Does MRI help in the pre - operative evaluation of pelvic fracture urethral distraction defect? - a pilot study

ABSTRACT Objectives To study the usefulness of MRI in preoperative evaluation of PFUDD. Can MRI provide additional information on urethral distraction defect (UDD) and cause of erectile dysfunction (ED)? Materials and Methods In this prospective study, consecutive male patients presenting with PFUDD were included from Feb 2011 till Dec 2012. Those with traumatic spinal cord injury and pre-existing ED were excluded. Patients were assessed using IIEF questionnaire, retrograde urethrogram and micturating cystourethrogram (RGU+MCU) and MRI pelvis. Primary end point was erectile function and secondary end point was surgical outcome. Results Twenty patients were included in this study. Fourteen patients (70%) were ≤40years; fifteen patients (75%) had ED, seven patients (35%) had severe ED. MRI findings associated with ED were longer median UDD (23mm vs. 15mm, p=0.07), cavernosal injury (100%, p=0.53), rectal injury (100%, p=0.53), retropubic scarring (60%, p=0.62) and prostatic displacement (60%, p=0.99). Twelve patients (60%) had a good surgical outcome, five (25%) had an acceptable outcome, three (15%) had a poor outcome. Poor surgical outcome was associated with rectal injury (66.7%, p=0.08), cavernosal injury (25%, p=0.19), retropubic scarring (18.1%, p=0.99) and prostatic displacement (16.7%, p=0.99). Five patients with normal erections had good surgical outcome. Three patients with ED had poor outcome (20%, p=0.20). Conclusions MRI did not offer significant advantage over MCU in the subgroup of men with normal erections. Cavernosal injury noted on MRI strongly correlated with ED. Role of MRI may be limited to the subgroup with ED or an inconclusive MCU.

Prostatic disorders in acromegalic patients experience of a Brazilian center

Introduction Published data suggest that patients with acromegaly have an increased prevalence of prostate disorders. Objective To evaluate prostatic disorders in acromegalic patients comparing these results after one year of treatment of acromegaly and with a group of healthy men. Materials and Methods This study was composed of two parts: sectional study comparing patients with healthy controls (baseline) and prospective, longitudinal study (at baseline and after one year of treatment). Forty acromegalic patients were enrolled and evaluated at baseline and after one year with the application of international prostatic symptoms score (IPSS), digital rectal examination, measurements of growth hormone (GH), insulin-like growth factor-I (IGF-I), insulin-like growth factor-binding protein-3 (IGFBP-3), sex hormone-binding globulin (SHBG), prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone, total and free prostate-specific antigen (PSA) levels and prostate ultrasonography (US). Thirty healthy men were selected as control group. Results We stratified patients and controls according to age, considering 40 years-old as cut off. Healthy controls under 40 had IPSS values lower than acromegalic patients. When considering only older patients and controls prostate hyperplasia and structural abnormalities were more frequent in acromegalics. After one year of treatment there was significant decrease in GH, IGF-I and prostate volume in acromegalics over 40 years-old. Conclusions Acromegalics under 40 have more urinary symptoms according to IPSS and above 40 years-old higher frequency of structural changes and increased prostate volume than healthy men. Significant reduction of GH and IGF-I levels during treatment of acromegaly leads to decrease in the prostate volume. .

Evaluación prostática con examen digital rectal y antígeno prostático específico en la consulta urológica / Prostatic evaluation by digital rectal examination and prostate specific antigen

Se evaluaron 468 pacientes con antígeno prostático específico (APE) y examen digital prostático (EDP), seguidos de ecografía prostática transrectal (EPTR). En caso de anormalidad en algunos de los dos métodos, se efectuó biopsia en todos los pacientes con PSA mayor de 10,0 ng/ml o con EDP sospechoso. Con APE entre 4,1 y 9,9 ng/ml y EDP normal, se efectuó biopsia sólo cuando existió alguna anormalidad en la EPTR o en la densidad del antígeno prostático específico (DAPE) fue mayor que 0,15 ng/ml. El índice de biopsia fue del 10 por ciento (48 de 468) y resultó positivo en el 56 por ciento de los casos (27 de 48). El índice de detección global de carcinoma de próstata fue del 5,8 por ciento. Los índices de detección de APE y EDP fueron del 5 por ciento y 4,7 por ciento, respectivamente

Caracterizacion de elementos formes en liquido seminal / Characteristics of the elements of seminal fluid

Han sido estudiados los resultados de 195 muestras de liquido seminal para la caracterizacion de bacterias, piocitos, leucocitos, globulos rojos y cristales de espermina. Los hallazgos en las preparaciones de semen han mostrado que el 93,84 por ciento contenian bacterias; 87,68 por ciento piocitos; el 57,47 por ciento leucocitos; el 27,69 por ciento globulos rojos y el 28,71 por ciento cristales de espermina. Estos elementos formes parecen identificar procesos infecciosos, en su mayoria cronicos, de la prostata y las vesiculas seminales. No se pudo descartar lesiones a nivel del conducto uretral. El hallazgo de cantidades significativas de globulos rojos en algunos pacientes permite presumir antecedentes bacilares (tuberculosis genital o urogenital). Del mismo modo, el hallazgo de cristales de espermina hace suponer lesiones prostaticas antiguas cuya importancia debera ser dilucidada.