Conservative Management of a Prostate-Symphyseal Fistula With Osteomyelitis: A Case Report and Management of a Rare Complication.

This article presents the case of a 77-year old male who was found to have a prostate-symphyseal fistula with associated pubic symphysis osteomyelitis. He had a history of previous radiation for prostate cancer and two transurethral resections of the prostate. He was managed conservatively with long-term antibiotics and urinary diversion as he was a suboptimal surgical candidate. To our knowledge, this case report is the first reported successful conservative management of a prostate-symphyseal fistula.

Not just a simple inguinal hernia. A rare case of an inguino-scrotal ureter!

Inguinal hernias involving the ureter or inguino-scrotal ureters are a rare and infrequently described finding with both clinical and surgical consequence. While the majority are asymptomatic and rarely cause obstructive uropathy our case aptly highlights the risk to a general surgeon prior to an elective hernia repair. A review of the literature outlines a systematic approach of investigation if clinical suspicion of an inguino-scrotal ureter is raised, with careful operative planning and a multidiscipline approach for repair recommended.

Profiles of dyadic adjustment for advanced prostate cancer to inform couple-based intervention.

OBJECTIVE: The purpose of the study is to describe from a relational perspective, partners' psychological adjustment, coping and support needs for advanced prostate cancer. DESIGN: A mixed methods design was adopted, employing triangulation of qualitative and quantitative data, to produce dyadic profiles of adjustment for six couples recruited from the urology clinics of local hospitals in Tasmania, Australia. METHODS: Dyads completed a video-taped communication task, semi-structured interview and standardised self-report questionnaires. RESULTS: Themes identified were associated with the dyadic challenges of the disease experience (e.g. relationship intimacy, disease progression and carer burden). Couples with poor psychological adjustment profiles had both clinical and global locus of distress, treatment side-effects, carer burden and poor general health. Resilient couples demonstrated relationship closeness and adaptive cognitive and behavioural coping strategies. The themes informed the adaption of an effective program for couples coping with women's cancers (CanCOPE, to create a program for couples facing advanced prostate cancer (ProCOPE-Adv). CONCLUSION: Mixed method results inform the development of psychological therapy components for couples coping with advanced prostate cancer. The concomitance of co-morbid health problems may have implications for access and engagement for older adult populations in face-to-face intervention.

Photoselective vaporization of the prostate using the 180W lithium triborate laser.

INTRODUCTION: Photoselective vaporization of the prostate (PVP) is widely used to treat benign prostatic obstruction (BPO), but there is little experience reported on the new more powerful 180W lithium triborate (LBO) laser. This study evaluates the safety and efficacy of using the 180W LBO laser to treat BPO by examining a multicentre Australian experience. METHODS: Retrospective review of prospectively collected data on all men treated by 180W LBO laser PVP by eight urologists across six Australian hospitals, from July 2011 to August 2011, was performed. Perioperative and functional outcomes were examined at baseline and 3 months. RESULTS: Of the 85 men (median age 70 years, prostate volume 51 cm(3)) identified, 27% (23/85) were in urinary retention and 44% (37/85) were taking antiplatelet/anticoagulant medication. Median operating time was 46 min, laser time 27 min, energy use 211 kJ, post-operative duration of catheterization 15 h and hospitalization 22 h. Functional outcomes from baseline to 3 months, respectively, were for IPSS 25-7; QoL 5-2; Qmax 7.7-18.4; and PVR 147-38. All improvements were statistically significant (P < 0.01). Thirty-eight percent (32/85) of patients experienced at least one adverse event. Most adverse events were low Clavien-Dindo grade I-II. There were five grade III, two grade IV and no grade V adverse events. Sixty per cent (51/85) of men were able to be discharged home voiding successfully without a catheter within 24-h post-PVP. CONCLUSIONS: Our early multicentre Australian experience indicates the 180W LBO laser PVP is an efficacious and safe treatment for BPO.