application of [18]f-fluorodeoxyglucose positron emission tomography in assessment of patients with prostate cancer after initial treatment

There is a significant risk of prostate cancer recurrence after therapy. The aim of this study is to assess the use of [18]F-fluorodeoxyglucose positron emission tomography [[18]f-FDG PET] in the detection of local recurrence and distant metastases after initial treatment of patients with prostate cancer. Thirty patients with histologically proven prostatic adenocarcinoma were studied within 24 months [mean: 15 months] after their initial treatment. They were assessed by serum total prostate specific antigen [t-PSA], chest and abdomino-pelvic computerized tomography [CT], bone scintigraphy and [18]f-FDG PET. Local recurrence was diagnosed by pelvic CT and FDG-PET in 4/13 cases who had performed radical prostatectomy. Their mean standardized uptake value [SUV] calculated by FDG-PET was 3.1. This local recurrence was confirmed by pathological analysis of transrectal ultrasonography [TRUS] guided needle biopsies. Bone metastases were diagnosed by bone scintigraphy and FDG-PET in 18/30 patients, where their mean SUV was 5.6. While para aortic and/or pelvic lymph node metastases were diagnosed by abdomino-pelvic CT and FDG-PET in 10/30 cases with their mean SUV 4.7. The diagnosis of para aortic lymph node metastases was confirmed by the pathological analysis of abdominal CT guided needle biopsies in 3/10 cases. The metastases in the lung was diagnosed by chest CT and FDG-PET in 5/30 patients with their mean SUV 4.5. [18]F-FDG PET can be applied to complement other conventional studies for diagnosis of local recurrence and distant metastases in patients with cancer prostate

Impact of management of lower urinary tract symptoms [LUTS] on men sexual function

Troublesome lower urinary tract symptoms TS] and sexual dysfunction are common and often problematic in older men. We prospectively evaluated the effect treatment of LUTS on sexual function. In all, 167 men aged between 48 77 years with LUTS suggestive of benign prostatic hyperplasia [BPH] were enrolled in this study. In addition to the diagnostic work up of BPH, only 136 patients were setected and assessed at baseline and three months after tment by means ofICS sex questionnaire items concerned i erectile stiffness, ejaculatory volume, pain or discomfort on ejaculation and whether sex life was spoilt by urinary symptoms. Treatment modalities included surgical [Transurethral resection of the prostate [TURP], transurethral incision of the prostate [TUIP], or open prostatectomy] and medical treatment [alphablocke, doxazosin]. At the baseline assessment before BPH treatment, stile dysfunction, abnormal ejaculatory volume, pain or;omfort on ejaculation and sex life spoilt by LUTS were in 63%, 60%, 31% and 50% patients respectively. lowing treatment, erectile dysfunction was significantly roved [29.4%] after both surgical and medical treatment, the no significant difference between both treatment modal: All patients who underwent surgical treatment suffered from retrograde ejaculation except 50% of those treated by TUIP. Meanwhile, reduced ejaculation was reported in 32.8% patients on medical treatment. Pain or discomfort on ejaculation and sex life spoilt by LUTS were observed after treatment in 12.5% and 32.4% of patients respectively. The over all sexual satisfaction was better in patients who were on midical treatment [78.1%] compared to those on surgical III [58.3%]. Sexual dysfunction is strongly associated with LUTS. Therefore, sexual function should be carefully ssessed in the initial evaluation of patients with LUTS and deciding the appropriate treatment modality as it may have legative impact on sexual life. However, a large scale ilticenter randomized controlled study is now required to laluate the different invasive and non-invasive surgical idalities and different medical treatment options on sexual BCtion or patients complaining of BPH.

Ureteral segmental replacement using peritoneal graft in a dog model

Ureteral replacement has always been a challenge. In this article, we tried to assess the outcome of segmental ureteral replacement using a free peritoneal tubal graft in a dog. Transperitoneal exploration of the upper urinary tract of 6 Mongrel dogs was performed and creating a free peritoneal graft. A 2cm segment of right upper ureter was excised, while the left ureter was left as a control. This segment was replaced by a peritoneal tube around a 6 F double-J ureteral stent which was removed after one month. Follow up intravenous urography [IVU] and abdominal ultrasonography were done prior to autopsy. All animals were sacrificed 3 months after the initial procedures for gross and histopathological assessment. All animals survived the entire follow up of 3 months without serious complications. Two months after stent removal, follow-up IVU and abdominal ultrasonography revealed that variable degrees of hydroureteronephrosis were noticed on the right kidney and ureter with normal left side. At the time of sacrifice, there was moderate to severe hydroureteronephrosis above the level of the periotoneal tube in all animals. Abdominal adhesions and narrowing of the ureteral lumen at the site of the graft were observed. Histopathological interpretation showed that the urothelium was creeping over the mesothelial graft with focal inflammation and fibrosis in all cases while local osseous metaplasia of the graft was noticed in three dogs. Ureteral replacement by peritoneal tube was unsatisfactory despite the usage of ureteral stent. Further studies are needed to evaluate the use of peritoneal patch graft or other biomaterials for ureteral reconstructions

Early cystoscopic examination in yesicovaginal fistulae, Is it a must?

This study was performed on ten female patients who were exposed to total abdominal hysterectomy, and suffering from early postoperative [2-7 days] leakage of urine through the vagina. Cystoscopy was done for all cases and showed traumatic lesion in the bladder mucosa with a stitch in 6 cases and shready necrotic defect in the posterior bladder wall in the remaining 4 cases. Supratrigonal shreds and necrotic mucosa were found over the suture material [vicryl] in 6 cases. Via cystoscopy the suture thread was cut using the cold-knife resectoscope, bilateral ureteric catheters number 8 Fr were introduced and fixed, and a silicon urethral catheter was fixed while urine diversion via urethra catheter was done to the other 4 cases. Follow-up with methylene blue [MB] test was done weekly. MB test was -ve in 8 cases after 3 weeks. Two cases did not improve and were operated upon 3 months later

Ureterosopic lithotripsy with and without preliminary ureteric dilatation for management of distal ureteral calculi

The aim of this study was to evaluate the use of variable sized rigid ureteroscopes for treatment of lower ureteric calculi with and without ureteral dilatation Between August 2000 and July 2003, 156 patients with stone lower ureter underwent ureteroscopy. The patients were randomized preoperatively and divided equally into two groups: Group I [78 patients] underwent ureteroscopy without dilatation using mini- ureteroscope [8.5 F] and their stone diameter was up to 10 mm and group II [78 patients with stone diameter more than 10 mm up to 20 mm] were treated by rigid ureteroscope [12.5 F]. Ureteral dilatation was performed before stone extraction. Swiss lithoclast was used in both groups for stone fragmentation. The mean operative time, hospital stay, complications and success rate were recorded in each group of patients. The results showed that in group I the mean operative time was 35 minutes, the mean hospital stay was 1.2 days and complication rate was 15.4%. In group II, the mean operative time, mean hospital stay and complication rate were 45 minutes, 1.5 days and 24.4% respectively. The success rate was 93.6% in group I versus 96.2% in group II