Transrectal sonographic features of prostatic intraepithelial neoplasia: correlation with pathologic findings.

PURPOSE: This study was conducted to evaluate the transrectal sonographic (TRUS) features of prostatic intraepithelial neoplasia (PIN) by comparing the histopathologic results with TRUS findings in patients who had undergone TRUS-guided prostate biopsy. METHODS: From an initial set of 307 patients who underwent TRUS-guided prostate biopsy, TRUS findings for 44 patients whose pathologic results were consistent with PIN were reviewed retrospectively. Among these 44 patients, 12 had only PIN, 20 PIN associated with prostatitis, and 12 PIN associated with prostate cancer foci. After exclusion of the foci that included PIN associated with prostatitis and PIN associated with prostate cancer at the same site, the pathologic results for the core specimens from the 100 PIN foci were correlated with TRUS findings according to their location. The sonographic features sought were hypoechoic areas and regions of heterogeneous echogenicity. RESULTS: Positive TRUS findings were detected in 43% of PIN and 36% of high-grade PIN (HGPIN) focise. For the HGPIN foci with positive TRUS findings, the detected sonographic features were clusters of millimetric hypoechoic foci (CMHF) (53%), hypoechoic areas with well-defined borders (27%), and heterogeneous echogenicity (20%) (not significant). The sensitivity of the presence of CMHF for the diagnosis of HGPIN was only 19%. CONCLUSIONS: TRUS-detected CMHF may indicate HGPIN. Because of the limited sensitivity of this finding, TRUS detection of CMHF does not warrant biopsy, although these lesions warrant close monitoring.

Efficacy of transrectal ultrasonography in the evaluation of hematospermia.

OBJECTIVE: To assess the efficacy of transrectal ultrasonography (TRUS) in the evaluation of hematospermia. MATERIAL AND METHODS: This study included 54 patients with hematospermia. Patients age range was between 25 and 75 years (mean=49.7 years). All patients were evaluated by TRUS using a biplane transducer and a Toshiba SSA-270A device. RESULTS: TRUS revealed one or more abnormalities in 51 patients (94.5%). Prostatic calcifications were found in 23 patients, ejaculatory duct calculi in 21, dilated ejaculatory ducts in 18, benign prostatic hyperplasia in 18, dilated seminal vesicles in 12, calcifications in seminal vesicles in 11, ejaculatory duct cyst in 6, prostatitis in 6, and periurethral Cowper gland mass in 1. CONCLUSION: TRUS is a noninvasive, safe method for the investigation of causes of hematospermia. We believe that it should be the first radiological investigation to be performed in patients presenting with hematospermia.

Isolated local recurrence of renal cell carcinoma after radical nephrectomy: experience with 10 cases.

OBJECTIVES: Isolated local recurrence of renal cell carcinoma after radical nephrectomy is very uncommon and the effect of aggressive surgical management of this clinical entity remains controversial. We report our experience with 10 such cases. METHODS: Between 1994 and 2002, 10 patients with isolated local recurrence of renal cell carcinoma without any evidence of metastatic disease after radical nephrectomy were treated at our department. The mean patient age was 51.7 years (range 26 to 74); 7 patients were men and 3 were women. All patients underwent extensive surgery for local recurrence. RESULTS: Only 3 patients were symptomatic, and the others were diagnosed during routine follow-up examinations. The mean time to local recurrence was 33.6 months (range 3 to 68), and the mean size of the recurrent tumor was 8.45 cm (range 3 to 12). An aggressive surgical approach was taken in all patients. One patient died in the postoperative period because of a surgical complication. Of the remaining 9 patients, 2 died of metastatic disease after a mean survival of 8.5 months (range 3 to 14). Seven patients were alive with a mean survival of 16.6 months (range 3 to 38+). CONCLUSIONS: We believe that patients with isolated local recurrence after radical nephrectomy may benefit from an aggressive surgical approach, but this kind of surgery may also have significant complications.

Effect of potassium citrate therapy on stone recurrence and residual fragments after shockwave lithotripsy in lower caliceal calcium oxalate urolithiasis: a randomized controlled trial.

BACKGROUND AND PURPOSE: To evaluate the efficacy of potassium citrate treatment in preventing stone recurrences and residual fragments after shockwave lithotripsy (SWL) for lower pole calcium oxalate urolithiasis. PATIENTS AND METHODS: One hundred ten patients who underwent SWL because of lower caliceal stones and who were stone free or who had residual stone 4 weeks later were enrolled in the study. The average patient age was 41.7 years. All patients had documented simple calcium oxalate lithiasis without urinary tract infection and with normal renal morphology and function. Four weeks after SWL, patients who were stone free (N = 56) and patients who had residual stones (N = 34) were independently randomized into two subgroups that were matched for sex, age, and urinary values of citrate, calcium, and uric acid. One group was given oral potassium citrate 60 mEq per day, and the other group served as controls. RESULTS: In patients who were stone free after SWL and receiving medical treatment, the stone recurrence rate at 12 months was 0 whereas untreated patients showed a 28.5% stone recurrence rate (P < 0.05). Similarly, in the residual fragment group, the medically treated patients had a significantly greater remission rate than the untreated patients (44.5 v 12.5%; P < 0.05). CONCLUSION: Potassium citrate therapy significantly alleviated calcium oxalate stone activity after SWL for lower pole stones in patients who were stone free. An important observation was the beneficial effect of medical treatment on stone activity after SWL among patients with residual calculi.