Prostatic carcinoma at Siriraj Hospital.

In Thailand, carcinoma of the prostate gland ranks at the number tenth of the most common malignancy in male. Here we report the incidence of carcinoma of the prostate during 1990-1992. The average number of patients was about 30 per year. The incidence was common at the age of 70-79. The common symptoms were difficulty in urination 48%, hematuria 19%, back and bone pain 16%, urinary retention 14.4%,Most of them were in stage C and D and treatment of choice were TUR and orchidectomy. Only one patient, the histologic section was transitional cell carcinoma.

The pattern of lymph node metastasis of penile cancer in Thais.

The prognosis of penile cancer is dependent on ilioinguinal lymph node metastasis. However, some controversy still exists concerning the management of those lymph nodes because the pattern of lymph node metastasis, especially in Thai males, is questionable e. Hence a prospective study of the pattern of lymph node metastasis was undertaken in 26 penile cancer patients from 1992 to 1995. All patients had the same pattern of lymph node metastasis. From primary lesion, tumour metastasized first to the inguinal lymph node, and then to the ipsilateral pelvic lymph node. There was no skip pattern. There was no correlation between Jackson staging, degree of cell differentiation, extension of primary lesion, palpability of clinical inguinal lymph node and pathological staging of lymph node metastasis after bilateral ilioinguinal lymphadenectomy. The primary lesion with poor differentiation was highly related to lymph node metastasis at the initial diagnosis. In patients with a clinically negative inguinal lymph node, 50 percent had inguinal lymph node metastasis and 12.5 percent had inguinal lymph node metastasis. In patients with a clinically positive inguinal lymph nod, 83.3 percent had inguinal lymph node metastasis and 38.8 percent had pelvic lymph node metastasis. In conclusion, lymph node metastasis in penile cancer is unpredictable by clinical evidence. Therefore prophylactic bilateral inguinal lymphadenectomy is recommended in all patients, and especially in cases with poor differentiation of the primary lesion, low education or low compliance with follow up. If there is inguinal lymph node metastasis, ipsilateral pelvic lymphadenectomy is recommended.

Bladder augmentation: Siriraj experience.

Since 1987, 13 patients with low compliance bladder secondary to genitourinary tuberculosis, neuropathic bladder and contracted bladder from other causes underwent augmentation cystoplasty. Ileal segments were used in all of them and no serious complication was found. All eight patients with tuberculous cystitis and chronic scarring of the bladder from other causes, who had been suffering from frequent voiding, were free of these symptoms postoperatively. Three patients could void by themselves but the others required intermitted catheterization to remove residual urine. In five cases of neuropathic bladder, four patients with reflex incontinence were continent postoperatively and in one case with vesicoureteral reflux the symptoms subsided. All patients were satisfied with the outcome following surgery. Augmentation cystoplasty appears to offer a reliable procedure for low compliance bladder.