New method for minimally invasive urodynamic assessment in men with lower urinary tract symptoms.

OBJECTIVES: Urodynamic studies are considered the reference standard to diagnose bladder outlet obstruction. However, the procedure is invasive, expensive, and time-consuming. The purpose of this study was to evaluate a new minimally invasive urodynamic assessment model and compare the results with those of conventional urodynamic evaluation. METHODS: The study included 50 male patients who presented with lower urinary tract symptoms. Their mean age was 62 years (range 34 to 82). After undergoing a conventional urodynamic study, they underwent the minimally invasive evaluation. The urethral device is a conical apparatus that adapts to the urethral meatus and fossa navicularis. The isometric bladder pressure and interrupted flow were recorded. The results of the conventional assessment were classified according to the Abrams-Griffiths number and a logistic regression fit was applied to the minimally invasive method. RESULTS: Only two variables demonstrated the predictive capacity: the isometric pressure and interrupted flow. In addition to selecting the relevant variables, logistic regression analysis is a more adequate model that provides a binary result of obstructed and unobstructed, used to predict the normal and equivocal categories of the Abrams-Griffiths classification, and taken as the reference standard. The sensitivity and specificity of the new method was 67% and 79%, respectively. CONCLUSIONS: The urethral device proved to be simple and easy to use. The minimally invasive method was able to detect most patients with bladder outlet obstruction; thus, the conventional urodynamic assessment could be avoided. We consider this method to have a place as a first-line noninvasive examination.

Long-term followup of penile carcinoma treated with penectomy and bilateral modified inguinal lymphadenectomy.

PURPOSE: We evaluated modified inguinal lymphadenectomy in the treatment of penile carcinoma, analyzing the rate of complications compared to complete inguinal lymphadenectomy, the complications in performing lymphadenectomy and penectomy concomitantly, and the long-term locoregional recurrence rate. MATERIALS AND METHODS: A total of 26 patients with squamous cell carcinoma of the penis were clinically assessed, and underwent penectomy and bilateral modified inguinal lymphadenectomy at the same operative time. Frozen section analysis of lymph nodes was performed and if metastases were detected a complete ipsilateral inguinal dissection was performed. RESULTS: A total of 52 modified lymphadenectomies were performed. In 10 procedures lymph node metastasis was present. Clinical staging presented false-positive and false-negative rates of 50% and 7.9%, respectively. The complication rate for modified lymphadenectomy was 38.9% and for complete inguinal lymphadenectomy it was 87.5%. Followup ranged from 5 to 112 months and mean followup of recurrence-free cases was 78 months (range 38 to 112). A total of 18 patients underwent bilateral negative modified inguinal lymphadenectomy and 2 of these experienced locoregional recurrence within 2 years after surgery. CONCLUSIONS: Modified inguinal lymphadenectomy causes a lower complication rate than complete inguinal lymphadenectomy. Bilateral modified inguinal lymphadenectomy performed at the same time as penectomy does not increase the complication rate. When frozen section analysis is negative bilaterally, 5.5% of inguinal regions might still harbor occult metastasis. Modified inguinal lymphadenectomy is recommended as a staging procedure in all patients with T2-3 penile carcinoma. A straight followup is required for 2 years since all recurrence was within this period.