Residual urinary volume and urinary tract infection--when are they linked?

PURPOSE: Large post-void residual urinary volume may be related to the development of urinary tract infection. However, the maximum post-void residual volume that predisposes patients to a higher risk of urinary tract infection is not known. In this prospective study we determined the cutoff value for post-void residual volume that places adult men at risk for bacteriuria. MATERIALS AND METHODS: Data were obtained from 196 consecutive healthy adult men (median age 62 years) who came for prostate evaluation without symptoms of acute urinary tract infection. Right after spontaneous voiding, bladder catheterization was performed under normal aseptic conditions, and the post-void residual volume measured. Urine samples were collected for culture from each patient and the results were compared to the various post-void residual volume. RESULTS: Overall 27% of the patients presented with a positive urine culture. The mean post-void residual volume in this group was 257 ml (range 150 to 560) compared to 133 ml (range 10 to 340) for the group with negative culture (p <0.001). The post-void residual volume value of 180 ml was determined to have the best specificity and sensitivity. The positive predictive value for bacterial growth at a post-void residual volume of 180 ml or greater was 87.0% and the negative predictive value was 94.7%. CONCLUSIONS: Clinically asymptomatic adult men with a post-void residual volume of 180 ml are at a high risk for bacteriuria. Such cases require close medical attention since it may be necessary to introduce early drug therapy or surgical intervention to improve the bladder emptying.

PSA screening for prostate cancer.

Screening of prostate cancer with prostate-specific antigen (PSA) is a highly controversial issue. One part of the controversy is due to the confusion between population screening and early diagnosis, another derives from problems related to the quality of existing screening studies, the results of radical curative treatment for low grade tumors and the complications resulting from treatments that affect the patient's quality of life. Our review aimed to critically analyze the current recommendations for PSA testing, based on new data provided by the re-evaluation of the ongoing studies and the updated USPSTF recommendation statement, and to propose a more rational and selective use of PSA compared with baseline values obtained at an approximate age of 40 to 50 years.

PSA screening for prostate cancer / Rastreamento do câncer de próstata com PSA

Summary Screening of prostate cancer with prostate-specific antigen (PSA) is a highly controversial issue. One part of the controversy is due to the confusion between population screening and early diagnosis, another derives from problems related to the quality of existing screening studies, the results of radical curative treatment for low grade tumors and the complications resulting from treatments that affect the patient's quality of life. Our review aimed to critically analyze the current recommendations for PSA testing, based on new data provided by the re-evaluation of the ongoing studies and the updated USPSTF recommendation statement, and to propose a more rational and selective use of PSA compared with baseline values obtained at an approximate age of 40 to 50 years.

Resumo O rastreamento do câncer de próstata com antígeno prostático específico (PSA) é uma questão altamente controversa. Parte da polêmica se deve à confusão entre rastreamento populacional e diagnóstico precoce, e outra parte está ligada a problemas relacionados à qualidade dos estudos de rastreamento recentes, a resultados do tratamento curativo radical para tumores de baixo grau ou em estágio precoce, e a complicações advindas de tratamentos que afetam a qualidade de vida do paciente. Nossa revisão teve como objetivo analisar criticamente as recomendações atuais para o teste de PSA, com base em dados obtidos da reavaliação de estudos em andamento e na recomendação atualizada do USPSTF, e propor o uso mais racional e seletivo do PSA comparado a níveis iniciais obtidos em uma idade aproximada de 40 a 50 anos.