Early catheter removal in 100 consecutive patients undergoing radical retropubic prostatectomy.

OBJECTIVES: To investigate the outcome of 100 consecutive patients selected for early catheter removal after radical retropubic prostatectomy (RRP), where urethral catheter drainage is used routinely for 2-3 weeks. PATIENTS AND METHODS: The study included 129 consecutive patients with clinically localized prostate cancer who underwent RRP. Catheters were removed in the clinic (with no radiographic studies) 8-9 days after RRP provided there was no evidence of urine leak, pelvic haematoma, rectal injury or severe obesity. The follow-up (mean 21 months) results were available for 118 patients, 100 of whom were candidates for early catheter withdrawal. Their records were reviewed for evidence of complications, including urinary retention, anastomotic stricture formation and urinary incontinence. RESULTS: Urinary retention developed in two of the 100 patients, requiring simple catheter replacement. Nine patients developed bladder neck contracture requiring dilatation or incision. No patients developed anastomotic disruption, urinary tract infection or pelvic abscess. At the mean follow-up of 21 months, 76% of patients were continent and did not require pads; 19% of patients had mild stress urinary incontinence requiring the use of 4 pads/day. CONCLUSION: With appropriate patient selection as described, catheters can be removed in the clinic (with no radiographic studies) 8-9 days after RRP, with no increased incidence of complications, including anastomotic stricture, retention or incontinence.

Characterization of ureteral dysfunction in an experimental model of congenital bladder outlet obstruction.

PURPOSE: Ureteral dysfunction is a significant sequela of congenital bladder outlet obstruction. However, the structural and functional alterations associated with ureteral dysfunction are not well defined. A model of fetal bladder obstruction in sheep was used to characterize the changes in ureteral smooth muscle, extracellular matrix (ECM) and functional properties in response to bladder outlet obstruction. MATERIALS AND METHODS: Partial bladder outlet obstruction was created in fetal sheep at gestational age 95 days via placement of a metal ring around the proximal urethra as well as ligation of the urachus. Ureters were harvested at 109 and 135 days (full term = 140 days) to determine the relative composition of smooth muscle, ECM and urothelium by morphometric analysis and to measure DNA and protein concentrations. Ureteral tissue from 135 day gestation obstructed and control sheep was harvested and immediately placed in Krebs solution. Smooth muscle strips (2-3 mm. x 7-8 mm.) were suspended in organ baths. The frequency and amplitude of spontaneous ureteral contractions was as well as the response to electric field stimulation (EFS) were determined. RESULTS: Bladder outlet obstruction caused a significant increase in ureteral weight, smooth muscle mass and total ECM at both 109 and 135 days gestation. Total ureteral DNA was greater in obstructed compared with sham ureters at 135 days gestation. Obstructed ureters demonstrated greater amplitude and frequency of spontaneous contractions as well as more pronounced response to EFS when compared to sham ureters. CONCLUSIONS: The fetal ureter responds to bladder obstruction with smooth muscle hyperplasia and hypertrophy which is associated with increased spontaneous activity and augmented response to EFS. ECM content is markedly increased indicating a shift in the balance of connective tissue synthesis and degradation. Congenital post-obstructive ureteral dysfunction therefore appears to be the result of dysregulated smooth muscle cell growth and altered ECM homeostasis producing abnormal ureteral contractility.

Metastatic merkel cell tumor to bladder presenting as an encroachment tumor with gross hematuria.

Merkel cell carcinoma is an uncommon and aggressive tumor of neuroendocrine and epithelial origin. A case of metastatic Merkel cell tumor with hematuria secondary to invasion into the bladder is presented. This is the second reported case of metastatic Merkel cell tumor to the bladder and the first published cystoscopic image of such a lesion.

Clinicopathological characteristics of prostatic adenocarcinoma in men with atypical prostate needle biopsies.

PURPOSE: Atypical or nondefinitive diagnoses comprise 1.5 to 10% of all prostate needle biopsies and many men with atypical biopsy have carcinoma on rebiopsy. We characterize the clinical and pathological features of these men and the tumors, and compare them to those of other men who had more than 1 biopsy. MATERIALS AND METHODS: All prostate needle biopsies done at our institution between 1989 and 1996 on men with a followup biopsy were reviewed and the clinicopathological features were correlated. RESULTS: A total of 343 men had more than 1 biopsy during this period. Of the biopsies 64 were atypical and followup (repeat biopsy) was available for 59. Men with an atypical diagnosis were more likely to have carcinoma (34%) and to be diagnosed subsequently earlier (270 days) than those with an initial negative diagnosis (22%, 603 days). No significant differences were noted in patient age, results of digital rectal examination, initial or followup serum prostate specific antigen, subsequently identified tumor size or Gleason score on needle biopsy or at resection. Although on review as many as 38% of the original atypical foci could be reclassified, this reclassification did not significantly change the results of rebiopsy. CONCLUSIONS: Men with an atypical diagnosis on prostate biopsy are significantly more likely to have carcinoma on rebiopsy than men with an initial negative diagnosis, and the second biopsy should be performed at a significantly shorter interval. The tumors that are subsequently identified in these men are similar to those identified in men without an atypical biopsy.