Variability in patient preparation for prostate biopsy among American urologists.

OBJECTIVES: To assess the variability in patient preparation for prostate biopsy (PBX) among practicing American urologists. METHODS: A survey was sent to 900 practicing American urologists randomly selected by the American Urological Association computer files. The survey asked about their pre-PBX protocol. RESULTS: Approximately 63% (568 of 900) of the surveys were returned and showed considerable differences in pre-PBX protocol among those urologists. The pre-PBX regimen included prophylactic antibiotics in 98.6% and a cleansing rectal enema in 81%. Eleven different antibiotics were used, with 20 different doses and 23 different timing-duration regimens. CONCLUSIONS: The pre-PBX preparation is not standardized among American urologists.

Efficacy of one dose fluoroquinolone before prostate biopsy.

OBJECTIVES: To demonstrate the efficacy of a simple preparation for prostate biopsy (PBX) and to determine its potential cost savings. METHODS: One hundred fifty consecutive PBXs were performed using a Fleet enema and a single oral dose (300 mg) of ofloxacin as the pre-PBX preparation. RESULTS: Of the 150 PBXs we performed, only 1 (0.67%) patient developed a urinary tract infection. CONCLUSIONS: A simple and inexpensive pre-PBX preparation proved to be successful in preventing infectious complications and is presented as a potential model for inclusion in clinical pathways for diagnosing adenocarcinoma of the prostate.

Buccal mucosal graft for hypospadias repairs.

Buccal mucosal grafts are being utilized increasingly in urethral reconstruction for hypospadias and urethral stricture disease. We describe our technique for harvesting and utilizing buccal mucosal grafts in cases of severe proximal hypospadias anomalies or failed prior hypospadias repair.

Prognostic value of BHCG and local tumor invasion in stage I seminoma of the testis.

Approximately 10-15% of patients with stage 1 pure seminoma of the testis have an elevated preorchiectomy serum beta human chorionic gonadotropin level [1-4]. The prognostic significance of this elevation is unknown. We performed a multi-institutional retrospective review of 332 men with stage I pure seminoma of the testis and evaluated the prognostic significance of this elevation and the prognostic value of local invasion of the primary tumor. Twenty-five of 191 evaluable patients (13%) had elevated preorchiectomy beta human chorionic gonadotropin. All normalized postoperatively and are alive without evidence of disease with a median follow-up of 50 months (range 1-124 mo). Of 191 patients, 190 (99.5%) are alive and free of disease. One patient underwent salvage chemotherapy for a chest recurrence, and he is alive and free of disease at 72 months. We conclude that elevated preorchiectomy serum beta human chorionic gonadotropin level and local invasion of the primary tumor do not portend a poor prognosis in patients with clinical stage I pure seminoma of the testis.

Colonic duplication: an unusual cause of enterovesical fistula.

Intestinal duplications are rare, occurring in 1 in 4000 births. Even rarer are tubular hindgut duplications, with less than 75 cases reported in the literature to date. We report an uncommon case of an enterovesical fistula caused by a duplication of the sigmoid colon. This is the first reported case of a tubular colonic duplication presenting as a colovesical fistula in an adult. We discuss the presentation and shortcomings in the diagnosis and treatment of enterovesical fistulas and colonic duplications.

Indwelling ureteral stents as definitive therapy for distal ureteral calculi.

Distal ureteral calculi are a common urological problem often requiring surgical and anesthetic intervention. In a health care system with limited resources this intervention can lead to the expenditure of significant monies. Ureteral stents are often used to stabilize symptomatic patients preoperatively. Since stent placement causes passive ureteral dilation, we hypothesized that temporary placement of a ureteral catheter would facilitate spontaneous calculus passage. We prospectively studied 27 patients who presented with distal ureteral calculi less than 10 mm. large and met criteria established for surgical intervention. Self-retaining Double-J stents were placed in 10 male and 7 female patients, and left for 2 weeks using only topical anesthesia during the procedures. In the majority of the patients (83%) the calculi passed spontaneously after stent removal, obviating surgical or anesthetic intervention.

Biopty gun testis needle biopsy: a preliminary clinical experience.

OBJECTIVE: To assess the reliability, safety and patient satisfaction of transcutaneous Biopty (Bard Urological, Covington, GA, USA) gun testis biopsies. PATIENTS AND METHODS: Nineteen young men who were referred for evaluation of azoospermia were included in the study. The procedure was performed in an outpatient setting, under local anaesthesia and without sedation. Two passes of the Biopty gun spring-loaded needle were performed unilaterally in each patient. RESULTS: An average of 38.9 seminiferous tubules were evaluable per patient. The procedure was extremely well-tolerated by all patients and most felt that the procedure was no more distressing than simple phlebotomy. CONCLUSION: Transcutaneous testis needle biopsy performed with the Biopty gun is safe, rapid and cost-effective. This technique may represent a viable alternative to the open method of testis biopsy.

Proliferative activity as an adjunct in the diagnosis of prostatic adenocarcinoma.

Sixty-nine men underwent transrectal ultrasound-directed biopsy of the prostate. One biopsy core from each side of each gland was sent for DNA flow cytometric testing (138 total specimens). Results were correlated with findings from standard hematoxylin and eosin staining of other cores. Twelve patients (17.4%) had biopsies with histopathologic evidence of prostatic carcinoma. Of 57 patients (82.6%) with benign biopsies, two had stage A prostate adenocarcinoma noted on subsequent transurethral resection. Proliferative activity was calculated from DNA histograms by adding the percentage of nuclei in the proliferative (S and G2/M) phases of the cell-division cycle. Mean proliferative activity for the malignant group (19.08) was significantly higher (p < 0.001) than that of the benign group (13.43). Inflammation was associated with elevated proliferative activity scores among benign glands. Proliferative activity is an objective, easily obtainable indicator of the biological activity of a population of cells which, when elevated, may suggest a need for repeat biopsy in patients with otherwise normal prostate biopsies. Flow cytometry may have value as a complement to standard histologic analysis of transrectal core biopsies in the diagnosis of prostate cancer.

Management of urinary tract in children with epidermolysis bullosa.

Epidermolysis bullosa is a group of rare genetic disorders characterized by noninflammatory blistering lesions of the skin occurring after minor mechanical trauma. In association with junctional epidermolysis bullosa, a syndrome of pyloric atresia has occasionally been noted in the literature. Several infants who had this combined disorder have been reported to have severe genitourinary tract involvement. Most of these patients have died at an early age because of severe urinary tract involvement. We describe a rare survivor who was initially treated with urinary diversion. Subsequent attempts at undiversion of this patient were unsuccessful. He is presently stable following rediversion. The entities of e. bullosa and e. bullosa/pyloric atresia are reviewed with emphasis on urologic associations.

Renal responses to graded hemorrhage in conscious pig.

We developed a conscious pig model with a chronically instrumented kidney to measure renal blood flow (RBF), glomerular filtration rate (GFR), and excretory functions during hemorrhage. Seven to 10 days before experimentation, pigs were splenectomized, arterial and venous catheters were implanted, an ultrasonic flow probe was placed on the renal artery, and a pyelostomy was performed for nonocclusively placing a ureteral catheter. Measurements were taken before hemorrhage, and at hemorrhage volumes of 7, 14, 21, and 28 ml/kg (equivalent to 10.5, 21, 31, and 42% of the estimated blood volume), or at corresponding time points for controls. RBF was decreased by 30% when 21% of the blood (14 mg/kg) was removed, before arterial pressure, GFR, or urine flow or excretion was changed. At volumes of hemorrhage greater than 14 ml/kg, there were progressive decreases in RBF, GFR, urine flow rate, osmotic and electrolyte excretion, and arterial pressure. Thus pigs, like humans, respond to hypovolemia with an early redistribution of blood flow away from the kidney.

Furosemide-induced disturbances of renal function in patients undergoing TURP.

Furosemide remains the drug of choice for patients with the transurethral resection syndrome. Furosemide is often used intraoperatively to treat patients suspected of having excessive irrigant absorption. To examine the efficacy of such therapy, a randomized study was performed in which furosemide was administered to patients undergoing routine transurethral resection of the prostate (TURP) to determine the effect of furosemide on electrolyte and fluid volume conservation in these patients. Seven patients treated with furosemide on completion of TURP had a statistically significant delayed drop in serum sodium values after normal initial values (139 mEq/L to 134 mEq/L). Seven untreated control patients did not have a similar drop in sodium values, and the difference between groups was significant. We suggest that furosemide be used with caution in patients undergoing routine TURP, and when given it should be accompanied by the infusion of an isotonic balanced salt solution.

Management of pregnancy after major urinary reconstruction.

Major reconstructions of the urinary tract are being performed with increasing frequency. However, published experience concerning pregnancy after urinary reconstruction is limited. Complications in women who have undergone such complex procedures may endanger them or their fetuses and can disrupt the reconstruction or impair renal function. To counsel better those patients who have undergone urinary reconstruction and who desire to bear children, and to develop an approach to the management of their pregnancies, we reviewed the available literature. We found that the incidence of complications was low during pregnancy after a genitourinary reconstruction; the majority of women had an uneventful pregnancy and vaginal delivery. Close observation of renal function and prophylaxis against urinary tract infection during pregnancy are recommended. Elective cesarean is advised for women who have had a reconstruction of the bladder neck or urethra or who have received an artificial urinary sphincter. Urologists and gynecologists must continue to report the outcome of pregnancy in their patients who have undergone reconstruction so that we may develop meaningful data about the incidence of complications.

Endometrioid carcinoma of prostate.

A prostatic tumor that was excised from a sixty-two-year-old man was found histologically to resemble papillary endometrial carcinoma. A specimen of this prostatic endometrioid carcinoma tested positive for prostate-specific antigen and focally positive for mucin, confirming the prostatic epithelial origin of the tumor. A review of the literature indicates that tumors of this type are best approached as a standard acinar adenocarcinoma of the prostate.

Mucinous adenocarcinoma of the prostate.

A case of mucinous adenocarcinoma of the prostate that was diagnosed with the aid of prostate-specific antigen immunoperoxidase staining is reported. Focal areas of the tumor, which were morphologically similar to the remainder of the tumor, stained with neuron-specific enolase by an immunoperoxidase technique and with the Grimelius stain. This tumor is best thought of as a variant of the classic acinotubular adenocarcinoma of the prostate with well-differentiated cells that secrete mucin, rather than as a completely different type of cancer, as proposed previously.