Cholinergic drugs for treatment of recurrent urinary retention in high surgical risk/elderly BPH patients. A pilot study.

AIM: Urinary retention (UR) secondary to benign prostatic hyperplasia often leads patients to surgery, especially those who fail to urinate following a trial without catheter (TWOC). However, patients of high surgical risk and/or elderly patients with co-morbidities are usually not eligible for surgical treatment. Moreover, recurrent UR may indicate a poor detrusor function representing a risk factor of surgical therapy failure. Our objective was to evaluate the role of distigmine bromide, an anticholinesterase agent, to promote a successful TWOC in patients with recurrent UR. METHODS: Seventeen elderly and/or high surgical-risk patients with recurrent UR and prior failures to TWOCs received a combination of alpha-blocker along with distigmine bromide and have been retrospectively compared with that of 20 first-time UR patients who received only the alpha-blocker just after emergency catheterization. The short-term outcome was measured by resumption of voiding, number of TWOC failures preceding successful voiding, determination of post-voiding residual volume (PVR), and International Prostate Symptom Score (IPSS). RESULTS: The majority of patients on combination therapy had a successful TWOC, similarly to all first-time urinary retention patients. Compared to patients on monotherapy, patients on combination therapy needed more TWOCs to void due to gradual increase in the dosage of distigmine bromide. PVR was significantly reduced with treatment in both groups. Statistically, there was no significant difference between the two groups on the PVR and IPSS mean change. CONCLUSION: Our results suggest that the combination of alpha-blocker and distigmine may eventually benefit patients with recurrent UR and prior unsuccessful TWOCs, to void.

Cromo hexavalente y riesgo de cáncer de vejiga / Hexavalent chromium and bladder cancer risk

No disponible

Urofacial syndrome: a subset of neurogenic bladder dysfunction syndromes?

The urofacial syndrome (Ochoa syndrome) is considered to represent a subgroup of the non-neurogenic bladder dysfunction, characterized by non-neuropathic bladder-sphincter dysfunction, along with a characteristic inversion of the facial expression with laughing. Recent research suggests that it is probably a genetic inherited disease transmitted in an autosomal recessive fashion and might represent a distinct entity. We report a case of this syndrome in a 14-year-old boy who presented with left pyelonephritis, hydronephrosis, and bladder dilation.

Prostate sarcomatoid carcinoma as accidental finding in transurethral resection of prostate specimen. A case report and systematic review of current literature.

BACKGROUND: Sarcomatoid carcinoma of the prostate is an extremely rare and highly aggressive neoplasm that accounts for less than 0.1% of primary prostate malignancies. Long-term survival rates for adult patients with prostate sarcomatoid carcinoma are poor. Surgical treatment seems to be the most effective therapeutic approach. In contrast radiation therapy alone has shown limited efficacy. AIM: The purpose of the study is to present a case of sarcomatoid carcinoma of the prostate treated with a combination of radiotherapy and TURP. CASE REPORT: A 76-year-old man treated with TURP due to acute urinary retention was finally diagnosed with sarcomatoid carcinoma upon pathology examination of the surgical specimen. Patient was initially treated with external beam radiotherapy. Six months later, he presented with urinary retention suggesting extension of the tumor into the bladder neck. Pathology report diagnosed prostate sarcomatoid carcinoma containing also large areas of necrosis. Patient underwent an extensive TURP and he received a second round radiotherapy. One year after the initial diagnosis of sarcomatoid carcinoma, patient is free of symptoms and follow up investigation shows no evidence of metastatic disease. CONCLUSIONS: Radiation therapy in combination with extensive TURP may delay disease progression.

Measurement of tumor markers in chronic hemodialysis patients.

Tumor markers are widely used for screening certain tumors, however, their use in chronic hemodialysis (HD) patients in hemodialysis has been a controversial issue. To determine the reliability of the tumor markers, CA 15-3, CA 19-9, CA 125, alpha-fetoprotein and carcinoembryonic antigen (CEA), in chronic HD patients, and the impact of active hepatitis C on the variation of tumor markers values, we studied 30 patients (16 men and 14 women) aged from 40 to 78 years old (mean age: 54 + or - 5 years), on intermittent hemodialysis (with a mean duration of 10.5 years), and clinically free from neoplastic disease. The control group included 30 healthy volunteers. All subjects were of Greek origin and residents of the Korinthos region. The tumor markers were measured once in the control group and before and afterwards the hemodialysis, in the study group. Alpha fetoprotein was within normal limits in all the study patients, CA 125 was slightly increased in one (3.3%) patient, CA 15-3 levels were twice normal in 4 (13%) patients, CA 19-9 levels were twice normal in 5 (16%) patients, and CEA levels were twice normal in 4(13%) patients. More than half (7/13) of anti HCV positive and all Australian antigen positive patients had abnormal serum levels of CA 15-3 and CA 125 after hemodialysis treatment. We conclude that measurement of some tumor markers such as alfa-fetoprotein may be beneficial in HD patients. However, the elevated levels of other markers including CA 15-3 and CA 125 are not specific for neoplasms and related to active hepatitis C.

Urofacial syndrome: A subset of neurogenic bladder dysfunction syndromes?

The urofacial syndrome is probably a subset of neurogenic bladder dysfunction syndromes characterized by detrusor-sphincter discoordination along with a characteristic inversion of facial expression with laughing. This characteristic facial expression can facilitate early detection of this disorder, which leads to poor bladder emptying with high residual urine, hydro-nephrosis with vesico-ureteral reflux and potentially renal failure if left untreated. The etiology of the urofacial syndrome is unknown. In our case, a 12-year-old boy of Middle-Eastern origin presented to the Outpatient Department of our hospital with left pyelonephritis, hydronephrosis and bladder dilatation. Voiding cystourethrography performed 15 days later revealed left vesicoureteral reflux. Cystoscopy revealed bladder trabeculation however an anatomic urethral obstruction was not noticed. Both, neurological examination and radiography of the lumbosacral spine were normal. Urodynamic evaluation revealed the typical findings of detrusor-sphincter discoordination.

Imaging of the acute scrotum: is there a place for contrast-enhanced ultrasonography?

PURPOSE: To present and evaluate the findings of contrast-enhanced ultrasonography (CEUS) in typical cases of acute painful scrotum. MATERIALS AND METHODS: Nineteen patients aged from 19 to 61 years old were included in the study. All patients underwent grey-scale and color Doppler ultrasonography (US) of the scrotum, followed by imaging after i.v. administration of 2.4 mL of a second generation ultrasound contrast agent (microbubbles of sulphur hexafluoride). ? dedicated, contrast-sensitive technique was used (Contrast Tissue Imaging - CnTI). The diagnosis was confirmed surgically in 6 cases while in the remaining 8 cases it was based on the combination of clinical, imaging and laboratory findings. RESULTS: The final diagnosis was testicular torsion (n = 4), epididymitis (n = 2, one of the cases complicated by abscess), testicular abscess (n = 1), scrotal abscess (n = 1), testicular trauma of varying severity (n = 6). Five out of 19 cases were true negatives: neither clinical examination nor laboratory tests revealed any pathology. CEUS showed complete lack of enhancement in all cases of torsion, permitting a rapid and definitive diagnosis. In the cases of infection complicated by abscesses, CEUS delineated the lesions much better than the combination of B-mode/Color Doppler US. The severely traumatized testicles showed minimal, inhomogeneous or patchy enhancement, while cases of minor trauma showed no significant enhancement defects. Hematomas were presented as non-enhancing lesions. CONCLUSION: Generally, there was no advantage over Doppler US as has been previously shown. However, CEUS can be used supplementary to traditional Doppler US in the investigation of blunt testicular trauma especially when there is uncertainty in diagnosis after appropriate clinical and radiographic evaluations occurs. Further studies are required to clearly define the indications of this method.

Imaging of the acute scrotum: is there a place for contrast-enhanced ultrasonography?

Purpose: To present and evaluate the findings of contrast-enhanced ultrasonography (CEUS) in typical cases of acute painful scrotum. Materials and methods: Nineteen patients aged from 19 to 61 years old were included in the study. All patients underwent grey-scale and color Doppler ultrasonography (US) of the scrotum, followed by imaging after i.v. administration of 2.4 mL of a second generation ultrasound contrast agent (microbubbles of sulphur hexafluoride). A dedicated, contrast-sensitive technique was used (Contrast Tissue Imaging - CnTI). The diagnosis was confirmed surgically in 6 cases while in the remaining 8 cases it was based on the combination of clinical, imaging and laboratory findings. Results: The final diagnosis was testicular torsion (n = 4), epididymitis (n = 2, one of the cases complicated by abscess), testicular abscess (n = 1), scrotal abscess (n = 1), testicular trauma of varying severity (n = 6). Five out of 19 cases were true negatives: neither clinical examination nor laboratory tests revealed any pathology. CEUS showed complete lack of enhancement in all cases of torsion, permitting a rapid and definitive diagnosis. In the cases of infection complicated by abscesses, CEUS delineated the lesions much better than the combination of B-mode/Color Doppler US. The severely traumatized testicles showed minimal, inhomogeneous or patchy enhancement, while cases of minor trauma showed no significant enhancement defects. Hematomas were presented as non-enhancing lesions. Conclusion: Generally, there was no advantage over Doppler US as has been previously shown. However, CEUS can be used supplementary to traditional Doppler US in the investigation of blunt testicular trauma especially when there is uncertainty in diagnosis after appropriate clinical and radiographic evaluations occurs. Further studies are required to clearly define the indications of this method.

The impact of diabetes type 2 in the pathogenesis of benign prostatic hyperplasia: a review.

INTRODUCTION: Clinical observation of larger prostate glands in men with diabetes mellitus type 2 led some investigators to hypothesize that an association between these two conditions exists. In fact, both diseases are very common in men as they age and seem to be sharing similar epidemiologic features. Several studies examining the above hypothesis were yielded. AIM: The purpose of this paper is to summarize the existing literature focusing on the coexistence of BPH and diabetes mellitus type 2 and to elucidate whether or not an association among these conditions exists. METHODS: We identified studies published from 1990 onwards by searching the MEDLINE database of the National Library of Medicine. Initial search terms were benign prostatic hyperplasia, epidemiology, and risk factor, combined with diet hyperinsulinemia, and diabetes mellitus type 2. RESULTS: Diabetes mellitus type 2 and hyperinsulinemia are quite common conditions and often coexist with BPH. There are several studies (observational, epidemiological, and experimental) examining the association between them in literature. CONCLUSION: Evidence suggests that an association between BPH and diabetes through a common pathogenic mechanism is possible. The specific pathway interfering in the development of both conditions is still poorly investigated; thus, the exact relationship of BPH to diabetes remains unclear.

Unusual case of multilocular cystic renal cell carcinoma treated with nephron-sparing technique.

INTRODUCTION: The spectrum of cystic renal neoplasms includes both benign and malignant tumors and the order is as follows: benign multilocular cyst, multilocular cystic renal cell cancer and cystic renal cell cancer. Gross similarities among multicystic tumors of the kidney may cause conflict in the diagnosis and treatment of these lesions. CASE REPORT: We report a 37-year-old male who presented with a mild persistent left flank pain and a painful left renal mass. After a series of examinations including abdominal ultrasound, intravenous pyelography and computed tomography, he underwent surgical exploration despite the benign appearance on radiological evaluation. A partial nephrectomy has been finally performed. The pathologic examination showed multilocular cysts lined by flattened to cuboidal epithelium, separated by cellular spindle cell stroma. Few scattered foci of lining cells showing the typical features of clear cell carcinoma of the kidney have been revealed also. CONCLUSION: According to the current literature, prognosis of multilocular renal clear cell carcinoma is excellent in most of the cases. Indeed, metastases development is rare while local recurrence is related to inadequate local excision. Despite the relatively benign nature, urologist should be always aware of such complex renal masses since both the non specific clinical findings and poor contribution of imaging examinations make the preoperative distinction of benign from malignant cystic renal neoplasias difficult.

Brucella melitensis: a rarely suspected cause of infections of genitalia and the lower urinary tract

We examined the clinical presentation and outcome of Brucellar infections of genitalia and the lower urinary tract through a review of the medical records of 10 cases of male patients with brucellar infections of the genitalia and lower urinary tract. The mean age of the patients with brucellosis was 49.2, (median 52, range 15-77 years). Eleven out of 17 patients were rural residents, 15 reported that they might have consumed unpasteurized dairy products) and four reported occupational exposure. Symptoms onset was acute in almost all cases. Scrotal pain, epidedimal swelling and fever were the most common symptoms. The Wright test was positive in 13 patients, while Brucella sp. was isolated from blood cultures in six cases. Only two patients were found with abnormal liver ultrasonography. All patients underwent treatment with doxycycline and aminoglycoside for seven days and doxycycline alone for two months. Most of them responded to antibiotic therapy with rapid regression of symptoms. One patient failed to respond to therapy and presented necrotizing orchitis, as well as abscesses, which required orchectomy. Brucellar infections of the genitalia and lower urinary tract have no specific clinical presentation; the usual laboratory examination is not sufficient to diagnose this kind of infection, therefore it could easily be misdiagnosed. An analytical medical history (including overall dietary habits and recent consumption of non-pasteurized dairy products) could indicate Brucelosis as would the persistence of symptoms despite a one-week antibiotic treatment. In general, patients afflicted by brucellar epididymoorchitis respond to Brucellosis antibiotic therapy, except for some rare cases that present necrotizing orchitis and require surgical treatment.

Brucella melitensis: a rarely suspected cause of infections of genitalia and the lower urinary tract.

We examined the clinical presentation and outcome of Brucellar infections of genitalia and the lower urinary tract through a review of the medical records of 10 cases of male patients with brucellar infections of the genitalia and lower urinary tract. The mean age of the patients with brucellosis was 49.2, (median 52, range 15-77 years). Eleven out of 17 patients were rural residents, 15 reported that they might have consumed unpasteurized dairy products, and four reported occupational exposure. Symptoms onset was acute in almost all cases. Scrotal pain, epidedimal swelling and fever were the most common symptoms. The Wright test was positive in 13 patients, while Brucella sp. was isolated from blood cultures in six cases. Only two patients were found with abnormal liver ultrasonography. All patients underwent treatment with doxycycline and aminoglycoside for seven days and doxycycline alone for two months. Most of them responded to antibiotic therapy with rapid regression of symptoms. One patient failed to respond to therapy and presented necrotizing orchitis, as well as abscesses, which required orchectomy. Brucellar infections of the genitalia and lower urinary tract have no specific clinical presentation; the usual laboratory examination is not sufficient to diagnose this kind of infection, therefore it could easily be misdiagnosed. An analytical medical history (including overall dietary habits and recent consumption of non-pasteurized dairy products) could indicate Brucellosis as would the persistence of symptoms despite a one-week antibiotic treatment. In general, patients afflicted by brucellar epididymoorchitis respond to Brucellosis antibiotic therapy, except for some rare cases that present necrotizing orchitis and require surgical treatment.

Do clinically insignificant tumors of the prostate exist?

BACKGROUND: The discrepancy between minimal disease on biopsy and disease found in the subsequent prostatectomy specimen, in terms of the size and grade of tumor, extracapsular extension or positive margins, led several authors to dispute the existence of clinically insignificant impalpable tumors of the prostate. However, considering that prostate-specific antigen (PSA) is an indicator of prostate malignancy and since many impalpable prostatic carcinomas (PCs) are detected by a combination of PSA, transurethral ultrasound and needle biopsy (T1c), in the era of PSA screening, it is expected that most of the impalpable tumors found incidentally at transurethral resection of the prostate (stage T1a/b), could be clinically insignificant. AIM: The aim of this study was to identify the characteristics of latent, impalpable PCs and to analyze the incidence of clinically insignificant PCs among hypothetical stage T1 prostate cancers in tumors found incidentally at postmortem examination. METHODS: We examined 40 cases of impalpable PCs found in 212 prostate autopsy specimens of men between 30 and 98 years of age who died of diseases other than carcinoma of the prostate and related conditions. RESULTS: Most of T1 histological PCs (57.5%) had a Gleason score between 2 and 4, while 30% had Gleason score between 5 and 6. Only 5 (12.5%) had a Gleason score above 7. Twenty-nine of 40 stage T1 histological cancers (67.5%) had volume of <1 cm(3). The highest volume tumors were those of intermediate and high grade (Gleason sums 5-8). Among tumors with volumes of <1 cm(3), 96.55% were confined within the prostatic capsule. CONCLUSIONS: The majority of impalpable PCs were low-volume, well-differentiated tumors corresponding to clinically insignificant neoplasms. Similar characteristics could be attributed to most of the impalpable carcinomas detected after prostatectomy in clinical practice.

[PSA variations in persons with latent prostate cancer]. / Variatia valorilor PSA la persoanele cu cancer de prostata în stadiu latent.

The introduction and common use of serum PSA (Prostate Specific Antigen) has been demonstrated a useful index on latent prostate cancer diagnostic but in the same time has increased surgical intervention on histological forms with no eventual future evolution. Benign comportment of latent carcinomas being well known in advance, we correlated in vitro serum PSA from latent tumors, with the samples from a control group (prostates without signs of malignization). Levels of PSA were slightly elevated compared to age norms, mainly in cases with a large coexistent hypertrophy. Our reduced sample does not stand any statistic analysis, but this observation could eventually explain increased diagnostic and hyper-treatment of non-important carcinomas from a clinical point of view.

[Spontaneous renal bleeding in a dialysis patient with acquired cystic disease of the kidney: case report and review of the literature]. / Emorragia renale spontanea in paziente in emodialisi per nefropatia cistica acquisita: descrizione di un caso e revisione della letteratura.

The aim of this paper is to describe a rare clinical case of spontaneous haemorrhagic rupture of a multicystic kidney in a patient on haemodialysis for acquired cystic disease. We also discuss current issues about the management of this rare condition, with a short review of the literature.

Study on the efficacy of cefaclor for the treatment of asymptomatic bacteriuria and lower urinary tract infections in pregnant women with a history of hypersensitivity to penicillin.

PURPOSE: The purpose of this study was to compare the efficacy and safety profile of twice daily versus the conventional three daily intake of cefaclor administrated orally for five to seven days in the treatment of asymptomatic bacteriuria or acute cystitis in pregnant women with a history of hypersensitivity to penicillin. METHODS: Between August 2003 and August 2004, 63 pregnant women with a positive urine culture and a history of suspicion of hypersensitivity to penicillin were randomly divided into two groups. The women in the first group received 500 mg of cefaclor while those in the second group received 750 mg of cefaclor for five to seven days. Laboratory and clinical results were assessed a week and a month after complettion of the therapy. RESULTS: Final therapy (bacteriologic eradication) succeeded in 93.7% (30/32) of the first group and in 90.3% (28/31) of the second group. CONCLUSION: Dosage of cefaclor at 750 mg is as effective as conventional cefaclor at 500 mg and better tolerated.

Appendicitis in pregnancy: a case report and a review of the current literature.

Acute appendicitis is the most common surgical problem in pregnancy. Antibiotic treatment does not always improve the outcome and emergency intervention is required. We present a case of appendicitis complicated by a plastron formation occurring during pregnancy and the outcome.