Comparison of Digital Rectal Examination and Serum Prostate Specific Antigen in the Early Detection of Prostate Cancer: Results of a Multicenter Clinical Trial of 6,630 Men.

To compare the efficacy of digital rectal examination and serum prostate specific antigen (PSA) in the early detection of prostate cancer, we conducted a prospective clinical trial at 6 university centers of 6,630 male volunteers 50 years old or older who underwent PSA determination (Hybritech Tandom-E or Tandem-R assays) and digital rectal examination. Quadrant biopsies were performed if the PSA level was greater than 4 µg./l. or digital rectal examination was suspicious, even if transrectal ultrasonography revealed no areas suspicious for cancer. The results showed that 15% of the men had a PSA level of greater than 4 µg./l., 15% had a suspicious digital rectal examination and 26% had suspicious findings on either or both tests. Of 1,167 biopsies performed cancer was detected in 264. PSA detected significantly more tumors (82%, 216 of 264 cancers) than digital rectal examination (55%, 146 of 264, p = 0.001). The cancer detection rate was 3.2% for digital rectal examination, 4.6% for PSA and 5.8% for the 2 methods combined. Positive predictive value was 32% for PSA and 21% for digital rectal examination. Of 160 patients who underwent radical prostatectomy and pathological staging 114 (71%) had organ confined cancer: PSA detected 85 (75%) and digital rectal examination detected 64 (56%, p = 0.003). Use of the 2 methods in combination increased detection of organ confined disease by 78% (50 of 64 cases) over digital rectal examination alone. If the performance of a biopsy would have required suspicious transrectal ultrasonography findings, nearly 40% of the tumors would have been missed. We conclude that the use of PSA in conjunction with digital rectal examination enhances early prostate cancer detection. Prostatic biopsy should be considered if either the PSA level is greater than 4 µg./l. or digital rectal examination is suspicious for cancer, even in the absence of abnormal transrectal ultrasonography findings.

Persistent erectile dysfunction following radical prostatectomy: the association between nerve-sparing status and the prevalence and chronology of venous leak.

INTRODUCTION: . Failure to recover erectile function after radical prostatectomy (RP) may result from venous leak as a sequela of neuropraxia-induced erectile tissue damage. Venous leak portends a poor prognosis for erections recovery as well as phosphodiesterase type 5 inhibitor (PDE5i) response. AIMS: To define the impact of RP nerve-sparing status on venous leak prevalence and chronology. STUDY POPULATION: men who underwent RP for localized prostate cancer, had functional erections prior to RP, developed postoperative erectile dysfunction (ED), had a Doppler ultrasonography within 6 months of RP, and did not receive any ED treatment for the first 6 months after RP other than on-demand PDE5i. MAIN OUTCOME MEASURES: Venous leak prevalence and erectile function recovery at different time-points. RESULTS: Data on 142 patients were analyzed, mean age: 58 +/- 16 years. Sixty percent had bilateral nerve-sparing (BNS) surgery, 20% unilateral nerve-sparing (UNS) surgery, and 20% non-nerve-sparing (NNS) surgery. Eleven percent and 21% had venous leak by 3 and 6 months, respectively. Venous leak prevalence by 6 months was 7%, 11%, and 75% for BNS, UNS, and NNS surgery (P < 0.001). Mean end-diastolic velocity was 1.8, 2.1, and 7.2 cm/second for the three groups (P < 0.01). The only patients developing venous leak prior to 3 months were NNS patients, one-third of NNS-associated venous leak occurring before this time-point. At 18 months, the proportion of men having return of unassisted erections was 49%, 42%, and 7% with mean erectile function domain scores of 21, 18, and 12, and PDE5i response rates were 72%, 64%, and 12% for the three groups, respectively. CONCLUSIONS: Nerve-sparing status impacts heavily upon the prevalence and the chronology of venous leak development post-RP. NNS RP is associated with early development of venous leak, increased prevalence of venous leak, and reduction in return of natural erections.

Nephron sparing surgery using a bipolar radio frequency resection device.

PURPOSE: We evaluated operative outcomes during nephron sparing surgery using a handheld radio frequency ablation resection device. MATERIALS AND METHODS: Patients with a newly diagnosed renal mass who elected treatment were prospectively enrolled in a comparative trial designed to evaluate the usefulness of the handheld HABIB 4X radio frequency ablation device during open nephron sparing surgery. Preoperative variables were determined and patients subsequently underwent open nephron sparing surgery with (group 1) or without (control group 2) the assistance of the radio frequency ablation device. Data were collected on preoperative and postoperative creatinine and hematocrit, estimated operative blood loss, intraoperative and postoperative complications, and pathological outcomes. RESULTS: A total of 90 patients underwent open nephron sparing surgery with (45) and without (45) the radio frequency ablation device. Mean pathological tumor size was 3.31 and 3.13 cm in groups 1 and 2, respectively (p = 0.49). Mean estimated blood loss was 133.2 and 417.2 cc in groups 1 and 2, respectively (p <0.001). Mean operative time was 83.5 and 97.2 minutes in groups 1 and 2, respectively (p = 0.012). Ten of 45 group 2 patients underwent hilar clamping with hypothermia, while no patients in group 1 underwent hilar clamping. Margins were positive in 1 patient in group 1 (2.2%) and in 2 in group 2 (4.4%). Group 1 complications included postoperative urine leakage in 1 case, which required stent placement. Group 2 complications included 2 cases of urine leakage requiring stent placement, 4 of blood transfusion, 2 of ureteral lacerations, 2 episodes of clot retention and 1 death. CONCLUSIONS: The handheld radio frequency ablation device can yield a significant benefit during open nephron sparing surgery, namely decreased blood loss and operative time.

Quality of life in men with locally advanced adenocarcinoma of the prostate: an exploratory analysis using data from the CaPSURE database.

PURPOSE: We present longitudinal quality of life outcomes in a national observational cohort of men with locally advanced prostate adenocarcinoma. MATERIALS AND METHODS: The CaPSURE registry was used to evaluate quality of life in men with clinical T3 or T4 prostate adenocarcinoma who underwent primary treatment and had a minimum followup of 2 years. Records were reviewed for treatment, patient age, T stage, prostate specific antigen at diagnosis, body mass index, and initial and posttreatment quality of life using the SF-36 and UCLA-PCI questionnaires, which can each be scored from 0 to 100 with higher scores indicating better outcomes. The association of treatment type and quality of life changes after treatment were evaluated with multivariate mixed model analysis, adjusting for age, time of quality of life assessment, and interaction between treatment and time. RESULTS: Of the 13,740 men enrolled in CaPSURE 608 (4.42%) presented with T3 or T4 tumors. In this subgroup 151 men completed baseline and a minimum of 2 years of followup with quality of life data available. These men underwent primary treatment with radical prostatectomy (21%), cryotherapy (8%), brachytherapy (17%) or hormonal ablation (54%). The treatment cohort demonstrated significant decreases in quality of life, most profoundly in urinary and sexual function. Mean urinary function was 91 at baseline, which decreased to 82, 83 and 82 at 1, 2 and 3 years after treatment, respectively (p = 0.04). Mean sexual function was 38 at baseline, which decreased to 15, 16 and 14 at 1, 2 and 3 years after treatment, respectively (p <0.01). On multivariate analysis quality of life varied significantly by treatment type (p <0.01). CONCLUSIONS: Treatment for locally advanced prostate adenocarcinoma is associated with a significant burden in patients, notably decrements in urinary and sexual function. Clinicians should consider the impact that treatment imparts on quality of life when counseling patients with locally advanced disease.

Splenic rupture following shock wave lithotripsy.

We present the case of a 61-year-old female who underwent extracorporeal shock wave lithotripsy (ESWL) treatment of a 12 mm left ureteropelvic junction stone. Following an uneventful and successful treatment, the patient was discharged. The patient re-presented to the emergency room 24 hours later with abdominal pain and hypotension. CT of the abdomen revealed a shattered spleen necessitating emergent removal. The patient recovered without difficulty. Although splenic rupture following shock wave lithotripsy (SWL) has been reported previously, this case represents the only published report of splenic rupture with use of a third generation electromagnetic lithotripter. Our report will highlight the details of the case and comment on the salient literature concerning visceral injury following lithotripsy.

Low-dose computed tomography for the evaluation of flank pain in the pregnant population.

BACKGROUND: Evaluation of the pregnant patient with suspected renal colic is complex. Fetal irradiation concerns have traditionally prohibited the use of CT in this population. We report our institution's experience using low-dose CT in the evaluation of pregnant patients with refractory flank pain. PATIENTS AND METHODS: A retrospective review of all patients who underwent low-dose CT evaluation of the urinary tract for suspected urinary tract stones was performed. Data obtained included gestational age, urinalysis and ultrasonography results, CT findings, and calculated fetal radiation exposure. RESULTS: Between April 2004 and December 2006, 20 patients with an average gestational age of 26.5 weeks presented to our institution with acute, refractory flank pain consistent with a diagnosis of urolithiasis. All patients underwent renal ultrasonographic evaluation before unenhanced CT of the abdomen and pelvis using a low-dose protocol. The average radiation exposure was 705.75 mrads (range 210-1372; SD +/- 338.66 mrads). Of the 20 patients, CT demonstrated urinary stones (1-12 mm) in 13. Of those patients with documented stones, 4 were treated conservatively, 2 underwent intrapartum stent placement, 5 had ureteroscopy with stone extraction, and 2 were treated postpartum. CONCLUSION: Low-dose CT is highly sensitive and specific for the detection of urinary calculi in the pregnant population. CT confers a low risk of fetal harm and can improve patient care when used judiciously.

Ability of community-based prostate cancer screening to target an appropriate and underserved population.

Screening is not universally beneficial due to over- and under-diagnosis, and false positives that beget additional testing and associated adverse events and expense. We examined data from all men who participated in a mass community prostate cancer screening between May 2009 and September 2010. The data contained information regarding patient demographics, family history of prostate cancer, lower urinary tract symptoms, prior history of prostate cancer, most recent digital rectal examination, and the presence of an established relationship with a physician. Current American Urological Association screening recommendations were then applied to determine the appropriateness of our outreach effort. A total of 438 men (mean age 66.5 years) underwent screening. A total of 106 (24.2%) patients in our study met contemporary criteria for screening. Of these men, the vast majority was well educated, well insured, and well informed about the need for prostate cancer screening. Based on these data, mass community-based prostate cancer screening does not appear to identify and screen at-risk men. Future efforts at mass screening should more carefully target men most likely to benefit.

Effect of patient age on early detection of prostate cancer with serum prostate-specific antigen and digital rectal examination.

This study was designed to determine the effects of age by decade on the efficacy of digital rectal examination (DRE) and serum prostate-specific antigen (PSA) for early detection of prostate cancer in men aged fifty and over. A prospective multicenter clinical trial was conducted at six university centers. All 6,630 male volunteers underwent a serum PSA (Hybritech, Tandem) determination and DRE. Quadrant biopsies of the prostate were performed if PSA was > 4 ng/mL or DRE suspicious. A total of 1,167 biopsies were performed, and 264 cancers were detected. The cancer detection rate increased from 3 percent in men aged fifty to fifty-nine to 14 percent in men eighty years or older (p < 0.0001). PSA detected significantly more of the total cancers than DRE at all age ranges (p < 0.05). The positive predictive values (PPV) for PSA were 32 percent (50-59 years), 30 percent (60-69 years), 34 percent (70-79 years), and 38 percent (80+ years). The corresponding PPVs for DRE were 17 percent, 21 percent, 25 percent, and 38 percent. Eighteen percent of the cancers were detected solely by DRE, whereas 45 percent of cancers were detected solely by PSA. Thus, the use of both tests in combination provided the highest rate of detection in all age groups. One hundred-sixty patients underwent radical prostatectomy and pathologic staging. Cancer was organ-confined in 74 percent (25/34) of men aged fifty to fifty-nine, 76 percent (65/86) of men aged sixty to sixty-nine, and 60 percent (24/40) of men aged seventy or over (chi 2, < 70 vs. > or = 70, p < 0.05). Early detection programs yield a lower, yet still substantial, cancer detection rate in younger men, and there is a greater likelihood for detection of organ-confined disease in this age range. Younger men have the longest projected life expectancy and, therefore, the most to gain from early prostate cancer detection.

Management of low-stage nonseminomatous germ cell tumors of testis: SIU/ICUD Consensus Meeting on Germ Cell Tumors (GCT), Shanghai 2009.

OBJECTIVE: To advise urologists and other clinicians on the appropriate management of low-stage (clinical Stage [CS] I, IS, IIA, and IIB) nonseminomatous germ cell tumors of the testis. METHODS: A panel was convened of experts from 5 countries. A literature search in MEDLINE was used to identify evidence from relevant studies on the outcome and toxicity of observational, surgical, and chemotherapeutic approaches for low-stage nonseminomatous germ cell tumors to form the basis of the panel's recommendations. RESULTS: The panel has recommended the treatment of nonseminomatous germ cell tumors in centers with medical, surgical, and diagnostic expertise in testicular cancer. The cancer-specific survival rate for CS I and CS IIA-IIB should approach 100% and 95%-100%, respectively. Patients with CS I should be made aware of all treatments (ie, surveillance, primary chemotherapy, and retroperitoneal lymph node dissection) and the potential side effects. For patients with CS I at low risk of occult metastasis, surveillance is preferred. For patients at high risk of occult metastasis, all 3 options can be considered. For immediate treatment, the choice between primary chemotherapy and retroperitoneal lymph node dissection should be determined by patient preference and the specific expertise of the treating institution. Patients with increasing postorchiectomy serum α-fetoprotein or human choriogonadotropin levels (CS IS and CS IIA-IIB) should receive induction chemotherapy. Induction chemotherapy or retroperitoneal lymph node dissection can be considered for patients with CS IIA-IIB with normal postorchiectomy α-fetoprotein and human choriogonadotropin levels. Surveillance can be considered for patients with equivocal computed tomography retroperitoneal findings who are otherwise at low risk of metastatic disease. CONCLUSION: These clinical practice guidelines are designed to improve clinical practice from the available evidence and the expert opinion of the panel. As such, deviation from these recommendations should be based on sound clinical judgment, considering the unique situation of the patient and the expertise of the treating physician and institution.

Validity of Pelvic Pain, Urgency, and Frequency questionnaire in patients with interstitial cystitis/painful bladder syndrome.

OBJECTIVES: To determine the validity of the Pelvic Pain, Urgency, and Frequency (PUF) questionnaire according to its correlation with cystoscopy with hydrodistension (C-HD) findings. METHODS: A prospective study of new patients with a clinical history consistent with interstitial cystitis/painful bladder syndrome (IC/PBS) was undertaken. All patients underwent history and physical examination, urinalysis, and urine culture and completed a PUF questionnaire before undergoing C-HD. The pertinent data collected included the preoperative PUF scores, bladder capacity, and cystoscopic findings consistent with IC/PBS (petechial hemorrhage and/or terminal hematuria). Statistical analysis was performed. RESULTS: From June 1, 2005 to December 31, 2005, 97 patients with a new clinical diagnosis of IC/PBS were prospectively evaluated. All patients completed a PUF questionnaire before C-HD. The average PUF score was 21 (range 8 to 35). The mean bladder capacity was 756 mL (range 250 to 1400). The C-HD was positive in 54 (56%) of 97 patients. Of these 54 patients, 27 had a PUF score of less than 20, 22 had a PUF score of 20 to 29, and 5 patients had a PUF score of greater than 30. When evaluated statistically, no correlation was apparent between the PUF questionnaire scores and the cystoscopic findings of IC/PBS (P <0.05). CONCLUSIONS: As determined by the correlation with the C-HD, the PUF questionnaire appears to be neither a reliable predictor of IC/PBS nor a valuable predictor of disease severity. However, the inherent limitations of C-HD and the lack of a definitive diagnostic instrument for IC/PBS limit any authoritative conclusions. Therefore, the diagnosis of IC/PBS should remain one of exclusion and should depend on a constellation of widely recognized symptoms.

Prospective radiographic followup after en bloc ligation of the renal hilum.

PURPOSE: We determined the risk of arteriovenous fistula after en bloc ligation of the renal hilum. MATERIALS AND METHODS: A prospective evaluation of all patients who underwent en bloc ligation of the renal hilum during nephrectomy for malignant disease was performed. Pertinent operative data were recorded and patients were followed for clinical evidence of arteriovenous fistula formation, including hypertension, abdominal bruit and new onset congestive heart failure. Patients with at least 12 months of followup underwent computerized tomographic arteriography to assess arteriovenous fistula formation. RESULTS: A total of 94 patients underwent en bloc renal hilar ligation during open (43) and laparoscopic (51) nephrectomy using a 45 mm titanium endovascular stapler. Of this cohort 11 patients were lost to followup and 3 died of disease. The remaining 80 patients were followed an average of 35.2 months with no clinical evidence of arteriovenous fistula formation. Specifically there was no statistically significant difference in preoperative and postoperative blood pressure (p = 0.18 and 0.62, respectively), no evidence of abdominal bruit on examination and no new onset congestive heart failure. A total of 32 had increased serum creatinine and, therefore, they were excluded from followup computerized tomographic arteriography. Eight patients had a followup of less than 1 year and they were not yet eligible for evaluation. In the 40 patients who underwent computerized tomographic arteriography no fistulas were noted. CONCLUSIONS: Based on clinical followup and prospective radiographic evaluation there appears to be a low risk of arteriovenous fistula formation after en bloc ligation of the renal hilum using a titanium endovascular stapler.

Fibromatous periorchitis of testis.

Fibrous pseudotumors of the tunica vaginalis, epididymis, and spermatic cord are uncommon benign paratesticular masses. An extremely rare variant termed "fibromatous periorchitis" exhibits diffuse proliferative encasement of the testis and manifests grossly as an indurated testis reminiscent of malignancy. We present the case of a 25-year-old man who presented with a grossly abnormal testicular examination and benign scrotal ultrasound findings and pathologic evidence of fibromatous periorchitis. The natural history, gross and histologic findings, and management of fibrous pseudotumors and fibromatous periorchitis are discussed.

Metastasis of squamous cell carcinoma of the bladder to the heart: case report and review of the literature.

A 79-year-old woman with no previous history of genitourinary disease presented to an outside urologist with gross hematuria and irritative voiding symptoms. Cystoscopy revealed a papillary bladder mass thought initially to represent urothelial carcinoma of the bladder with squamous features. The patient presented to our hospital 6 months later with dyspnea and edema. Computed tomography of the chest revealed a cardiac mass, and endomyocardial biopsy revealed metastatic squamous cell carcinoma. A review of the patient's pathology report confirmed the very rare diagnosis of metastatic squamous cell carcinoma of the bladder to the heart.

The use of an erectogenic pharmacotherapy regimen following radical prostatectomy improves recovery of spontaneous erectile function.

PURPOSE: It has been suggested that postradical prostatectomy (RP) erectile function outcomes are improved by early use of erectogenic medications. This analysis was designed to assess the ability of a post-RP vasoactive drug program to improve long-term spontaneous erectile function. METHODS: Men with functional preoperative erections who underwent RP were challenged early postoperatively with oral sildenafil. Nonresponders were switched to intracavernosal injection therapy (ICI). Patients were instructed to inject three times a week. Only patients who presented within 6 months post RP, who completed the International Index of Erectile Function (IIEF) questionnaire on at least three separate occasions after surgery, and who had been followed for at least 18 months were included. Data from men who were committed to rehabilitation were compared with those of men who did not follow the protocol but continued to be followed serially following RP. RESULTS: There were 58 patients in the rehabilitation (R) group and 74 in the nonrehabilitation (NR) group. No differences existed in mean patient age, comorbidity profile, intraoperative nerve sparing status, or postoperative erectile hemodynamics between the two groups. At 18 months post RP, there were statistically significant differences between the two groups in the percentage of patients who were capable of having medication-unassisted intercourse (R=52% vs. NR=19%, P<0.001); mean erectile rigidity (R=53+/-21% vs. NR=26+/-43%, P<0.01); mean IIEF erectile function (EF) domain scores (R=22+/-6 vs. NR=12+/-14, P<0.01); the percentage of patients with normal EF domain scores (R=22% vs. NR=6%, P<0.01); the percentage of patients responding to sildenafil (R=64% vs. NR=24%, P<0.001); the time to become a sildenafil responder (R=9+/-4 vs. NR=13+/-3 months, P=0.02); and the percentage of patients responding to ICI (R=95% vs. NR=76%, P<0.01). CONCLUSIONS: The data generated from this nonrandomized study indicate that a pharmacologic penile rehabilitation protocol results in higher rates of spontaneous functional erections and erectogenic drug response after RP.

Risk assessment for occult malignancy in the prostate before radical cystectomy.

OBJECTIVES: To assess our clinical ability to predict prostate involvement by transitional cell carcinoma (PI-TCC) or occult prostate cancer (CAP) in patients undergoing radical cystectomy (RCx). METHODS: We retrospectively analyzed 70 male patients undergoing RCx for TCC of the bladder between 1995 and 2003, focusing on preoperative factors to predict PI-TCC or CAP. RESULTS: Of 70 RCx patients, 30 (43%) had PI-TCC (14) or CAP (16). Risk factors for PI-TCC included carcinoma in situ, multifocal TCC, and bladder neck involvement (P <0.05 for all three analyses). All 14 patients with PI-TCC had one or more risk factors, and none of 40 patients without these risk factors had PI-TCC (P <0.001). Risk factors for CAP included elevated prostate-specific antigen level, abnormal results on digital rectal examination, and age more than 65 years. Of 16 patients with CAP, 14 had one or more of these risk factors (P <0.05). Sixteen of the seventy patients in this series (22.9%) had no risk factors for PI-TCC or CAP, and none of these had prostatic involvement with either malignancy (P <0.05). CONCLUSIONS: Our findings suggest that a well-defined subset of patients undergoing RCx might be at low risk for malignancy in the prostate. However, further evaluation of these risk factors in a prospective setting will be required to substantiate these findings and guide clinical decision making in this controversial field.

Seminal vesicle cyst presenting as rectal obstruction.

We report an unusual case of a pelvic mass arising from the seminal vesicle. A 45-year-old man presented with difficulty voiding and difficult bowel movements. Computed tomography demonstrated a large 14 x 10 x 15-cm cystic pelvic mass displacing the bladder anteriorly and the rectum posteriorly. Magnetic resonance imaging confirmed that this lesion appeared to be originating from the right seminal vesicle. On surgical exploration of the abdomen, a large cystic lesion in the posterior retroperitoneum was identified and removed. The patient improved, with restoration of normal bowel function.

Bladder cancer facts: accuracy of information on the Internet.

PURPOSE: Patients continually seek information regarding the etiology, diagnosis, management and treatment of bladder cancer. The Internet has a growing number of health web sites and it is a tremendous resource for medical information. We examined the accuracy and completeness of bladder cancer sites on the World Wide Web. MATERIALS AND METHODS: Internet searching was performed by retrieving the first 30 universal resource locators from 8 popular search engines using the search term bladder cancer. A total of 38 independent web sites were evaluated. Other sites were inaccessible, duplicates or only contained linked pages. Two reviewers evaluated the accuracy and completeness of information using a predetermined 41-point checklist rating instrument that evaluated essential information related to bladder cancer. The kappa statistic was used to evaluate interrater variability. RESULTS: The mean kappa statistic for evaluable variables was 0.70. Most nonevaluable variables had excellent agreement, indicating good overall interrater reliability. No rating factor was present on 100% of sites. Eight factors were present and accurate on 80% to 90% of web pages and related to signs/symptoms, risk factors, diagnostic tests and treatment of early stage disease. Six factors were inaccurate on 32% of sites, including incidence (7), staging (3), recurrence (1), and treatment of early invasive (1) and metastatic (1) disease. CONCLUSIONS: Bladder cancer information retrieved from the majority of medical web sites was incomplete. However, general information relating to presentation, diagnosis, staging and treatment of low stage disease was present and accurate on most sites. Although inaccurate information was detected on 32% of the sites, it tended to be related to outdated information. It is reasonable to refer patients to select comprehensive web sites to obtain pertinent information about bladder cancer.

Erectile dysfunction after radical prostatectomy: hemodynamic profiles and their correlation with the recovery of erectile function.

PURPOSE: Despite the advent of nerve sparing radical prostatectomy some men experience erectile dysfunction. Many of these men have vasculogenic erectile impairment in the form of arterial insufficiency or venous leakage. Recent data imply that early postoperative injection therapy may decrease the rate of erectile dysfunction. We defined hemodynamic patterns in patients who underwent bilateral nerve sparing radical prostatectomy to assess the chronology of venous leakage development and explore the correlation of hemodynamic profiles with the return of functional erection 12 months postoperatively. MATERIALS AND METHODS: Patients with excellent preoperative erectile function who underwent bilateral nerve sparing surgery and had no pharmacological support for erectile dysfunction in the initial 12 months after surgery received vascular evaluation at presentation. Vascular evaluation involved cavernosometry or penile ultrasonography. Patients were then interviewed again at least 12 months postoperatively to assess the ability to achieve sexual intercourse. RESULTS: Our study group comprised 96 men with a mean age plus or minus standard deviation of 54 +/- 12 years who met all inclusion criteria. All patients had pathologically proved organ confined disease. Mean time to the initial postoperative presentation was 6 +/- 5 months. Patients were divided into 4 groups according to the time of vascular studies postoperatively, namely less than 4 to 8, 9 to 12 and greater than 12 months. Normal vascular status, arterial insufficiency and venous leakage were diagnosed in 35%, 59% and 26% of the group, respectively. No difference in the incidence of arterial insufficiency was noted in the 4 time groups. Time postoperatively was significantly associated with the incidence of venous leakage (14% at less than 4 months and 35% at between 9 and 12). In regard to the correlation of the vascular diagnosis with the return to functional erection 47% of the normal, 31% of the arteriogenic and 9% of the venous leakage group achieved sexual intercourse 12 months postoperatively. CONCLUSIONS: These data imply that the longer the duration of erectile dysfunction after radical prostatectomy, the greater the risk of venous leakage. Furthermore, it appears that the prognosis for the return of functional erection is worst when venous leakage is present.

Cytogenetic analysis of a series of 13 renal oncocytomas.

PURPOSE: Only about 50 renal oncocytomas have been studied cytogenetically. They fall into 3 categories, namely 1-normal karyotype, 2-monosomy 1, often with Y chromosome loss, and 3-structural abnormalities of 11q13. Additional abnormalities may occur with transformation to chromophobe renal cell carcinoma, although exactly which one is unclear. We expanded the oncocytoma data base to shed light on changes that characterize transformation. MATERIALS AND METHODS: A total of 14 oncocytomas from 12 patients were collected in 2(1/2) years. One tumor failed to grow but 13 were successfully karyotyped. RESULTS: Seven tumors (53.8%), including 2 from 1 kidney, had normal karyotypes or abnormalities characteristic of normal kidney tissue. A total of 6 tumors from 5 individuals (46.2%) had chromosome 1 abnormalities. Monosomy 1 was detected in 2 single tumors and in both tumors in a bilateral case. Structural anomalies resulting in loss of the short arm of chromosome 1 were found in an additional 2 patients. Other abnormalities, including Y chromosome loss and monosomy 14, were observed but no abnormalities of 11q13 were seen. CONCLUSIONS: Our series confirms that 1p loss is the most common anomaly in oncocytoma. Additional studies are required to understand the transformation potential of this usually benign tumor, identify the putative 1p tumor suppressor gene and determine whether karyotypically normal tumors have molecular abnormalities of 1p.