Concomitant transrectal ultrasound-guided biopsy and transurethral resection of prostate in patients with urinary retention and elevated serum prostate-specific antigen levels.

BACKGROUND: There was no consensus about the management of patients with urinary retention and elevated serum prostate-specific antigen (PSA) levels. This study aimed to determine whether concomitant transrectal ultrasound (TRUS)-guided biopsy and transurethral resection of prostate (TURP) is practical in patients with urinary retention and elevated serum PSA levels. METHODS: From March 2007 to May 2015, a total of 34 patients with urinary retention and elevated PSA (≥ 4 ng/mL) underwent concomitant TRUS-guided biopsy and TURP. The medical records were evaluated retrospectively, and data including PSA, prostate volume, TURP results, TRUS-guided biopsy results, length of hospitalization, and complications were collected. These patients were then compared with 40 patients with urinary retention who underwent TURP alone. RESULTS: The mean age of the patients was 71.6 years. The mean PSA levels were 16.9 ng/mL. Prostate cancer was detected in eight cases (23.5%): one case by TRUS-guided biopsy alone, two cases by TURP alone, and five cases by both TRUS-guided biopsy and TURP. Complications included fever in five patients (14.7%), recatheterization for urine retention in two patients (5.9%), urinary tract infection in two patients (5.9%), and de novo urge incontinence in seven patients (20.6%). The complication rate was not significantly increased compared with that of the patients who underwent TURP alone. CONCLUSION: This study showed that concomitant TRUS-guided biopsy and TURP was safe and of possible clinical significance in urinary retention patients with elevated serum PSA.

Primary prostatic Wilms' tumor: a case report.

BACKGROUND: Extrarenal Wilms' tumors (EWTs) are very rare, and a single case of prostatic EWT has been reported in the English-language literature. CASE: A 46-year-old man presenting with lower urinary tract symptoms was diagnosed with a prostatic tumor histologically proven to be a EWT. CONCLUSION: During the evaluation of a patient with a prostatic tumor, more common prostatic neoplasms such as adenocarcinoma, transitional cell carcinoma and carcinosarcoma must first be considered. However, the presence of a primary prostatic Wilms' tumor must also be taken into consideration.

Ureteral carcinoid tumor.

Most ureteral tumors are transitional cell neoplasms. Neuroendocrine tumors of the genitourinary tract are extremely rare. To our knowledge, only one ureteral carcinoid tumor has been reported before. We report a second case of ureteral carcinoid tumor found in a 70-year-old female.

Ureteroscopic management of sepsis associated with ureteral stone impaction: is it still contraindicated?

INTRODUCTION: Retrograde decompression is generally not advocated for patients with sepsis owing to ureteral obstruction by stone impaction, and the initial treatment of choice is percutaneous nephrostomy (PCN). We report our experience with the treatment of urosepsis with retrograde ureteroscopy (URS) instead of PCN drainage. PATIENTS AND METHODS: Fifty-six consecutive patients diagnosed with ureteral stone-related sepsis received URS as primary treatment at our institution. Patients with uncontrollable sepsis underwent emergent URS and hemodynamically stable patients underwent elective URS within two days of diagnosis. RESULTS: URS was successful in 53 (94.6%) of the 56 patients. PCN was performed in the 3 cases of URS failure. Internal ureteral stenting was performed in 48 patients. Secondary procedures were performed in 10 (18.9%) patients. Twenty-six patients suffered from postoperative fever for an average of 1.6 days (range 1-4 days). There were no anesthesia-related morbidities, postoperative exacerbations of the clinical condition, or postoperative deaths. The median length of hospital stay was 7 days (range 3-94 days). CONCLUSION: PCN drainage is the standard treatment of sepsis associated with ureteral stone obstruction. However, our results show that URS can be safely and successfully performed by skilled endourologists in select clinical situations.

Gyrus plasmasect: is it better than monopolar transurethral resection of prostate?

INTRODUCTION: This randomized prospective study was conducted to compare the efficacy and safety of the Gyrus Plasmasect loop bipolar transurethral resection of prostate (TURP) and conventional monopolar TURP in the treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 117 men were enrolled in this study. Fifty-eight patients underwent Gyrus Plasmasect TURP and 59 patients underwent monopolar TURP. They were followed up for 3 months after surgery. RESULTS: Significant improvements were seen postoperatively in both the Gyrus and monopolar groups in terms of prostatic volume, International Prostate Symptom Score, quality of life score, peak flow rate, and post-void residual urine volume. However, the degree of improvement was not statistically different between the 2 groups. Significantly less blood loss, shorter postoperative catheterization time and length of hospital stay were seen in the Gyrus group. CONCLUSIONS: Gyrus Plasmasect TURP yielded comparable results to monopolar TURP; however, this is only a preliminary study and follow-up is necessary to assess its long-term efficacy.

Stimulatory effect of cinnamic acid analogues on alpha1A-adrenoceptors in-vitro.

We have characterized the effects of cinnamic acid and its derivatives on alpha(1)-adrenoceptor subtypes. The cinnamic acid with a methoxyl group and/or a hydroxyl group showed the ability to stimulate radioactive glucose uptake into C(2)C(12) cells, a cell line that specifically expresses the alpha(1A)-adrenoceptor subtype of alpha(1)-adrenoceptors. However, cinnamic acid without chemical modification diminished the glucose uptake into C(2)C(12) cells. It was shown that methoxylation and/or hydroxylation of cinnamic acid had higher affinities for alpha(1A)-adrenoceptors investigated using [(3)H]prazosin binding experiments in C(2)C(12) cells. The effect of these derivatives on alpha(1A)-adrenoceptors was further characterized using the displacement of [(3)H]prazosin binding in rat prostate. We found that 3,5-dimethoxy-4- hydroxycinnamic acid, the cinnamic acid derivative with two methoxyl groups and hydroxylation at the fourth carbon on the benzene ring, had a higher affinity for the alpha(1A)-adrenoceptor subtype, showing a smaller IC50 value (the concentration for production of 50% inhibition) to displace [(3)H]prazosin binding in rat prostate. Affinity of these compounds for alpha(1B)-adrenoceptors was identified using [(3)H]prazosin-binding experiments in rat spleen. However, we found no marked differences in the IC50 values between these cinnamic acid analogues to displace the [(3)H]prazosin binding in rat spleen. In conclusion, our data indicated that methoxylation and/or hydroxylation of cinnamic acid might raise the affinity for alpha(1A)-adrenoceptors.