Remission of idiopathic retroperitoneal fibrosis after sequential therapy with corticosteroids and tamoxifen.

The most favored therapy for idiopathic retroperitoneal fibrosis is the surgical relief of ureteral obstruction and use of corticosteroids to prevent recurrence. Although effective, long-term corticosteroid treatment could be associated with serious side effects. We would like to present a case of idiopathic retroperitoneal fibrosis treated successfully with intraperitonealization of the ureters and sequential therapy with steroids and tamoxifen to minimize the side effects.

Case report: Incidental primary transitional cell carcinoma of the prostate treated with transurethral prostatectomy only.

A 65-year-old man presented with a history of painless gross hematuria and severe obstructive symptoms. Abdominal ultrasonography and intravenous urogram revealed the absence of any disease in the urinary tract except benign prostatic hyperplasia. He underwent a transurethral resection of the prostate and was found to have incidental primary transitional cell carcinoma of the prostatic ducts localized to the gland. Radical cystoprostatectomy was offered but the patient was hypertensive, had a history of cerebrovascular accident and refused another major operation. Since also his general condition was not good enough for further therapy, he was treated with transurethral prostatectomy only. After 16 months he is still alive and free of disease.

Serum concentrations of sex hormones in men with severe lower urinary tract symptoms and benign prostatic hyperplasia.

OBJECTIVE: To find out the impact of age-related changes in serum concentrations of sex hormones on the development of severe lower urinary tract symptoms and benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: The study group consisted of 61 consecutive patients subjected to prostatectomy for BPH between 2000-2001 in our clinic. Forty-five randomly assigned, age and socioeconomically matched cases without any lower urinary tract symptoms were taken as the control group. Both clinical BPH and control groups were divided to 3 age groups (namely 50-59, 60-69 and > or = 70 years) and age-related changes in serum concentrations of sex hormones were investigated. RESULTS: Prostate adenoma weight was found to be increased significantly (p = 0.02) with advancing age in clinical BPH group. There was no difference between serum concentrations of measured sex hormones between small and large prostates except for serum estradiol levels, which were found to be significantly higher in patients who had an adenoma weight of > 50 g (p = 0.047). Similar results were obtained in both clinical BPH and control groups with respect to age-related changes in serum concentrations of sex hormones. Briefly there was an age-related decrease in serum free testosterone levels and increase in serum estradiol, prolactin and gonadotropin levels. Serum free testosterone concentration was significantly higher in the control group for ages 60-69 (p = 0.015) while total testosterone was higher in BPH patients for patients older than 70 years of age (p = 0.027). No other significant change was documented between 2 groups. An age-dependent increase in serum E/freeT ratio was documented in both clinical BPH and control patients whereas serum freeT/T ratio was decreased in the BPH group with advancing age (p = 0.008). CONCLUSION: The decrease in serum free testosterone concentrations with a relative rise in serum estradiol levels with advancing age might be an important factor in the development of BPH. However it is likely that serum concentrations of sex hormones play little impact on the clinical severity of BPH.

Factors affecting outcome of one-stage anterior hypospadias repair: analysis of 422 cases.

The repair of hypospadias is among the most difficult problems in urology, as it demands the construction of a well-functioning urethra and a good cosmetic appearance. We performed a retrospective analysis of 422 cases subjected to one-stage anterior hypospadias repair between 1982 and 1999 in our clinic and investigated the effects of factors like degree of hypospadias, surgical technique, and the surgeon's experience on outcome. The operations used were MAGPI (91), urethral advancement (10), Mathieu (260), modified Allen-Spence (50), onlay island flap (5), and double-faced island flap (6) procedures. The early complication rate was 18%, while the final success rate following secondary interventions was 95%. The complications included fistula formation in 49 cases (12%), flap necrosis in 12 (3%), meatal problems in 12 (3%), residual chordee in 4 (1%), and urethral stricture in 1 (<1%). Complication rates were significantly higher if the meatus was proximal or there was severe chordee and in the first 6 years of the study. The flap procedures were associated with a higher complication rate. It is concluded that one-stage procedures are successful in the repair of anterior hypospadias in experienced hands with proper patient selection.

Are clinical characteristics of familial benign prostatic hyperplasia different than in sporadic cases?

OBJECTIVE: Familial benign prostatic hyperplasia (BPH) is a recently popularized entity with yet uncertain clinical and pathological features. In the present study we investigated whether there was any difference between clinical characteristics of familial and sporadic BPH in a series of 148 surgically treated BPH patients. MATERIALS AND METHODS: A retrospective analysis was performed in 148 patients subjected to transvesical or transurethral prostatectomy to determine the clinical features of familial BPH. Patients were categorised as having familial BPH when 3 or more (including the patient) first-degree family members gave a history of BPH. Accordingly 23 cases who fit this criterion were accepted as having familial BPH and the rest of the cases were taken as the control group. The two groups were compared with respect to age, International Prostate Symptom Score (IPSS), quality of life score, prostate specific antigen (PSA), maximum urinary flow rate and the weight of the surgical prostate specimen. RESULTS: The mean age, IPSS, quality of life score, total PSA, maximum urinary flow rate and the weight of the surgical prostate specimen were found as 65.13 +/- 5.51 years, 23.13 +/- 4.82, 4.78 +/- 0.95, 6.0 +/- 4.1 ng/ml, 6.9 +/- 2.7 ml/s and 62.96 +/- 38.76 g, respectively, in the familial BPH group whereas the same parameters were measured as 68.13 +/- 7.68 years, 24.74 +/- 3.73, 4.52 +/- 0.85, 5.93 +/- 4.75 ng/ml, 4.6 +/- 1.71 ml/s and 70.87 +/- 53.21 g, respectively. No significant difference was present between familial and sporadic BPH cases in any of the studied parameters. CONCLUSION: The clinical features of familial BPH did not differ significantly from those of sporadic BPH.

Case report: further upward migration of a misplaced double-J ureteral stent.

A 45-year-old man was referred to our hospital for the removal of a misplaced double-J ureteral stent. The lower end of the stent shortly after insertion was at the level of sacroiliac joint. However one week later the stent was further migrated upwards to the level of 4th lumbar vertebra. Immediate ureterorenoscopy was performed to prevent further migration of the stent to the renal pelvis and the stent was removed by the grasping forceps under direct vision successfully.

Effects of combined androgen blockade on bone metabolism and density in men with locally advanced prostate cancer.

OBJECTIVE: To investigate whether combined androgen blockade (CAB) produces any adverse effects on bone metabolism and mineral density in patients with locally advanced prostate cancer. MATERIALS AND METHODS: The study group consisted of 17 stage T4 prostate cancer patients treated with CAB and had no evidence of bone metastasis on bone scintigraphy. The mean duration of CAB and final total prostate specific antigen (PSA) level at the time of study were found at 28.5 +/- 15.9 (6-58) months and 0.39 +/- 0.5 (0.1-2) ngml, respectively. Twenty age and socioeconomically matched benign prostate hyperplasia (BPH) patients were taken as the control group. Both groups were compared with regard to lumbar bone mineral density (LBD), femur bone mineral density (FBD) and serum parameters of bone metabolism namely calcium (Ca), phosphate (P), magnesium (Mg) and alkaline phosphatase (ALP). Bone mineral density was measured with dual energy x-ray absorptiometry. RESULTS: The mean FBD, LBD and serum Ca, P, Mg and ALP measurement of the patients treated with CAB were 0.85 +/- 0.1 g/cm2, 1.16 +/- 0.2 g/cm2, 9.1 +/- 0.3 mg/dl, 3.6 +/- 0.6 mg/dl, 1.95 +/- 0.14 mg/dl, 187.5 +/- 61 mg/dl, respectively. No significant difference was found between patients subjected to CAB and the age matched controls in any of the studied parameters namely age, FBD, LBD, Ca, Mg and ALP except serum phosphate. Serum phosphate levels were significantly (p = 0.001) higher in patients treated with CAB suggesting a minor effect of CAB on bone metabolism. CONCLUSION: No convincing evidence was found about the detrimental effect of CAB on bone mineral density and metabolism in a highly selected group of patients with advanced prostate cancer without bone metastases.