Transurethral microwave thermotherapy in the management of lower urinary tract symptoms from benign prostatic obstruction: follow-up after five years.

OBJECTIVE: This study reports on a 5-year follow-up after transurethral microwave thermotherapy (TUMT) from benign prostatic obstruction using a lower power treatment protocol. MATERIAL AND METHODS: Ninety-one patients with uncomplicated benign prostatic obstruction were treated in a 1-h session using the PRIMUS U + R device. RESULTS: Twenty-nine (32%) of the patients were evaluable after 5 years, while 42 had received additional treatment for their lower urinary tract symptoms. In the 29 patients without additional therapy after TUMT, the decrease in the International Prostate Symptom Score was 37% compared with the pretreatment value. A moderate increase in peak uroflow, seen 1 year after TUMT, was not confirmed in an extended follow-up. Patients still on TUMT monotherapy after 5 years had smaller prostates from the outset than the group receiving additional treatment. No serious side-effects were observed. CONCLUSION: Lower power TUMT has a symptomatic effect of limited duration in most cases; in the long-term perspective only a minority of patients will benefit from this treatment.

Interstitial laser coagulation in patients with lower urinary tract symptoms from benign prostatic obstruction: treatment under sedoanalgesia with pressure-flow evaluation.

OBJECTIVES: To evaluate the effects on lower urinary tract symptoms and pressure-flow variables after interstitial laser coagulation (ILC) of the prostate using the Indigo diode laser system (Indigo, Palo Alto, USA). PATIENTS AND METHODS: Forty-nine men (median age 68 years, range 52-80) were assessed using symptom scores and voiding variables before and at 3 and 12 months after ILC. A subset of 26 men (median age 68 years, range 63-72) underwent pressure-flow measurements before and at 6 months after ILC. All treatments were performed in the outpatient department using sedoanalgesia. RESULTS: The International Prostate Symptom Score decreased from 22 to 11 at 12 months after ILC. The peak urinary flow (Qmax ) was 8.6 mL/s at baseline and increased to 9.9 mL/s at 12 months. Residual urine volumes were unchanged. The median duration of urinary retention after ILC was 3 days. From pressure-flow recordings, 17 patients were categorized as obstructed and seven as equivocally obstructed before ILC (using the International Continence Society definition). Their Qmax increased from 7.7 to 9.0 mL/s after 6 months, the detrusor pressure at Qmax decreased from 68 to 51 cmH2O and the Abrams-Griffiths number decreased from 54 to 29 (P<0.01). Patients with moderate to equivocal obstruction had a greater relief of symptoms than those who were clearly obstructed. Patients with prostate volumes of >40 mL had a greater decrease in the Abrams-Griffiths number than had patients with smaller prostates. Postoperative perineal pain was reported by 72% of patients; the pain subsided after 1-2 weeks. The re-treatment rate was 15% within the first year. CONCLUSION: Treatment with ILC produced substantial effects on symptoms and moderate to small changes in urodynamic variables. Patients with moderate or equivocal bladder outlet obstruction or large prostates seem to be the best candidates for this treatment. However, treatment was followed by perineal pain for 1-2 weeks in most cases. A long-term follow-up is necessary to determine the role of ILC.

Three-year follow-up after transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia using the PRIMUS U + R device.

OBJECTIVE: We report long-term (3 years) follow-up data of transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH) using a lower-power treatment protocol. MATERIAL AND METHODS: Ninety-one patients were treated in a 1-h session with the PRIMUS U + R device. RESULTS: Forty-five of the patients were still on TUMT monotherapy at 3-year follow-up, while 32 received additional therapy for their lower urinary tract symptoms. In patients with monotherapy there was a 45% decrease in international prostate symptom score (IPSS) when compared to pretreatment values. The moderate increase in peak uroflow seen early after TUMT could not be observed after 3 years. No serious side-effects were seen. CONCLUSION: Three years after lower-power TUMT, 49% of patients treated were on TUMT monotherapy, while 35% received additional therapy for their voiding symptoms. Symptom score decreased 45% in patients with TUMT monotherapy concomitant with unchanged uroflow.

The long-term outcome in patients with superficial transitional cell carcinoma of the bladder: a single-institutional experience.

OBJECTIVE: To determine the natural history of transitional cell carcinoma (TCC) of the bladder, and to identify factors which place patients at lifelong risk of developing progression and dying from bladder carcinoma. PATIENTS AND METHODS: The long-term outcome was evaluated retrospectively in 231 patients with superficial bladder TCC, assessed for the first time within a 6-year period from 1981 to 1986, with a median follow-up of 108 months. Of 231 patients, 217 (94%) were initially treated by transurethral or segmental resection. RESULTS: Recurrence developed in 141 of 217 (65%) patients; the duration of the interval free of recurrence was significantly less for patients with initial G3 tumours than that for those with G1 (P<0.01) and for pT1 compared with pTa disease (P<0.01). The disease progressed in 42 of 231 (18%) patients. Differences in the progression-free interval between patients with G1 and G3 tumours, and with pTa and pT1 disease, were statistically significant (P<0. 005 and P<0.001, respectively). In 27 of 231 patients (12%), TCC of the bladder was the cause of death, whilst 118 (51%) died from unrelated causes. There were no deaths among patients with initial pTaG1 tumours, compared with 10 of 26 (38%) deaths in those with pT1G3 disease at presentation. CONCLUSION: The long-term prognosis is good for patients with pTaG1 tumours, whilst pT1G3 is a potentially aggressive disease. Lifelong endoscopic surveillance is mandatory in patients in whom new tumours are very active, at least in those of younger age. Routine cystoscopy can possibly be discontinued in patients with low-grade, low-stage disease in whom a low liability of recurrence has been shown during follow-up.

Surgical management of chylous fistula after retroperitoneal lymph node dissection.

Conservative treatment with low-fat diet, medium-chain triglyceride or total parenteral nutrition, depending on the general condition of the patient, is the mainstay in the treatment of chylous ascites. In patients with persistent chylous fistula direct surgical closure is a valid treatment option.

Survival after radical treatment for transitional cell carcinoma of the bladder.

AIMS: To investigate survival after radical treatment for transitional cell carcinomas of the bladder. METHODS: This retrospective study included 135 patients with transitional cell carcinoma of the bladder undergoing radical cystectomy or radiotherapy at Haukeland Hospital, Bergen, Norway, during the period 1981-1986. Forty-five patients had cystectomy and 90 underwent external high-dose radiotherapy. RESULTS: The overall 5- and 10-year survival rates were 39 and 23%, respectively. After cystectomy 10-year overall survival rates for superficial and muscle-infiltrating tumours were 67 and 26%; after radiotherapy, the corresponding survival rates for superficial and muscle-infiltrating tumours were 26 and 5%, respectively. CONCLUSIONS: Long-term survival and cure can be achieved after cystectomy in many patients with aggressive superficial or muscle-infiltrating bladder carcinoma. The introduction of orthotopic neobladder reconstruction should encourage the use of cystectomy in patients with aggressive superficial tumour.

Use of pelvic surface coil MR imaging for assessment of clinically localized prostate cancer with histopathological correlation.

We evaluated the ability of magnetic resonance imaging (MRI) operating at 1.0 Tesla with a Helmholz pelvic surface coil to predict the pathological stage of prostate carcinoma. Radiological diagnosis was based on fast spin-echo axial T2-weighted images with and without frequency selective fat-suppression and fast spin-echo coronal T2-weighted images. Thirty-one consecutive patients (mean age 61 years, range 49 to 71 years) underwent pelvic MRI before radical prostatectomy. Correlation with whole-mount step-sections of the surgical specimens showed that the tumours were correctly localized in all but one prostate gland in which the tumour could not be seen on pelvic MRI. The transverse diameter of the visible tumour at pelvic MRI appeared to represent an approximate estimate of the true tumour dimension. Based on histopathologic whole-mount step-sections of the surgical specimens, 22 of 31 patients (71%) had tumours extending beyond the confines of the prostatic capsule. The specificity for MRI to predict capsular penetration and seminal vesicle invasion was relatively high (0.80 and 0.86, respectively). The sensitivity was acceptable for capsular penetration (0.62) but poor for seminal vesicle invasion (0.30).

MRI with an endorectal coil for staging of clinically localised prostate cancer prior to radical prostatectomy.

The purpose of this study was to evaluate the ability of MR imaging with an endorectal coil (erMRI) to predict the local pathological stage of prostatic carcinoma prior to radical prostatectomy. Thirty-one consecutive patients (median age 61 years, range 40-71 years) with clinically localised prostate cancer were assessed preoperatively by endorectal MRI (at 1.0 T). The pulse sequences consisted of fast spin-echo axial and coronal T2-weighted images and inversion recovery with two echoes for axial fat-suppressed images. The assessment of tumour stage and measurement of tumour dimension by erMRI were compared with the corresponding findings on whole-mount step sections of the surgical specimens. Postoperatively, 14 of the 31 patients (45 %) were found to have extracapsular extension, 7 with capsular penetration (CP) only, and 7 had a combination of CP and seminal vesicle invasion (SVI). Capsular penetration was detected by erMRI with a sensitivity of 0.71 and specificity of 0.47, whereas the sensitivity for SVI detection was 0.71 and the specificity 0.83. Endorectal MRI for staging clinically localised prostatic carcinoma gives a good prediction of invasion of the seminal vesicles but is unreliable in predicting capsular penetration.

Interstitial laser coagulation and transurethral needle ablation in the management of lower urinary tract symptoms due to benign prostatic obstruction.

Interstitial laser coagulation and transurethral needle ablation, two different techniques for heat-treatment of symptomatic benign prostatic hyperplasia, are outlined. Both treatments have been performed in sedoanalgesia. The results of this research and data from the literature show that both treatment modalities have a marked effect on symptoms. Objective parameters, such as uroflow, are moderately changed postoperatively. The side-effect profiles appear favourable, especially with respect to bleeding per- and post-operatively. However, further long-term data is required.

Low-frequency mutation of Ha-ras and Ki-ras oncogenes in transitional cell carcinoma of the bladder.

UNLABELLED: BACKGROUND, PATIENTS AND METHODS: The objective was to study the frequency of mutations of Ha-ras and Ki-ras oncogenes in bladder tumours. Transitional cell tumours of the bladder from 55 patients were subjected to analyses of Ha-ras and Ki-ras oncogenes using a variety of techniques including sequencing to detect mutations. RESULTS: Two tumours (4%) exhibited mutation of the Ki-ras oncogene, both tumours were fast growing and invasive. We did not detect Ha-ras mutation in any of the samples. Nineteen tumours (35%) with established invasion of the detrusor muscle, did not reveal any mutation. CONCLUSION: Analyses of ras oncogenes seem to be of limited value for the biological assessment of transitional cell carcinomas.

Comparison of polidocanol and tetracycline in the sclerotherapy of testicular hydrocele and epididymal cyst.

OBJECTIVE: To compare the effects and side-effects of polidocanol and tetracycline when used as sclerosants for testicular hydrocele and epididymal cyst. PATIENTS AND METHODS: Forty-five men (median age 67 years, range 42-81) with 46 hydroceles or epididymal cysts were assessed. After puncture and aspiration, the empty sac was instilled with either polidocanol or tetracycline, assigned randomly. Patients recorded any treatment-associated pain on a visual analogue scale. RESULTS: At 9 months of follow-up, nine of 17 men were cured after sclerotherapy with polidocanol compared with 17 of 20 men treated with tetracycline (P < 0.05). Tetracycline produced some pain for 3 days after treatment while polidocanol therapy was almost pain-free. Re-instillation should be considered for recurrences. At the follow-up after 35 months, 16 of 18 men treated with polidocanol and 20 of 22 men treated with tetracycline were satisfied with the outcome. CONCLUSION: Both polidocanol and tetracycline are useful sclerosants for treating testicular hydrocele and epididymal cyst. We prefer polidocanol as a first choice in older patients because there were few short-term side-effects.

Risk-adapted treatment of clinical stage 1 non-seminoma testis cancer.

250 patients with clinical stage 1 non-seminomatous germ cell tumours of the testis (NSGCT 1) were included into a prospective multicentre protocol during 1990-1994 and treated according to three risk strata: patients without tumour cell invasion of vascular structures in the testis (VASC-) and elevated serum AFP levels (AFP+) at orchiectomy were considered low risk (LR) and only observed closely. VASC- and AFP- or VASC+ and AFP+ patients were presumed intermediate risk (IR) and pathologically staged (PS) by retroperitoneal lymph node dissection (RPLND). VASC+ and AFP-patients were regarded as high risk (HR) and received adjuvant chemotherapy (PEB x 3). At a median observation time of 40 (7-68) months, all patients were alive and without evidence of active germ cell cancer. The actuarial relapse rate in the 106 LR patients was 22%, and 70% (14/20) had elevated serum tumour markers at relapse. One of 32 (3%) HR patients relapsed with a resectable retroperitoneal mature teratoma despite adjuvant chemotherapy. Only 14% of the 99 IR patients who underwent RPLND had PS2 disease, and the actuarial relapse rate in 85 PS1 patients was 18%. This multicentre study demonstrated that excellent therapeutic outcome is possible when 18 comparatively small urological and oncological centres follow a strict and formal cancer care programme. The useful prognostic effect of VASC was once again verified. Pathological staging by RPLND in NSGCT1 is, in our opinion, not necessary, with presumed low-risk patients offered surveillance and high-risk patients offered adjuvant chemotherapy.

[Torsion of the spermatic cord. A clinical material on 109 patients]. / Funikkeltorsjon. Et klinisk materiale på 109 pasienter.

The authors review experiences from the operation of 109 patients for torsion of the spermatic cord at a single surgical clinic. The peak incidence was seen amongst adolescents. The patients reported the sudden onset of severe scrotal pain. Clinical examination showed a tender scrotal mass. About half of the patients showed testicular retraction or scrotal erythema. 22% underwent orchidectomy because of gangrene. All these patients had a history of more than 24 hours. On the other hand, 95% of patients with a vital testis had a history of less than 24 hours. Significant testicular injury will occur in a large share of these patients as well. The true urgency of this condition is emphasized.

Transurethral microwave thermotherapy for management of benign prostatic hyperplasia: one-year results with the PRIMUS U + R device.

We report on one-year results after transurethral microwave thermotherapy (TUMT) in patients with symptoms due to benign prostatic hyperplasia (BPH). The material consists of 91 cases, treated with the PRIMUS U + R device in a single, one-hour out-patient procedure. The International Prostate Symptom Score (I-PSS), S, fell from baseline 23 (17-27) to 12 (7-18.8), quality of life assessment, L, improved from 4 (3-5) to 2 (1-3) and peak urinary flow increased from 9.6 +/- 0.3 to 11.1 +/- 0.4 (ml/sec) after one year. No changes in postvoiding residuals were observed. Sixty five per cent of the patients were assessed as responders to the treatment. Complications were urinary retention and bacteriuria. Neither enlargement of prostate nor a prominent median lobe, seem to be predictors of subjective outcome. TUMT appears to be a safe and, in the majority of patients, effective measure to relieve symptoms due to BPH.

Shock wave lithotripsy of urinary calculi with Lithocut C-3000 in a small center.

We report clinical results with the Lithocut C-3000 shock wave lithotriptor used in treatment of kidney and ureteral stones. The Lithocut C-3000 is a low-cost device. There is no need for anaesthesia. The overall success rate after 3 months was 64% in 143 treatment sessions of 120 stones. For small stones (diameter < 10 mm), the success rate was 69% and for stones with a diameter > or = 10 mm, success was achieved in 60%. The treatment-associated morbidity was low. The Lithocut C-3000 device appears to be safe and effective, suitable for small centers.

[Interstitial laser coagulation in the treatment of benign prostatic hyperplasia. Preliminary results]. / Interstitiell laserkoagulasjon ved behandling av benign prostatahyperplasi. Preliminaere erfaringer.

51 patients aged 68 (range 52-81) years with lower urinary tract symptoms compatible with obstruction from benign prostatic hyperplasia were treated with interstitial laser coagulation (ILC). Postoperative urinary retention lasting less than one week was seen in the majority of cases. All patients were followed up for three months and ten cases had further follow-up after one year. Three months after treatment the international prostate symptom score decreased from 23.3 +/- 0.7 to 8.9 +/- 0.8 and was 10.2 +/- 2.1 after one year. Peak urinary flow increased concomitantly from 8.3 +/- 0.4 to 12.2 +/- 0.7 at three months and was 11.5 +/- 1.4 ml/sec after one year. Three patients received other, additional treatment because the ILC-treatment failed. In conclusion, interstitial laser coagulation had marked effects on symptoms, whereas the effects on objective parameters were less pronounced in this selected group of patients. However, more extensive follow-up, is essential for further evaluation of this new treatment procedure.

Serum concentrations of prostate-specific antigen after diagnostic procedures and transurethral microwave thermotherapy of benign prostatic hyperplasia.

The objective was to study the effects of diagnostic and therapeutic procedures on serum prostate-specific antigen (PSA) concentration. Urethrocystoscopy in combination with digital rectal examination was followed by a moderate increase of serum PSA for 7-10 days. At 1 day after transurethral microwave thermotherapy (TUMT), an acute and pronounced effect on PSA was observed, which returned to baseline level after 4 weeks. The initial rise in serum PSA corresponded to a PSA density of 1.11, compared to 0.07 at baseline. The present data should be taken into consideration in conjunction with endoscopic evaluation of the lower urinary tract. Additionally, the acute effect on PSA after TUMT strongly suggests the ability of thermotherapy to induce cellular injury and death. One-year follow-up, however, was associated with increased PSA levels, indicating that only a minor part of the PSA-producing compartment was lost in the acute phase.

Follow-up after torsion of the spermatic cord.

Fifty-two patients were examined 4-10 1/2 years after operation for torsion of the spermatic cord. The testicular salvage rate was 56%. Loss of testicular tissue was correlated to preoperative duration of symptoms. Serum testosterone concentration was found to be within the reference range. FSH was elevated in patients with the longest duration of symptoms (> 24 h), suggesting an impairment of testicular function in these patients. There were two our of 13 patients with a severe oligo-azoospermia, both had a previous orchiopexy for undescended contralateral testis.

[Prostate-specific membrane antigen. A new sensitive molecular indicator in metastasizing prostatic cancer]. / Prostataspesifikt membranantigen. Ny sensitiv molekylaer indikator ved metastaserende cancer prostatae.

Prostate cancer is the most common malignant disease in men in western societies. Extracapsular spread of carcinoma is found in approximately half of the patients that are treated by radical prostatectomy. Recently, a new prostate-specific membrane glycoprotein was cloned and sequenced. A highly sensitive and specific nested reverse transcriptase polymerase chain reaction has been developed to detect early occult haematogeneous micrometastatic prostate cells. We analysed venous samples from 17 patients with metastatic prostate cancer using a modified reaction assay. This showed presence of micrometastatic prostate cells in 14 patients. Molecular detection of circulating prostatic epithelial cells could improve clinical staging and treatment of early prostate cancer.

Thanatogen expression during involution of the rat ventral prostate after castration.

After castration the rat ventral prostate undergoes regression. This process occurs due to the induction of apoptosis, or active cell death, in the epithelial cells of the gland. Several genes, including TRPM-2, (testosterone repressed prostate message), RVP.1, fos, and myc, have been shown to be induced in the prostate during this process. We have investigated the expression of several other genes that may be associated with apoptosis, including tissue transglutaminase (TGase), poly(ADP)ribose polymerase (PARP), and heat shock protein 27 (Hsp27). Northern hybridization has been used to determine the steady-state mRNA levels of these genes in the ventral prostate after castration, and the time course of induction has been compared to the changes in the steady-state levels of prostate steroid binding protein (PSBP), alpha-tubulin, and TRPM-2 mRNAs. The results show that the mRNAs for PARP, transglutaminase, and Hsp27, in addition to TRPM-2, are induced by androgen ablation in the rat ventral prostate and reach maximum levels between days 3 and 4 after castration. Using in situ hybridization we have established that these genes are expressed in the epithelial cells of the prostate that are known to undergo active cell death; this result suggests that their gene products may be required in the dying cells to ensure that the biochemical and morphological processes of apoptosis are completed appropriately.