifteen years were considerably better in those patients treated with radical surgery.

Assessment of the feasibility and impact of shared decision making in prostate cancer.

OBJECTIVES: To assess the feasibility and patient impact of using standardized video presentations concerning alternative treatments for managing localized prostate cancer. METHODS: One hundred eleven men with newly diagnosed localized prostate cancer were shown a video tape concerning the risks and benefits of four treatment options: radical surgery, external beam radiation, hormonal therapy, and watchful waiting. The impact of the video presentation was assessed using a questionnaire completed by the patient before and after viewing the video and again following a discussion with his treating physician. RESULTS: Patients demonstrated significant increases in their understanding of treatment options to manage prostate cancer after viewing the video presentation. Treating physicians confirmed the increased sophistication of their patients' knowledge of their disease and the potential outcomes associated with alternative treatments. CONCLUSIONS: Standardized video presentations of treatment alternatives for prostate cancer can be incorporated into busy office practices. Both patients and physicians benefit from the increased level of understanding that allows physician/patient discussions to focus on the critical risk/benefit tradeoffs rather than simply describing treatment alternatives.

Improved pump placement with infrapubic penile prosthetic implantation.

A common problem with implantation of an inflatable penile prosthesis is inadequate placement and/or fixation of the pump mechanism. We report on a total of 45 of our most recent patients who underwent penile prosthesis implantation for erectile dysfunction. In all cases the implants were placed with an infrapubic approach in conjunction with a penoscrotal counterincision for improved pump placement and fixation. One patient (2.2%) had an infectious complication requiring revision. When we compared this infection rate with the infectious complication rates reported in the literature, we found that adding a penoscrotal counterincision did not increase the risk of infectious complication to the patient.

Pyelolithotomy of a renal transplant.

A large calculus developed in a renal transplant patient and was removed by pyelolithotomy. Hyperparathyroidism was not present. Important factors to consider before performing a nephrolithotomy in a transplanted kidney are whether the transplant was a right or left kidney and the timing of the operation in relation to renal function and infection. The etiology for renal stone formation in renal transplant recipients includes hyercalciuria, renal tubular acidosis, antacid administration and infection.