Transurethral resection of the prostate: failure patterns and surgical outcomes in patients with symptoms refractory to alpha-antagonists.

BACKGROUND: alpha-Antagonists (AAs) are ineffective in some men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Transurethral resection of the prostate (TURP) may be required. Reasons for AA failure and surgical outcomes in these patients have not been reported. METHODS: We retrospectively reviewed cases of TURP for LUTS due to bladder outlet obstruction from 1995 to 1998. The TURP patients in whom AA therapy had failed (group 1) were compared with those who had symptomatic BPH but were not taking AAs (group 2). Comorbid conditions that might influence treatment results were considered, as were sizes of resection and pathologic results. RESULTS: No differences occurred between groups 1 (n = 38) and 2 (n = 25) in age, length of postoperative follow-up, or resection size. However, outcomes were poorer in group 1 than in group 2. A trend toward greater comorbidity that might lead to voiding dysfunction, though not statistically significant, was seen in group 1. CONCLUSIONS: Postoperative results of TURP may be less successful after AA therapy failure. This may be due to preoperative risk factors that affect voiding function rather than to prostatic size.

Comparison of the ileal conduit to the continent cutaneous diversion and orthotopic neobladder in patients undergoing cystectomy: a critical analysis and review of the literature.

In recent years, many investigators have devised innovative urinary diversions to improve the quality of life of patients requiring urinary diversions after cystectomy. In this article, we report a literature review in which we compare the outcomes of patients receiving an ileal conduit to those receiving either a continent cutaneous diversion or an orthotopic neobladder. In this discussion, we analyze the data in the literature that pertains to quality of life, incontinence rates, and metabolic complications. We conclude that although the newer urinary diversions are promising, randomized prospective trials comparing patients receiving these diversions to those receiving an ileal conduit need to be performed.

Cystine calculi. Diagnosis and management.

The genetics, pathophysiology, diagnosis, and treatment of cystinuria are discussed in this article. Newer chemotherapeutic and surgical options that are used to treat this disease process also are reviewed. The authors suggest a multimodal approach in the treatment of cystinuria and cystine calculi.

Collagen alterations in the corpus cavernosum of men with sexual dysfunction.

Previous studies have noted the abundance of collagen in human erectile tissues and the association of altered collagen content with erectile dysfunction. We investigated these notions by studying the collagen characteristics of biopsies from the corpus cavernosum of men who required surgical correction of their sexual dysfunction. Histologic analysis revealed abundant collagen within the erectile tissues. With the exception of patients with Peyronie's disease and priapism, only mild alterations in collagen architecture were noted in the remainder of the patients. Biochemical quantitation confirmed the histologic study. The mean collagen content represented 47% of total protein in most patients. The proportion rose to 68% and 73% in the patients with Peyronie's disease and priapism, respectively. No statistical difference in collagen content was noted in all the patients studied. Immunohistochemistry revealed collagen types I and IV to predominate in the corpus cavernosum, with type III making up the minority. There were no qualitative changes in collagen ratios with age and disease. We conclude that though collagen is a major component of the penis, there are no changes in its histologic characteristics that can be correlated to senescence or to the etiology of erectile dysfunction.