Does Formalin Disinfection Reduce Bacterial Colonization of Biopsy Needle? A Prospective Study.

OBJECTIVE: To investigate the efficacy of formalin disinfection of the needle tip in transrectal prostate biopsy (TRB) procedure to reduce infectious complications. The primary aim is to assess the impact of formalin on bacterial contamination of biopsy needle tips and its association with post-biopsy infective events. MATERIALS AND METHODS: We have employed a bacterial culture-based observational cohort design in this study. Two groups, formalin disinfection and non-formalin group, both underwent systematic 12-core TRB. In the formalin group, the biopsy needle tip was immersed in 10% formalin solution after each core, while in the non-formalin group, no formalin solution immersion was used. The primary outcomes include bacterial growth on biopsy needle tips and post-biopsy infective events. RESULTS: Formalin disinfection significantly reduced bacterial growth on needle tips (P <.001). The formalin group had no post-biopsy infections or sepsis, while the non-formalin group experienced a 7.5% infective event rate after TRB. CONCLUSION: Formalin disinfection of biopsy needle tip significantly reduces bacterial growth on biopsy needle and urinary tract infectious complications developed secondary to TRB. Further multicenter randomized controlled studies with larger cohorts are warranted to validate and establish formalin disinfection as a routine practice in TRB procedures.

Risk-Adapted Strategy Combining Magnetic Resonance Imaging and Prostate-Specific Antigen Density to Individualize Biopsy Decision in Patients With PI-RADS 3 ``Gray Zone'' Lesions.

INTRODUCTION: Recent guidelines suggest that biopsy may be omitted in some groups of patients with PI-RADS 3 lesions on mpMRI. In this study, we aimed to evaluate biopsy strategies involving prostate-specific antigen density (PSAd) to avoid unnecessary biopsy versus the risk of missing clinically significant prostate cancer (csPCa) in patients with PI-RADS 3 lesions. MATERIAL AND METHODS: Data of 616 consecutive patients who underwent PSAd and mpMRI before prostate biopsy between January 2017 and January 2022 at a single center were retrospectively assessed. All of these patients underwent combined cognitive or fusion targeted biopsy of suspicious lesions and transrectal ultrasonography guided systematic biopsy. PI-RADS 3 based strategies with PSAd and mpMRI combination were created. For each strategy, avoided unnecessary biopsy, reduced ISUP Grade 1, and missed ISUP Grade ≥ 2 ratios were determined. Decision curve analysis (DCA) was used to statistically compare the net benefit of each strategy. RESULTS: DCA revealed that patients who had PI-RADS 3 lesions with PSAd ≥ 0.2, and/or patients who had PI-RADS 4 and 5 lesions had the most benefit, under the threshold probability level between 10% and 50%, which avoided 48.2% unnecessary prostate biopsies and reduced 51% of ISUP grade 1 cases, while missed 17.5% of ISUP grade ≥ 2 cases. (22.1% for ISUP grade 2 and 8.8% for ISUP grade ≥ 3). Strategy 1 (PI-RADS 4-5 and/or PSAd ≥ 0.2), 3 (PI-RADS 4-5 and/or PI-RADS 3 if PSAd ≥ 0.15), and 7 (PI-RADS 4-5 and/or PI-RADS 3 if PSAd ≥ 0.15 and/or PI-RADS 2 if PSAd ≥ 0.2) were the next three best strategies. CONCLUSION: mpMRI combined with PSAd strategies reduced biopsy attempts in PI-RADS 3 lesions. Using these strategies, the advantage of avoiding biopsy and the risk of missing the diagnosis of csPCa can be discussed with the patient, and the biopsy decision can be made afterwards.

Effect of lesion diameter and prostate volume on prostate cancer detection rate of magnetic resonance imaging: Transrectal-ultrasonography-guided fusion biopsies using cognitive targeting.

OBJECTIVE: This study aimed to evaluate the effect of prostate volume and lesion size on the clinically significant prostate cancer (csPCa) detection rates of transrectal ultrasonography (TRUS)-guided prostate biopsies, performed by a cognitive targeting method for sampling peripheral zone lesions. MATERIAL AND METHODS: We retrospectively enrolled 219 consecutive patients, who underwent multiparametric magnetic resonance imaging with a 3-T scanner and had peripheral zone lesions suspected for prostate cancer. All of these patients underwent combined cognitive targeted biopsy of suspicious lesions and TRUS-guided systematic biopsy. The detection rates of csPCa according to different lesion diameters (<5 mm, 5-9.9 mm, and ≥10 mm) and prostate volumes (<30 mL, 30-49.9 mL, 50-79.9 mL, and ≥80 mL) were calculated per lesion basis. In addition, subgroup analysis of csPCa detection rates was performed according to Prostate Imaging Reporting and Data System scores of lesions. RESULTS: The csPCa detection rates according to lesion diameters <5 mm, 5-9.9 mm, and ≥10 mm were 4%, 9.8%, and 33.1%, respectively, and were significantly lower for lesions <10 mm (p<0.001). The csPCa detection rates were 61.5%, 24.1%, 16.2%, and 6.9%, respectively, for prostate volumes <30 mL, 30-49.9 mL, 50-79.9 mL, and ≥80 mL, and were significantly higher for prostate volumes <30 mL (p<0.001). CONCLUSIONS: Clinicians should be very careful when they prefer cognitive targeted prostatic biopsy in patients with periferal zone lesions less than 10 mm and with prostate volumes greater than 30 mL, because of significantly low csPCa detection rates.

Risk factors for infection development after transrectal prostate biopsy and the role of resistant bacteria in colonic flora.

INTRODUCTION: In this study, we aimed to identify risk factors for the development of infectious complications after prostate biopsy and to investigate the role of intestinal colonization of bacteria that are resistant to prophylactic antibiotics. METHODOLOGY: A total of 168 patients who had undergone transrectal prostate biopsy (TRPB) under ciprofloxacin and gentamycin prophylaxis were included in the study. Stool cultures and subsequent antibiotic susceptibility testing were performed in all patients before the start of antibiotic prophylaxis. RESULTS: Of the 168 patients, 17 (10.1%) developed urinary tract infection (UTI), while 6 (3.57%) developed sepsis within seven days after biopsy. Ciprofloxacin-resistant bacterial colonization was detected in 81 (48.2%) of the patients. None of the patients with ciprofloxacin-sensitive bacteria in intestinal flora developed a UTI. The colonization of intestinal ciprofloxacin-resistant bacteria increased UTI risk significantly after TRPB (p < 0.0001). Urolithiasis history, presence of permanent urinary catheterization, hospitalization history for more than 48 hours in the last year, and recent antibiotic usage significantly increased UTI risk after TRPB. CONCLUSIONS: Development of an infection was more frequent in patients with resistant bacterial colonization. We hope to guide more comprehensive studies designed to find a standard prophylactic regimen for TRPB that can be used all over the world.

Comparison of imaging modalities for detection of residual fragments and prediction of stone related events following percutaneous nephrolitotomy.

INTRODUCTION: Achieving stone free status (SFS) is the goal of stone surgery. In this study it is aimed to compare effectiveness of unenhanced helical computerized tomography (UHCT), KUB and ultrasonography (US) for detection of residual RFs and predicition of stone releated events following percutaneous nephrolitotomy (PNL). MATERIALS AND METHODS: Patients underwent PNL for radiopaque stones between November 2007 and February 2010 were followed. Patients were examined within 24-48 hours after the procedure by KUB, US and UHCT. For stone size 4 mm was accepted as cut off level of significance.Sensitivity and specificity of KUB and US for detection of RFs and value of them for prediction of stone related events were calculated. RESULTS: SFS was achieved in 95 patients (54.9%) and when cut off value of 4 mm for RFs was employed, SFS was achieved in 131 patients (75.7%). Sensitivity was 70.5% for KUB, and 52.5% for US. UHCT was shown to be significantly more efficient for detection of RFs compared to both KUB (p=0.01) and US (p=0.001). When cut off level of 4 mm employed, sensitivity of KUB and US increased to 85.7% and 57.1%. Statistical significant superiority of UHCT still remained (p value vs. KUB: 0.03 and p value vs. US: 0.008). CONCLUSION: UHCT is the most sensitive diagnostic tool for detecting RFs after PNL. It has higher sensitivity regardless of stone size compared to KUB and US. Additionally UHCT has higher capability of predicting occurrence of stone related events.

Comparison of imaging modalities for detection of residual fragments and prediction of stone related events following percutaneous nephrolitotomy

Introduction Achieving stone free status (SFS) is the goal of stone surgery. In this study it is aimed to compare effectiveness of unenhanced helical computerized tomography (UHCT), KUB and ultrasonography (US) for detection of residual RFs and predicition of stone releated events following percutaneous nephrolitotomy (PNL). Materials and Methods Patients underwent PNL for radiopaque stones between November 2007 and February 2010 were followed. Patients were examined within 24-48 hours after the procedure by KUB, US and UHCT. For stone size 4 mm was accepted as cut off level of significance.Sensitivity and specificity of KUB and US for detection of RFs and value of them for prediction of stone related events were calculated. Results SFS was achieved in 95 patients (54.9%) and when cut off value of 4 mm for RFs was employed, SFS was achieved in 131 patients (75.7%). Sensitivity was 70.5% for KUB, and 52.5% for US. UHCT was shown to be significantly more efficient for detection of RFs compared to both KUB (p=0.01) and US (p=0.001). When cut off level of 4 mm employed, sensitivity of KUB and US increased to 85.7% and 57.1%. Statistical significant superiority of UHCT still remained (p value vs. KUB: 0.03 and p value vs. US: 0.008). Conclusion UHCT is the most sensitive diagnostic tool for detecting RFs after PNL. It has higher sensitivity regardless of stone size compared to KUB and US. Additionally UHCT has higher capability of predicting occurrence of stone related events. .

Near infrared spectroscopy to diagnose experimental testicular torsion: comparison with Doppler ultrasound and immunohistochemical correlation of tissue oxygenation and viability.

PURPOSE: Near infrared spectroscopy measures tissue oxygenation even when there is complete cessation of blood flow. We evaluated near infrared spectroscopy to diagnose testicular torsion and blindly compared its accuracy with that of Doppler ultrasound. We also compared it by immunohistochemical evaluation of hypoxia and cell viability. MATERIAL AND METHODS: Rats were randomized to 4 groups, including group 1-720-degree unilateral torsion, group 2-360-degree unilateral torsion, group 4-sham operation and group 4-720-degree unilateral torsion followed by surgical torsion reduction at minute 180. Near infrared spectroscopy and Doppler ultrasound were done blindly at minutes 0, 5, 30, 60, 180 and 400. All torsed and contralateral testicles were excised for pathological examination using hypoxia inducible factor-α for hypoxia and the TUNEL test for apoptosis. We compared all groups with the contralateral testis and the sham operated group. RESULTS: All blinded, near infrared spectroscopy measurements correctly identified the torsed testis after minute 5. Median oxygen saturation in groups 1 and 2 was significantly different compared to that in the sham operated group after minute 5. In group 4 near infrared spectroscopy detected detorsion with the loss of a significant oxygen saturation difference between the affected and the contralateral testicle after detorsion. At minute 400 median oxygen saturation in group 4 was not statistically different compared to that in the sham operated group (p = 0.09) but it was significantly different compared to that in groups 1 and 2 (p <0.001). In each torsed testis oxygen saturation was at least 18.75% lower than in the contralateral testis. In groups 1 and 2 hypoxia inducible factor-α staining in torsed testicles was significantly greater than that in the contralateral organ and the sham operated group. In group 4 hypoxia inducible factor-α staining after detorsion was significantly decreased compared to that in groups 1 and 2. There was no significant difference in the apoptotic index between the experimental and the contralateral testis or the sham operated group. CONCLUSIONS: Near infrared spectroscopy is as effective but quicker than Doppler ultrasound for detecting testicular torsion without a radiologist. Near infrared spectroscopy accurately reveals oxygen saturation, which is more vital than blood flow, on which Doppler ultrasound focuses.

Urinary ultrasonography in screening incidental renal cell carcinoma: is it obligatory?

PURPOSE: To analyze the rate of incidental renal carcinoma in patients with no upper urinary tract symptoms (UUTS) or hematuria depending on the sonography reports and medical records of the patients and to determine whether there is a need for routine US screening for RCC. MATERIALS AND METHODS: We reviewed the reports of 18.686 consecutive urinary US examinations performed in our department between March 1995 and February 2008. A total of 18.203 urinary US examinations formed the study group. Patients with UUTS, patients with presumed diagnosis of or previously diagnosed renal masses, and patients with hematuria were excluded. RESULTS: There were 11,654 male and 6,549 female patients with a mean age of 55 years. Ultrasonography revealed incidental solid renal masses in 0.44% of the patients. Seven of the 81 patients with incidentally detected renal masses could not be followed up. Thirty-eight of the remaining 74 patients had masses that were proved to be benign with other imaging techniques. Thirty-six of the 74 patients with preoperative diagnosis of renal tumor underwent surgery, and the histopathological diagnosis was renal cell carcinoma in all patients. One patient expired in the postoperative 18th month due to the progression of the metastatic disease. The rest of the patients with malignant renal tumor are disease free and are still under follow-up. CONCLUSION: The rate of incidental renal cancer in patients without UUTS is found to be 0.20%. We believe that scanning for incidental renal masses is not obligatory except for the patients with symptoms suggestive of renal carcinoma.

Analysis of suprapubic and transrectal measurements in assessment of prostate dimensions and volume: is transrectal ultrasonography really necessary for prostate measurements?

INTRODUCTION: The objective of this study was to evaluate the correlation of suprapubic ultrasonography and transrectal ultrasonography in measurements of prostate dimension and volume. MATERIALS AND METHODS: One hundred consecutive patients with lower urinary tract symptoms were examined by suprapubic and transrectal ultrasonography modalities in a same session. Measurements of the 3 dimensions of the prostate (anteroposterior, transverse, and craniocaudal) and its volume performed by suprapubic ultrasonography were compared with the corresponding measurements by transrectal ultrasonography in order to determine the correlation of the measurements. Prostate volumes were calculated using the ellipsoid formula. Data were further analyzed in subgroups according to prostate volumes smaller or larger than 50 mL, measured by suprapubic ultrasonography. RESULTS: The mean prostate volume of the 100 patients, measured by suprapubic and transrectal ultrasonography were 65.9 +/- 35.8 mL and 62.5 +/- 32.0 mL, respectively (r = 0.94; P < .001). The craniocaudal diameters had the strongest correlation among dimension measurements (r = 0.89; P < .001). Suprapubic and transrectal ultrasonography measurements also showed significant correlations for both prostates smaller or larger than 50 mL. Eighty-five percent of the patients had both volume measurements under or above this limit. CONCLUSION: There was strong correlation between suprapubic and transrectal ultrasonography measurements of the prostate sizes, including both for volume or specific dimension measurements.

A new parameter for staging bladder carcinoma: ultrasonographic contact length and height-to-length ratio.

OBJECTIVE: The purpose of this study was to investigate the value of tumor-bladder wall contact length (CL), tumor height (H), and height-to-length ratio (H/CL) for preoperative staging of bladder carcinoma. METHODS: Fifty-seven patients with bladder tumors underwent suprapubic ultrasonography preoperatively, and the CL of the tumor with the bladder wall and H in the bladder lumen were measured. The CL, H, and H/CL values were correlated with the wall invasion determined by histopathologic analysis of the cystectomy material. Invasion was staged according to the TNM classification system. RESULTS: Statistically significant differences were found for CL (P < .001) and H/CL (P = .001) between the superficial and invasive tumor groups. These parameters were also effective for differentiating superficial or deep muscle invasion. A CL of greater than 41.5 mm and an H/CL of less than 0.605 were calculated as cutoff values for differentiating superficial and invasive tumors. Height had no value for determining invasion. CONCLUSIONS: The ultrasonographic measurements of CL of the tumor with the bladder wall and H/CL may be useful for staging bladder carcinoma by verification of these findings in larger groups of patients.

Effect of dimensions and volume of the prostate on cancer detection rate of 12 core prostate biopsy.

PURPOSE: To evaluate if volume or any of the three dimensions of prostate influences cancer detection rate by 12-core transrectal ultrasound (TRUS) guided prostate biopsy. MATERIALS AND METHODS: We have searched our database for patients who underwent 12 core TRUS guided prostate biopsy with PSA values between 4.0 and 9.9 ng/ml, benign digital exam and no suspicious lesions at TRUS. The measurements of three dimensions and volume of the prostate of 99 patients were correlated with cancer detection rates of biopsy. RESULTS: There were no statistically significant differences between patients with prostate cancer or with benign histopathologic result for mean age, PSA and % PSA. Patients without cancer had a significantly higher mean prostate volume (58.88 cc) than patients with cancer (48.85 cc) (P = 0.038). A volume of 48.5 cc was determined as a cut-off value above which cancer detection rate decreases. Of the three dimensions, only the difference for the craniocaudal dimension between benign and malignant groups was marginally significant (P = 0.052). CONCLUSIONS: With 12 core biopsy, cancer detection rate is lower in patients with prostates larger than 48.5 cc. Further studies comparing biopsy results with prostatectomy specimens can clarify whether these results necessitates higher number of cores for such patients.

Effect of bladder carcinoma location on detection rates by ultrasonography and computed tomography.

OBJECTIVES: To evaluate the effect of the location of bladder carcinoma on detection rates by ultrasonography (US) and computed tomography (CT). METHODS: The study included 85 patients with bladder cancer who were examined by US and CT before cystoscopy. The bladder wall was divided into 13 separate regions, and the tumor detection rates by US and CT were calculated for each location and lesion diameter with regard to the cystoscopy findings. RESULTS: A total of 214 bladder tumors were detected at cystoscopy. The lowest detection rate for US was noted for the anteroinferior region (47%) of the bladder. The lowest detection rate for CT was also noted for the same region (55.5%). The detection rate of all anterior wall tumors by US and CT was 48.27% and 62.5%, respectively. The detection rate by CT was 100% for tumors greater than 5 mm in diameter. The greatest detection rates by both of the imaging modalities were for the bilateral side walls of the bladder. CONCLUSIONS: The results of this study suggest that bladder tumor location highly affects the detection rates by US and CT. The lowest detection rates by both modalities were noted for anterior wall tumors. Because of the lower detection rate of tumors located in the anterior wall of bladder and those smaller than 5 mm, we recommend cystoscopy whenever a bladder tumor is suspected.

A novel parameter by EFOV US for the quantification and the distinction of physiological amount of scrotal fluid and hydrocele: ratio of testis volume/scrotum volume.

OBJECTIVE: To determine the limits for the amount of tunical fluid enough to be termed as hydrocele by using extended-field of view US technology and to define hydrocele for the first time with standard numerical criteria. METHODS: A total of 60 patients were evaluated in this prospective study. Group 1 consisted of 20 patients with unilateral clinical hydrocele. Group 2 included 20 patients referred for scrotal US for reasons other than hydrocele. Group 3 comprised 20 male controls with no scrotal complaints. Testis volume (V(t)), scrotum volume (V(s)) and V(t)/V(s) ratio were calculated for each subject by dimensions measured in longitudinal and tranverse planes. RESULTS: Mean V(t)/V(s) ratio was 0.28 +/- 0.17 (range, 0.07-0.57), 0.69 +/- 0.08 (range, 0.53-0.80) and 0.71 +/- 0.07 (range, 0.61-0.85) for groups 1, 2 and 3, respectively. Mean V(t)/V(s) for group 1 was significantly lower than those for groups 2 and 3, respectively (p<0.001 for each). Based on the ROC curve analysis, 0.55 for V(t)/V(s) ratio was determined as the optimal cut-off point below which the US diagnosis of hydrocele could be made (sensitivity 95.0% and specificity 97.5%). CONCLUSIONS: We propose a novel US parameter of V(t)/V(s) ratio below 0.55 for a standard distinction between hydrocele and physiological amount of scrotal fluid.

Chronic constipation as a causative factor for development of varicocele in men: a prospective ultrasonographic study.

OBJECTIVE: The purpose of this study was to determine the role of chronic constipation in the etiopathogenesis of varicocele in men. METHODS: In this prospective study, group 1 included 25 male patients who had symptoms of chronic constipation for a mean duration +/- SD of 17.0 +/- 20.3 months (range, 3-96 months), and group 2 included 26 male subjects without any symptoms associated with constipation. All subjects were evaluated by both physical examination and scrotal ultrasonography. For the plexus pampiniformis (PP) veins, a mean diameter exceeding 2 mm and reflux for more than 1 second were accepted as suggestive findings for varicocele, as described previously. RESULTS: Left varicocele was detected in 13 (52%) of the 25 patients in group 1 and in 5 (19%) of the 26 subjects in group 2 (P = .02). The mean diameters of the left PP veins were 2.58 +/- 0.97 mm (range, 1.2-4.3 mm) in group 1 and 1.71 +/- 0.53 mm (range, 1.0-3.0 mm) in group 2 (P < .001). A significant difference was detected between the two groups for varicocele prevalence and the mean diameter of the left PP veins. CONCLUSIONS: Chronic constipation is a significant causative factor for the development of left varicocele, which may be attributable to the accompanying distention of the sigmoid colon and distal part of the descending colon, with resultant compression of the left testicular vein in the retroperitoneum. Therefore, we propose routine ultrasonographic examinations for the possible development of varicocele in men with chronic constipation.

Effect of premicturitional bladder volume on the accuracy of postvoid residual urine volume measurement by transabdominal ultrasonography: rate of bladder fullness is of great importance for preventing false-positive residue diagnosis.

OBJECTIVE: The purpose of this study was to evaluate the effect of premicturitional bladder volume (V1) on postvoid residual urine volume (V2) measurements and to assess the ideal V1 for an accurate V2 determination. METHODS: Twenty-five healthy men without any urinary symptoms constituted the study group. Measurements by transabdominal ultrasonography for V1 and V2 were performed for each subject at 3 different phases, each of which was preceded by oral intake of 1000 mL of water and accompanied by "mild," "moderate," and "severe" sensations of micturition, respectively. RESULTS: Mean +/- SD V1 and V2 during the first, second, and third phases were 117.7 +/- 70.3 and 1 +/- 1, 356.2 +/- 112.3 and 11.5 +/- 12 and 639.6 +/- 171.8 and 58.8 +/- 35.2 mL, respectively. With 50 mL as the cutoff value for a pathologic V2, 15 (60%) men had V2 in the third phase exceeding this value, whereas the same rate was calculated as 0% for either of the first 2 phases. No patient with V1 of less than 540 mL had V2 of greater than 50 mL. CONCLUSIONS: Postvoid residual urine volume measurements with an uncomfortably full bladder result in high false-positive postmicturitional residue values even in healthy young men. We strongly advise that V1 measurements of the bladder be performed before V2 measurements and that V2 not be measured if V1 is greater than 540 mL.

Unilateral idiopathic hydrocele has a substantial effect on the ipsilateral testicular geometry and resistivity indices.

OBJECTIVE: The purpose of this study was to determine whether hydrocele has any effect on the volume and shape of the ipsilateral testis and can be implicated as a cause of testicular ischemia. METHODS: Group 1 consisted of 23 patients with unilateral idiopathic hydrocele, whereas 30 healthy men constituted group 2. All patients underwent scrotal ultrasonography by which testicular dimensions in craniocaudal (D(cc)), anteroposterior (D(ap)), and mediolateral axes were measured, followed by calculation of the D(cc)/D(ap) ratio and testicular volume. By color Doppler analysis, the resistivity index of the subcapsular artery (RI(sc)) and the resistivity index of the intratesticular artery were determined. RESULTS: The mean D(cc)/D(ap) ratio +/- SD for group 1 was 1.7 +/- 0.3 (range, 1.1-2.3), significantly lower than that of group 2, which was 1.9 +/- 0.3 (range, 1.3-2.2) (P = .028). Mean testicular volume values of subjects having hydrocele for more than and less than 6 months were 13.4 +/- 7.3 and 22.5 +/- 5.1 cm3, respectively; the difference between the subgroups was significant (P = .003). For the ipsilateral testis, mean RI(sc) values were 0.70 +/- 0.06 (range, 0.60-0.80) in group 1 and 0.65 +/- 0.06 (range, 0.59-0.83) in group 2. The mean RI(sc) was significantly higher in group 1 (P = .006). CONCLUSIONS: Unilateral idiopathic hydrocele has a tendency for rounding rather than flattening the ipsilateral testis as well as elevating the RI(sc) on the affected side. To the best of our knowledge, no strict spectral Doppler analysis criteria have been proposed for testicular ischemia yet. Therefore, the impact of the difference of the RI(sc) should raise the suspicion for ischemia, and further research is needed to elucidate any effect on spermatogenesis.

3-Dimensional computerized tomography in follow-up of patients with urinary diversion.

INTRODUCTION: The aim of our study was to evaluate the usefulness of 3-dimensional computerized tomography (3D-CT) in routine follow-up of patients who had undergone radical cystectomy and different kinds of urinary diversions and compare it with conventional CT. PATIENTS AND METHODS: Nineteen patients (18 men, 1 woman) who had undergone radical cystectomy and different kinds of urinary diversions with diagnosis of invasive bladder cancer were enrolled into the study. The mean age of the patients was 55.5 (46-69) years. For all patients, conventional CT was performed, followed by 3D reconstruction of these images. RESULTS: Orthotopic ileal neobladder (Abol-Enein and Ghoneim procedure) was performed in 12, rectosigmoid pouch (Mainz pouch II) in 2 and ileal conduit in 5 patients. There were no pathological findings visible either on conventional CT or on 3D-CT, but the shape, configuration, and the relationships of the pouch with ureters, urethra and other adjacent organs were much better visualized on 3D-CT. CONCLUSION: 3D-CT did not have any advantages over conventional CT for showing pathological findings that were oncological origin, but as the anatomy of the lower urinary tract can be perfectly demonstrated, we think that it may be used for planning of a re-operation after urinary diversion and may help the urologist who has less experience with radiological studies to evaluate pouch configuration and indentations to the adjacent organs better.

Is fluid ingestion really necessary during ultrasonography for detecting ureteral stones? A prospective randomized study.

OBJECTIVE: Ultrasonographic evaluation of ureteral stones is usually performed after fluid ingestion for filling the bladder to visualize the ureterovesical junction better. We hypothesized that water ingestion may decrease the imaging quality of ultrasonography for detecting ureter stones. In our prospective randomized study, the accuracy of ultrasonography for detecting ureteral stones performed with or without fluid intake were evaluated. METHODS: The study population comprised 150 consecutive patients thought to have ureteral stones who underwent ultrasonography. Patients were divided into 2 groups. Group A patients ingested 500 mL of water to distend the bladder before ultrasonographic examination. Group B patients were restricted from drinking any water at least 4 hours before the procedure. RESULTS: Ultrasonography showed 35 (67.30%) of 52 stones in group A and 68 (93.15%) of 73 stones in group B. The difference of detection rates between the 2 groups was statistically significant (P < .001). The greatest improvement in detection rates was noted in the middle ureter stones. The evaluated sensitivity and specificity rates for group A were 67% and 82%, respectively, and those for group B were 93% and 94%. When the 2 methods were compared, total accuracy of ultrasonography increased from 71% in group A to 93% in group B. CONCLUSIONS: This prospective randomized study showed that the diagnostic accuracy of ultrasonography for detection of middle ureteral stones increased significantly when performed without any water ingestion before the procedure. We recommend that patients thought to have ureteral stones should be first examined without any fluid ingestion.

Follow-up of the transrectal ultrasonographic features of the prostate after biopsy: does any ultrasonographically detectable lesion form secondary to the first biopsy?

OBJECTIVE: The purpose of this study was to evaluate the transrectal ultrasonographic features of the prostate after biopsy and to find out whether any ultrasonographically detectable lesion forms secondary to biopsy. METHODS: Prebiopsy transrectal ultrasonographic findings in 60 consecutive patients who underwent repeated biopsies were evaluated. Detected lesions that were not defined before the first biopsy were considered postbiopsy-formed lesions and were sampled during the second biopsy. All transrectal ultrasonographically detected lesions were correlated with histopathologic results in the same locations. RESULTS: There were 7 (11.6%) patients with new hypoechoic lesions formed after the first biopsy. Histopathologic analysis of postbiopsy-detected lesions showed that 38.5% were cancer; 62.5% of the detected benign lesions were prostatitis foci. CONCLUSIONS: Prostate biopsy does not give rise to formation of fibrotic scar tissue in the peripheral zone. Most postbiopsy-detected lesions are prostatitis foci, but all hypoechoic lesions must be sampled during repeated prostate biopsies because of the 38.5% cancer detection rate.