Effect of Patient-Optimized Doses of Tamsulosin on Erectile Function in Men With Erectile Dysfunction and Lower Urinary Tract Symptoms

PURPOSE: To investigate the relationship of improvement in erectile function (EF) with improvement in lower urinary tract symptoms (LUTS) and to assess the contribution of tamsulosin dose to the improvement of EF apart from the indirect influence of LUTS improvement in men with LUTS and erectile dysfunction (ED). MATERIALS AND METHODS: Fifty patients received tamsulosin 0.2 mg/d for the first 4 weeks and were subsequently divided into two groups by patient-reported outcomes. Nonescalators were maintained starting dose and escalators increased to 0.4 mg for the remaining 8 weeks. International Prostatic Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5), and underwent uroflowmetry were evaluated at baseline, and weeks 4 and 12. RESULTS: LUTS parameters were significantly improved in both groups but insignificant between the 2 groups. The degree of the improvement in the total IPSS and in the voiding, storage, and quality of life (QoL) subscores were significantly correlated with the degree of the improvement in EF; this was especially prominent in patients successfully treated LUTS. The escalators experienced a significantly greater increase in IIEF-5 scores than did the nonescalators (3.3 vs. 1.5). CONCLUSIONS: Dose escalation provided similar LUTS improvement in patients with refractory to starting dose. The improvements of LUTS were correlated with the improvement of EF. The increase in the IIEF-5 score was significantly higher in escalators. These findings imply that tamsulosin may contribute to the improvement in EF through the improvement of LUTS and QoL and direct relaxation of the corpus cavernosum in a dose-dependent fashion.

Massive Scrotal Hematoma with Active Bleeding Caused by Sparganum

Development of swelling and pain without trauma in a scrotal hematoma is very rare. We report on a case of scrotal hematoma with active bleeding caused by sparganosis. A 75-year-old male patient who presented with left scrotal swelling and moderate pain that started one day ago was admitted to the emergency department. On the computed tomography (CT) scan, a hematoma of greater than 10 cm was observed in the left scrotum and contrast extravasation was observed on the post-enhanced CT scan. Therefore, we concluded massive left scrotal hematoma with active bleeding. The patient underwent immediate surgery, and approximately 200 cc of hematoma was evacuated, and a movable whitish colored sparganum was found and removed. In cases involving development of scrotal hematoma without trauma, confirmed by surgery, sparganosis should be suspected, and should be removed.

Association of Metabolic Syndrome and Benign Prostate Enlargement in Young Korean Males

PURPOSE: This study was designed to evaluate the association of metabolic syndrome and benign prostate enlargement in young Korean males. We analyzed the clinical data associated with metabolic syndrome and prostate volume in the study population. MATERIALS AND METHODS: We retrospectively analyzed the clinical data obtained from 1,506 young men under the age of 60 who visited the health promotion center in our institution for routine checkups. The patients were interviewed with a questionnaire including the International Prostate Symptom Score (IPSS) and were evaluated by medical history, blood chemistry, digital rectal examination, and prostate volume via transrectal ultrasonography. The presence of metabolic syndrome was determined according to the modified National Cholesterol Education Program Expert Panel on Detection, Evalution, And Treatment of High Blood Cholesterol in Adults criteria. We divided the subjects into two groups: those with metabolic syndrome and those without. Logistic regression analysis was carried out to determine which metabolic components were associated with an increased risk of benign prostate enlargement. RESULTS: Significant differences in prostate volume were noted between the groups. The prostate volumes were significantly larger in the metabolic syndrome group than in the non-metabolic syndrome group in all subgroups divided by age (in decades). However, no significant differences in IPSS or voiding or storage subscore were noted. In the multivariate regression analysis, only diabetes and obesity were identified as risk factors for benign prostate enlargement among the metabolic components. CONCLUSIONS: Metabolic syndrome and prostate volume were significantly related, even in young males. Diabetes and obesity were identified as significant risk factors for benign prostate enlargement in young males under the age of 60.

Testosterone Replacement in Men with Late-onset Hypogonadism Symptoms and Loss of Diurnal Rhythm of Total Testosterone / 대한남성과학회지

PURPOSE: It is known that the loss of diurnal rhythm of testosterone by age is related to late-onset hypogonadism (LOH). Currently testosterone replacement therapy (TRT) has been recommended only in men with hypogonadism. We evaluated the effectiveness and safety of TRT for men with LOH symptoms and the loss of diurnal rhythm of total testosterone but normal values of total testosterone. MATERIALS AND METHODS: We enrolled 62 patients in whom the difference in testosterone between morning and evening was lower than 108 ng/dl, whose morning values were higher than 300 ng/dl, and who were diagnosed with LOH using the Androgen Deficiency in Aging Male (ADAM) questionnaire. Among the 62 patients enrolled, 44 completed the daily application of 1% testosterone gel or the intramuscular injection of long-acting testosterone undecanoate for the full 20-week period. We compared the data at baseline, and the 8th and 20th week using the Aging Males' Symptoms (AMS) scale, the International Index of Erectile Function (IIEF)-15, the International Prostate Symptoms Score (IPSS), and the serum levels of total testosterone, prostate specific antigen (PSA), complete blood cell count (CBC), and lipid profile. RESULTS: The mean age was 54.9+/-7.2 years. Subjects main symptoms were sexual dysfunction and decrease of ejaculate volume. AMS scales before and after TRT were 41.3+/-18.5 and 35.8+/-19.7 (p<0.05). IIEF total scores before and after TRT were 29.7+/-13.7 and 38.9+/-17.4 (p<0.001). However, 18 patients (40.9%) were not satisfied with TRT and only 11% were fully satisfied. Total testosterone and estradiol were higher after TRT but the other values had not changed. The most common adverse event (27.3%) was erythrocystosis (18.2%). CONCLUSIONS: TRT could induce total testosterone to reach the mid-normal level and was relatively effective for aging male symptoms and sexual function. It is essential for physician to inform patients about potential adverse events and the low satisfaction rate associated with TRT even though TRT has generally been effective.

Comparison of Patient Satisfaction with Treatment Outcomes between Ureteroscopy and Shock Wave Lithotripsy for Proximal Ureteral Stones

PURPOSE: We examined patient satisfaction with treatment outcomes after shock wave lithotripsy (SWL) and ureteroscopic removal of stone (URS) for proximal ureteral stones. MATERIALS AND METHODS: We evaluated 224 consecutive patients who underwent SWL (n=156) or URS (n=68) for a single radiopaque proximal ureteral stone. Stone-free rates, defined as no visible fragment on a plain X-ray; complications; and patient satisfaction were compared. Patient satisfaction was examined through a specifically tailored questionnaire that included overall satisfaction (5 scales) and 4 domains (pain, voiding symptoms, cost, and stone-free status). RESULTS: The stone-free rates after the first, second, and third sessions of SWL were 36.5%, 65.4%, and 84.6%, respectively. The overall stone-free rate of URS was 82.4%, which was comparable to that of the third session of SWL. Complications were similar between the two groups except for greater steinstrasse in the SWL group. Overall satisfaction and voiding symptoms, cost, and stone-free status showed no significant difference between the groups. In the pain domain, the SWL group had a relatively lower satisfaction rate than did the URS group (p=0.05). Subanalysis showed that the satisfaction rate of the URS group with stone-free status was significantly lower than that of the SWL group in patients with > or =10 mm stones (p=0.032). CONCLUSIONS: Overall treatment outcomes and patient satisfaction were not significantly different between SWL and URS. However, patients undergoing URS for > or =10 mm proximal ureteral stones had lesser satisfaction with stone-free status, because of relatively lower stone-free rates due to upward stone migration. We suggest that factors regarding the subjective satisfaction of patients be included in counseling about treatment options for proximal ureteral stones.

A Case of Synchronous Double Primary Cancer of the Penis and Urinary Bladder / Journal of the Korean Cancer Association, 대한암학회지

Multiple primary cancers are the occurrence of more than two cancers of different origin in an individual. Penile cancer is a rare disease, and finding it combined with other cancers is even rarer. A 64-year-old man with a painful penile mass was referred to us from a primary urological clinic. We performed a biopsy of the penile mass and the histology revealed a well-differentiated squamous cell carcinoma. Abdominal computed tomography showed a localized bladder tumor with inguinal lymphadenopathy. The patient underwent a partial penectomy, transurethral resection of the bladder tumor and inguinal lymph node dissection. The histology of the bladder tumor was high-grade papillary carcinoma, and that of the lymph node was squamous cell carcinoma. The penile and bladder tumors were in stage II (T1N1M0) and stage I (T1N0M0), respectively. We successfully treated the patient with adjuvant radiotherapy and systemic chemotherapy.

Contralateral Patent Processus Vaginalis in Unilateral Undescended Testis: Comparison between Preoperative Ultrasonographic and Transinguinal Laparoscopic Inspection

PURPOSE: The presence of a contralateral patent processus vaginalis (CPPV) is a risk factor for a metachronous hernia and may alter the surgical approach in unilateral cryptorchidism. We prospectively investigated the prevalence of a CPPV and compared the results between ultrasound (US) and transinguinal laparoscopy (TIL). MATERIALS AND METHODS: We analyzed a single surgeon's experience with preoperative US, TIL, and inguinal orchiopexy. We included 74 patients with a palpable (or identified by US) cryptorchidism with patent processus vaginalis who underwent inguinal orchiopexy. We performed an inguinal exploration when we could identify an opened internal ring through TIL. RESULTS: The prevalence of a CPPV was 18.9%. There was no significant difference in the occurrence of a CPPV by laterality, age, gestational age, or location of testis. A CPPV was detected 10 patients by US and in 15 patients by TIL, but one of them was revealed to be a blind pouch. The sensitivity and the specificity of US were 71.4% and 100%, respectively. Four CPPV cases were undiagnosed by US; all had a narrow internal ring. The accuracy of US was dependent on the width of the CPPV and the morphology of the internal ring. CONCLUSIONS: It was considerable that about 20% of patients with unilateral cryptorchidism had a CPPV, a risk factor for metachronous hernia. The presence of a CPPV in unilateral cryptorchidism should be considered in clinical practice.

A Patient with Congenital Agenesis of the Seminal Vesicles / 대한남성과학회지

Congenital agenesis of the seminal vesicle is commonly associated with mullerian duct cysts and frequently combined with anomalies of the vas deferens or urinary tract. We report a case of a 29 year-old man with congenital agenesis of the seminal vesicle without any associated anomaly of the urogenital organs. He had infertility for 2 years and two semen analyses revealed azoospermia. There was no abnormal finding in physical examination of the testis, epididymis, or vas deferens. However, we could not locate the seminal vesicles in a transrectal ultrasound and computed tomography. We referred him to an infertility clinic for assisted reproductive technology.

A Patient with Congenital Agenesis of the Seminal Vesicles / 대한남성과학회지

Congenital agenesis of the seminal vesicle is commonly associated with mullerian duct cysts and frequently combined with anomalies of the vas deferens or urinary tract. We report a case of a 29 year-old man with congenital agenesis of the seminal vesicle without any associated anomaly of the urogenital organs. He had infertility for 2 years and two semen analyses revealed azoospermia. There was no abnormal finding in physical examination of the testis, epididymis, or vas deferens. However, we could not locate the seminal vesicles in a transrectal ultrasound and computed tomography. We referred him to an infertility clinic for assisted reproductive technology.

Ureteral Sciatic Hernia: A Case Report

A ureteral hernia that occurs through the sciatic foramen is very rare. We present a case of a ureteral sciatic hernia with hydronephrosis. Intravenous urography (IVU) showed the presence of a curved, laterally displaced ureter, and computed tomography (CT) clearly depicted the herniated ureter through the sciatic foramen. The patient was treated transiently with a double J catheter.

Analysis of the Expression of Peroxiredoxin I in Human Bladder Cancer / 대한비뇨기과학회지

PURPOSE: Peroxiredoxins(PRDXs) are antioxidant enzymes that play an important role on cell differentiation, proliferation and apoptosis. In this study, we investigated if the expression levels of PRDX I were related to bladder cancer. MATERIALS AND METHODS: The mRNA level of PRDX I was examined via real time polymerase chain reaction(PCR) in 186 cancer specimens from patients with primary bladder cancer, 73 corresponding samples of normal looking bladder mucosae surrounding the cancer and 21 samples of normal bladder mucosae. We investigated the correlation between the expression levels of PRDX I and the clinico-pathological parameters of the 154 patients who could be followed up more than three years. RESULTS: The expression levels of PRDX I in bladder cancer(0.73pg/ml) were significantly higher that that in the normal bladder mucosae (0.04 pg/ml)(p<0.01) or that in the corresponding normal bladder mucosae surrounding the cancer(0.38pg/ml)(p<0.01). The expression level of PRDX I was not significantly enhanced in the non-recurred(0.87pg/ml) superficial bladder tumor patients compared with the recurred superficial bladder tumor patients(0.63pg/ml), but it was significantly enhanced in the non-progressed(0.82pg/ml) patients compared with the progressed (0.50pg/ml) patients(p<0.05 for each). CONCLUSIONS: An enhanced expression of PRDX I is strongly associated with the development of bladder cancer. Moreover, enhanced expressions of PRDX I are also positively associated with a low rate of progression of bladder cancer, and this might be useful as a marker for assessing progression in human bladder cancers.

Laparoscopic Partial Nephrectomy: An Useful Method of Decision Making for Determining the Approach and Surgical Method Based on the Systematic Classification of Tumor Location / 대한비뇨기과학회지

PURPOSE: Laparoscopic patial nephrectomy is still one of challenging surgeries in laparoscopic urologic field and needs skillful technique of surgeons. When performing laparoscopic partial nephrectomy, initial plan of how to approach affects the whole course of the surgery. To propose a systematic decision guideline, we used the tumor location as the determining factor for selecting initial plan and analyzed our initial experience. MATERIALS AND METHODS: From September 2005 to April 2008, we performed 22 LPNs for small renal tumors less than 40mm in diameter, as measured from the preoperative computed tomography scans. We divided the tumor locations into 18 categories with the combinations of the anterior and posterior renal axes, and the upper, middle, lower parts of the kidney and the peripheral, central and hilar locations of the tumor. According to the tumor location categories, we performed LPNs through the retroperitoneal simple and complex approaches, and the transperitoneal simple and complex approaches. RESULTS: Twenty of twenty-two tumors(91%) were removed successfully through 4 different approaches, but 2 cases were converted to laparoscopic radical nephrectomies(LRNs). The mean operation time was 203 minutes, including a mean warm ischemic time(WIT) of 30.7 minutes. Among the 17 cases of RCC, 15 tumors were successfully removed via LPNs, and there were no cases with positive margins and no tumor recurrence during a mean of 14.9 months follow-up with a maximum follow-up period of 34 months. CONCLUSIONS: Dividing the tumor location into 18 categories is useful for deciding on the appropriate laparoscopic approach.

Diurnal Rhythms of Serum Total Testosterone, Sex Hormone Binding Globulin, Estradiol and Luteinizing Hormone in Young Korean Men: a Circadian Study / 대한남성과학회지

PURPOSE: Currently, no studies have examined the diurnal variation of sex hormones in Korean men. We realized that accurate models of the diurnal variation of the sex hormones in Korean males are needed to evaluate and manage patients in urology. Therefore diurnal variation of testosterone and related sex hormones were investigated in young Korean men. MATERIALS AND METHODS: Healthy Korean men from 20 to 25 years old who had evident secondary growth were enrolled. We drew blood from each subject 12 times at 2-hour intervals for 24 hours. The concentrations of total testosterone, estradiol, luteinizing hormone, sex hormone binding globulin and albumin were measured. The free and bioavailable testosterone were calculated by Vermeulen's equation. To analyze the rhythmicity of diurnal variation in sex hormones, 24-hr cosine regression analysis was used for the statistical analysis. RESULTS: Total testosterone, free testosterone, estradiol, and testosterone estradiol ratio demonstrated a significant diurnal cosinor rhythm. The diurnal variation of bioavailable testosterone did not demonstrate a statistically significant cosinor rhythm. CONCLUSIONS: The diurnal variations of serum total and free testosterone concentration in Korean young men were similar to those found in studies of Caucasian men. Our study provides basic data for future studies of Korean male sex hormones. Furthermore, additional studies targeted toward various male age groups are needed to make the standard models of sex hormones in Korean men.

A Case of Primary Syphilis in the Rectum

A 30-yr-old man was referred for suspicious rectal cancer because of ulcerated lesions in the rectum and a palpable mass in left inguinal area. Sigmoidoscopy showed two indurated masses and histologic evaluation of biopsy revealed obliterative endarteritis with heavy plasma cell infiltration. Both venereal disease research laboratories (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) tests were positive. After injection of penicillin G benzathine for 3 weeks, the rectal chancre and the palpable mass disappeared.

A Torsion of the Cyst of Tunica Vaginalis Presented with Acute Scrotum / 대한비뇨기과학회지

We report a case of torsion of a benign cyst arising from the parietal layer of the tunica vaginalis, which presented on an acute scrotum. Physical examination revealed a tender swelling of the left hemiscrotum. Surgical, we happened to find torsion of a cyst originating from the parietal layer of the tunica vaginalis. The pedicle of the cyst was twisted about 360 degrees.

Long Term Follow-up Results of Anterior Vaginal Wall Sling Procedure for Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The anterior vaginal wall sling (AVWS) was introduced to be a simpler and less morbid procedure than the fascial or synthetic slings. However, the long-term outcome of the AVWS has not been fully assessed. In this study, the long-term outcomes of AVWS in female stress urinary incontinence were determined. MATERIALS AND METHODS: A total of 54 patients, followed-up postoperatively for at least five years, were surveyed. The surgical outcome was evaluated by pre- and post-operative SEAPI scores, subjective satisfaction and complications. The preoperative clinical parameters were analyzed using a multivariate analysis to determine the factors influencing the success. RESULTS: After a follow-up period of at least 60 months (mean 72.3 months), 63% were cured, 24% showed improvement and 13% had unsuccessful outcomes. The multivariate analysis demonstrated no preoperative factors for the prediction of the outcome of the AVWS. In a subjective satisfaction assessment, 40.8% were extremely satisfied, 40.8% were satisfied, 9.3% felt fair, and 9.3% were dissatisfied. The short-term complications were; UTI (1 case) and operation related transfusion (1 case). The long-term complications were; de novo urge incontinence (3 cases), removal of suture material due to extra-vaginal protrusion (3 cases) and chronic pelvic pain (1 case), but there was no chronic retention. CONCLUSIONS: An AVWS has many benefits, such as low morbidity, easiness of familiarization and can be performed on patients with anatomical incontinence and internal sphincter deficiency. Nevertheless, the complete dry rate of AVWS is 63% for a follow-up of over 5-years. With regard to its long-term durability, this procedure is considered a less effective treatment modality for female stress urinary incontinence.

The Role of Renal Ultrasonography in Asymptomatic Microscopic Hematuria / 대한비뇨기과학회지

PURPOSE: Serious urologic lesions have been reported in 4.8% to 16.5% of patients referred for asymptomatic microscopic hematuria. This study aimed to demonstrate the cause of microscopic hematuria and to evaluate the diagnostic efficacy of urologic workup methods. MATERIALS AND METHODS: Between February 1995 and July 1999, 970 patients with asymptomatic microscopic hematuria were examined by urinalysis, urine culture, intravenous pyelography and renal ultrasonography. Patients with proterinuria of 2+ or more and RBC casts were excluded from the study. Average patient age was 53 years (20-82 years). The male-to-female ratio was approximately 1:1 (473:497). RESULTS: Among 970 patients with asymptomatic microscopic hematuria, the cause was detected in 96 patients, including 2 renal cell carcinoma and 2 bladder tumor. In patients over the age of 50 years, the incidence of malignancy was 6.6% (4/610) and higher incidence of significant lesions was found (11.0%) compared to patients under the age of 50 (8.1%). Malignancy was not found in any of the 360 patients under the age of 50 years. Neither the degree of hematuria nor sexual difference correlates with clinically significant lesions. In 96 patients with significant lesions, the detection rate of abnormalities by renal ultrasonography and IVP was 26% (25/96) and 12.5% (12/96), respectively (p=0.004). CONCLUSIONS: Our report has shown that 9.9% of the patients had significant urologic lesions including 4 malignancies. We demonstrate that renal ultrasonography was more beneficial than IVP for the evaluation of the upper tract in patients with asymptomatic microscopic hematuria. It may be more appropriate to consider renal ultrasonography in addition to IVP as an initial examination in the evaluation of microscopic hematuria.

A Follow-up Guideline after Radical Nephrectomy for Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: To establish the stage specific follow-up guideline for renal cell carcinoma (RCC), we evaluated the pattern of metastases and the clinical course of patients who had underwent radical nephrectomy. MATERIALS AND METHODS: We reviewed retrospectively the records of 165 patients who underwent radical nephrectomy with a final pathologic diagnosis of RCC. We compared the time of the first recurrence, the site of metastasis and detection modality according to the pathologic stages. RESULTS: Metastases were found in 18 patients in an average of 12.9 9.5 months after nephrectomy. None of the 77 patients with pT1 ( or = 5cm), 4 of the 47 patients with pT2 disease and 10 of the 20 patients with pT3 disease. CONCLUSIONS: The risk of recurrence and metastasis in RCC is stage-dependent. Therefore, a different follow-up guideline should be applied for each stage of RCC after surgical treatment. There is no need for follow-up in patients with pT1 tumors smaller than 5cm. For patients with pT1 tumor larger than 5cm, pT2, pT3 diseases, follow-up studies including history of symptoms, laboratory studies, chest x-ray, and computerized tomography are indicated at defined intervals.

The Etiology and Classification of Nocturia in Adults / 대한비뇨기과학회지

PURPOSE: Nocturia, from which the patients feel the most discomfort, is one of the frequently complained urologic symptoms combined with insomnia. Studying the etiology and classification of nocturia is not enough. In this study, we analyzed the voiding diary and urodynamic study to investigate the etiology of nocturia. We classified the type of nocturia based on the etiology. MATERIALS AND METHODS: We reviewed the urodynamic study (UDS) as well as the three days voiding diary of 152 patients with nocturia. We classified nocturia into three groups based on the voiding diaries and the results of UDS: Pure nocturnal polyuria in which the voided urine volume during the hours of sleep is more than 35% of the 24-hours urine volume, detrusor overactivity defined as existing uninhibited contraction on filling cystometrogram, and mixed (nocturnal polyuria with detrusor overactivity). Polyuria (24-hours urine output >2,500cc) was classified separately. RESULTS: The mean number of nocturia was 3.3 (3.1 for men, 3.4 for women). octurnal polyuria, detrusor overactivity and mixed were 50.0%, 7.9% and 17.1% respectively. Nocturnal polyuria was not related with detrusor overactivity, bladder outlet obstruction and impaired detrusor contractility, but significantly increased with age (p<0.01) and in men (p<0.05). Detrusor overactivity was not related to impaired detrusor contractility, but was significantly related to the bladder outlet obstruction (p<0.05) and increased with age (p<0.01) and in men (p<0.01). Seventeen (11.2%) had polyuria. CONCLUSIONS: In 75% of nocturia patients, there were nocturnal polyuria, detrusor overactivity or mixed type and 11.2% of them had polyuria. Therefore we conclude that these three causes were the main etiology of nocturia, and nocturia could be classified and treated based on these results.

The Usefulness of Endo-rectal Coil MRI in the Staging of Clinically Localized Prostate Cancer / 대한비뇨기과학회지

PURPOSE: We evaluated the ability of endo-rectal coil MRI (ER-MRI) to predict the local pathological stage of prostate cancer prior to radical prostatectomy and compared the results with those of transrectal ultrasonography (TRUS). MATERIALS AND METHODS: ER-MRI using high field magnets (1.5 Tesla) were performed in 22 patients (mean age 62.8 years, range 51-73) with clinically localized prostate cancer before radical prostatectomy. Of the 22 patients, 17 patients were also assessed by TRUS. The results of the imaging techniques were compared with the post-operative histopathological findings. As one patient with pelvic lymph node metastasis, which was detected on frozen-section examination during surgery, was spared radical prostatectomy, the final evaluation included 21 patients. RESULTS: DSeven of the 21 patients (33%) were found to have extraprostatic extension (EPE), and 5 had seminal vesicle invasion (SVI). The sensitivity and specificity for diagnosing EPE using ER-MRI were 62.5% and 84.6%, respectively, and 16.7% and 100% with TRUS. The sensitivity and specificity for diagnosing SVI were 80.0% and 93.8%, respectively with ER-MRI, and 0% and 92.3% with TRUS. The accuracy of predicting SVI was 90.5% with ER-MRI compared to 70.6% with TRUS. CONCLUSIONS: ER-MRI was significantly better than TRUS for determining the local extent of prostatic cancer and for prediction of SVI in the preoperative staging of clinically localized prostate cancer.