Changing trends in the management of prostatic disease in a single private practice: a 5-year followup.

Evaluation and management services provided by the practicing urologist have changed dramatically during the last few years. This is particularly evident in the approach to men with bladder outlet symptoms and in those in whom the diagnosis of prostate cancer is a distinct possibility. The impact of medical management/observation of symptomatic benign prostatic hypertrophy, as well as the influence of prostate specific antigen, transrectal ultrasound and biopsy, radical prostatectomy and hormonal agents in a 3-man private clinical practice is analyzed. The records of 2,206 patients new to the practice who presented with a variety of prostate-related complaints from July 1, 1986 to June 30, 1991 were reviewed. Of these patients 1,822 (82%) were evaluated for presumed benign bladder outlet symptoms. During year 1 of the study, ending on June 30, 1987, 28% of the presumed benign prostatic hypertrophy patients were treated with transurethral prostatectomy, compared to only 8% of such patients in 1991. In contrast, alpha-blocking agents were used to treat 21% of these patients in 1991. Transrectal ultrasound biopsy currently accounts for 87% of all prostatic biopsies, increasing 4-fold during 5 years. Radical prostatectomy has increased 6-fold during the course of the study. Administration of a luteinizing hormone-releasing hormone analogue has supplanted orchiectomy and estrogen therapy for the treatment of disseminated disease, as witnessed by a 4-fold increase in its use. While it is recognized that these trends are presently applicable to our local metropolitan region, they may reflect practice patterns in similar demographic groups, as well as predict future tendencies nationwide.

Extraperitoneal paravesical spaces: CT delineation with US correlation.

The extraperitoneal space around the urinary bladder is lamellate, just like the retroperitoneal space around the kidneys. The bladder, urachus, and obliterated umbilical arteries lie within the perivesical space, surrounded by umbilicovesical fascia, analogous to the perinephric space within the renal fascia. A much larger prevesical space, analogous to the anterior pararenal space, lies anterior and lateral to the umbilicovesical fascia. Posterior to the urinary bladder, the lower uterine segment or seminal vesicles lie within the perivesical space, rather than in a separate compartment, corresponding to the posterior pararenal space. The cul-de-sac, and the inferolateral extension of its peritoneal layers as the rectovaginal or rectovesical septum, separate the posterior perivesical space from the rectum. The sectional anatomy of these spaces, and particularly their computed tomographic and ultrasound appearances, were noted in normal anatomic sections, patients with extraperitoneal fluid collections, and a cadaver into which fluid was injected.

Testosterone secreting adrenal cortical adenomas.

We report the hormonal and radiological evaluation of two cases of adrenal cortical adenomas that secreted testosterone exclusively. We discuss some of the pitfalls in the diagnosis of this lesion, and summarize the current knowledge of the characteristic hormonal features in the two cases and the 12 cases previously reported.

Hemiacidrin irrigations to dissolve stone remnants after nephrolithotomy. Problems with solution flow.

Following surgery for branched renal calculi, hemiacidrin irrigation may be useful to dissolve any residual stones. Struvite, the mineral in these stones, is itself an alkaline buffer and can raise the pH of the irrigating solution rendering it ineffective. Large volumes of hemiacidrin must reach the stone remnants or they are unlikely to dissolve. Two cases are described in which creative positioning of the patient or the irrigation catheters was necessary to permit adequate amounts of hemiacidrin to reach and dissolve stone remnants.

Lack of effect of spironolactone on male genital development.

Spironolactone, which has been shown to have antiandrogen action in mature male rats, was given to pregnant rats from day 14 of pregnancy until delivery in a dose equivalent to the 400-mg adult human regimen. The male members of the resultant litters were then dissected and examined for evidence of pseudohermaphroditism. No evidence of hypospadias, malformation of Wolffian ducts, or narrowing of anogenital distances was found. In the experimental model used, no evidence of an antiandrogen action of spironolactone was found.

Bilateral anorchism.

A case of surgically proved bilateral anorchism is reported. Emphasis is placed on the importance of early diagnosis and treatment in the proper management of this rare entity.

A safe, simple and reliable method for percutaneous (closed) renal biopsies in children: results in 100 consecutive patients.

A safe, simple and reliable technique for percutaneous renal biopsy in children has been described. Specimens adequate for pathologic interpretation were obtained in 97 patients. Significant complications (gross hematuria lasting more than 36 hours, severe pain, perirenal mass or unexplained fever) occurred in 8 patients. No secondary operations or transfusions were required. No mortailty or late complications occurred.