The Correlation between Diffusion-Weighted Imaging and Histopathological Evaluation of 356 Prostate Biopsy Sites in Patients with Prostatic Diseases.

Purpose. The aim of this study is to investigate the reliability of diffusion MRI for detection of cancer foci by comparing diffusion-weighted imaging (DWI) results and pathology results of prostate biopsy sites. Methods. Of the patients who applied with lower urinary tract symptoms, 36 patients who had suspected DRE and/or PSA ≥2.5 ng/mL were included in the study. Patients underwent DWI prior to 10 cores-prostate biopsy. 356 biopsy cores were obtained from the patients. Foci from the patients with prostate cancer were labeled as malignant or benign foci, likewise foci from the patients with benign pathology were grouped as BPH and inflammation foci. Apparent diffusion coefficients (ADCs) of biopsy groups were compared with each other in order to measure the reliability of DWI in detection of PCa foci. Results. When ADC values of adenocarcinoma foci and BPH foci were compared, a statistically significant difference was found (P < 0.001). When ADC values obtained from adenocarcinoma foci and chronic inflammation foci are compared, the difference between two groups is statistically significant, too (P < 0.001). Conclusions. Biopsies focused on suspected regions after formation of ADC maps by means of DWI would provide to start definitive treatment immediately as well as being beneficial to prevent morbidity related to repeated prostate biopsies.

Can the reverse transcriptase-polymerase chain reaction for prostate specific antigen and prostate specific membrane antigen improve staging and predict biochemical recurrence?

OBJECTIVE: To evaluate the perioperative gene-specific primed nested reverse transcription-polymerase chain reaction (RT-PCR) for prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSMA) for staging patients undergoing radical prostatectomy and predicting biochemical recurrence. PATIENTS AND METHODS: In 80 consecutive patients undergoing radical prostatectomy for prostate cancer, blood samples were drawn before, during and 1 and 7 days after removing the prostate. After buffy coat and mRNA extraction, gene-specific primed nested RT-PCR was performed for PSA, PSMA and glyceraldehyde-3-phosphate dehydrogenase mRNA, and Southern blot analysis of the PCR reaction. RESULTS: The sensitivity of gene-specific RT-PCR to detect tumour cells was comparable with random primed RT-PCR. In the 80 patients the stage distribution was pT1 in two (2.5%), pT2 in 30 (37.5%) and > or = pT3 in 48 (60%); the nodal status was pN0 in 57 (71%), pN1 in 11 (14%) and pN2 in 12 (15%). The gene-specific RT-PCR reaction for PSA and PSMA was positive in no patients with pT1, 11 (37%) with pT2 and 23 (48%) with stage > or = pT3 disease. The result for PSA was positive in 12 (52%) and for PSMA in 11 (48%) of those with positive nodal status. Neither gene-specific RT-PCR for PSA or PSMA was able to predict organ-confined disease (P > 0.5). After a median (range) follow-up of 37 (11-67) months a biochemical recurrence was predicted in 65% of patients by preoperative RT-PCR for both PSA and PSMA, with a sensitivity, specificity, positive and negative predictive value of 58%, 80%, 87% and 47%, respectively; the assay after surgery predicted a recurrence in 73%, with respective values of 68%, 84%, 84% and 57%. CONCLUSIONS: Gene-specific primed nested RT-PCR for PSA and PSMA is a sensitive and simple assay; it might add substantial information for tumour staging in individual patients. RT-PCR before surgery allows the prediction of recurrence in 65% of cases and after surgery in 73%.

Relationship between prostate specific antigen density, microvessel density and prostatic volume in benign prostatic hyperplasia and advanced prostatic carcinoma.

The aim of this study was to investigate the relationship between prostate specific antigen density and prostate volume with microvessel density in patients with benign prostatic hyperplasia and advanced prostatic carcinoma. Sixty-eight patients with benign prostatic hyperplasia and 11 patients with advanced prostatic carcinoma participated in the study. The paraffin blocks of all patients were stained with CD34 by the standard immunohistochemical technique and microvessel density, prostate specific antigen density and prostatic volume were determined. In patients with benign prostatic hyperplasia the mean microvessel density, mean prostate specific antigen density and mean prostatic volume were 74+/-89+/-22.73, 0.12+/-0.10 and 59.97+/-27.0 ml, respectively. There was no correlation between prostate specific antigen density and mean prostatic volume or microvessel density (r = 0.079 and -0.095, respectively). In patients with advanced prostatic carcinoma the mean microvessel density, mean prostate specific antigen density and mean prostatic volume were 147.90+/-47.55, 0.63+/-0.41 and 54.00+/-22.42 ml, respectively. In this group, while there was a good correlation between prostate specific antigen density and microvessel density (r = 0.785), no significant correlation was found between prostatic volume and microvessel density (r = -0.07). There was significant statistical difference in patients with advanced prostatic carcinoma compared to patients with benign prostatic hyperplasia in terms of mean microvessel density (p<0.0001). The findings that there was no correlation between prostatic volume and MVD either in benign prostatic hyperplasia or in prostatic carcinoma suggest that microvessel development is not correlated with prostatic volume but may be correlated with morphology.

Erectile dysfunction in premature ejaculation.

Between October 1993 and December 1995, 45 patients with premature ejaculation were included in this study. The patients were divided into two groups etiologically, as having primary or secondary ejaculation. After a complete laboratory evaluation all patients underwent papaverine tests color Doppler ultrasonography pharmacocavernosometry-cavernosography and consequently organic etiology were investigated. Venous leakage was found in 5 (22,7%), arterial or mix insufficiency in 2 (9%) of the patients with primary premature ejaculation. In secondary premature ejaculation group, venous leakage was encountered in 9 patients (39,1%), arterial insufficiency in 2 patients (8,6%). In conclusion, investigation of organic etiology for the patients with premature ejaculation, particularly with secondary premature ejaculation, seems to be beneficial for correct diagnosis.

The value of cavernous body biopsy in evaluating of impotent men.

Rapid advances in the basic understanding of the anatomy, physiology and pharmacology of penile erection have drastically changed the clinical approach to patients with erectile dysfunction. To evaluate the value of microscopic architecture of the corpora cavernosa, we examined cavernous body biopsies taken during penile prosthesis implants. We studied on 12 impotent patients 25 to 67 years old who underwent implantation of a penile prosthesis. The biopsy was stained with H&E (Hematoxylin and Eosin) for general architecture, Masson Trichrome for collagen distribution and EVG for elastic fibers. Except 3 cases no pathological changes were determined at H&E staining. At collagen staining, roughly increased collagen distribution was determined in all cases. There were no appreciable differences in distribution of elastic fibers. In conclusion our data demonstrate that cavernous body biopsy is of limited value to determine etiologic factors in patients with erectile dysfunction.

A case of growing teratoma syndrome.

Residual masses are a common finding after chemotherapy for metastases from nonseminomatous germ cell tumours of the testes. The prognosis of these patients with resected teratoma following successful cisplatin-based combination chemotherapy generally has been assumed to be good. Herein we reported an unusual teratoma case named "growing teratoma syndrome' by Logothetis et al. This patient was treated with multiple operations.

Spontaneous fragmentation of a double J stent.

A variety of indications have made the use of double J stents routine in urology. Minimal and moderate side effects of ureteral stent are common, when the indwelling time exceeds 6 weeks the incidence of severe complications, like fragmentation increase. We report a case of stent fragmentation after an indwelling period of 12 months. Despite the variety of complications the severity requires close monitoring of the patient.

Comparative early results of transurethral electroresection and transurethral electrovaporization in benign prostatic hyperplasia.

OBJECTIVE: To compare the results of conventional transurethral electroresection of the prostate (TURP) and transurethral electrovaporization (TUEP) in patients with symptomatic benign prostatic hyperplasia. PATIENTS AND METHODS: The study comprised 46 patients with moderate or severe symptoms of prostatism and a maximal flow rate of < 15 mL/s. Pre-operatively, all patients underwent a digital rectal examination and the determination of prostatic volume by ultrasonography, and a symptom score, the maximal flow rate, post-void residual urine, routine biochemical variables and serum prostate specific antigen were measured. The haematocrit and blood Na+ levels were also determined pre-operatively and again 24 h after the operation. Patients were divided randomly into two groups: the first underwent a conventional TURP and the second TUEP using 240-300 W of cutting current. Three months after operation, all the variables were remeasured and the values compared with those before treatment and between the groups. RESULTS: The improvements in symptom score, maximum flow rate and residual urine were slightly better after TURP than after TUEP but the differences between treatments were not statistically significantly different. However, TUEP used slightly less irrigant solution, allowed earlier removal of the urethral catheter, required no blood transfusions and was easier to perform. CONCLUSION: Although the improvements in the objective variables 3 months after TUEP were almost the same as after TURP, there were advantages in using less resources: further studies with more patients and a longer follow-up are required to determine the efficacy and safety of this procedure.

A urodynamic evaluation of patients with renal, upper and lower ureteric stones.

OBJECTIVE: To investigate the urodynamic variables of the patients with renal, upper and lower ureteric stones and compare the results according to the location of the stone. PATIENTS AND METHODS: Pre-operatively, 49 patients with kidney, upper and lower ureteric stones were evaluated to determine bladder capacity, compliance and urine volume at first sensation. Patients with urinary tract infection, neurogenic pathology and bladder outlet obstruction were excluded. The patients were divided into two groups; 20 patients with kidney and upper ureteric stones and 29 patients with lower ureteric stones. RESULTS: The mean bladder compliance, bladder capacity and volume at first sensation were all significantly lower in patients with lower ureteric stones (P = 0.026, P = 0.005 and P = 0.042, respectively). These patients also had more prominent irritative symptoms, urgency and frequency. However, the mean values of bladder capacity, compliance and volume at first sensation were within normal limits in both groups. CONCLUSION: Lower ureteric stones cause more irritative bladder symptoms than do renal and upper ureteric stones and lower ureteric stones should be considered as a possible cause of sensory urgency.

A giant bladder stone: managed with osteotome.

An unusual case of bladder stone is presented. The size of stone and the operation technique were exceptional in the urologic literature. The stone could be palpated on physical examination. The stone was removed by fragmentation with osteotome because of adherence of the stone to the bladder wall. The stone weighed 570 g.

Urodynamic parameters in preoperative evaluation of patients with bladder tumours.

Urodynamic evaluation was done in 28 patients with various staged bladder tumours. In 12 patients with superficial bladder tumours all urodynamic parameters were in normal range. Thirteen patients of 16 with invasive bladder tumours had low capacity of bladder and 5 of them also had involuntary contractions. In this study we suggest that urodynamic parameters in patients with bladder tumour became significantly abnormal when the first tumour invasion is seen at the muscular layer of the bladder (p < 0.05); so compliance significantly decreased and the other pathological conditions were followed (p < 0.05).

Treatment of renal hydatid disease by pedicled omentoplasty.

Renal hydatid disease is uncommon and accounts for only 2 to 3% of all hydatid diseases. The treatment of choice is surgical. Medical therapy is not always satisfactory and radical cure depends mostly on removal of all affected tissue. There is controversy concerning the treatment of residual cavity after evacuation of the cyst. For this problem we performed the pedicled omentoplasty in 4 patients with renal hydatid disease. To our knowledge, this method has not been described previously for renal hydatid disease. Cystectomy with pedicled omentoplasty appears to be safe and effective in the management of renal hydatid disease.

Thrombosis of the inferior vena cava by a testicular tumour.

We report on an unusual case of testicular tumour presenting as thrombosis of the inferior vena cava. The inferior vena cava thrombosis due to tumour invasion is a rare presentation of testicular tumour. After four cycles of chemotherapy, the tumour which invaded and obstructed the vena cava was replaced by scar tissue.

Metastatic carcinoma of the gallbladder due to renal cell carcinoma in the ectopic kidney.

We report a rare case of secondary involvement of the gallbladder by metastatic renal cell carcinoma originating from ectopic kidney. The first diagnosis of the patient is a gallbladder carcinoma due to a polypoid mass within the gallbladder. The preoperative examinations revealed that there was also a synchronous renal cell carcinoma. The histopathologic examination of the polypoid mass and kidney after operation revealed the resected polypoid mass to be metastasis of renal cell carcinoma.

Bilateral Leydig cell tumors with unilateral cryptorchidism. Case report.

Bilateral leydig cell tumors of testes are very rare. There is no evidence from literature that in the cryptorchid man, bilateral leydig cell tumors are prone to develop. We report a man with bilateral leydig cell tumors in association with unilateral cryptorchidism.

Antispermatozoal antibody values after varicocelectomy.

Although there are many causes of the production of antispermatozoal antibodies, there are still unknown aetiological factors. Antispermatozoal antibodies were investigated in the postoperative period in 25 infertile men with varicocele whose antispermatozoal antibody tests were negative in the preoperative period. Antispermatozoal antibodies were found in the serum in 4 of the 25 (16%) infertile men after varicocele operation. Postoperative genital infections were detected in 6 patients and antispermatozoal antibodies were present in only 2 of them. The correlation between these antibodies and varicocele has been demonstrated but there is no report on the association of antibodies with varicocelectomy in the literature to date.

Persistent müllerian duct syndrome.

Persistent müllerian duct syndrome is a rare form of pseudohermaphroditism, in which well developed müllerian structures are present in an otherwise normal male, possibly resulting from absence of müllerian duct inhibiting factor. Two cases of the syndrome are presented. The diagnosis, as in most cases, was confirmed at herniorrhaphy or exploration for undescended testis.

Color-Doppler imaging in acute scrotal disorders.

Eighteen patients who referred to our hospital with acute scrotal pain and swelling were evaluated with color-Doppler imaging (CDI) after the initial clinical examinations. Five of these subjects were considered to have testicular torsion as diagnosed with CDI. These diagnoses were surgically confirmed, and appropriate treatments were performed. CDI findings of 13 patients were in accordance with inflammatory pathologies (epididymitis and/or orchitis). These patients received medical treatment. The CDI diagnoses of all patients were in agreement with the final clinical diagnoses. We conclude that CDI, which is a practical, rapid and high-resolution technique, promises to be the leading and decisive scanning method in acute scrotal disorders.