The safety of overnight hospitalization for transurethral prostatectomy: a prospective study of 200 patients.

PURPOSE: Our goal was to determine the appropriateness, safety and cost-effectiveness of catheter removal and hospital discharge 1 day after transurethral prostatectomy. MATERIALS AND METHODS: A prospective study of 200 patients who underwent transurethral prostatectomy during a 23-month period was done. On the morning of postoperative day 1 catheters were removed from 156 patients (78%) who had normal vital signs, adequate urine output, absence of clots and acceptable character of the catheter effluent. RESULTS: Among the 156 patients whose catheters were removed 4 of 5 went home on postoperative day 1. Two of these patients were rehospitalized within 30 days, as were 2 others whose catheters were removed later. Overall length of patient stay was 1.6 days. CONCLUSIONS: Overnight hospitalization after transurethral prostatectomy is an appropriate, safe and cost-effective pathway of patient care that is readily applicable to any urology practice.

Comparison of laparoscopic and minilaparotomy pelvic lymphadenectomy for prostate cancer staging in a community practice.

OBJECTIVES: To compare the cost-effectiveness and morbidity of minilaparotomy (MINILAP) and laparoscopic pelvic lymphadenectomy (LAP) in a community practice setting. METHODS: We reviewed our experience with 44 consecutive patients with prostate cancer who had staging pelvic lymphadenectomy from January 1992 through April 1995 in a general health maintenance organization urology practice. Of this group, 22 men had LAP and 22 men had MINILAP. RESULTS: MINILAP and LAP groups were similar in age (mean 67 years). Gleason score (mean 7.2 and 6.8), prostate-specific antigen level (mean 46 and 49 ng/mL), and clinical stage (T1 to T3). Operative time was statistically significantly shorter for MINILAP (mean 1.2 hours) than for LAP (mean 2.9 hours). Complication rate was 9.1% for MINILAP and 31.8% for LAP. Lymph node metastasis was found in 45% of MINILAP patients and in 27% of LAP patients. Mean initial hospital stay was 1.0 day for MINILAP and 1.6 days for LAP. Total hospital stay including hospital readmission for complications was 1.5 days for MINILAP and 2.6 days for LAP. Cost of MINILAP was at least $1900 less than that of LAP because of shorter total hospital stay, shorter operation time, and lower equipment cost. CONCLUSIONS: Compared with LAP, MINILAP was more cost-effective and produced less morbidity. Patient satisfaction with the procedures was similar. MINILAP is an excellent alternative to LAP for prostate cancer staging in general urology practice.

Fine needle aspiration biopsy of the prostate gland: a study of 103 cases with histological followup.

Fine needle aspiration specimens of the prostate gland were compared to histological material in 103 patients. The sensitivity was 95 per cent, specificity 97 per cent and efficiency 87 per cent. Initial core needle biopsy compared to the final histological diagnosis in this study had a sensitivity of 76 per cent, specificity 100 per cent and efficiency 71 per cent. Fine needle aspiration by a well trained cytopathologist is less traumatic, and has fewer side effects and a higher sensitivity rate than conventional core needle biopsy.

Obstructing urethral valve in a woman: a case report.

We report on a woman with a urethral valve causing obstruction, hyperreflexia, vesicoureteral reflux and retention. The diagnosis of urethral valves in female subjects rests on endoscopy and radiographic studies. Transurethral resection of the valve is effective treatment. The literature is discussed briefly.

Pyeloplasty for ureteropelvic junction obstruction in adults: correlation of radiographic and clinical results.

Pyeloplasty for hydronephrosis secondary to ureteropelvic junction obstruction is a proved efficacious procedure. In many cases the clinical improvement effected by technically successful pyeloplasty in children has been reported to exceed substantially radiographic improvement in caliceal appearance. To address this issue in the adult population we did a retrospective review of 52 patients who had undergone pyeloplasty for ureteropelvic junction obstruction. In 91 per cent of the patients the clinical result was satisfactory, while improvement was observed in 92 per cent of the renal units that could have been expected to benefit. The caliceal appearance on the postoperative excretory urogram was normal in only 25 per cent of the cases, showed diminution of calicectasis in 65 per cent, was unchanged in 30 per cent and deteriorated in 5 per cent. Earlier appearance of contrast medium in the upper ureter on the postoperative excretory urogram was seen in all patients who had a satisfactory clinical result. Deterioration of caliceal grade or delayed appearance of contrast medium in the ureter in the postoperative excretory urogram always was associated with a poor clinical result and/or further parenchymal loss. While a salutary effect of a technically successful operation on the clinical manifestations of hydronephrosis secondary to ureteropelvic junction obstruction is not necessarily correlated with improved or normal caliceal appearance it does correlate strongly with improvement of drainage as manifested by earlier appearance of contrast medium in the ureter. Deterioration of the caliceal grade or delayed appearance of contrast medium in the ureter implies that effective drainage is not present, which presages a poor clinical outcome and further loss of renal parenchyma.

Transitional cell carcinoma of bladder in first four decades of life.

A retrospective analysis of 27 patients seen at UCLA in whom transitional cell carcinoma of the bladder developed at age forty or younger was conducted. Forty-one per cent had tumors manifesting known characteristics of aggressive and lethal potential: high histologic grade, muscular invasion, severe epithelial atypia, and frequent multifocal recurrence. One of these patients had extensive pelvic node metastases. The time from the first symptom, usually hematuria, to endoscopic diagnosis exceeded six months in 8 patients. The results of segmental cystectomy were very poor, in the absence of narrowly defined criteria for selection of this mode of therapy. No evidence was found to suggest that transitional cell carcinoma of the bladder in patients forty years of age and under differs clinically or morphologically from that of older patients. Treatment should be determined by the stage of the tumor and other indices of potential lethality.

Prognostic implications of vena caval extension of renal cell carcinoma.

Vena caval extension of renal cell carcinoma occurs in 4 to 10 per cent of the patients and usually is considered a poor prognostic sign. To ascertain the true effect of vena caval extension on survival a retrospective analysis was done of 27 patients who had undergone radical nephrectomy and removal of vena caval thrombus between 1970 and 1980. An additional 46 cases were collected from series in the literature and composite statistics were compiled. Extension to the vena cava alone had a limited impact on prognosis (survival for 2 years--81 per cent, 5 years--53 per cent, median--81 months). Capsular invasion negatively influenced survival (2-year survival 66 per cent). Disease in the regional lymph nodes had a much greater impact on survival, with a 2-year survival rate of 35 per cent and no patient survived 5 years (median survival 24 months). Only 5 per cent of the patients with distant metastases survived 2 years and none survived 5 years (median survival 8.5 months). In conclusion, the prognosis of patients with vena caval tumor thrombus is influenced primarily by known adverse prognostic factors: capsular invasion, nodal disease and distant metastases. Aggressive surgery in patients with gross nodal involvement or distant metastases is unwarranted since it contributes nothing to survival and only 7 per cent of the patients had significant signs or symptoms secondary to the vena caval thrombus itself. Patients with vena caval extension alone have a cure rate approaching that of patients with stage I renal carcinoma following radical nephrectomy and complete removal of the vena caval thrombus.