Transurethral microwave hyperthermia in the treatment of chronic nonbacterial prostatitis.

Chronic nonbacterial prostatitis is an ill-understood and difficult-to-diagnose disease. Symptoms of chronic nonbacterial prostatitis are similar to those of chronic prostatitis and include low back pain, frequency, dysuria, perineal discomfort, and painful ejaculation. In view of uncertainty about etiology, treatment of chronic nonbacterial prostatitis remains speculative. Most treatment is aimed at relieving symptoms and not at curing the disease. Because of the troublesome nature of chronic nonbacterial prostatitis and the poor results obtained from traditional treatment methods, a new modality of transurethral microwave hyperthermia was investigated. Six patients were treated from January 1994 through June 1995 by use of transurethral microwave hyperthermia. These men were treated four times during a 2-week period. Their average symptom score decrease was 74.9% and was associated with minimal morbidity. Based on this result, it is concluded that transurethral microwave hyperthermia is a safe and effective treatment modality for chronic nonbacterial prostatitis.

Metastatic Sertoli cell carcinoma of the testis.

Metastatic Sertoli cell tumor is a very rare and deadly disease accounting for approximately 1% of all testicular carcinomas. With fewer than 30 cases reported in the literature, there has not been a uniform treatment regimen with good results. Retroperitoneal lymph node dissection, chemotherapy, and radiation therapy in combination appear to offer the best outcome. This report describes the occurrence of this rare tumor in a 38-year-old man 2 years after left orchiectomy.

Early detection of stage A prostate carcinoma: combined use of prostate-specific antigen and transrectal ultrasonography.

We prospectively studied 103 men who had normal results on digital prostate examinations but had bladder outlet obstruction secondary to prostatic hypertrophy and needed transurethral prostatectomy. All men underwent a preoperative transrectal ultrasonographic examination of the prostate and prostate-specific antigen (PSA) level determination. A total of 30 cancers were ultimately detected, 22 (73%) of which were detected preoperatively by either an abnormal ultrasonogram or elevated PSA levels (or both). Eight of these men were spared transurethral prostatectomy and had definitive treatment based on transrectal biopsy and appropriate staging evaluation. For PSA and ultrasonography combined, the sensitivities and negative predictive values for cancer (92% and 94%, respectively) were superior to the specificities and positive predictive values (71% and 64%, respectively). The combined use of both studies is recommended to rule out cancer in candidates for prostatectomy but not to routinely screen the general male population older than 40 years.

Priapism associated with intranasal cocaine abuse.

Cocaine abuse has escalated to epidemic proportions in the United States. In addition to the social and economic problems associated with the recreational use of this agent, a variety of medical complications have been reported. The occurrence of priapism with intranasal use has not been documented previously. We report a case of priapism secondary to intranasal cocaine abuse and describe the possible neurochemical etiology for this phenomenon.

Massive hemorrhage secondary to metastatic testicular carcinoma.

Massive bleeding secondary to metastatic foci of testicular carcinoma is a rare finding. Two cases of metastatic testicular carcinoma in which massive intraabdominal and gastrointestinal hemorrhage occurred are reported. The first patient, who had metastasis to the duodenum and stomach, first underwent surgery because of the concern that chemotherapy might result in rapid tumor necrosis and bowel perforation. The bleeding was controlled, postoperative chemotherapy was administered, and the patient was alive 15 months after chemotherapy. In the second case, in which metastasis was to the liver and lungs, aggressive chemotherapy was begun because of the patient's poor pulmonary status. Three days later, the patient began to hemorrhage. Operative and massive resuscitative measures failed, and the patient died shortly after surgery.

Ceftriaxone in the prevention of postoperative infection in patients undergoing transurethral resection of the prostate.

One hundred twenty-nine patients undergoing transurethral resection of the prostate were treated preoperatively with either 1 g of ceftriaxone or placebo in a double-blind, randomized study. Sixty-three patients received placebo and 66 received ceftriaxone. Postoperative urinary tract infections developed in eight placebo-treated patients, for a 12.7 percent failure rate, compared with two ceftriaxone-treated patients, for a 3 percent failure rate. The difference in rates of infection was statistically significant (p less than 0.05). No adverse effects due to treatment were noted. The high rate of postoperative infection in the placebo-treated group indicates that maintenance of sterility during and after this operative procedure is a problem. A single 1 g prophylactic preoperative dose of ceftriaxone was safe and efficacious in reducing the rate of postoperative infection after transurethral resection of the prostate.

Idiopathic priapism treated with inhalation of amyl nitrite.

Presented is a case of idiopathic priapism that was successfully treated with inhalation of amyl nitrite. Routine treatment measures had failed. The same patient presented on several other occasions in a similar fashion. Each time amyl nitrite was successful. An investigation for diseases known to be associated with priapism proved negative. Due to the frequency of recurrences, definitive surgical management was offered. The patient refused and has been lost to follow up.