Effects of finasteride on hematuria associated with benign prostatic hyperplasia: long-term follow-up.

OBJECTIVES: To report long-term follow-up in 18 patients with gross hematuria associated with benign prostatic hyperplasia (BPH) who have been treated with finasteride and to report preliminary follow-up in an additional 10 patients. METHODS: The charts of the 18 original patients, and 10 additional patients who had been placed on finasteride (5 mg daily) for intermittent gross hematuria associated with BPH, were reviewed. All had evaluations that were negative for tumor. A hematuria grading system was devised using grades 0, 1, 2, and 3 (grade 0 the least severe, grade 3 the most severe hematuria). RESULTS: Sixteen of 18 patients have continued finasteride therapy. Mean follow-up is 31 months (range 10 to 47). Twelve had undergone prior prostatectomy. In this group, 3 patients had grade 1, 5 grade 2, and 4 grade 3 hematuria prior to treatment with finasteride. During finasteride therapy, 9 patients had grade 0, 2 grade 1 (pretreatment grades 2 and 3), and 1 grade 3 (pretreatment grade 3) hematuria. Of the 4 patients without prior prostate surgery, 2 had grade 0 (pretreatment grades 1 and 3), and 2 had grade 1 (pretreatment grade 2) hematuria. In summary, 14 of 16 patients improved according to their hematuria grade. We have since added another 10 patients to our study, with a mean follow-up of 11 months. Six of 7 patients who had previous prostatectomies in this group now have grade 0 hematuria. Overall, 8 of the 10 have improved according to hematuria grade. CONCLUSIONS: Long-term follow-up has confirmed the efficacy of finasteride in treating gross hematuria associated with BPH and we now recommend finasteride as first line therapy in the treatment of BPH-associated gross hematuria. reserved.

Urologic problems associated with imperforate anus.

A total of 120 children with both high, intermediate, and low types of imperforate anus were evaluated urologically. Genitourinary anomalies were associated with all types of imperforate anus but were found more often in children with high rectal deformities. Because the over-all incidence of genitourinary anomalies was high, early and complete urologic evaluation is necessary to achieve the best functional result.

32p-labeled thio-tepa absorption in normal rat bladders: potential guide for intravesical chemotherapy in bladder cancer.

Bladders of normal rats were used to evaluate the absorption of thio-tepa after intravesical instillation. Thio-tepa labeled with 32P (radioactive phosphorus) was utilized to measure drug concentrations in bladder wall, liver, and bone marrow. Thio-tepa was rapidly absorbed into the general circulation, and significant amounts of isotope were found. Thio-tepa absorption patterns in the normal rat may serve as a guide in adjusting drug dosages when thio-tepa is used intravesically in human beings for the treatment of superficial, papillary bladder tumors.

The effects of finasteride on hematuria associated with benign prostatic hyperplasia: a preliminary report.

PURPOSE: The efficacy of finasteride was assessed in the treatment of gross hematuria associated with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A retrospective review was done of 18 patients who had been placed on finasteride (5 mg . daily) for the treatment of gross hematuria associated with BPH. A hematuria grading system was devised. RESULTS: Of the 12 patients with longer than 3 months of followup (mean 14) 11 improved according to the grade of hematuria after finasteride therapy. CONCLUSIONS: Finasteride is effective in treating hematuria associated with BPH. This finding is especially relevant for patients with multiple medical problems and anesthetic risks.

Male exstrophy patients: a preliminary report on the reproductive capability.

Semen analyses from 9 male patients with bladder exstrophy revealed a high incidence of infertility (7 cases). Possible causes and measures that might help to preserve the fertility potential are suggested.

Delayed development of the scrotum in exstrophy.

Early attempts at orchiopexy should be avoided in children with exstrophy, since the testes will often descend spontaneously by puberty. In many cases the scrotum will grow much larger and will become pendulous by puberty. In a patient with a rudimentary scrotum orchiopexy will only result in fixing the testes in an abnormally high position owing to the lack of a sac into which to place them. If the scrotum develops later the testicles will probably be unable to descend further. Scrotal skin should not be used for urethroplasty operations in children with exstrophy and special techniques should be applied if it is necessary to repair hernias in these patients. In the child with partially descended testes but with only a small patch of wrinkled scrotum efforts may be undertaken to increase scrotal size by topical hormone treatment (or by injections) before the onset of puberty to help fertility and emotional development.

Pregnancy in women with bladder exstrophy.

Little is known about pregnancies in women with bladder exstrophy. Of 28 women with bladder exstrophy who were evaluated 7 became pregnant and 5 delivered successfully. Problems seen during pregnancy, the long-term effects and the need for early, informed counseling by the urologist are discussed.

Prognostic variables in patients with transitional cell carcinoma of the renal pelvis and proximal ureter.

Recent technological advances in urological endoscopic surgery of the renal pelvis and proximal ureter via ureteroscopy or percutaneous nephroscopy have made it possible to consider parenchymal-sparing procedures in patients with transitional cell carcinoma. To define the role of these procedures in the management of renal pelvic or proximal ureteral transitional cell carcinoma we analyzed retrospectively 31 patients who underwent nephroureterectomy for transitional cell carcinoma of the renal pelvis and/or proximal ureter. High grade upper urinary tract transitional cell carcinoma and a history of metachronous or synchronous bladder transitional cell carcinoma were independent adverse prognostic factors. However, patients with low grade upper urinary tract transitional cell carcinoma and no evidence of a urothelial field change had a 100 per cent 5-year survival rate. It would appear that parenchymal-sparing endoscopic techniques should be regarded with caution in patients with either high grade transitional cell carcinoma of the renal pelvis and proximal ureter or a history of bladder cancer.

Rapid reduction in blood flow to the rat ventral prostate gland after castration: preliminary evidence that androgens influence prostate size by regulating blood flow to the prostate gland and prostatic endothelial cell survival.

BACKGROUND: Androgenic steroids regulate the development and size of the mammalian prostate gland. The mechanism(s) for this growth control might involve a direct effect on prostate cell proliferation and survival as well as more complex effects on the tissue environment supporting nourishment and oxygenation. In this study, we evaluated an animal model of androgen action on the prostate, the rat ventral prostate gland, to determine whether acute androgen withdrawal, by means of castration, might alter the primary blood flow to the prostate gland and for the effects of castration on prostatic endothelial cell viability. METHODS: Groups of rats studied included intact control males, males that had been surgically castrated, or males that received a sham-surgical castration. Relative blood flow (RBF) to the rat ventral prostate glands and rat bladders were measured at 18 and 24 hr after castration or sham castration using a fluorescent microsphere infusion technique. Thin sections from fixed and embedded rat ventral prostate glands obtained from unoperated or 12-hr castrated rats were analyzed by the TUNEL immunostaining technique to microscopically identify and quantify apoptotic epithelial, stromal, and endothelial cells. RESULTS: RBF to the rat ventral prostate was reduced by 38%, at 18 hr after castration when compared with intact or sham-operated rats and by 45% at 24 hr after castration (P=0.038 unoperated/0.025 sham operated). In contrast, RBF to the bladder was not significantly different between any of the groups in the 24-hr castrate experiment. TUNEL staining analysis of ventral prostate tissues obtained from 12-hr castrated rats showed only rare TUNEL-positive epithelial cells similar to the control tissue but significantly increased TUNEL labeling for endothelial and other ventral prostate stromal cells. CONCLUSIONS: Castration resulted in a rapid and significant reduction of blood flow to the mature rat ventral prostate gland that was not seen in the bladder. This reduction precedes the appearance of apoptosis in the epithelial cells of the tissue but more coincided with the appearance of TUNEL-positive prostate vascular endothelial and stromal cells, suggesting that androgens support the survival of cells in the vascular and stromal compartment of the rat prostate as well as in the prostatic epithelium. These preliminary data support the concept that androgen action on the prostate might involve primary regulation of prostate blood flow and prostate vascular cell vitality.

Long-term followup after exstrophy closure: late improvement and good quality of life.

Now that we have observed the growth and development of 17 of our anatomically reconstructed exstrophy patients through 20 or more years of followup, we are convinced that reconstruction should be the preferred primary treatment. Most of these patients are healthy, attractive, well educated adults and have achieved emotional maturity and stability, despite their many problems. Anatomical reconstruction also has considerable advantages over other current treatments for exstrophy that were not apparent initially.