RESUMO
INTRODUCTION: Lower urinary tract symptoms (LUTS) affect 18-26% of men aged 40-79 years, many of whom present with a fear of having cancer. Current guidelines for the assessment of LUTS focus mainly upon benign prostatic hypertrophy. It has been our practice to perform an abdominal ultrasound scan (USS), a prostate-specific antigen (PSA) blood test and urine cytology during the assessment of males presenting with LUTS to investigate the alternative potentially life-threatening causes for LUTS. We report on the added value of these tests during the assessment of men with LUTS. RESULTS: A total of 263/3976 (6.6%) patients investigated for LUTS were found to have incidental urological malignancies, urinary tract calculi or abdominal aortic aneurysms (AAA). Abdominal USSs resulted in the incidental diagnosis of four renal carcinomas (0.1%), 45 AAAs (incidence = 1.1%) and 44 urinary tract calculi (1.1%). Urine cytology testing and bladder USSs helped diagnose 17 new bladder cancers (0.4%), five of which did not present with haematuria. Patients found to have an elevated age-specific PSA had a 23.6% chance of being diagnosed with prostate cancer (3.8%). CONCLUSION: The addition of abdominal ultrasound scanning, urine cytology and PSA testing as part of an LUTS assessment protocol can help to diagnose significant, potentially life-threatening conditions in up to 6.6% of patients. While the pick up rate of each individual condition is not higher in the LUTS patient than in the general population, the combined pick up rate may justify these additional investigations.
Assuntos
Antígeno Prostático Específico/sangue , Prostatismo/diagnóstico , Adolescente , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células de Transição/patologia , Humanos , Hidronefrose/diagnóstico por imagem , Achados Incidentais , Neoplasias Renais/urina , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/patologia , Neoplasias da Próstata/patologia , Prostatismo/etiologia , Ultrassonografia , Neoplasias da Bexiga Urinária/patologia , Cálculos Urinários/diagnóstico por imagem , Urina/citologia , Adulto JovemRESUMO
The TRH-related peptide, pGlu-Glu-ProNH2, which was first identified in rabbit prostate has recently been named fertilization-promoting peptide (FPP) because of its ability to enhance the in vitro fertilizing potential of mouse epididymal spermatozoa. This study set out to examine the nature of the TRH-related peptides in human prostate and semen but, first, the optimal conditions for collection of semen samples were investigated. FPP was degraded slowly (t1/2 = 163 min, S.E. +/- 51.3, n = 6) in seminal plasma which has allowed us to measure accurately the concentrations of FPP, after extraction of the peptide in acidified acetone precisely 5 min after ejaculation. In this way, high levels of FPP (mean: 49.5 nmol/l) were detected in normal human semen, from young men, although other TRH-related peptides did not appear to be present. We have also examined the TRH-related peptides present in prostate samples from clinical patients both with and without evidence of benign prostatic hyperplasia (BPH), by ion-exchange chromatography followed by radioimmunoassay. Substantial concentrations of FPP were observed in normal (4.10 pmol/g tissue, S.E. +/- 1.46) and BPH prostate (6.27 pmol/g tissue, S.E. +/- 1.65). In addition, a second, neutral TRH-immunoreactive peptide was always detected in BPH tissue (7.40 pmol/g tissue, S.E. +/- 1.98) with only low levels generally present in normal prostate. The possibility that the presence of high levels of the neutral peptide in prostate may be used as an indicator of the onset of BPH deserves further scrutiny.
Assuntos
Peptídeos/análise , Próstata/química , Sêmen/química , Hormônio Liberador de Tireotropina/análogos & derivados , Hormônio Liberador de Tireotropina/química , Adulto , Idoso , Sequência de Aminoácidos , Animais , Biomarcadores/análise , Meia-Vida , Humanos , Masculino , Dados de Sequência Molecular , Peptídeos/isolamento & purificação , Hiperplasia Prostática/metabolismo , Ácido Pirrolidonocarboxílico/análogos & derivados , Coelhos , Radioimunoensaio , Hormônio Liberador de Tireotropina/análise , Hormônio Liberador de Tireotropina/imunologia , Hormônio Liberador de Tireotropina/isolamento & purificaçãoRESUMO
The purpose of this study was to determine the incidence of prostate cancer in patients who have an elevated referral prostate-specific antigen (PSA), which subsequently falls to within their normal age-specific reference range prior to prostate biopsy. The study demonstrated that of the 160 patients recruited, 21 (13%) had a repeat PSA level which had fallen back to within their normal range. Five of these 21 patients (24%) were diagnosed with prostate cancer following biopsy, two of whom had a benign prostate examination. The study, therefore, demonstrates that normalisation of the PSA level prior to biopsy does not exclude the presence of prostate cancer even when the prostate feels benign.
Assuntos
Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Idoso , Envelhecimento/sangue , Biópsia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/patologia , Valores de ReferênciaRESUMO
Transabdominal ultrasound may have a limited but useful role in the surveillance of bladder cancer. Its advantages over other diagnostic methods are that it is easy to use and that it can be repeated as many times as necessary without harm or discomfort to the patient. As such, it is an extension of the physical examination by the clinician, who should, if politics allow, take up its use more frequently. Only by using it routinely and understanding its limitations can urologists hope to use ultrasound as a safe and helpful aid to diagnosis.
Assuntos
Ultrassonografia , Neoplasias da Bexiga Urinária/diagnóstico , Humanos , Ultrassonografia/métodos , Neoplasias da Bexiga Urinária/patologiaRESUMO
In the past 8 years at St George's Hospital, 13 women underwent urinary diversion for disabling incontinence. Seven patients had multiple sclerosis, 2 had suffered trauma to the lumbar spine and 4 had failed repeated surgery for urethral sphincter incompetence. One patient died several months postoperatively due to relapse of her multiple sclerosis. The remaining 12 were interviewed to determine the effect of the operation on their quality of life. Preoperatively, 9 patients (75%) were either housebound or only ventured out to do the shopping and none led a full social life. Postoperatively 8 patients (67%) managed a full social life and all were improved. Most managed their stomas proficiently and none regretted having the operation. The most common late complication was pyocystis. We conclude that patients with disabling incontinence can have their quality of life substantially improved by urinary diversion. The incidence of pyocystis is probably high enough to warrant vaginal vesicostomy to be performed routinely at the time of diversion, at least in those women with chronic urinary infection.
Assuntos
Derivação Urinária , Incontinência Urinária/cirurgia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Supuração , Doenças da Bexiga Urinária/etiologiaRESUMO
Prostate cancer is being diagnosed earlier and in higher numbers than ever before. The nature of the disease means many patients have to be monitored regularly and for a prolonged period leading to increased pressure on urology outpatient resources and inconvenience for the patient. Here we investigate patient satisfaction with a nurse-led telephone-based follow-up clinic and compare it to satisfaction with traditional outpatient consultations. A Consultation Satisfaction Questionnaire (CSQ) evaluating four domains, namely General Satisfaction (GS), Professional Care (PC), Depth of Relationship (DR) and Perceived Time (PT) was used to assess satisfaction in three groups. Group 1 consisted of 299 patients attending the outpatient department before commencing telephone consultations; Group 2 consisted of 163 men attending outpatients after commencement of the telephone consultations; and Group 3 was the telephone group (234 men). We demonstrated no significant difference in GS or PC between Group 1 and Group 3 or Group 2 and Group 3, although DR and PT was significantly lower in the telephone group compared with Group 1. We also found that waiting times were significantly shorter in the telephone group. In conclusion, telephone follow-up appears to be an acceptable alternative to outpatient follow-up in terms of GS and PC and appears to be more convenient for the patient, although these benefits come at the expense of loss of DR and PT with the clinician.
Assuntos
Satisfação do Paciente , Neoplasias da Próstata/enfermagem , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Relações Profissional-Paciente , Encaminhamento e Consulta , Inquéritos e Questionários , TelefoneRESUMO
This is a retrospective study of 18 acute traumatic tetraplegic patients admitted to the Cardiff Royal Infirmary within 12 hours of injury. The nursing charts of pulse rate, blood pressure and respiratory rate were scrutinized and the mean values over a 24-hour period were plotted against outcome with regard to mortality and respiratory complications. A systolic blood pressure below 115 mmHg was found to be associated with a high morbidity and mortality. A hypothesis is advanced that this finding is related to autonomic imbalance.
Assuntos
Quadriplegia/diagnóstico , Acidentes , Adulto , Pressão Sanguínea , Humanos , Pessoa de Meia-Idade , Prognóstico , Pulso Arterial , Quadriplegia/complicações , Quadriplegia/etiologia , Insuficiência Respiratória/etiologia , Estudos RetrospectivosRESUMO
We have reviewed 500 consecutive prostatectomies with a follow-up period of between 5 and 8 years; 184 surviving patients were sent a questionnaire and patients with residual urinary symptoms were interviewed, examined and a flow rate was performed. The operative mortality rate was 0.5%. Patients who presented with retention of urine had a high mortality rate in the first 3 years after the operation. Thirty-six per cent of surviving patients with chronic retention and 24% of those who underwent elective prostatectomy had residual urinary symptoms at the time of the study. Of patients who were sexually active pre-operatively, 34% felt that the operation was responsible for a deterioration in their sex lives. The incidence of retrograde ejaculation was 93%. It was concluded that prostatectomy is a safe operation with good patient acceptability. Patients with symptoms of prostatism require careful evaluation before prostatectomy and sexually active patients should be warned of the risks of impotence and decreased satisfaction due to retrograde ejaculation.
Assuntos
Prostatectomia , Doenças Prostáticas/cirurgia , Fatores Etários , Idoso , Atitude Frente a Saúde , Causas de Morte , Comportamento do Consumidor , Disfunção Erétil/etiologia , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias , Prostatectomia/efeitos adversos , Prostatectomia/psicologia , Doenças Prostáticas/complicações , Doenças Prostáticas/mortalidade , Doenças Prostáticas/psicologia , Transtornos Urinários/etiologiaRESUMO
We report a case of actinomycosis associated with a penile pilonidal sinus. This association does not appear to have been described previously. We recommend the submission of biopsies of unusual lumps in the genital region (fresh biopsies for bacteriological examination and fixed biopsies for histomorphological assessment).
Assuntos
Actinomicose/complicações , Doenças do Pênis/patologia , Seio Pilonidal/complicações , Actinomicose/patologia , Adulto , Humanos , Masculino , Seio Pilonidal/patologiaRESUMO
OBJECTIVE: To identify urodynamic factors that might determine the clinical outcome of detrusor myotomy in incontinent children. PATIENTS AND METHODS: Six girls and three boys (aged 5-14 years) underwent detrusor myotomy for severe urinary incontinence. Seven children had spina bifida, one had traumatic paraplegia and one had low bladder compliance. The patients were followed for a minimum of 5 years. RESULTS: Urodynamic studies before surgery showed that three patients had normal compliance with grossly unstable detrusor contractions, and six had low bladder compliance with few phasic detrusor contractions. Detrusor leak-point pressures were > 40 cmH2O in five patients and < 40 cmH2O in four. Only two patients, both with grossly unstable detrusor contractions and leak-point pressures of > 40 cmH2O, had a successful 5-year outcome. The other seven patients remained incontinent; six underwent further surgery and one died from unrelated causes. CONCLUSION: Detrusor myotomy appears to have the best outcome in those patients with marked phasic unstable detrusor contractions with a competent urethral sphincter. In this group it may have distinct advantages over more commonly used procedures.
Assuntos
Doenças da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Incontinência Urinária/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Contração Muscular , Paraplegia/complicações , Pressão , Reflexo Anormal/fisiologia , Disrafismo Espinal/complicações , Resultado do Tratamento , Doenças da Bexiga Urinária/fisiopatologia , Incontinência Urinária/fisiopatologia , Urodinâmica/fisiologiaRESUMO
A continent urinary diversion was formed for 16 patients using the Mitrofanoff principle for continence. As originally described, this system used the appendix tunnelled into the bladder to form a continent catheterisable vesicostomy. We have expanded the technique and have used all available narrow tubes as continent conduits (ureter 10 cases, appendix 5, Fallopian tube 1). The urine container was made of large and small intestine and bladder in several combinations. The system has been very satisfactory: 14 patients were continent and able to catheterise; 1 required a revision to achieve continence and 1 awaits revision; 3 patients required revision procedures for stricture.
Assuntos
Apêndice/cirurgia , Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Adolescente , Feminino , Humanos , Ureter/cirurgiaRESUMO
OBJECTIVE: To determine the intra-individual (physiological) variation of prostate-specific antigen (PSA) measurements in men after a benign prostatic biopsy. PATIENTS AND METHODS: Sixty-four men were prospectively assessed, all of whom had a benign prostatic biopsy within the preceding 13 months. The degree of intra-individual variability was established by calculating the coefficient of variation on four PSA levels obtained from each patient weekly over a month. RESULTS: Six patients were subsequently diagnosed with prostate cancer and their data are presented separately. In the remaining 58 patients the median (range) individual mean PSA value was 6.3 (0.5-34.1) ng/mL. The median (range) coefficient of variation within the group was 9.5 (2.4-76.1)%. There was a clear linear relationship between mean PSA level and the standard deviation. CONCLUSION: In 48 of the 63 patients analysed, the coefficient of variation for serum PSA values in the group as a whole was greater than the variation claimed for the assay technique. The significance of the linear relationship between PSA and the standard deviation is discussed, with particular reference to those men who had a benign prostate biopsy.
Assuntos
Antígeno Prostático Específico/sangue , Próstata/patologia , Hiperplasia Prostática/sangue , Neoplasias da Próstata/sangue , Idoso , Idoso de 80 Anos ou mais , Biópsia/métodos , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Valores de Referência , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To evaluate the role of urine cytology in the investigation of men with lower urinary tract symptoms (LUTS) in the absence of haematuria. PATIENTS AND METHODS: The study comprised 336 men attending a LUTS assessment clinic, who had neither macroscopic nor microscopic haematuria. One sample of urine was collected for cytology. Those with suspicious urine cytology were investigated with intravenous urography and cystoscopy. RESULTS: Five men had abnormal urine cytology results; on further investigation one of them was found to have carcinoma in situ (CIS) and one to have a transitional cell carcinoma. Three had false-positive urine cytology results. CONCLUSION: A bladder tumour or CIS was detected in 0.6% of the population tested. The cost per cancer diagnosed was GB pound 2020. Urine cytology is a simple noninvasive way of assisting accurate diagnosis of men who have LUTS in the absence of haematuria.
Assuntos
Carcinoma in Situ/urina , Carcinoma de Células de Transição/urina , Neoplasias da Bexiga Urinária/urina , Carcinoma in Situ/patologia , Carcinoma de Células de Transição/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Bexiga Urinária/patologiaRESUMO
We screened a series of 15 superficial and invasive transitional cell carcinomas of the bladder for transforming activity on the NIH/3T3 transfection assay. In addition, by obtaining tumour DNA and normal lymphocyte DNA from the same patients we looked for evidence of gene amplification or rearrangement of the c-H-ras-1 gene by Southern blot analysis. One patient (with a grade 2T1 tumour) was shown to have an activated oncogene on the NIH/3T3 transfection assay and this was identified as a c-H-ras-1 gene. We could find no evidence of gene amplification or rearrangement of this gene in any tumour. The significance of activation of ras oncogenes in the pathogenesis of human bladder carcinoma is unclear.
Assuntos
Carcinoma de Células de Transição/genética , Oncogenes , Neoplasias da Bexiga Urinária/genética , DNA/genética , DNA de Neoplasias/genética , Eletroforese em Papel , Humanos , Linfócitos/metabolismo , Transfecção , Neoplasias da Bexiga Urinária/patologiaRESUMO
The efficacy and metabolic consequences of a standardised forced diuresis regime following prostatectomy were studied in three parts. A retrospective review of 372 patients. A detailed prospective study of blood and urine electrolyte changes in 25 patients. A prospective study of urinary oxalate levels in 15 patients. The regime was effective in safely preventing post-operative clot retention. In 54% of patients the plasma sodium fell below 135 mmol/l. Hypokalaemia was mild and transient except in patients on long-term diuretics. There was a significant per-operative fall in serum calcium levels. It was concluded that forced diuresis is a safe and effective method of reducing clot retention following prostatectomy. The high incidence of post-operative hyponatraemia suggests that absorption of glycine solution at transurethral prostatectomy is a common occurrence.
Assuntos
Diurese , Prostatectomia , Creatinina/metabolismo , Eletrólitos/metabolismo , Humanos , Hidrocortisona/metabolismo , Masculino , Oxalatos/urina , Ácido Oxálico , Estudos Prospectivos , Prostatectomia/efeitos adversos , Estudos Retrospectivos , Sódio/metabolismoRESUMO
We have studied the accuracy of transabdominal ultrasound (TAUS) in the diagnosis of early superficial bladder carcinoma. One hundred and twenty-six patients returning for check cystoscopy were scanned pre-operatively with the Technicare Autosector Scanner and the results compared with the endoscopic findings. Forty-four patients (37%) had a tumour recurrence. TAUS demonstrated a lesion in 50% of these with a false positive rate of 11%. The diagnostic accuracy was proportional to the tumour size (82% of patients with tumours above 5 mm were detected compared with 38% below 5 mm), but was not affected by grade, stage or position in the bladder. TAUS may prove a useful adjunct to cytology as a screening test for bladder cancer.
Assuntos
Ultrassonografia , Neoplasias da Bexiga Urinária/diagnóstico , Humanos , Recidiva Local de Neoplasia/diagnósticoRESUMO
We report the results of the first use of a steroidal aromatase inhibitor, 4-hydroxyandrostenedione (4-OHA, CGP 32349), in the palliation of patients with advanced, hormone resistant, prostatic cancer. Twelve of 19 patients (63%), who had relapsed following castration and other therapies, gained significant pain relief following weekly intramuscular injections of 4-OHA. Five patients (31%) experienced a transient 'tumour flare', represented by an increase in bone pain soon after commencing treatment. The mechanism of action of 4-OHA in palliating patients with advanced prostatic cancer is obscure at present, but may represent an important new treatment modality which may lead to greater insight into prostatic biology.
Assuntos
Inibidores da Aromatase , Neoplasias da Próstata/enzimologia , Idoso , Idoso de 80 Anos ou mais , Androstenodiona/efeitos adversos , Androstenodiona/análogos & derivados , Androstenodiona/uso terapêutico , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Ensaios Clínicos como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/tratamento farmacológicoRESUMO
PURPOSE: We evaluate the pharmacodynamics, pharmacokinetics and tolerability of a sustained release depot formulation of avorelin, a new potent super agonist of luteinizing hormone-releasing hormone receptors, in patients with prostate cancer. MATERIALS AND METHODS: A total of 60 patients were randomized to receive a 10 mg. (31) or 15 mg. (29) avorelin subcutaneous depot. Serum testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and plasma avorelin were measured regularly until depot exhaustion. RESULTS: Of the 10 mg. group patients 3 withdrew from the study after 31 to 35 weeks due to disease progression. Of the 15 mg. group patients 1 did not complete the study for logistical reasons. After the expected flare in serum testosterone, LH and FSH during week 1, medical castration (testosterone concentration less than 1.735 nmol./l.) was achieved within 4 weeks of depot injection. Median duration of testosterone suppression was 40 weeks in the 10 mg. (95% confidence interval 35 to 42) and 39 in the 15 mg. (37 to 43) group. The reduction in serum LH was similar to that of testosterone, while that of FSH was less pronounced. Plasma avorelin was proportional to the dose and correlated with serum testosterone. Normalization of serum prostate specific (4 ng./ml. or less) at 6 months was achieved in 80 and 88% of the 10 and 15 mg. groups, respectively. During the (7 to 20-month) observation period 94 and 86% of the 10 and 15 mg. groups, respectively, complained of adverse events mainly related to androgen suppression (hot flushes, decreased libido and impotence) or the nature of the disease (skeletal pain). In each group 3 patients had serious adverse events requiring hospitalization for reasons unrelated to avorelin treatment. The depot was well tolerated locally. CONCLUSIONS: Subcutaneous depot formulations of avorelin were well tolerated and had protracted inhibitory effects on pituitary gonadotropin secretion in patients with prostate cancer. Testosterone suppression was maintained for more than 6 months in all patients. Avorelin depots could be the first luteinizing hormone-releasing hormone agonist formulation to be administered at 6-month intervals.