Salvage high-intensity focused ultrasound for biopsy-confirmed local recurrence of prostate cancer after radical prostatectomy.

OBJECTIVE: To present experience in high-intensity focused ultrasound (HIFU) used as a salvage therapy for biopsy-confirmed local recurrence at the vesico-urethral anastomosis after radical prostatectomy (RP). PATIENTS AND METHODS: From July 2006, four patients diagnosed with prostate cancer recurrence after RP were treated with HIFU, with or without salvage radiotherapy, using the Sonablate 500 (Focus Surgery, IN, USA). Biochemical failure was defined as in increase in prostate-specific antigen (PSA) level of >0.2 ng/mL. No patients received any adjuvant therapy after HIFU therapy before reporting failure. RESULTS: The mean age and initial PSA level before RP was 74 years and 10.0 ng/mL, respectively. After RP, one patient was stage T2aN0M0, two were stage T3N0M0 and the last had an unknown pathological stage. Three patients received external beam radiotherapy as salvage therapy after RP. The mean PSA level before HIFU, tumour volume at the vesico-urethral lesion and operative duration were 4.3 ng/mL, 4.6 mL and 27 min, respectively. Adenocarcinomas were confirmed by biopsy of the tumour at the vesico-urethral anastomotic lesion before HIFU. At 24 months of follow-up, patients 2 and 4 were classified a biochemically disease-free. Biopsies at the anastomotic site after HIFU in three patients showed no malignancy, with fibrosis. There were no complications. CONCLUSION: Salvage HIFU for patients with recurrence after RP is feasible, even though they received salvage radiotherapy before HIFU. More patients and a longer follow-up are needed to evaluate the safety and oncological adequacy of this new approach.

Outpatient basis extracorporeal shock wave lithotripsy for ureter stones: efficacy of the third generation lithotripter as the first line treatment.

AIM: We assessed the efficacy of a third generation extracorporeal shock wave lithotripsy (ESWL) machine for ureter stones using the Dornier Lithotriptor Compact Delta. METHODS: A total of 471 consecutive ureter stones were treated with ESWL using the Dornier Lithotriptor Compact Delta from December 2001 on an outpatient basis. Four hundred and one cases were followed up at least once after the procedure and were included in this study. All of the cases, except one patient who was three years old, were treated without anesthesia, and the procedure was principally performed on outpatient basis. RESULTS: The overall stone free rate was 94.5% and the mean number of treatment sessions was 1.23. The stone free rates were compared considering various clinical factors and significant differences were observed in the stone length, the stone location and the sex in univariate analysis. However, only the stone length maintained a statistically significant impact in multivariate analysis and the stone free rates were 91.2% and 98.0% respectively in larger stones (length 10mm) and smaller stones (length < 10mm) (p = 0.004). In mid-distal stones, the stone free rate was higher than that of proximal stones (97.5% vs 92.6%, p = 0.04) and not affected by stone length. CONCLUSIONS: Extracorporeal shock wave lithotripsy performed by the third generation machine achieved an excellent stone free rate with a relatively small number of treatment sessions. This procedure is strongly recommended as the first line therapy for all ureter stones including mid-distal ones.

Evidence that gonadotropin-releasing hormone (GnRH) II stimulates luteinizing hormone and follicle-stimulating hormone secretion from monkey pituitary cultures by activating the GnRH I receptor.

Mammalian gonadotropin-releasing hormone (GnRH) I is the neuropeptide that regulates reproduction. In recent years, a second isoform of GnRH, GnRH II, and its highly selective type II GnRH receptor were cloned and identified in monkey brain, but its physiological function remains unknown. We sought to determine whether GnRH II stimulates LH and FSH secretion by activating specific receptors in primary pituitary cultures from male monkeys. Dispersed pituitary cells were maintained in steroid-depleted media and stimulated with GnRH I and/or GnRH II for 6 h. Cells were also treated with Antide (Bachem, King of Prussia, PA), a GnRH I antagonist, to block gonadotropin secretion. In monkey as well as rat pituitary cultures, GnRH II was a less effective stimulator of LH and FSH secretion than was GnRH I. In both cell preparations, Antide completely blocked LH and FSH release provoked by GnRH II as well as GnRH I. Furthermore, the combination of GnRH I and GnRH II was no more effective than either agonist alone. These results indicate that GnRH II stimulates FSH and LH secretion, but they also imply that this action occurs through the GnRH I receptor. The GnRH II receptors may have a unique function in the monkey brain and pituitary other than regulation of gonadotropin secretion.

Video urodynamics using transrectal ultrasonography for lower urinary tract symptoms in women.

AIMS: To understand the properties of lower urinary tract disorders in women, we evaluated 60 female patients with lower urinary tract disorders or symptoms of recurrent cystitis by free uroflowmetry and video urodynamics using transrectal ultrasonography (VU-TRUS). METHODS: Results of urodynamic studies or symptoms of stress incontinence were used to divide 60 women into 7 normal controls and 53 with voiding dysfunctions. RESULTS: In normal controls, VU-TRUS showed that the mean posterior urethrovesical angle and anteroposterior diameter of the proximal urethra at maximum flow was 151.4 degrees and 4.9 mm, respectively. In patients with voiding dysfunction, VU-TRUS during voiding revealed various urethral abnormalities, including 16 detrusor sphincter dyssynergia, 4 detrusor bladder neck dyssynergia, and 13 insufficient opening of the entire urethra. VU-TRUS also showed pelvic floor abnormalities, including 24 urethral hypermobilities (group 1) and 11 cystoceles (group 2). Eighteen patients had neither urethral hypermobility nor cystocele (group 3). Major pressure-flow abnormalities in the 53 patients with voiding dysfunctions were weak detrusor (72%) and/or bladder outlet obstruction (25%). There were no significant differences in the distribution of the pressure-flow abnormalities among the three groups. However, the mean values of abdominal pressure at maximum flow of group 1 (20.9 cm H(2)O) and group 2 (17.9 cm H(2)O) were significantly higher than that of group 3 (6.3 cm H(2)O; each P < 0.05). The mean values of residual urine volume of group 2 (60.8 mL) and group 3 (77.6 mL) were significantly higher than that of group 1 (23.5 mL; each P < 0.05). CONCLUSIONS: The symptoms of women with lower urinary tract disorders were frequently accompanied by urethral and/or pelvic floor abnormalities during voiding that were clearly detected by VU-TRUS. VU-TRUS is useful for objective evaluation of female lower urinary tract symptoms.