A presentation of glandular penile metastases from prostate adenocarcinoma.

Secondary tumours of the penis are rare; they most commonly arise from the prostate and the bladder. These lesions are often associated with disseminated malignancy and have a poor prognosis, with a 6-month mortality of up to 80% reported. Penile metastases have a variety of clinical manifestations including incidental penile nodules, cutaneous findings, urinary symptoms, pain and malignant priapism. Treatment options are mainly targeted at improving the patients' quality of life and are tailored to their clinical condition, but are primarily palliative. This study reports a case of a 92-year-old man with a presentation of glandular penile metastases from prostate adenocarcinoma treated conservatively.

A case of epididymal sarcoidosis.

Sarcoidosis is a systemic inflammatory condition that primarily affects the lungs, lymphatic system and skin. Extra thoracic manifestations occur in about 50% of cases; however, it rarely affects the male reproductive tract. The first documented case of epididymal and testicular sarcoid in the Irish literature is of a 25-year-old male who presented with a painful 1-cm extra-testicular scrotal mass. While the involvement of the male reproductive tract is rare, it should be included in the differential of testicular pathology. It can be diagnosed on frozen section and may be managed conservatively.

A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision.

OBJECTIVE: To determine the sensory innervation of the penis, as regional anaesthesia is often used either for postoperative analgesia or as the sole anaesthetic technique for circumcision. Since first described in 1978 the dorsal penile nerve block has become the standard technique, but some blocks are ineffective; a better understanding of the sensory innervation of the penis might improve the efficacy of the dorsal penile block technique. PATIENTS AND METHODS: In 13 men undergoing circumcision with local anaesthetic, cutaneous sensation was tested before and after infiltration of the dorsal aspect of the penis, and then again after infiltration of the ventral aspect. The area of anaesthesia was mapped using pin-prick sensation. RESULTS: Ten of the 13 patients showed a similar pattern of sensory distribution. After the dorsal block, the dorsal aspect of the shaft of the penis and glans penis became insensate. The ventral aspect of the shaft remained sensate up to and including the frenulum. After successful ventral infiltration all sensate areas became insensate and circumcision proceeded. In one case the frenulum and distal ventral foreskin was anaesthetized after the dorsal block and ventral infiltration was not required. No patient experienced pain during circumcision. CONCLUSION: For consistently successful regional anaesthesia of the foreskin in circumcision, a dorsal block must be used. This should be combined with ventral infiltration at the site of incision. This method will avoid inconsistencies and allow pain-free circumcision using local anaesthesia in most men.

Acute urinary retention in a young man secondary to colonic irrigation: a case report.

INTRODUCTION: Autonomic innervation of the bladder is complex and regulated by a hierarchy of mechanisms of the central nervous system. Any dysfunction in these regulatory mechanisms can lead to acute urinary retention. CASE PRESENTATION: A 36-year-old Caucasian man presented with acute urinary retention following extensive bowel irrigation. His urinary bladder was decompressed and his normal voiding mechanism was restored thereafter. CONCLUSION: We postulate that prolonged anorectal and sigmoid dilatation can stimulate the recto-vesicourethral reflex and lead to acute urinary retention via autonomic dysfunction.

Alterations in the expression of inhibitors of apoptosis during differentiation of prostate epithelial cells.

OBJECTIVE: To investigate alterations in the apoptotic phenotype, specifically the inhibitors of apoptosis (IAP) family, in prostate epithelial cells after differentiation from an apoptotic-resistant basal cell to an apoptotic-susceptible secretory cell. MATERIALS AND METHODS: Cells of the immortalized human prostate epithelial line HPr-1AR were cultured with and with no 5alpha-dihydrotestosterone (DHT) to drive differentiation. Western blotting and reverse transcription-polymerase chain reaction (RT-PCR) were used to determine changes in differentiation markers such as cytokeratins (CK) 14 and 18, and in XIAP, cIAP-1 and cIAP-2. Flow cytometry was used to assess viability and apoptosis, by propidium iodide DNA staining of the cells during differentiation. RESULTS: Morphological changes and the increased CK-18 and decreased CK-14 expression confirmed differentiation of cells towards a secretory phenotype. Real-time PCR and Western blotting confirmed the expression of the IAPs in the HPr-1AR cells. There was a time-dependent decrease in the mRNA expression of XIAP, cIAP-1 and cIAP-2 after treatment with DHT. Differentiation also resulted in decreased cIAP-1 and XIAP protein expression, but cIAP-2 remained unchanged. Spontaneous apoptosis was significantly increased during cellular differentiation. CONCLUSION: We show for the first time that differentiation of HPr-1AR prostate epithelial cells results in the development of a transient end-stage cell that might be explained by the loss of the IAP family of proteins.

Prostate epithelial cell differentiation and its relevance to the understanding of prostate cancer therapies.

Prostate cancer is the most common malignancy in males in the western world. However, little is known about its origin and development. This review highlights the biology of the normal prostate gland and the differentiation of basal epithelial cells to a secretory phenotype. Alterations in this differentiation process leading to cancer and androgen-independent disease are discussed, as well as a full characterization of prostate epithelial cells. A full understanding of the origin and characteristics of prostate cancer epithelial cells will be important if we are to develop therapeutic strategies to combat the heterogeneous nature of this disease.