The role of noninvasive penile cuff test in patients with bladder outlet obstruction

PURPOSE: The aim of this study was to compare the penile cuff test (PCT) and standard pressure-flow study (PFS) in patients with bladder outlet obstruction. MATERIALS AND METHODS: A total of 58 male patients with moderate to severe lower urinary tract symptoms (LUTS) were selected. Seven patients were excluded; thus, 51 patients were finally enrolled. Each of the patients underwent a PCT and a subsequent PFS. The sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio were calculated. Chi-square and Fisher exact test were used to evaluate relationships between PCT results and maximal urine flow (Qmax); a p<0.05 was considered statistically significant. RESULTS: The mean (±standard deviation) age of the study group was 65.5±10.4 years. Overall, by use of the PCT, 24 patients were diagnosed as being obstructed and 27 patients as unobstructed. At the subsequent PFS, 16 of the 24 patients diagnosed as obstructed by the PCT were confirmed to be obstructed, 4 were diagnosed as unobstructed, and the remaining 4 patients appeared equivocal. Of the 27 patients shown to be unobstructed by the PCT, 25 were confirmed to not be obstructed by PFS, with 13 equivocal and 12 unobstructed. Two patients were diagnosed as being obstructed. For detecting obstruction, the PCT showed an SE of 88.9% and an SP of 75.7%. The PPV was 66.7% and the NPV was 93%. CONCLUSIONS: The PCT is a beneficial test for evaluating patients with LUTS. In particular, this instrument has an acceptable ability to reject obstruction caused by benign prostatic hyperplasia.

Bladder neck preservation during radical retropubic prostatectomy and postoperative urinary continence

Bladder neck-sparing modification of radical retropubic prostatectomy has been reported to lower the risk of urinary incontinence after prostatectomy. We reviewed the outcomes in men with prostate cancer who had undergone prostatectomy with either bladder neck preservation or bladder neck reconstruction. In this retrospective study, a total of 103 patients who had undergone radical retropubic prostatectomy were assessed. The patients were divided into two groups of bladder neck preservation [51 patients] and bladder neck reconstruction [52 patients]. WE compared frequency of biochemical failure, bladder neck stricture, and urinary incontinence between these two groups. Biochemical failure was defined as a serum prostate-specific antigen level higher than 0.2 ng/mL and its rising trend in at least 2 postoperative subsequent measurements. Continence was defined as no need to use sanitary pads or diapers. The two groups were comparable in terms of age, serum prostate-specific antigen level, Gleason score, and prostate volume. After a mean follow-up period of 32.5 months, all patients with bladder neck preservation and 46 [88.5%] with bladder neck reconstruction were continent [P=.03]. There were no significant differences in the frequency of biochemical failure and bladder neck stricture that required dilation between the two groups of the patients. Bladder neck preservation during radical retropubic prostatectomy may improve long-term results of urinary continence and be effective in eradicating prostate cancer without increasing the recurrence rate

Organ yield from deceased donors: initial experience of an organ procurement unit in Iran

To promote organ transplantation in Iran, organ procurement from deceased donors should be supported. For this policy, some organ procurement units have been established in university hospitals. Further researches in these activities are warranted to better elucidate the role of cadaveric organ transplantation in Iran. We retrospectively studied deceased organ donation from June 2005 through December 2007 in Organ Procurement Unit of Shariati Hospital in Tehran. We analyzed a total of 141 organs that were retrieved from 46 brain-dead organ donors. The median age of all donors was 29 years [min: six, max: 63]. Two third of them were males. The average of harvested organs was 3.06 per donor and four organs per month. The main cause of brain death was head trauma [n=33, 72%]. Organ yield per donor was correlated to the time of the organ procurement unit activity and increased during the three years [r=0.261, P=0.017]. Other variables were not changed during this period. Donor characteristics such as age, sex, blood group, and causes of brain death impacted on the organ yield. This study showed that organ procurement units can improve organ yield and both experience and donor characteristics influence on the number of harvested organs