workup of microscopic and gross hematuria

Based on the American Urological Association best practice policy statement, the presence of gross hematuria is always an indication for prompt full investigation

Pelvic recurrence following radical cystectomy and orthotopic neobladder substitution for invasive bladder cancer

To determine the incidence, characteristics and factors influencing local pelvic recurrence following radical cystectomy and orthotopic neobladder substitution for invasive bladder cancer. Seventy two radical cystectomies and orthotopic neobladder substitution were performed on 70 men and 2 women. Sixty nine patients had transitional cell carcinoma [TCC], 2 patients had squamous cell carcinoma [SCC] and one had rhabdomyosacrcoma. Seven patients with TCC received adjuvant chemotherapy; 6 for micro-nodal disease and one patient had open cystotomy. Median follow up was 36 months. Eight of the 72 patients [11%] developed pelvic recurrence, 6 patients with TCC, one patient with SCC and another with rhabdomyosarcoma. All recurrences developed within 12 months of cystectomy. None of the recurrences involved the uretero-ileal anastomosis. Of the 6 patients with TCC, 4 patients had P3bN+ GIII TCC with vascular invasion while 2 patients had P3aN+ GIII TCC tumors. In one patient with P3b NO GIII TCC the recurrence invaded the neobladder. Three of the 6 patients with TCC had received adjuvant chemotherapy, 2 for positive nodes and one for open cystotomy. Five patients with TCC received a combination of external beam radiation and chetherapy. Partial response was achieved and 3 died of their disease. The patient with SCC was treated with radiation and the patient with recurrent rhabdomyosarcoma, that also invaded the neobladder, had total pelvic extenteration. Both died of their disease. Neobladder tolerated adjuvant chemotherapy and radiation well. Pelvic recurrence following orthotopic neobladder substitution is comparable to other forms of urinary diversion. Factors influencing recurrence are high stage, high grade disease, positive nodes, bladder violation and vascular invasion. Local recurrence can invade the neobladder. Radiation and chemotherapy result in partial response with poor prognosis

effect of antibiotics on elevated serum prostate specific antigen in patients with urinary symptoms and negative digital rectal examination: a pilot study

Introduction and objectives 65-70% of patients with abnormal prostate specific antigen [PSA] do not have cancer on prostate needle biopsy. Prostate biopsy is a potentially morbid procedure. Prostatitis is commonly reported on needle biopsies. To cut down on the number of unnecessary prostate biopsies we evaluated the effect of antibiotic on PSA level in patients with lower urinary tract symptoms [LUTS], normal digital rectal examination [DRE], normal urinalysis and elevated PSA. Material and methods 48 selected patients with LUTS, normal DRE, normal urinalysis and elevated PSA [range 5.0-28.5 ng/ml], that usually will undergo prostate biopsy, received 2 weeks of Ciprofloxacin. An alpha-blocker was added if the patient was bothered. PSA was repeated and prostate biopsy was performed if PSA did not drop. Results 25/48 patients [52%] dropped their PSA [median of 42% drop], with 80% improvement in LUTS, were not biopsied. 23/48 patients [48%] did not drop their PSA, with 65% improvement in LUTS, were biopsied. 9/23 patients [39%] had prostate cancer. Conclusion Almost 50% of patients with LUTS, normal DRE and elevated PSA will drop their PSA following 2 weeks of Ciprofloxacin thus by avoiding prostate biopsy. This needs to be done in a very strict manner with careful follow-up of those patients dropping their PSA especially not to normal levels

Inapparent adenocarcinoma of the prostate-Study of 80 consecutive prostatectomies performed for clinically benign disease

Background and Inapparent prostate cancer in patients undergoing prostatectomy with a preoperative diagnosis of benign prostatic hyperplasia [BPH] was reported in between 10-24% of cases in the preprostate-specific antigen [PSA] era. With the increased use of PSA and a heightened awareness of prostatic cancer, we examined the incidence and characteristics of carcinoma diagnosed in patients undergoing prostatectomy for symptomatic BPH. Patients and 80 consecutive prostatectomies performed for symptomatic BPH were reviewed. All patients had undergone digital rectal and ultrasound examination. 65 patients had PSA measured and 15 did not. 43 patients had PSA between 0-4 ng/ml. 15 patients had PSA from 4.1-10 ng/ml, and 7 patients had PSA > 10 ng/ml. 9 patients underwent preoperative prostatic needle biopsy. All 9 biopsies were negative for carcinoma. 4/80 patients [5%] had adenocarcinoma on pathological examination. One patient had stage T[1b] and 3 patients had stage T[1b]. None of the patients with PSA <4 ng/ml had carcinoma. Two patients with PSA from 4-10 had carcinoma. One had stage T[1a] and the other stage T[1b]. Biopsy had not been done in these 2 patients. One specimen from a patient with PSA >10 ng/ml and a negative preoperative needle biopsy demonstrated stage T[1b] cancer of the prostate. One patient who did not have PSA measured preoperatively had T[1b] disease. The use of PSA and other techniques to diagnose prostate cancer prior to surgery for BPH have reduced the incidence of clinically inapparent cancer but have not eliminated it entirely. Significant numbers of cancers continue to be missed

Spermatic vein doppler examination: use and abuse

Varicoceles have been shown to be detrimental to spermatogenesis and to cause male infertility. Patients with infertility referred for spermatic vein Doppler ultrasound evaluation were studied prospectively to correlate the findings on physical examination and those on Doppler ultrasound evaluation. Twelve out of thirty four spermatic veins [35%] with no evidence of varicocele on physical examination were found to have definite reflux on Doppler ultrasound examination, while all the unoperated spermatic veins with clinically evident varicoceles had reflux on Doppler ultrasound examination. In the absence of newer methods of diagnosis like high resolution real-time scrotal ultrasonography or scrotal colour Doppler duplex ultrasonography, our results support the use of Doppler ultrasound to detect subclinical varicoceles in patients with infertility but we do not recommend its use in patients with clinically evident varicoceles