A presentation of glandular penile metastases from prostate adenocarcinoma.

Secondary tumours of the penis are rare; they most commonly arise from the prostate and the bladder. These lesions are often associated with disseminated malignancy and have a poor prognosis, with a 6-month mortality of up to 80% reported. Penile metastases have a variety of clinical manifestations including incidental penile nodules, cutaneous findings, urinary symptoms, pain and malignant priapism. Treatment options are mainly targeted at improving the patients' quality of life and are tailored to their clinical condition, but are primarily palliative. This study reports a case of a 92-year-old man with a presentation of glandular penile metastases from prostate adenocarcinoma treated conservatively.

The increasing incidence of mumps orchitis: a comprehensive review.

There has been a recent increase in mumps orchitis among pubertal and postpubertal males. These outbreaks can be attributed to a reduction in the uptake of measles-mumps-rubella (MMR) vaccine during the early to mid-1990 s in children who have now matured. The mumps virus is commonly associated with extra-salivary complications. Unvaccinated postpubertal males diagnosed with mumps virus frequently develop complications such as mumps orchitis. Therefore, it is important that urologists are familiar with the diagnosis, treatment and complications of this condition. Here we review the epidemiology, clinical presentation, diagnostic methods, treatment options and complications of mumps orchitis, as a complication of mumps virus, with particular emphasis on testicular atrophy, subfertility and infertility.

Can prostate biopsies predict suitability for nerve-sparing radical prostatectomy?

OBJECTIVE: The process for selecting patients suitable for nerve-sparing radical prostatectomy (NSRP) has been the source of much debate. In this study we analysed the use of prostate biopsies as the principal selection tool. MATERIAL AND METHODS: Patients undergoing radical retropubic prostatectomy (n = 133) were retrospectively categorized as having "unilateral" (biopsy demonstrated malignancy confined to one side of the gland) or "bilateral" carcinoma. The accuracy and reliability of this categorization were determined by correlation with the final histopathology of the resected radical prostatectomy specimen. RESULTS: Prostate biopsy suggested "unilateral" carcinoma in 30/58 (52%) and 45/75 (60%) patients diagnosed using transrectal ultrasound-guided (TRUS) and transperineal digital-guided (TP) routes, respectively. Subsequent analysis of the resected specimen, however, revealed "bilateral" malignancy in 50 patients (86%) in the TRUS group and in 63 (84%) in the TP group. Furthermore, positive surgical margins were identified on the "benign" side (by preoperative biopsy) in 6 (20%) patients in the TRUS subgroup whose biopsy had suggested "unilateral" carcinoma, and in 12 (27%) of the comparative TP subgroup. CONCLUSIONS: Biopsy-suggested "unilateral" carcinoma was associated with both a high incidence of "bilateral" disease on final histology following radical prostatectomy and an alarming incidence (24%) of positive surgical margins on the "benign" side where NSRP might be advocated.

Positive apical surgical margins after radical retropubic prostatectomy, truth or artefact?

OBJECTIVE: The significance of a positive apical surgical margin following radical retropubic prostatectomy has been the subject of controversy. We examined the hypothesis that a positive apical margin alone is not associated with an increased probability of biochemical relapse. MATERIAL AND METHODS: A total of 162 men underwent radical prostatectomy for clinically organ-confined disease between May 1990 and December 1998. The mean follow-up period was 55 months (minimum 24 months). The mean patient age was 60.8 years. Clinical staging was 67.9% T1 and 32.1% T2. The mean preoperative prostate-specific antigen level was 11.5 ng/ml, and the mean Gleason score was 5.8. RESULTS: Overall, 5/64 patients (7.8%) with negative surgical margins and 42/98 (42.9%) with at least one positive surgical margin had biochemical recurrence (p < 0.001). Seven of 25 patients (28%) with a solitary positive apical margin relapsed. A solitary apical positive margin was associated with a statistically significant higher risk of recurrence versus controls (p < 0.05). CONCLUSION: All patients with a positive surgical margin, including those with a solitary apical margin alone, are at significantly increased risk of biochemical failure.

Long-term followup of cadaveric renal transplantation in patients with spina bifida.

PURPOSE: Access related problems in hemodialysis and peritoneal dialysis are increased in cases of spina bifida due to vascular and body habitus limitations. Reports of renal transplantation in this patient group are exceedingly rare. We report long-term followup data on cadaveric renal transplantation for end stage renal failure in cases of spina bifida. MATERIALS AND METHODS: Between February 1986 and April 2000, 17 cadaveric renal transplants were performed in 11 females and 5 males with spina bifida. Mean age at transplantation was 20.2 years (range 10 to 35). Of the patients 11 were wheelchair bound and 5 were independently mobile. Before transplantation surgical management of the urological tract included clean intermittent self-catheterization in 3 cases, enterocystoplasty and clean intermittent self-catheterization in 8, and ileal conduit urinary diversion in 5. A total of 14 patients were on renal replacement therapy before receiving the graft. Cyclosporine based triple therapy was administered to maintain immunosuppression in all cases and antithymocytic globulin was given for induction in 7. RESULTS: Six grafts have failed, including 1 in a patient who underwent successful re-transplantation. Median graft survival was 7.23 years. Two patients died after graft nephrectomy. At a mean followup of 52.8 months (range 1 month to 14 years) 11 of 17 grafts are functioning with a mean serum creatinine of 112.7 +/- 29.4 mmol./l. CONCLUSIONS: These data demonstrate the feasibility of cadaveric renal transplantation in patients with spina bifida and end stage renal failure. We currently recommend that these patients should not be deprived of the benefits of renal transplantation.

Influence of biopsy perineural invasion on long-term biochemical disease-free survival after radical prostatectomy.

OBJECTIVES: To investigate the influence of biopsy perineural invasion (PNI) on long-term prostate-specific antigen recurrence rates, final pathologic stage, and surgical margin status of men treated with radical prostatectomy. Radical prostatectomy offers the best chance for surgical cure when performed for organ-confined disease. However, the histologic identification of PNI on prostate biopsy has been associated with a decreased likelihood of pathologically organ-confined disease. METHODS: Seventy-eight men with histologic evidence of PNI on biopsy underwent radical prostatectomy by a single surgeon between April 1984 and February 1995 and were compared with 78 contemporary matched (biopsy Gleason score, prostate-specific antigen level, clinical stage, age) controls without PNI. Biochemical disease-free survival and pathologic findings were compared. RESULTS: After a mean follow-up of 7.05 +/- 2.2 years and 7.88 +/- 2.7 years (P = 0.04) for patients with biopsy PNI and controls, respectively, no significant difference in the long-term prostate-specific antigen recurrence rates was observed (P = 0.13). The final Gleason score and pathologic staging were also similar in this matched cohort. Although the numbers of neurovascular bundles resected were comparable between the groups, no difference was found in the rate of positive surgical margins identified (13% versus 10%, P = 0.62). CONCLUSIONS: We were unable to show that PNI on needle biopsy influences long-term tumor-free survival.