Giant penile tumour: a case report.

The verrucous carcinoma of the penis is described as a low-grade, well-differentiated variant of the spinocellular carcinoma of the penis. We treated a patient with an enormous tumour of the external genitals. The resected specimen weighed 1850 grams. A review of the literature published in the last 10 years concerning this issue confirms its rare nature. A tumour of this size described.

Incarcerated vesico-inguinal hernia: a case report.

In this paper we report a rare case of an incarcerated inguinoscrotal hernia of the urinary bladder in a 64-year-old male patient. He presented with a giant inguinal hernia and pollakisuria. The bladder was surgically repositioned intra-abdominally and resection of part of the bladder fundus was performed through laparotomy. Closure of the inguinal defect was performed through an inguinal approach. The patient's further recovery was uneventful. Herniation of the bladder is a very infrequent finding in inguinal hernias. We searched the literature and only found a few case reports describing this rare pathology. The literature and treatment options are discussed.

Phase III trial of satraplatin, an oral platinum plus prednisone vs. prednisone alone in patients with hormone-refractory prostate cancer.

Satraplatin is a novel oral platinum (IV) complex that shows activity against hormone-refractory prostate cancer (HRPC) in cisplatin-resistant human tumor lines in phase I and phase II trials. A randomized multicenter phase III trial with a target sample size of 380 patients was initiated in men with HRPC. After 50 randomized patients, the trial was closed to further accrual by the sponsoring company. An ad hoc analysis of all available data is reported here. Eligibility criteria included pathological proof of prostate cancer, documented progression despite prior hormonal manipulation, WHO PS 0-2, and no daily intake of narcotic analgesics. Patients were randomized between satraplatin 100 mg/m(2) for 5 days plus prednisone 10 mg orally BID or prednisone alone. Compliance was excellent. 48/50 patients have progressed and 42 have died, mostly due to prostate cancer. Median overall survival was 14.9 months (95% CI: 13.7-28.4) on the satraplatin plus prednisone arm and 11.9 months (95% CI: 8.4-23.1) on prednisone alone (hazard ratio, HR = 0.84, 95% CI: 0.46-1.55). A >50% decrease in prostrate specific antigen (PSA) was seen in 9/27 (33.3%) in the satraplatin plus prednisone arm vs. 2/23 (8.7%) on the prednisone alone arm. Progression-free survival was 5.2 months (95% CI: 2.8-13.7) on the satraplatin plus prednisone arm as compared to 2.5 months (95% CI: 2.1- 4.7) on the prednisone alone arm (HR = 0.50, 95% CI: 0.28-0.92). This difference is statistically significant (p = 0.023). Toxicity was generally minimal in both arms. This randomized comparison of a combination of satraplatin and prednisone versus prednisone alone supports the antitumor activity of the combination. Its role in the treatment of HPRC remains to be elucidated in an appropriate phase III setting.

[The cost of complicated acute urinary retention: a patient chart analysis in Belgium]. / Le coût de la rétention urinaire aiguë compliquée: analyse rétrospective en Belgique.

OBJECTIVES: Acute Urinary Retention (AUR) is a troublesome event in patients with benign prostate hyperplasia and often results in adenectomy, associated with increased morbidity and mortality. The objective of this study is to document the current medical practice and resource utilization in AUR, with Belgium as a case setting. METHODS: In this study, a retrospective patient chart review, the 6-month medical resource use of 63 patients hospitalised in 5 different centres with a first episode of AUR and failing a first attempt to remove the catheter (defined as complicated AUR) was recorded and costs were calculated from the public health care payer's perspective. Only direct medical costs (2002 values) were taken into account. RESULTS: The 6 month cost of complicated AUR was Euro 6,766 (St. Err: Euro 491), whereas the cost of hospitalisation for the acute event was Euro 4,722 (St. Err: Euro 526). The cost of a transurethral resection of the prostate (TURP) performed during the index hospitalisation is much higher than the cost of a TURP performed during a subsequent--scheduled--hospitalisation (Euro 6,101 vs. Euro 4,237). CONCLUSIONS: The cost of complicated AUR is quite important. Preventing AUR or improving the medical management of AUR may reduce the number of adenectomies that have to be performed, and thus, may reduce mortality, morbidity and health care costs.

Phyllodes tumor of the prostate. A case report and review of the literature.

Prostatic cystic epithelial-stromal tumors, commonly described as phyllodes tumors of the prostate, are extremely rare lesions. They exhibit a spectrum of histological features similar to their better known counterpart in the breast. Although a benign clinical course has been emphasized in some reports, cumulative evidence in the literature indicates that these lesions should be considered neoplasms rather than atypical hyperplasia due to the frequent early recurrences with possible dedifferentiation, infiltrative growth and potential for extraprostatic spread in some cases. An individualized approach to complete excision of the tumor is needed. A case record of a patient recently treated at our medical center with a low-grade phyllodes tumor is presented and a review of the literature was done.

Non-parasitic chyluria: a case report and review of the literature.

Chyluria is due to the passage of chyle into the urine giving it a typical milky appearance. Although rarely seen in our countries it is well-known in areas where infections with Wuchereria bancrofti are endemic. Chyluria can also have non-parasitic causes of which only a few cases have been described. We briefly discuss etiologies and pathogenesis of chyluria and present a case of non-parasitic chyluria successfully treated by surgery. A short and critical review of the different treatment modalities is made.

Surgery or radiation: is there really a choice for early prostate cancer.

One of the most difficult tasks for the practicing urologist is to counsel the patient in a decision for the optimal treatment for his localized prostate cancer. After providing the patient with contemporary and unbiased information and data, it is important to find the preferred treatment based on his age, the medical realities and, last but not least, the patient's personal preference. Radical prostatectomy, radiotherapy and observation are standard treatment options. TRUS-guided brachytherapy and cryosurgery are considered investigational treatment options since follow-up is inadequate to provide sufficiently precise outcome estimates. The literature does not provide clear-cut evidence for the superiority of any one treatment. The patient most likely to benefit from radical prostatectomy would have a relatively long life expectancy, no significant surgical risk factors and a preference to undergo surgery. The major advantage of radical prostatectomy is its potential for total removal of the cancer and cure in properly selected patients. Potential harm includes urinary incontinence and impotence. The patient most likely to benefit from radiation therapy would have a relatively long life expectancy, no significant risk factors for radiation toxicity and a preference for radiotherapy. The advantages of radiotherapy are that it has a potential for cure and it is well tolerated in the majority of men when the modern techniques are used. Potential harm includes radiation cystitis, proctitis and impotence, persisting severe complications are only seen in 1% of patients. The patient most likely to benefit from surveillance are those with a shorter life expectancy and/or a low grade tumour. Benefits are lack of treatment related morbidity with only marginal compromise of disease-specific survival at 5-10 years follow-up.

Urodynamic effects of Prolase 2 laser prostatectomy in benign prostatic hyperplasia.

This prospective study was undertaken to evaluate the safety and efficacy of visual laser ablation of the prostate with the Prolase 2 sidefiring neodymium: YAG laser fiber in patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia (BPH). The Prolase 2 fiber is a non-contact sidefiring fiber, producing coagulation of the prostatic tissue. Our study describes the results obtained in 30 patients who underwent VLAP with a mean follow-up of 6 months. The evaluation of symptoms according to the WHO International Prostate Symptom Score and Quality of Life Score (IPSS and QL) demonstrated a significant subjective response rate (p < 0.001). Objective assessment of treatment with peak and average urinary flow rates, post-void residual urine volumes and pressure-flow urodynamic studies showed a significant improvement after treatment (p < 0.001). Ultrasonic assessment of prostatic volumes at 6 months showed a mean decrease in total volume of 37% after laser prostatectomy. The early and late complications of the treatment are presented but overall toxicity is low. Laser prostatectomy performed with the Prolase 2 fiber seems to be safe and efficacious for BPH patients but long term efficacy and retreatment rates have to be awaited.

Use of ketoconazole in the treatment of a virilizing adrenocortical carcinoma.

Ketoconazole, an oral antimycotic agent, is known to have a potent inhibitory effect on adrenal steroid production. It was given at a dose of 1200 mg/day to a 52-year-old female patient with a virilizing adrenocortical carcinoma in order to achieve better metabolic control pre-operatively. Together with a rapid normalisation of hypertension and hyperglycemia, a dramatic fall was noticed in serum and urinary adrenal steroids after a few days. Levels of total testosterone (20 nmol/l), androstenedione (greater than 35 nmol/l) and DHEA-sulphate (greater than 28 nmol/l) fell to normal levels in 6 days. By contrast, levels of 17-OH-progesterone (30 nmol/l) and progesterone (2.45 nmol/l) increased slightly, indicating inhibition of adrenal 17,20-lyase. Cortisol (620 nmol/l at 08.00 h) fell to very low levels (50 nmol/l) on day 6 of the trial. We conclude that ketoconazole is very effective in suppression of adrenal tumoural steroidogenesis and merits consideration in pre-operative use. We warn against dangerous hypoadrenalism which seems to occur earlier in tumoural than in normal adrenal metabolism.

Early adjuvant adriamycin in superficial bladder carcinoma.

A multi-center study was performed in 110 patients with superficial transitional cell carcinoma of the bladder. Adriamycin (50 mg/50 ml) was administered intravesically within 24 hours after transurethral resection of TA-T1 (0-A) bladder tumours. Instillation was repeated twice during the first week, then weekly during the first month and then monthly for 1 year. The tolerance was evaluated in these 110 patients and 29 patients presented with local side effects. In 24 of these patients the chemical cystitis was severe enough to drop them out of the study. No systemic side effect was observed. Recurrence was studied on 82 evaluable patients at 1 year of follow up and on 72 patients followed for 2-3 years (mean: 32 months). Of these 82 patients, 23 were primary cases and 59 recurrent. On all 82 patients, 50 did not show any recurrence after 1 year (61%) while 32 presented with one or more recurrences (39%). Of these recurrences, 27 were T1 tumor while 5 progressed to more invasive lesions. In patients that were free of recurrence during the first year, 80% remained tumour free during the 2-3 years follow up period. In patients developing one or more recurrences during the first year, only half of them presented further recurrences once the instillations were stopped. The beneficial effect of Adriamycin appears obvious and might be related to the drug itself, the early and repeated instillations after TUR or both factors.

Early adjuvant adriamycin in superficial bladder carcinoma.

A multicenter study was performed in 110 patients with superficial transitional cell carcinoma of the bladder. Adriamycin (50 mg/50 ml) was administered intravesically within 24 h after transurethral resection of TA-T1 (O-A) bladder tumors. Instillation was repeated twice during the first week, then weekly during the first month and afterwards monthly for 1 year. The tolerance was evaluated in these 110 patients, and 29 patients presented with local side-effects. In 24 of these patients chemical cystitis was severe enough for them to drop out of the study. No systemic side-effects were observed. Recurrence was studied in 82 evaluable patients after 1 year of follow-up and in 72 patients followed for 2-3 years (mean 32 months). Of the 82 patients studied after 1 year, 23 had primary and 59 recurrent disease. Of the 82 evaluable patients, 50 did not show any recurrence after 1 year (61%), while 32 presented with one or more recurrences (39%). Of these recurrences, 27 were T1 tumors while five progressed to more highly invasive lesions. In patients that were free of recurrence during the first year, 80% remained tumor-free during the 2- to 3-year follow-up period. Of the patients developing one or more recurrences during the first year, only 50% presented with further recurrence once the instillations were stopped. The beneficial effect of Adriamycin appears obvious and might be related to the drug itself, the early and repeated instillations after TUR, or both.