Soft-tissue uptake of technetium-99m-MDP after prostate cryoablation.

Prominent soft-tissue uptake of 99mTc-methylene diphosphonate (MDP) within the prostate bed was found after cryoablation for prostate carcinoma. CT, MRI and sonographic studies demonstrated liquifactive necrosis of the prostate bed. The probable etiology for 99mTc-MDP uptake in this case is necrosis with subsequent neovascular hyperemia and microscopic calcium deposits. Three-phase scintigraphy with 99mTc-MDP appears to be useful for localizing the extent of soft tissue inflammation and necrosis.

Endoscopy for removal of unusual foreign bodies in urethra and bladder.

Numerous reports have been published concerning intraurethral foreign bodies. Two patients required endoscopic intervention: one for the removal of screws from the urethra and the other for extraction of a calculus. The technique utilized the Wolf universal nephroscope and stone dislodger with 3 jaws, and its success prevented a more aggressive surgical approach.

Relative merits of MRI, transrectal endosonography and CT in diagnosis and staging of carcinoma of prostate.

Magnetic resonance imaging (MRI) and transrectal sonography of 27 patients with biopsy-proved carcinoma of the prostate were performed to compare the sensitivity of these modalities to each other for diagnosis and to computed tomography (CT) for staging. Sonography was superior to MRI for the detection of intraglandular carcinoma and capsular disruption. MRI was superior to both sonography and CT for evaluating seminal vesicle invasion, and slightly better than CT for detecting lymphadenopathy.

Patients' choice of treatment in stage D prostate cancer.

Given the current preference of many patients for an active role in decision-making regarding their care, the feasibility of patients making their own treatment choices was investigated, and the reasons for their selections were studied. Subjects comprised previously untreated Stage D prostate cancer patients for whom hormonal therapy was indicated. Thirteen institutions entered 159 patients into the study. After discussing treatment choices with their physicians, the patients took home a two-page letter explaining two options: surgical castration and therapy with Zoladex (goserelin acetate), a depot luteinizing hormone-releasing hormone (LHRH) analogue injected subcutaneously every twenty-eight days. Patients were encouraged to discuss the treatment choices with their families. After selecting a treatment approach, patients completed a "decision questionnaire" and then treatment was initiated. Of the 147 patients who completed baseline questionnaires, 78 percent selected Zoladex and 22 percent selected orchiectomy. The primary reason for selecting Zoladex included avoidance of surgery (36%), success of treatment (18%), convenience of the drug (10%), and physician's advice (10%). Patients chose surgery primarily because of convenience (32%) and success of treatment (29%). Three months later, patients and their wives completed another questionnaire, which assessed their satisfaction with their treatment choices. Ninety-three percent of patients and 91 percent of patients' wives indicated that they would select the same treatment again.

Staging of ureteral transitional cell carcinoma by CT and MRI.

Intravenous urography and retrograde pyelography are the primary radiologic studies for detecting ureteral carcinoma but give limited information regarding stage of disease. Computed tomography (CT) and magnetic resonance imaging (MRI) delineate the extent of ureteral carcinomas with a high degree of accuracy by depicting the periureteral fat and presence or absence of lymphadenopathy. In selected cases, CT and MRI are valuable for assessing the presence or absence of tumor in a ureteral stump and for the differential diagnosis of ureteral obstruction. Five cases of ureteral carcinoma and 2 cases of stump carcinoma are presented with preoperative CT and/or MRI evaluation and staging.

Treatment of recurrent urinary tract infection with norfloxacin versus trimethoprim-sulfamethoxazole.

Norfloxacin, a broad-spectrum antimicrobial analog of nalidixic acid, was evaluated by comparing it to trimethoprim-sulfamethoxazole in 93 office patients with recurrent urinary tract infections. In this prospective randomized study, norfloxacin and trimethoprim-sulfamethoxazole were given on the same dosage schedule with the former drug given as a 400-mg tablet twice daily and the latter drug given as a double strength tablet twice daily. Overall, 50 patients received norfloxacin and 43 patients received trimethoprim-sulfamethoxazole with a cure rate of 96 percent and 79 percent, respectively. Whether a patient had one infection or multiple previous infections, norfloxacin appeared to be superior to trimethoprim-sulfamethoxazole. Only minor side effects were noted in either group, and no patient withdrew from this study as a direct result of these side effects. Minor complaints of nausea, dizziness, and headache were found in the norfloxacin group (24%) and in the trimethoprim-sulfamethoxazole group (16%). Both agents are effective in treating urinary tract infections but norfloxacin is superior to trimethoprim-sulfamethoxazole in patients with either recurrent complicated infections or one previous uncomplicated urinary tract infection.

Impact of magnetic resonance on staging of renal carcinoma.

Computerized tomography (CT), ultrasound, and angiography have been used for staging renal cell carcinoma. CT has proven to be the most reliable and sensitive of these techniques. Magnetic resonance (MR) has emerged recently as a viable alternative imaging modality. Five patients with renal cell carcinoma and suspected caval involvement were evaluated by CT, ultrasound, and MR. Caval extension and the differentiation of intra-versus retrocaval tumor was seen with greater clarity on MR scans; perinephric extension was seen equally well with both modalities. The primary tumor itself was better defined with CT. In patients with equivocal findings regarding the renal veins or inferior vena cava, MR is a valuable adjunct in preoperative evaluation. In patients at high risk for contrast administration, MR is the staging modality of choice.

Percutaneous endoscopic cystostomy for bladder localization and exact placement of a suprapubic tube.

PURPOSE: We describe a new technique for exact positioning and placement of a suprapubic tube. MATERIALS AND METHODS: The bladder dome and its relative position on the lower abdomen are localized using a flexible cystoscope, light source and abdominal palpation. RESULTS: The technique has been successfully used in patients who require long-term urinary drainage. CONCLUSIONS: Percutaneous endoscopic cystostomy is simple, effective and easily performed and it simplifies the placement of a suprapubic tube in the difficult to localize bladder.

The pH analysis of papaverine-phentolamine and prostaglandin E1 for pharmacologic erection.

Although papaverine-phentolamine preparations are being employed for pharmacologic erection programs across the nation, their chemical properties have not been described in the literature. We found that the pH of papaverine-phentolamine solution in all concentrations tested remained less than 4.0. Attempts to buffer the solution resulted in a precipitate at a pH greater than or equal to 5.0. The pH of prostaglandin E1 was less than 5.0 but could be easily buffered to pH 7.4 or even 10.75 and remained stable. The effect of an acidic solution on corporal connective tissue and smooth muscle meshwork is unknown. We believe that buffering by blood will lead to the precipitation of papaverine-phentolamine and may cause primary intracorporal scarring. Extravasation or improper injection into the subcutaneous tissue exposes the mixture to blood and may secondarily result in additional scarring for the same reason. Therefore, prostaglandin E1 may be a more appropriate agent for penile injection.

Use of immunohistochemistry for identification of primary lymphoma of the bladder.

Primary lymphoma of the bladder is a rare entity, and when found in such an unusual location it frequently is difficult to distinguish between a lymphoma and an undifferentiated carcinoma. Immunohistochemical staining techniques have been used to identify tumor cell origins when the tissue type or a primary site of involvement is unknown. We report a case of primary lymphoma (nonHodgkin's type) of the bladder and the use of immunohistochemical staining to distinguish definitively tissue type and then specific immunotype.

Corporoscopic-assisted removal of ruptured inflatable penile prosthesis.

Despite the recent availability of effective oral agents for treatment of erectile dysfunction, many patients do not respond to oral therapy and do not desire injection therapy. For some of these patients, inflatable prostheses remain an effective form of treatment for erectile dysfunction; however, prostheses are not without their own set of complications. The most common complications are infection and mechanical failure. We present the case of mechanical failure of a prosthesis and the use of corporoscopy to assist in the removal and subsequent successful reimplantation of a new inflatable prosthesis.

Colonization by Enterobacteriaceae of the respiratory tract of children with cystic fibrosis of the pancreas and their antibody response.

Of 72 patients with fibrosis, 49 harbored Enterobacteriaceae in the respiratory tract, including Escherichia coli, Klebsiella, and Enterobacter. Colonization by two to four genera was documented in 29 subjects. Staphylococcus aureus was recovered from 44 of these 49 patients. The distribution of serogroups of E. coli was similar to that seen in patients with urinary tract infection. Antibody response against the O antigens of the patients' own Enterobacteriaceae was documented in 29 of these 49 children and encountered more often in patients with severe disease. Colonization by Enterobacteriaceae in the absence of Pseudomonas aeruginosa was seen more frequently in children with the mild form of the illness.

Acute renal failure with thrombocytopenia after cryosurgery of the prostate.

We report three cases of transient acute renal failure accompanied by thrombocytopenia all occurring within 48 h of percutaneous transperineal cryoprostatectomy. Renal function spontaneously improved in all three patients, who currently have normal renal function and are voiding without difficulty. No known risk factor or specific etiology for the renal failure could be identified; therefore, we conclude that the renal failure is most likely secondary to the cryosurgery procedure, a common link shared by all three patients. We are currently administering intravenous mannitol before initiation of the freeze and have seen no further episodes of postcryosurgical acute renal failure in > 50 patients with prostate cancer. Because cryosurgery is currently becoming a more pervasive treatment option for localized prostate cancer, we believe it most important to report this heretofore unrecognized potential complication.

The staging pelvic lymphadenectomy: implications as an adjunctive procedure for clinically localized prostate cancer.

OBJECTIVES: To evaluate the utility of staging pelvic lymphadenectomy and to identify factors associated with nodal metastases in which a node dissection would be of clinical benefit. PATIENTS AND METHODS: A retrospective analysis (1989-1993) was performed on 303 consecutive patients who underwent staging bilateral modified pelvic lymph node dissection for clinically localized prostate cancer. Multivariate logistic regression analysis was used to evaluate age, race, clinical stage, prostate-specific antigen (PSA) level and Gleason score for predicting nodal metastases. RESULTS: Twenty-eight patients had nodal metastases, giving an overall prevalence of 9.2%. PSA and Gleason score (both P < 0.001) were significantly predictive of nodal involvement when combined or as independent variables. Relative to PSA and Gleason score, the patients' age, race and clinical stage were less relevant. Sensitivity analysis determined that combining a PSA of > or = 20 ng/mL (normal 0-4) and a Gleason score of > or = 8 gave a negative predictive value of 92% with a specificity of 99%, a positive predictive value of 67% and an overall accuracy of 91% for predicting nodal metastases. CONCLUSION: From this data, lymph node metastases are unlikely in patients with clinically localized prostate cancer who have a PSA of < 20 ng/mL and a Gleason score < 8, and that a pelvic lymph node dissection as an adjunctive procedure should be avoided in such individuals.

Venous intravasation of barium into the inferior mesenteric vein mimicking a coloureteral fistula: a case report and literature review.

Venous intravasation of barium following a barium enema is a rare event. We report a case of barium venous intravasation into the inferior mesenteric vein. Because of the close proximity to the course of the left ureter, this condition was interpreted initially as a coloureteral fistula. After further analysis of the original films, and left retrograde pyelography the true diagnosis was established. A literature review of barium intravasation is presented.

CT of vesicocorporeal fistula with menouria: a complication of uterine biopsy.

Vesicouterine fistulas are a rare complication of obstetrical-gynecological interventions and are the least common of the acquired urogenital fistulas. They are almost solely associated with cesarean section. A case is reported in which a patient with adenomyosis and pelvic adhesions presented with menouria (vesical menstruation) after uterine biopsy. A vesicocorporeal fistula was demonstrated by cystography and CT and confirmed by cystoscopy and hysteroscopy.

Use of endorectal surface coil magnetic resonance imaging for local staging of prostate cancer.

A total of 111 patients with clinically localized prostate cancer (stage A or B) underwent endorectal surface coil magnetic resonance imaging (MRI) for preoperative staging of the disease. Of the patients 43 with advanced disease on endorectal surface coil MRI (33 with stage C and 10 with stage D disease) received alternative therapy, as did 21 with stage B disease on MRI. The overall staging accuracy for the remaining 47 patients was 68%, with a 74% accuracy rate in staging advanced disease and a 91% accuracy rate for depiction of seminal vesicle involvement. Failure to recognize microscopic extracapsular disease was responsible for the majority of staging inaccuracies in this highly select group of patients. Endorectal surface coil MRI provides extremely high resolution images of the prostate and periprostatic structures, and is an exciting new modality for local staging of prostatic carcinoma.

Immediate postoperative feeding in urological surgery.

The value of immediate postoperative enteral hyperalimentation with an elemental diet (high nitrogen Vivonex, full strength) at 125 cc per hour for 4 days was assessed in patients after radical urological surgery. Of 32 patients studied 21 received an elemental diet using a Vivonex Moss tube, which is a 3-lumen tube with esophagogastric decompression and simultaneous duodenal feeding, and the remaining 11 had a nasogastric tube only without nutritional support. We have used a selected group of parameters, including serum albumin, serum transferrin, creatinine height index, weight loss, total lymphocyte count, nitrogen balance and plasma fibronectin. All patients in the Moss tube group approached or achieved positive nitrogen balance by 4 days postoperatively, whereas the nasogastric tube group remained in negative nitrogen balance. Postoperative paralytic ileus was prevented in the majority of patients in the Moss tube group while receiving full nutritional support. We have found that the use of the Moss tube is a reasonable approach for postoperative alimentation. The tube is relatively easy to insert and well tolerated, and its use is a less expensive alternative to parenteral hyperalimentation.