Transrectal ultrasonography directed intraprostatic injection of gentamycin-xylocaine in the management of the benign painful prostate syndrome. A report of a 5 year clinical study of 75 patients.

There is almost a complete failure of the urological profession to study chronic prostate gland pain, which is its most common and difficult condition to manage. Variations in nomenclature for the disease include pelvic floor myalgia syndrome, chronic anxiety syndrome, prostatodynia, interstitial cystitis and abacterial prostatitis, so comparison of treatment populations is difficult. Over 50% of negative prostate biopsies being performed for PSA elevation show prostatitis lesions. Transperineal aminoglycoside injection for 'hard-core' prostatitis reported a 77% cure rate. A 5 year study of 75 patients with recalcitrant benign painful prostate syndrome treated with transrectal ultrasound guided intraprostatic injection of gentamycin and xylocaine produced a 90% cure rate. Of the patients, 74% required only a single injection of 160 mg of gentamycin in 4 cc with 2 cc of 1% xylocaine to achieve a cure. Minimal injection pain was encountered. Some patients required 5 injections over the 5 year period. Multiple injection patients were considered therapeutic failures. Fourteen tumor-negative prostate needle biopsies showed prostatitis lesions. One elevated PSA patient had 3 biopsies. Current medical therapy of prolonged one month antibiotics, anti-inflammatory agents and alpha adrenergic blocking agents had failed in all injection treated patients. Of the patients, 60% had prostatic calculi. Cystic seminal vesicle abnormalities were frequent. Complications were only minor, with hematospermia, gross hematuria and mild pain. The 90% cure rate was defined by the absence of symptoms.

Computed axial tomography pancreatitis: an atypical asymptomatic postoperative disease without serum or urinary enzyme evaluation.

A case report of atypical postoperative pancreatitis following radical prostatectomy without any clinical symptoms is presented. The patient was asymptomatic in the postoperative period with regards to pancreas disease. Serum lipase, serum amylase and urinary amylase were normal. There was no history of alcoholism or biliary disease. The diagnosis was made by a CAT scan performed for an unrelated indication. The patient was followed for 17 months postoperatively. The pancreas CAT scan appearance returned to normal. No definitive treatment was given.

Malignant teratoma of the testicle: diagnosis suggested by preoperative ultrasonography.

A 22-year-old white man was found to have malignant teratoma of the testicle (nonseminomatous germ cell testicular tumor), which had been suggested by ultrasonography. Modified template retroperitoneal lymphadenectomy with nerve sparing showed no microscopic metastatic tumor.

Cervical cancer radiation injury to the urinary bladder and ureters: management by cecal augmentation to a previous ileal augmentation cystoplasty.

A case report of the management of severe post cervical carcinoma pelvic radiation injuries is presented. Management was accomplished by detubularized ileal augmentation cystoplasty followed by cecal augmentation to the detubularized ileal augmentation 4 years later when bilateral ureteral obstruction developed. The development of a vesicouterine fistula required the creation of a large bowel cecal conduit for cutaneous urinary diversion utilizing the cecal augmentation antireflux segment.

Transurethral insertion of a vaginal contraceptive suppository into the urinary bladder.

PIP: Patients usually come to the emergency room within 2 hours of accidentally inserting a vaginal contraceptive suppository into the urinary bladder. Usually, there is a history of intoxication of the patient associated with the misplacement of the suppository. The patient complains of severe urgency, stranguria, intensive suprapubic pain, and hematuria. The pH of the spermicide is 3.35. For Conceptrol, the pH of the vaginal suppository is 4.5. The acidic nature of the suppositories contributes directly to the severe chemical cystitis encountered. Physical examination may reveal marked urethral edema and urethral pain. Urological evaluation demonstrates a marked reduction in the capacity of the urinary bladder with uninhibited bladder contractions. These patients have a severe hemorrhagic cystitis with pseudopolyp formation and marked elevation of the mucosal surfaces of the urinary bladder. A 3-way catheter should be inserted into the urinary bladder, and the bladder emptied. Irrigation with an alkaline solution should be initiated because of the acidic nature of the suppositories to assist in the reduction of the symptoms and duration of the chemical cystitis. Broad spectrum antibiotic coverage should be instituted along with antispasmodic therapy for the uninhibited bladder contractions. The use of intravenous steroids at high doses is recommended. The patient should be hospitalized, and an oral steroid tapering dose with prednisone should be started. Urological evaluation should be performed because of submucosal bladder hemorrhage and blood clot formation in the bladder. Significant hemorrhage from the bladder and possibly permanent bladder damage can occur. Because a significant absorption of the nonoxynol-9 can occur via the bladder mucosa, appropriate liver and renal function studies should be obtained for the treatment of the patient. There was a significant reduction in the capacity of the urinary bladder reported in some cases of nonoxynol-9 suppository insertion that persisted for up to 6 weeks.^ieng

Severe chemical cystitis from the transurethral intravesical insertion of a vaginal contraceptive suppository: a report of 3 cases and proposed method of management.

We report on 3 patients who sustained severe chemical cystitis from the inadvertent insertion of a nonoxynol-9 containing vaginal contraceptive suppository into the bladder. A suggested treatment schedule is presented and the toxicity of nonoxynol-9 is discussed.

PIP: Case reports are presented on 3 patients who sustained severe chemical cystitis from the inadvertent insertion of a nonoxynol-9-containing vaginal contraceptive suppository into the bladder. A treatment schedule is suggested, and the toxicity of nonoxynol-9 is discussed. In Case 1, a 23-year-old woman had marked urinary urgency following inadvertent insertion of a vaginal contraceptive suppository into the bladder via the urethra. Emergency cystoscopy revealed severe chemical hemorrhagic cystitis with pain. The bladder was irrigated copiously with saline, and 50 cc 1% lidocaine, 100 mg hydrocortisone, and dimethyl sulfoxide were instilled intravesically. The substance in the suppository was a detergent, thus no specific treatment was performed. In case 2, a 22-year-old woman was hospitalized for severe symptoms of urgency, marked dysuria, and severe burning pain following inadvertent insertion of a vaginal suppository into the bladder. A 3-way Foley catheter was inserted, and oxybutynin and ciprofloxacin therapy was initiated. Bladder irrigations were begun with normal saline. She received 100 mg hydrocortisone intravenously every 8 hours. Cystoscopy revealed diffuse severe hemorrhagic cystitis. Retrograde cystography with the patient under anesthesia demonstrated a bladder capacity of only 300 cc. The patient had severe bladder spasms for approximately 1 month after initial insertion of the vaginal suppository. A serious fixed drug eruption developed in the right leg secondary to the nonoxynol-9. In case 3, a 26-year-old woman presented to a urology clinic 36 hours after transurethral insertion of a vaginal suppository into the bladder. Cystoscopy revealed severe hemorrhagic cystitis. The patient was treated with 1 tablet of trimethoprim-sulfamethoxazole twice a day and 5 mg oral oxybutynin every 6 hours. Significant irritation was reported using latex condoms lubricated with nonoxynol-9. The absorption of the drug via the bladder wall occurs rapidly and reaches high concentrations.

Müllerian duct cyst. Case report with diagnosis established by transrectal prostatic ultrasound.

A case is reported of müllerian duct cyst diagnosed by transrectal prostatic ultrasound in a twenty-eight-year-old white man presenting with symptoms of obstruction. A review of the symptoms and treatment found in the literature is presented.

Unilateral seminal vesicle cyst presenting as hematospermia; diagnosis established by transrectal prostatic ultrasound.

A case report of a unilateral seminal vesicle cyst presenting as painless hematospermia in a 44-year-old patient is presented. Ultrasound-guided needle aspiration of the cyst demonstrated a markedly elevated LDH level in the cyst fluid of unknown significance. Antibiotic injection under ultrasound guidance into the seminal vesicle cyst was accomplished. Laboratory evaluation on the cyst fluid is suggested.

Urogenital sinus-ejaculatory duct cyst: a case report with a proposed clinical classification and review of the literature.

A 31-year-old infertile white man presented with difficulty with defecation secondary to a large urogenital sinus-ejaculatory duct cyst. Computerized axial tomography and ultrasound evaluation were accomplished before retroperitoneal transvesical surgical removal of the cyst. A computerized tomography scan detected a septum in the cyst. A clinical classification is presented of the various retrovesical cystic lesions in the male patient and the literature is reviewed.