Long-term experience with sclerotherapy for treatment of epididymal cyst and hydrocele.

BACKGROUND: Symptomatic testicular hydrocele and cyst of the epididymis may be treated with either operation or sclerotherapy. METHODS: The current report presents the experience of a 9 year prospective study using sodium tetradecyl sulphate (STD) sclerotherapy for the treatment of symptomatic hydrocele and/or epididymal cyst. RESULTS: A total of 102 lesions were treated during the study period, with an initial success rate of 76% which improved to 94% with multiple treatments. The overall median follow up during the study was 30 months (range 2-100). CONCLUSIONS: Sclerotherapy offers a cost-effective outpatient method for the treatment of symptomatic scrotal cysts.

Bilateral epidermoid cysts of the testis.

We present a case of bilateral testicular epidermoid cysts. These lesions were identified in a 22-year-old male who had previously experienced mild testicular trauma. Management consisted of inguinal exploration and wedge resection on one side and transscrotal exploration and excision on the other. This case represents the second reported case of bilateral conservative management of testicular epidermoid cysts in an adult male. The etiology and management alternatives for testicular epidermoid cysts are discussed.

Squamous cell carcinoma of the prostate: a transformation from adenocarcinoma after the use of a luteinizing hormone-releasing hormone agonist and flutamide.

We report a primary squamous cell carcinoma of the prostate that developed in a 57-year-old man, 3 years after treatment with leuprolide and flutamide for Stage D1 adenocarcinoma of the prostate. This is the first case that describes this transformation from adenocarcinoma to squamous cell carcinoma following the use of luteinizing hormone agonists.

Bladder neck preservation following radical prostatectomy: continence and margins.

Between December 1991 and January 1994, 134 patients underwent radical retropubic prostatectomy with bladder neck preservation. Forty-nine patients had a positive margin. Number and location of positive margins were analyzed. A tumor was identified at the bladder neck in 10 cases (7.5%). In all 10 patients with bladder neck involvement, a tumor was also identified at multiple other sites. These data suggest that preservation of the bladder neck during radical prostatectomy does not appear to compromise the efficacy of the procedure. Using a self-administered patient questionnaire, we evaluated the effect of bladder neck preservation upon continence in 36 patients. At the initial 3-month follow-up, 24 (67%) patients did not wear any pads. Another 7 (19%) wore pads occasionally, while 5 (14%) patients wore pads daily. To date only 1 of the 134 patients has developed an anastomotic stricture. Bladder neck preservation may aid in an earlier return of continence following radical prostatectomy and reduces anastomotic strictures. It does not appear to compromise the removal of the cancer.

Quality of life 12 months after radical prostatectomy.

OBJECTIVE: To evaluate the impact of radical prostatectomy (RP) upon quality of life (QOL) in patients with prostate cancer. PATIENTS AND METHODS: Seventy-nine patients with prostate cancer were recruited to evaluate the impact of RP upon QOL. The patients comprised two groups: the first group (n = 51) was evaluated 12 months or longer after RP; and the second group (n = 28) was evaluated 1 month prior to RP. All patients completed two previously reported QOL measures: the Functional Living Index Cancer (FLIC) and Profile of Mood States (POMS), and a series of questions which evaluated bladder, bowel and sexual function. RESULTS: Comparison of patients before RP with those after RP at 12 month follow-up revealed significant (P < 0.05) deterioration in sexual function, continence and hardship scores following RP while tension scores improved significantly. Although 10 other subscale parameters were analysed, no other differences were observed. Of the 51 post-RP patients, 46 (90%) stated that given a choice they would have their surgery again. CONCLUSION: The results reported show that RP has minimal overall impact upon patient QOL. Although minimal voiding and bowel dysfunction was reported, many patients were dissatisfied with post-operative sexual function.

Management of ureteral and renal pelvic recurrence after cystectomy.

Relatively few data are available on UT TCC following cystectomy. In most circumstances nephroureterectomy is the treatment of choice. The risk of bilateral disease is small (2% to 4%); however, in patients with bilateral UT TCC, a solitary kidney, or poor renal function and low-stage, low-grade TCC, renal preservation by local resection and/or topical therapy may be effective. In high-grade or high-stage disease, whenever feasible nephroureterectomy should be performed.

Primary prostatic lymphoma: a rare prostatic malignancy.

Primary prostatic lymphoma is a very rare condition for which the treatment is ill defined. A case of this condition from Australia is reported and treatment recommendations reviewed.

Uretero-fallopian fistula: an unusual complication of open ureterolithotomy.

We report a case of uretero-fallopian fistula, manifesting as complete urinary incontinence, following open ureterolithotomy for a lower ureteral calculus.

Evolving experience with radical prostatectomy.

Thirty-six radical prostatectomies were performed over an 8-year period; 25 suitable patients (70%) presented with symptoms of bladder outflow obstruction. In 15 cases (44%), initial digital rectal examination was not indicative of malignancy. The primary tumour was understaged pre-operatively in 17 patients (48%). In 14 cases (41%) the pre-operative biopsy grade was different from the grade assigned to the tumour following radical prostatectomy. Radical prostatectomy is being performed with increasing frequency: trends in morbidity have been identified.

Spontaneous knotting of a pigtail ureteric stent in the ureter requiring percutaneous removal.

Insertion of a ureteric stent is a common procedure in urologic practice. Ureteric stenting may be performed for: ureteric obstruction, benign or malignant: to prevent ureteric obstruction from stone fragments after extracorporeal shockwave lithotripsy (ESWL); or to prevent leakage from the upper urinary tract. A case of spontaneous knotting of a ureteric stent in situ is reported. Although this complication has been reported previously it is rare.

Corporeal penile plication for correction of erectile penile deformity.

Penile curvature causing functional impairment of sexual intercourse is uncommon but a number of patients are significantly inconvenienced by this condition. Seven patients who had marked erectile deviation were treated with surgical plication for their penile deformity. Mean follow-up was 16 months (range 3-48 months) and no postoperative complications were encountered. In six cases the penis has remained straight. In one patient recurrence of deformity occurred 12 months after corporeal plication. The simplicity of the corporeal plication technique with the low incidence of associated complications makes it an attractive surgical alternative for the treatment of penile erectile deformity.

Laser ablation of the prostate in patients with benign prostatic hypertrophy.

Seventeen patients with bladder neck obstruction due to benign prostatic hypertrophy have been treated with the Neodymium: YAG laser. We review our experience since the first patient was treated in September 1990. Using a prototype deflecting gold alloy tip on a quartz laser fibre (Lateralase TM), we ablated obstructing prostatic adenoma and constricting bladder neck tissue. Experience with this technique has enabled a patient population to be defined in whom laser therapy for prostatic obstruction may be effective. The treatment is relatively simple, speedy and attended by virtually no blood loss. Laser ablation therapy may offer some advantages over conventional transurethral resection of the prostate (TURP) in a selected subgroup of patients. The advent of new delivery systems may make laser ablation therapy a practical alternative to TURP.

Continent ileal neobladder urinary diversion: as an alternative to ileal conduit diversion.

Total bladder replacement with an ileal neobladder was performed in five male patients undergoing cystoprostatectomy. The surgical technique and short-term results are reported. Four of these patients exhibited total urinary continence day and night. One patient was totally continent during the day but had difficulty with continence at night due to mucus leakage. All patients demonstrated satisfactory bladder emptying (average post-micturition residual < 40 mL) with a flow rate of 4-15 mL/s. Until 1989 the ileal conduit, first described by Bricker in 1950, was used as the preferred method of urinary diversion. We believe that the ileal neobladder in male patients is an excellent bladder substitute with an associated low operative and peri-operative morbidity and a high long-term continence rate, allowing the patient to be free from urostomy.

Calcitonin gene related peptide: vasodilator in ovine hepatic and renal vasculature.

1. Calcitonin gene-related peptide (CGRP) is a product of alternate splicing of the calcitonin gene. It is found in nerves in the vasculature and is known from in vitro studies to be a potent vasodilator. It is found abnormally in the circulation of patients with medullary thyroid carcinoma (MTC) and has been proposed to be a cause of symptoms. This study was designed to determine the dose-response effects of CGRP infusion in the intact conscious sheep on blood flow to liver and kidney, organs known to be richly innervated by CGRP-containing nerves. 2. Blood flow was measured by an indicator dilution technique using [131I]-labelled iodohippurate. CGRP infusion at both 1 and 5 pmol/kg per min produced significant (P less than 0.05) increases in both renal and hepatic blood flow. This increase in flow occurred despite a significant fall in perfusion pressure (P less than 0.05) at the higher infusion rate. At the highest infusion rate of 10 pmol/kg per min, when fall in perfusion pressure was even more marked, renal and hepatic blood flow was maintained. 3. We conclude that CGRP is vasodilatory in the renal and hepatic vascular beds and propose that nerves containing CGRP in those vessels may have a role in maintaining blood flow to those organs.

The cardiovascular effects of human calcitonin gene-related peptide in conscious sheep.

Calcitonin gene-related peptide (CGRP) is localized in nerve fibres in close association with the vasculature. The in vivo effect of human CGRP upon the cardiovascular system was investigated by intravenous infusion of CGRP into seven conscious sheep at doses of 1.5 and 10-pmol/kg per min for 75 min. CGRP at the 5- and 10-pmol/kg per min infusions decreased mean arterial pressure (maximal decrease of 10 mmHg) and stroke volume (maximal decrease of 42 ml/min), and increased heart rate by 60 beats/min. No changes in cardiac output were observed and total peripheral resistance only fell with the 5-pmol/kg per min infusion. Increases in both plasma arginine vasopressin and plasma renin concentration and a decrease in total and ionized plasma calcium were also observed. CGRP appears to be a potent vasodilator acting upon both arterioles and capacitance vessels in vivo.