Diagnostic yield of estimation of serum complexed PSA as a screening tool for prostate cancer patients

The present study aimed to evaluate the diagnostic yield of estimation of complexed prostate-specific antigen [cPSA] in random sample of patients with symptoms suggestive of prostate cancer [PC] and had serum PSA of 2.5-20 ng/ml and no previous histologic proof of prostate cancer. All patients underwent full history taking, complete physical examination and prior to prostatic examination or any manipulations, venous blood samples were collected for ELISA estimation PSA serum levels. Then, patients underwent trans-rectal ultrasonography [TRUS] to assess the prostate and the adenoma volume and the peripheral zone [PZ] of the prostate was checked. All patients underwent 10-core TRUS-biopsy taking from the peripheral zone ofthe prostate. The study included 223 male patients fulfilled the inclusion criteria of the study with mean age of 65.7 +/- 8 years. Mean prostatic volume was 60.1 +/- 14.8 cm3 and the mean PZ calculated volume was 41.8 +/- 9.4 cm3. Histopathological examination of core biopsies defined 23 cases with PC [PC group] with a frequency of cancer detection of 10.3% while the other 200 patients were free of PC [Control group]. Mean estimated serum tPSA and cPSA levels were significantly higher in PC group compared to its level estimated in control group, while serum fPSA levels were non-significantly lower in PC group compared to control group. Mean PSA densities [PSAD, PZ PSAD, cPSAD and PZ cPSAD] were significantly higher in PC group compared to control group. There was a positive significant correlation between the presence of PC and age of patients and with levels and densities of tPSA and cPSA. Using ROC curve analysis to define the most specific predictors of presence of PC revealed that cPSA level was highly specific with AUC=0.987 with a significant difference in favor of cPSA level in comparison to tPSA and fPSA. Using regression analysis defined cPSA level PZ cPSAD and PZ PSAD as the significant predictors of PC and ROC curve analysis of the three parameters defined PZ cPSAD and cPSA serum level as the highest specific predictors of PC. It could be concluded that estimation of serum complexed PSA could define cases of PC with high specificity during screening of patients had serum PSA levels ranged between 2.5 and 20 ng/ml and used in combination with determination of PZ cPSAD are highly significant specific predictors of PC

Evaluation of power Doppler imaging in detection of prostate cancer

Purpose: To evaluate power Doppler imaging techniques as new ultrasound technologies in prostate cancer detection and as a complementary part of TRUS assessment of the prostate

Material and Methods: 101 patients, suspected to have prostate cancer, were chosen from those attending the out-patient clinics of Urology Department in Benha Faculty of Medicine. Their ages ranged from 53 to 87 years. All patients were complaining of LUTS, they were subjected to thorough clinical examination, DRE, PSA measurement TRUS and PDI. Moreover, TRUS-guided biopsies from the prostates were done for all patients to confirm the diagnosis

Results: Forty patients [39.6%] were proved to have prostate cancer by TRUS-guided biopsy. DRE detected 27 prostate cancer patients [67.5%], while it was negative in 13 prostate cancer patients [32.5%]. PSA was high in 37 prostate cancer patients [92.5%], while it was normal in 3 prostate cancer patients [7.5%]. Positive TRUS findings were detected in 35 prostate cancer patients [87.5%], while 5 cancer patients [12.5%] were negative by TRUS. PDI was positive in 24 prostate cancer patients [60.0%], while it was negative in 16 [40.0%]. In addition, the results of PDI were studied in view of those of DRE, PSA and TRUS. PDI detected 17 [63.0%] prostate cancer patients out of 27 DREpositive cancer patients. Seven prostate cancers [53.8%] DRE-negative prostate cancer patients were detected by PDI. PDI detected 23 [62.2%] prostate cancer patients out of 37 cancer patients with elevated PSA levels and one [33.3%] prostate cancer patient with normal PSA. Finally PDI was positive in 23 [65.7%] prostate cancer patients out of 35 patients who were TRUS-positive, and one [20.0%] of TRUS-normal cancer patients detected by PDI

Conclusion: Although having a limited accuracy, the diagnostic triad of DRE, PSA and TRUS remains the clue and first step in the diagnosis of prostate cancer. In this respect, PDI can draw attention to the presence of hypervascular suspected lesions; however, a confirmatory TRUS-guided biopsy will still be necessary as a gold standard test in the diagnosis of prostate cancer

Laparoscopic decortication of symptomatic simple renal cysts

To investigate the technique and assess results of laparoscopic decortication of symptomatic simple renal cysts. Ten patients underwent trans-peritoneal laparoscopic decortication of symptomatic simple renal cysts. Complex renal cysts were excluded. Out of the 10 patients, 8 had undergone previous cyst aspiration with injection of sclerotic material for intended ablation. Out of these cysts, 8 were peripheral and 2 were peripelvic. The mean operative time was 116 +/- 37.7 minutes [range 90- 180] and blood loss was minimal. Symptomatic success was achieved in 9 patients with a mean follow up of 7 months [range 3-9], and radiologic success was achieved in 8 patients. Laparoscopic decortication of simple renal cysts is a safe and effective alternative to open surgery in patients who have failed conservative measures. Peripelvic cyst location makes laparoscopic decortications more challenging in the term of technical dissection yet feasible for the clinical outcome

Laparoscopic ureterolithotomy: is it an alternative technique replacing open surgery

To assess and evaluate the technique as a replacement to open surgical uretero-lithotomy. Fifteen patients with failed either ESWL or endoscopy and large calculi at the upper ureter were included in this study for performing transperitoneal laparoscopic uneterolithotomy Mean age was 47.2 7 +/- 9.32SD. 9 patients had right sided stones and 6 were left sided. Stone size range was 10-20 mm with mean 14.67 +/- 2.89 SD. 14 cases the stones were in the lumbar region and only 1 case at the iliac region. Successful laparoscopic stone removal were in 13 out of 15 [86.6%]. Two operative conversion to open surgery due to migration of stone in one case and in other conversion is due to injury of left common iliac artery. Operative times was 119.3 +/- 38.03 SD minutes [60-180min] estimated blood loss 62.3 +/- 11.6 [30-100] cc.. mean drain removal time was 3.4 days. mean post operative parentral analgesia was 150 mg of diclofenac sodium [75-300mg], mean hospital stay was 4.3 [3-8days] and mean resuming normal activity was 11.6[8-21 days]. Laparoscopic ureterolithotomy is a safe technique with a shorter hospital stay and rapid return to normal activity and offers an alternative modality than open surgery after treatment failure [ESWL, endoscopy] or for large size calculi. Open surgery has a role for managing laparoscopic converted cases

Role of urodynamic findings in revision of many concepts about chronic prostatitis syndrome

Objective: to evaluate urodynamic ally, patients with chronic prostatitis syndrome to define a specific urodynamic pattern in each prostatitis group that might add information about the pathogenesis of the syndrome and treating such patients more efficiently

Patients and Methods: fifty patients aged from 24-50 years with symptoms suggestive of chronic prostatitis, were evaluated by standard four-glass test using direct microscopy and culture for all specimens. Patients were classified according to National Institutes of Health Classifications System into non-inflammatory chronic pelvic pain syndrome [NiCPPS [Group1]], chronic bacterial prostatitis [CBP [Group 2]], and inflammatory chronic pelvic pain syndrome [ICPPS [Group 3]. Patients with documented urethritis urinary tract infection, lower urinary tract neuropathy or history of lower urinary tract surgery are excluded from the study. Furthermore all patients were evaluated by transrectal ultrasound and through urodynamic study including flowmetry, filling cystometry, pressure flow study [PFS] and electromyography of distal urethral sphincter [EMG]. Out of 50 patients pressure flow study [PFS] and EMG are conducted in only 27 patients, while the remainder cannot complete these urodynamic sturdies. Results were statistically analyzed rising F tests where P>0.05 was significant

Results: the common urodynamic finding represent decreased mean Q max the three groups of chronic prostatitis syndrome [l6 +/- 3 ml/sec]. However no significant difference between groups regarding the Q max [P value ~0.05] Out of the 50 who underwent filing cystometry, 30 patients [60%] had a first sensation of filling and 33 patients [66%] had a desire to void at low volumes [0.05]. Of 27 patients who underwent IPFS] and EMG, 16 patients had an obstructed pattern of micturition. However there was no significant difference between NICPPS and CBP group regarding [PFS] [P>0.05]. EMG study of distal urethral sphincter [27 patients] reveal that 9 patients from 16 patients with NICPPS and 2 patients from 11 with CBP show EMG activity during voiding, and there was a statistically significant difference between both groups [P <0.05, Chi square 3.9]

Conclusion: complaints, transrectal ultrasound and urodynamic findings were generally similar in the 3 groups of prostatitis syndrome. Therefore, the differentiation of the syndrome into 3 groups based on results of direct microscopic examination and cultures of the 4-glass test seem to be not logical. In addition, urodynamic evaluation explores sensory and motor dysfunctions, which may not only help in pathophysiological explanation of this syndrome but also in planning treatment

Rotoresection of the prostate: a preliminary report

To report the results and follow up of rotoresection of the prostate during one year. The rotoresection is a specially designed resection electrode, driven by a micromotor and a high frequency current to enable simmulataneous coagulation, vaporization and mechanical tissue removal during resection. Between October 2001 and October 2002, fifty patients with symptomatic benign prostatic hyperplasia [B.P.H.] have had their prostate resected with this new technique. The actively rotating electrode enables tissue coagulation and vaporization as well as mechanical tissue ablation. Only minimal bleeding was observed during the entire resection procedure. The mean resection time was 39.3 +/- 9.8 minutes. No intra-operative complications occurred. Post-operatively, no significant changes in hemoglobin and sodium concentration were detected. The urinary maximum flow rate was improved from 8.2 +/- 2.2 to 23.5 +/- 5.5 ml/ sec. and the residual urine volume reduced from 190.4 +/- 102.7 to 25.6 +/- 17.8 ml. The international prostate symptom scor [IPSS] improved from 25.3 +/- 6.1 to 7.2 +/- 2.5. Rotoresection of the prostate is a promising new technique which has the advantages of high ablation rate, minimal blood loss, no significant change in hematocrite and serum sodium concentration and short hospital stay. Longer follow up with larger numbers of patients will be essential in determining the durability of this technique as a treatment modality for symptomatic BPH

Surgical stripping of perihilar renal lymphatics for chyluria

To present the results of surgical lymphorenal disconnection and its advantages in patients with severe chyluria. Twenty patients [12 men and 8 women, age 32-65 years] with severe chyluria of variable duration [5 months to 4 years], underwent surgical disconnection of the lymphorenal communication after confirming the diagnosis of chyluria by urine examination for fat globules. All patients were either failed minimally invasive treatment with intrarenal pelvic instillation of sclerosing material [8 patients], or presented with severe chyluria [12 patients]. Cystoscopy was performed in all patients before treatment. Chyluria was seen to spurt from the ureteral orifice unilaterally in 16 patients and bilaterally in 4 patients. The areolar tissue containing dilated lymphatics traveling to the kidney in the perirenal and hilar regions was dissected and divided between ligatures, thus stripping these structures completely. Only one side was operated at a time. All patients were available for a minimum follow-up of 1 year, with the longest follow-up 3 years. With unilateral surgery, clearance was achieved in 15 patients [93.7%] immediately, with final success in 14 [87.5%] patients. Of the four patients who underwent bilateral surgery a clearance rate of 75% was achieved. In three cases of failure, instillation of sclerotherapy was successful in two patients but failed in one patients who cured by repeated surgery. Lymphorenal disconnection for chyluria is simple, successful as a permanent cure and with almost negligible complications. Salvage sclerotherapy is usually effective for the minority of patients who fail surgical stripping

Does urge incontinence contraindicates surgery for stress urinary incontinence?

Urge incontinence is commonly associated with female stress urinary incontinence [SUI]. Many surgeons hesitate to operate for SUI if associated with urgency. Our aim is to define whether urge incontinence contraindicates surgery for SUI or not. This study was conducted on 35 female patients complaining of mixed incontinence [Urge and stress]. Patients with uninhibited detrusor contractions in cystometrogram [CMG] excluded from the study. All patients underwent preoperative assessment by history, physical examination, oblique cystogram, urodynamics [CMG, flowmetry and Valsalva leak point pressure [VLPP]] and cystoscopy. All patients were managed with fascial patch sling either from anterior rectus sheath or fascia lata [in patients with previous suprapubic incision or scarring]. All patients were followed up for one year with the same preoperative parameters. SUI was cured in 34 patients [97.1%] while urge incontinence was cured in 25 patients [71.4%] and persisted in 10 patients [28.6%]. In conclusion, patients complaining of mixed incontinence with urodynamically proved signs of urethral relaxation, as the main component of urge incontinence, will benefit significantly from surgery of SUI

Comparison between extradural and intermuscular bupivacain infusion for control of pain after renal surgery

In this study we compared the analgesic and heamodynamic effects of continuous extradural bupivacain infusion and intermuscular bupivacain infusion after renal surgery 20 ASA I and II patients undergoining renal surgery through a muscle cutting loin incision were the material of this study. Patients were allocated to receive continuous bupivacain infusion after surgery via either a thoracic extradural catheter [G.I] or via an epidural catheter placed per-operatively between the muscle layers [G.II] for post operative pain relief. Immediately after operation group I patients were given 10 ml of 0.25% bupivacain followed by continuous infusion of 0.25% bupivacain delivered at a rate of up to 6 ml/h for 48 hs post-operatively. In group II patients, immediately after operation, 20ml of 0.25% bupivacain was introduced to the wound followed by continuous infusion commenced at 5ml/h. After operation arterial pressure and heart rate were recorded routinely at 10min intervals for the first hour, and there after at 1 h intervals for 12h, then every 6h for the next 36 hs. The first request for analgesia was treated with systemic morphine administered i.v in 1mg increments until pain was controlled adequately. Further requests for analgesia were treated with morphine 5mg i.m and repeated as required. The total morphine requirements for the initial 48 hs after operation were recorded. Pain scores on a visual analogue scale [VAS] [0 mm= no pain; 100 mm = worst pain imaginable] at rest, during mobilization from the supine into the sitting position and during coughing were assessed 1, 6, 12, 18, 24, 30, 36, 42, and 48hs post-operatively. No bacterially proven wound infection occurred in either group. Mean arterial pressure [MAP] decreased in group I within 30-60 min of administration of the bupivacain, although the differences were not significant between the two groups or compared with the pre-injection values. The mean morphine requirements for group I was 22.9 microg/Kg/h +/- 5.6 and 25.8 microg/Kg/h +/- 5.7 for group II, this difference is not statistically significant. Also there were no significant differences between the two groups in visual analogue pain scores [VAPS] during rest, mobilization from supine into sitting position or during coughing. The data have suggested that a continuous infusion of intermuscular bupivacain is nearly equal to epidural bupivacain infusion in controlling pain after renal surgery. The technique is simple, has few complications and it represents a good alternative when insertion of epidural catheter is contraindicated or difficult to be performed

Pubo-scrotal incision for repair of penile fractures

Fracture penis is a urologic emergency, which should be managed with prompt exploration and repair of the tunical tear. In this study we have evaluated a puboscrotal incision for the repair of penile fractures. Between Feb. 1995 till Dec. 2000, 42 cases of fracture penis were operated upon for repair using a puboscrotal incision. Patients presented at the emergency room and outpatient clinic of our department Full history, clinical examination and preoperative cavernosogram were done to all the patients to delineate the sites of Tunical tear. If urethral injury was suspected urethrography was performed. All cases included in this study presented to our department within 3-72 hours from injury. Their ages ranged from 18 to 44 years [mean 27.5 +/- 6.95 years]. Urethral injury was found in 5 cases [12%]. The follow-up of cases ranged from 12 to 34 months [average was 18 months]. The puboscrotal incision gave almost no complications in 30 cases [62.5%] and complications when happened were minimal and self-limiting. They included wound infection in one case [2.4%], residual fibrotic area in 3 cases [7.1%] minimal penile curvature in 2 cases [4.8%], painful erection during coitus in one case [2.4%], hematoma formation [small] in 2 cases [4.8%] and finally weak erection that resolved after 3 months postoperative in one case [2.4%]. In conclusion the puboscrotal incision is a good exposure of the penis with satisfactory repair of penile fractures and concomitant urethral injury. It avoids incision into markedly edematous penile skin

Suprapubic endoscopic procedures: a percutaneous approach

This study was carried out to assess whether suprapubic endoscopic surgery can be helpful in situations where trans urethral access is inadequate, difficult or likely to be associated with urethral damage. We have applied a new technique for percutaneous access to the bladder by using the self-retaining [locking] laparoscopic trocar. Forty male patients with lower urinary tract disorders were selected from the patients who attended the urology department at Benha University Hospitals during the period from June 1997 to October 1999. The patients ages ranged from 2 to 80 years old with a mean age of 48.1 years. According to the procedures done, 30 patients underwent percutaneous stone bladder clearance: 4 of them underwent a concomitant antegrade bladder neck incision. 6 patients treated with antegrade endoscopic dilatation [cut-to-the light of stricture posterior urethra] and 4 children underwent antegrade ablation of posterior urethral valve [PUV]. We concluded that, percutaneous access to the bladder by using the locking trocar is simple and safe technique. It avoids drawbacks of the other technique of creating and dilating the tract over a guide wire

Pre-and postoperative evaluation of cavernous autonomic innervation after nerve sparing radical cystoprostatectomy and radical retropubic prostatectomy

To assess the cavernous autonomic innervation using Single Potential Analysis of Cavernous Electrical Activity following nerve sparing radical pros tatectomy and cystoprostatectomy. This study was conducted on 23 cancer patients, 20 with invasive bladder cancer and three patients with cancer prostate [mean age 58.4, range 40- 71] operated upon using nerve sparing technique. Postoperative assessment of integrity of the cavernous innervation was done using single potential analysis of cavernous electrical activity [SPACE device]. Subjective and objective assessment of the erectile function was done pre- and postoperatively. Erectile function was preserved in 74% of patients 12 months following surgery, despite the sign drop in the mean erectile function score. The mean time for return of erection was 4.6 +1.6 months. which showed statistically sign positive correlation with the age at operation [r = 0.749, p value 0.00004]. SPACE device is a useful diagnostic tool in detecting the integrity of the cavernous nerves following nerve-sparing technique. The age at operation, and meticulous dissection of the neurovascular bundles, were significant factors for the return of postoperative potency

Acoustic rhinometric study of the nasal cycle in tracheostomized and laryngectomized patients

This study was performed on 13 postoperative tracheostomized cases, 11 postoperative laryngectomized patients and 10 control subjects. Acoustic rhinometry was used to determine minimum nasal cross- sectional area and nasal cavity volume as indices of nasal patency. Testing was repeated at an interval of 30 minutes over a period of 3-8 hours. The results demonstrated that there was normal cyclical fluctuations in nasal patency after airflow deprivation by tracheostomy and laryngectomy albeit of lower amplitude than normal. Different patterns were recorded with an irregular pattern being the most frequent pointing to crucial role of peripheral receptors on central controlling mechanism. The cycles tended towards normality sometimes after surgery. This interval was longer after laryngectomy compared with only tracheostomy indicating that even minimal airflow through the nose may be enough to stimulate nasal receptors and reestablish a trend towards normality

Effect of varicocelectomy on semen parameters in patients with subclinical varicocele

This study was carried out to assess the importance of subclinical grade of varicocele in evaluation of subfertile men. A total of 60 subfertile men with subclinical varicocele diagnosed by scrotal color dupplex ultrasound. Patients were randomly assigned to group I in whom high ligation varicocelectomy was performed and group II who received placebo treatment. Patients were followed up by seminogram at 3 and 6 months. Patients underwent high ligation varicocelectomy Group I showed statistically significant improvement in sperm count after. 3 months and highly statistically significant improvement in sperm count after 6 months. The statistically significant. Improvement in the percentage of abnormal forms was noticed only after 6 months postoperatively. In group II follow up showed non-significant improvement in sperm count, percentage of abnormal forms and grades of sperm motility at either 3 or 6 months. We concluded that the effect of varicocele on semen parameters has no relation to its size and consequently varicocelectomy for subclinical varicocele. diagnosed by color dupplex ultrasound, has benificial effect on semen parameters