Ovarian metastasis from a urachal adenocarcinoma primary in a young female.

Metastasis to the ovary from a bladder primary is extremely rare with limited case reports. The most common primary sites arise from stomach, colon or renal origin and usually occur from 40 years of age onwards. We report a case of an 18-year old woman with a right sided Krukenberg tumour from a bladder primary. This patient is much younger than any other case report of Krukenberg tumour and reiterates the need for early excision of urachal masses in all age groups.

A prospective audit of the 10-year outcomes from low dose-rate brachytherapy for early stage prostate cancer.

AIM: New Zealand men diagnosed with early stage prostate cancer need to know what outcomes to expect from management options. METHODS: Between 2001 and 2016, 951 men were treated with low dose-rate brachytherapy (permanent iodine-125 seed implantation) by the Wellington Prostate Brachytherapy Group based at Southern Cross Hospital, Wellington. At follow up after treatment, men had their PSA measured and were scored for urinary, bowel and sexual side effects. RESULTS: Median follow-up of men was 7.9 years (range 2.0-16.3 years). Ten-year PSA control was 95% for the 551 men with low-risk prostate cancer and 82% for the 400 men with intermediate-risk prostate cancer. Adverse effects were generally minor and short-term only. Temporary urinary obstruction developed soon after the implant in 2.6% men, and the 10-year cumulative risk of urethral stricture was 2.6%. Erectile dysfunction developed in 29% men, two-thirds of whom had a good response to a PDE5 inhibitor. Most men returned to a normal routine within four days of the implant. CONCLUSION: LDR brachytherapy is a highly effective low-impact treatment option for New Zealand men with early stage prostate cancer.

Patterns of failure after iodine-125 seed implantation for prostate cancer.

PURPOSE: To determine the site of relapse when biochemical failure (BF) occurs after iodine-125 seed implantation for prostate cancer. MATERIALS AND METHODS: From 2001-2009, 500 men underwent implantation in Wellington, New Zealand. Men who sustained BF were placed on relapse guidelines that delayed restaging and intervention until the prostate-specific antigen (PSA) was ⩾20 ng/mL. RESULTS: Most implants (86%) had a prostate D90 of ⩾90%, and multivariate analysis showed that this parameter was not a variable that affected the risk of BF. Of 21 BFs that occurred, the site of failure was discovered to be local in one case and distant in nine cases. Restaging failed to identify the site of relapse in two cases. In nine cases the trigger for restaging had not been reached. CONCLUSIONS: If post-implant dosimetry is generally within the optimal range, distant rather than local failure appears to be the main cause of BF. Hormone treatment is therefore the most commonly indicated secondary treatment intervention (STI). Delaying the start of STI prevents the unnecessary treatment of men who undergo PSA 'bounce' and have PSA dynamics initially mimicking those of BF.

Prospective, multicentre, randomized controlled trial of bladder filling prior to trial of void on the timing of discharge.

BACKGROUND: The objective of this study was to investigate whether bladder filling with saline prior to trial of void (TOV) was safe and whether it reduced time to discharge compared with standard TOV in the urology inpatient setting for patients post-transurethral resection of prostate, bladder neck incision or an admission with urinary retention. METHODS: Prospective, multicentre, randomized controlled trial at Hawkes Bay and Waikato hospitals with local ethics committee approval. All consecutive, consented patients requiring TOV were randomized into filling and control groups. The filling groups were filled with normal saline prior to TOV (up to 500 mL or first sensation of fullness). The control group had their catheter removed at 06.00 hours without filling. Time taken between catheter removal and discharge was recorded in minutes. Complications were recorded. RESULTS: Fifty-two patients were recruited and randomized with 27 and 25 patients in the filling and control groups, respectively. The mean time taken from catheter removal to discharge was 300.6 min in the filling group and 340.1 min in the control group. The filling group reduced the time to discharge by 39.5 min (P = 0.304). Furthermore, 2/27 and 2/25 patients in the filling and control groups, respectively, developed urinary retention after TOV and required re-catheterization prior to discharge. CONCLUSION: Bladder filling prior to TOV showed a non-statistically significant reduction in the time to discharge of 39.5 min. Despite the fact that bladder filling is a safe and cheap procedure, it cannot be recommended for use in an attempt to reduce time to discharge in an inpatient setting.

Chlorhexidine in urethral gel: does it cause pain at flexible cystoscopy?

OBJECTIVES: To investigate the effect of chlorhexidine gluconate in urethral local anesthetic gel on patients undergoing outpatient flexible cystoscopy. We postulated that chlorhexidine was contributing to the pain and urgency that occurs during and after cystoscopy. METHODS: A prospective randomized single-blinded study was conducted. A total of 141 patients undergoing outpatient flexible cystoscopy participated in the study. They were randomized to receive 10 mL of 2% lignocaine gel with 0.05% chlorhexidine gluconate (group 1, n = 72) or 10 mL of 2% lignocaine and aqueous gel mixture (group 2, n = 69). Pain scores were recorded on a numerical visual analog scale from 0 to 10. RESULTS: The groups were well matched for the purposes of comparison. The mean pain scores were not significantly different between groups 1 and 2 at the insertion of the scope (2.1 versus 2.2, P = 0.7), during cystoscopy (1.8 versus 1.9, P = 0.759), and immediately after cystoscopy (1.4 versus 0.8, P = 0.06). However, a significant difference was found in the mean pain scores between groups 1 and 2 during the first void (1.8 versus 1.0, P = 0.031) and after the first void (2.4 versus 1.2, P = 0.007). A significant increase occurred in the reported levels of urgency after cystoscopy in group 1 (P = 0.018). No difference was found in the level of culture-proven symptomatic infection. CONCLUSIONS: Chlorhexidine appears to contribute to significant levels of pain and urgency after outpatient flexible cystoscopy.

Allergy to chlorhexidine gluconate in urethral gel: report of four cases and review of the literature.

Chlorhexidine is a bis-biguanide molecule widely used in many preparations as a disinfectant and an antiseptic. We describe four confirmed cases of allergy to chlorhexidine gluconate in urethral gel and review the existing published reports. Pertinent issues in the treatment and investigation of these patients are discussed.