Time of administration of a single dose of oral levofloxacin and its effect in infectious complications from transrectal prostate biopsy.

OBJECTIVE: To evaluate the efficacy of two prophylactic schemes for prostate biopsy using a single dose of oral levofloxacin given either before, or immediately after transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS: A total of 300 men formed two groups of 150 patients each: the first group received one dose of 500 mg of levofloxacin 30 min to an hour before, and the second group the same antibiotic immediately after prostate biopsy. No pre-biopsy enema was used. Side effects after prostate biopsy were recorded, and the two groups were compared. RESULTS: Only one patient from the first group developed a urinary tract infection after biopsy. A mean number of more than 10 cores per patient were taken. Haematuria was the most common complaint, followed by haemospermia. Haematuria and rectal bleeding were more common in patients where more than 8 cores were taken from the prostate (P = 0.005 and P = 0.017, respectively). Prostate cancer was detected in 34.3% of patients in total. CONCLUSION: The use of a single dose of 500 mg levofloxacin given immediately after prostate biopsy proved to be quite effective for the prevention of infectious complications, even in the setting of an extensive biopsy protocol.

Synchronous Malignant Peripheral Nerve Sheath Tumor and Adenocarcinoma of the Prostate: Case Report and Literature Review.

Malignant Peripheral Nerve Sheath Tumors (MPNSTs) of the prostate are extremely rare. A very unusual case of simultaneous adenocarcinoma and MPNST of the prostate is reported. A 60-year-old Caucasian male presented for annual urologic examination. Digital rectal examination revealed a painless, toughish, and asymmetrically enlarged prostate. Serum prostate-specific antigen was 1 ng/mL. Radiologic examinations demonstrated a large mass, which was arising from the left peripheral lobe of the prostate. The patient underwent transrectal ultrasound-guided biopsy of the prostate which revealed a smooth muscle tumor of uncertain malignant potential. Radical retropubic prostatectomy with en bloc removal of the mass and the seminal vesicles was performed and histology demonstrated low-grade MPNST and adenocarcinoma of the prostate. To the best of our knowledge, this is the first report of simultaneous prostatic adenocarcinoma and MPNST in the English literature.

Chronic pyelonephritis presenting as a renal sinus tumor with retroperitoneal extension: a case report.

INTRODUCTION: Chronic pyelonephritis is associated with progressive renal scarring and occurs, most of the time, in patients with major anatomical anomalies, including urinary tract obstruction, calculi, renal dysplasia or vesicoureteric reflux. We report the computed tomography imaging findings of a patient with chronic pyelonephritis appearing as a renal sinus mass. To our knowledge, it is the first time that such a case has been published in the literature. CASE PRESENTATION: We present a case of a 68-year-old woman who underwent a computed tomography scan of the abdomen in the work-up for recently diagnosed hypertension. A non-enhancing left renal sinus mass was detected extending to the para-aortic space. The initial diagnosis was that of a tumor of the collecting system. Nephro-ureterectomy was performed and the pathology results revealed changes of chronic pyelonephritis. CONCLUSION: Chronic pyelonephritis presenting as a renal sinus mass is reported for the first time in the literature. This may lead to the conclusion that diagnostic ureteropyeloscopy and biopsy should be performed prior to radical surgery for possible upper tract urothelial tumors.

Characteristics of patients with stage T1b incidental prostate cancer.

OBJECTIVE: To study the characteristics of patients with incidental prostate cancer. MATERIAL AND METHODS: The proportion of incidentally diagnosed prostate cancer was investigated in patients who underwent transurethral resection of the prostate (TURP) at our clinic over a 5-year period. "True" incidental prostate cancer was defined as cases where the preoperative digital rectal examination (DRE) and the prostate-specific antigen (PSA) value were normal. Patients with known malignancy of the prostate were excluded, together with those with PSA >4 ng/ml and/or a positive DRE. The characteristics of these patients were compared to those of benign prostatic hyperplasia patients and the group as a whole. RESULTS: Of the 786 patients operated on between 1999 and 2003, 34 (4.3%) had a positive pathology report for "true" incidental prostate cancer. An increased frequency of poorly differentiated tumors (32.3%) was noted. Of the 34 patients, 17 were stage T1a and 17 T1b; 11 patients had a Gleason sum of 7-10, all of them in the T1b group. In the T1b group the mean age was 74 years, the mean PSA level 2.9 ng/ml and the mean weight of tissue resected 11.1 g. Corresponding values in the T1a patients were 70.1 years, 3.32 ng/ml and 18.2 g. CONCLUSIONS: Compared to previous studies, we noticed a low incidence of "true" incidental prostatic carcinoma but a high ratio of poorly differentiated tumors (all stage T1b). Compared to the group as a whole, patients with incidental prostate cancer were older and had smaller prostate and transition zone volumes. Further research is needed to identify parameters that may aid in the earlier identification of incidental prostate cancer, as patients may benefit from curative treatment.

Modified anatrophic nephrolithotomy for complete staghorn calculus disease -- does it still have a place?

OBJECTIVE: To report our experience with open surgery for the management of complete staghorn calculi using a modified anatrophic nephrolithotomy technique. MATERIAL AND METHODS: Between 1990 and 2001, 24 patients underwent anatrophic nephrolithotomy in our department. Bilateral complex stone disease was present in 9 patients, so that a total of 33 procedures were carried out. Preoperative evaluation included excretory urography (intravenous pyelography) and routine laboratory study in all patients and in 9 patients renal function was assessed using (99m)Tc dimercaptosuccinic acid renal scans before and 6 months after surgery. Postoperative follow-up consisted of kidney-ureter-bladder (KUB), ultrasound (U/S), urinalysis and urine culture. RESULTS: The mean operative time was 180 min, mean blood loss was 500 ml and renal ischemia time ranged between 10 and 35 min. Deep vein thrombosis occurred on the 5th postoperative day in an obese female patient. No other operative or postoperative complications were observed. Mean hospital stay was 8.2 days (range 7-12 days). The stone-free rate was 83.3%. Long-term follow up demonstrated stone fragments <4 mm in diameter in 4 patients (16.6%). Renal function remained unchanged or slightly improved in 15 patients; a slight worsening of renal function was noted in 9 patients (from an average of 39% before to 35% after the procedure). CONCLUSIONS: Anatrophic nephrolithotomy, although a major operative procedure, remains the most appropriate method for the one-stage management of a selected group of patients harboring large staghorn calculi with infundibular stenosis, and is associated with the highest stone-free rates.