Significance of examination of prostate-specific antigen and prostate-specific antigen density in patients with prostatic hyperplasia and prostate cancer.

Authors investigated PSA concentration and preoperative prostate volume in 113 histologically proved BPH and 31 prostatic cancer patients. PSA concentration was measured with the Hybritech kit, the prostate volume by ultrasound with the help of an ellipse and calculated by computer. There was no correlation between the age of patients and volume of the prostate, whereas a correlation was proved between marker concentration and prostate volume (p < 0.0001). The difference obtained by the correlation of the prostate volume and the PSA concentration ratio between the BPH and 31 tumorous patients (PSA density) was highly significant (0.143 vs. 0.699, p < 0.001). The use of PSAD further improves the diagnostic value of PSA.

Detection of Chlamydia trachomatis in the prostate by in-situ hybridization and by transmission electron microscopy.

Chlamydia trachomatis infection has been investigated in the prostate gland using in-situ DNA hybridization and transmission electron microscopy. Sixty-four samples of tissue removed by trans-urethral resection or by open surgery from men with benign prostatic hypertrophy (BPH), were examined histologically and 20 of the cases were found to be positive for mononuclear cell infiltration. Some samples were then investigated using in-situ hybridization and transmission electron microscopy. Out of 20 tissue samples with mononuclear cell infiltration, nine were found to be positive for C. trachomatis infection.

[Mainz pouch II, a modified method of ureterosigmoidostomy]. / Mainz pouch II, a módosított ureterosigmoidostomia.

The authors applied a new method, the low pressure ureterosigmoidostomy, namely the Mainz pouch II. The essence of the operation was a reverse "U" shape opening of the sigma, detubularization, then suturing together, so a diverticulum like cavity was created, and the ureters were implanted here. The detubularization broke the peristaltic pressure wave in the bowel and protected the kidneys from reflux, inflammation and stone formation. From early complications the suture insufficiency and sterile disruption of the abdominal wall emerged. The former was solved with conversion to rectal bladder, the latter with special stitches. Hyperchloraemic acidosis manifested in every case and it was compensated with medicines. For the 23 tumour free patients the operation brought daytime continency, a good quality of life, and as a palliation diminished the complaints. There were no inflammatory complications and only one ureter stricture and one fistula developed. The operation technically was simple and united the advantages of the ureterosigmoidostomy and the low pressure reservoir.

Minimal access ureterolithotomy.

A new minimally invasive ureterolithotomy is herein described which utilizes a 3 cm long skin incision. Surgery is performed with the aid of a newly developed bivalve retractor endoscope (Jakoscope) which provides excellent illumination with built-in double fiberoptic light cables and high intensity light source. The new surgical technique can be utilized in the rare cases of ureteral stone when other standard modalities may not work or when the patient demands definitive rapid treatment, and cannot be followed postoperatively.

Minimal and direct access surgery in urology.

An alternative method to laparoscopic surgery has been developed for urological procedures. The surgery is minimal access because the length of the single skin incision ranges from 3-6 cm depending on the type of operation. It is direct access because the surgeon sees the operative area directly and stereoscopically by eye without video-optical support. The procedure requires a special open-lumen retractorscope (Jakoscope(TM)) with a high intensity fiberoptic light system and modified standard hand instruments. Among the procedures performed nephrectomy, ureterolithotomy, prostatic adenomectomy, spermatic vein ligation and others have been performed. The kidney procedures have been operated retroperitoneally through a minilumbotomy incision. The procedures are simple, rapid and the instruments are inexpensive. The postoperative pain and morbidity are comparable to the laparoscopic approach.

Retractorscopic nephrectomy: initial report.

The authors describe a newly developed minimal access method for nephrectomy. The mini approach-a 5 cm skin incision-can be performed with a special retractorscope, which is an open lumen "scope" with fiberoptic light system.

[Results of studies of prostate-specific antigen and prostate-specific antigen density in patients with prostatic hypertrophy and prostatic cancer]. / Eredményeink prostata specifikus antigén és prostata specifikus antigén denzitás vizsgálatával prostata hyperplasiás és prostatarákos betegekben.

The authors investigated the PSA concentration and the preoperative prostate volume of 113 histologically proved BPH and 31 prostate cancer patients. There was no correlation between the age of the patients and the volume of the prostate. Whereas, correlation was proved between the marker concentration and the prostate volume (p < 0.0001). The prostate volume and the PSA concentration ratio correlated between the BPH and tumorous patients (PSA density). The difference was highly significant (p < 0.001). The use of PSAD improves further the diagnostical value of PSA.

[Flow cytometric examinations of patients after radical surgery for prostatic cancer]. / Flow cytometriás vizsgálatok radikálisan operált prosztatarákos betegekben.

Biological behavior of prostatic cancer is influenced by different tumor factors. The proliferative activity of the malignancies could be one of those parameters which serve as basis to design therapy and to estimate prognosis. Here ploidity and S-phase fraction of 44 prostatic cancer obtained by radical prostatectomy were compared to other known tumor characteristics (PSA, staging, grading). There are correlations between the PSA concentration, grading, staging and S phase fraction. The ploidity correlates with the grading. Neither of kinetic parameter correlated with the nodal involvement.

DNA content of prostatic cancer measured by flow cytometry in patients undergoing radical prostatectomy.

The biological behavior of prostatic cancer is influenced by many host and tumor factors. The proliferative activity of the malignancies can be one of those parameters which serve as the basis to estimate prognosis and design treatment. Here, DNA content and S-phase fraction of prostatic cancer samples obtained by radical prostatectomy from 46 patients were related to other known tumor characteristics (PSA, staging, grading). Nuclei from the paraffin embedded materials were isolated with overnight trypsin-ribonuclease mixture digestion. DNA content and cell cycle distribution were determined by flow cytometry. A correlation was found between the PSA concentration, grading and staging on the one hand and S-phase fraction on the other. DNA content correlated with grading. No kinetic parameter correlated with the nodal involvement. Due to the association between abnormal DNA content plus SPF > 5% with advanced stage and less differentiated appearance of the tumor, we can conclude that these parameters are useful to estimate prognosis.

Is seminal fluid a suitable specimen for detecting chlamydial infection in men?

As genital chlamydia infection is considered the most prevalent sexually transmitted bacterial disease worldwide, its correct diagnosis has a great clinical and epidemiological importance. Urethra is the recommended site for collecting specimen for detection of Chlamydia trachomatis in men, but urethral swabbing is very inconvenient for the patients. Testing of seminal fluid has two advantages: taking the sample is more convenient for the patient, and the ejaculate would provide more information on the possible infection of the upper genital tract. Three non-culture methods-enzyme immunoassay (EIA), DNA hybridization, and polymerase chain reaction (PCR)-were used for evaluation of suitability of seminal fluid as a sample for detection of Chlamydia in 4 patient groups comprising 259 symptomatic and asymptomatic, urology and andrology patients. The seminal fluids were tested parallel with the urethral samples. In one group of patients with typical prostatic complaints expressed prostatic secretion was examined parallel with urethral swab. C. trachomatis positivity rates were much higher in symptomatic (49.1%) than in asymptomatic patients (12.3%) in all kinds of sample. Seminal fluid was somewhat more frequently positive (7.9%) than urethral sample (6.2%). Simultaneous positivity was relatively rare (3.3%), it occurred most frequently in samples of patients with possible accessory gland infection tested by EIA. In a group of 17 patients with typical prostatic complaints the expressed prostatic secretion alone was positive in 7 cases, whereas only other two of the parallel urethral samples proved positive by PCR, simultaneous positivity occurred in one case. These findings suggest that testing of the ejaculate and/or the prostatic secretion parallel with the urethral sample would improve the sensitivity of detection of chlamydial infections.

Limited indication of gastrocystoplasty.

A 28-year-old woman presented a huge vesico-vagino-rectal fistula after radiotherapy applied because of a gynaecological tumour. Reconstruction consisted of a colostomy, closure of the rectal hole with a pedicled perineal skin graft, a bivalve opening of the bladder and, with the two halves coverage of the vaginal suture line, and augmentation gastrocystoplasty. The fistulas healed but the patient suffered from an intolerable burning sensation. That is, why the stomach wall was removed and ureteroileocutaneostomy was created. The colostomy was closed, and now the patient has a well-functioning urine stoma.

Minimal and direct access ureterolithotomy.

Authors developed an alternative method to laparoscopic surgery for ureterolithotomy. The surgery is of minimal access because the length of the single skin incision ranges from 3 to 4 cm, depending on the type of exploration. It is of direct access because the surgeon sees the operative area directly and stereoscopically with his own two eyes without video-optical support. The procedure requires a special open-lumen retractorscope (Jakoscope) with a high intensity fiberoptic light system and modified standard hand instruments. Ureterolithotomy is operated retroperitoneally through a minilumbotomy incision. The procedures are simple, rapid and the instruments are inexpensive. The postoperative pain and morbidity are comparable to the laparoscopic approach.

[ESWL in renal tubular acidosis]. / Extrakorporális lökéshullám-veseközúzás renális tubuláris acidózisban.

ESWL is a suitable modality for the management of lithiasis caused by RTA, especially in case of renal or ureteric stones. Smash of calculi in ducts of Bellini is worthy to be considered if the fragments can get into the renal pelvic space and the renal function improve. At present it is still a matter of discussion.

[Complex therapy of cystine calculi]. / A cisztinkövesség komplex terápiája.

Authors report their experiences with management of cystine urolithiasis between 1975-1992. 61 patients were observed and treated with dietotherapy, medicaments, open surgery, percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy. Difficulties of treatment of this rare stone have been demonstrated with data of 3 patients (lack of screening and early diagnosis, unsystematic prophylaxis, formation of large stones).

Experience in treating benign prostatic hypertrophy with Sabal serrulata for one year.

The authors treated 42 BPH patients with the Sabal extract Strogen forte for 12 months. The obstructive symptoms, residual volume, mean and maximum flow rates improved significantly by the 6th therapeutic month at the latest. The results seem to prove the effectiveness of the drug. Side effects have not been observed.

[Experience with the Direx Tripter X-1]. / Direx Tripter x-1 lökéshullám közúzóval szerzett tapasztalataink.

In nonselected patients 81.5% stone-free rate could be reached in 3 months. In authors's opinion Direx Tripter X-1 is suitable in the treatment of renal and ureteral calculi. They treated staghorn calculi by ESWL monotherapy with success. The Direx lithotripter was found to be effective and easy to operate; the potential cost reduction is of great significance. The treatment requires general anaesthesia and the equipment causes significant noise. After all, Direx lithotripter is a useful machine in the armamentarium of stone disease treatment.

Experience with the Direx Tripter X-1 shock-wave lithotripter.

The authors give account of the experience they gained with the Direx Tripter X-1 (ESWL) apparatus. In a random material they succeeded to render 81.5% of the patients stone free within three months. They judge the apparatus suitable for in situ treatment of pelvic and ureteric stones and for the monotherapy of staghorn calculi. It is easy to handle, inexpensive to buy and maintain but noisy to operate, moreover the patient has to be anaesthetized. All in all it is highly useful in the treatment of renal lithiasis.

Experience with the Peponen capsule in the management of benign prostatic hyperplasia.

Sixty patients in Stages I and II of benign prostatic hyperplasia were treated with Peponen capsule. Out of them 26 took the drug for 10 months, 22 for at least 7, and 12 for at least 4 months. The daily dosage was 3 x 2 capsules in the first month and 3 x 1 capsule for the rest of the time. On the ground of urodynamic test results and changes in subjective complaints, more than 80% of the patients experienced improvement. The therapy intensified the uroflow, appeased dysuria, the difficult and painful discharge, and reduced the frequency of nocturnal urination.

Radical prostatectomy and complications.

Radical prostatectomy has been successfully applied in the treatment of intracapsular prostatic tumour. A few modifications of the surgical technique are suggested to prevent complications. Initial results confirm that the method works, as all patients have remained continent. One of them died of pulmonary embolism right in the postoperative phase.