Coccidioidomycosis of the prostate: a determination of incidence, report of 4 cases, and treatment recommendations.

OBJECTIVE: To describe the incidence of Coccidioides immitis infection of the prostate gland in an endemic area, to describe four new cases discovered, and to propose treatment recommendations for this diagnosis. METHODS: The pathology reports of all prostate tissue specimens collected at the Arizona Health Sciences Center from February 1, 1994 through January 1, 2000 and the Southern Arizona Veterans' Affairs Health Care System from January 1, 1990 through January 1, 2000 were reviewed. RESULTS: A total of 3676 pathology reports were reviewed. Forty-four cases of granulomatous prostatitis were identified (incidence=1.2%). Among these, four cases of C. immitis prostatitis were identified (incidence of granulomatous prostatitis=10%; overall incidence=0.1%). Two cases were found at radical retropubic prostatectomy and two were found on prostate needle biopsy. Five months post-radical prostatectomy one man developed symptomatic coccidioidomycosis and died of complications despite treatment with amphotericin B. Another patient who underwent a radical retropubic prostatectomy was treated with oral fluconazole for 14 months immediately after surgery and had a good response. The remaining two patients received no anti-fungal therapy and are being observed. CONCLUSIONS: Coccidioidomycosis of the prostate is rare. However, when identified, the finding should not be ignored. Patients with symptomatic coccidioidomycosis require immediate anti-fungal therapy. When the diagnosis is an incidental finding and the patient does not manifest symptoms, the degree of tissue violation involved in making the diagnosis influences the need for treatment. Patients with minimal tissue violation (i.e. needle biopsy) can be observed whereas patients with more extensive tissue violation (i.e. prostatectomy) should receive anti-fungal therapy.

Laparoscopic dismembered pyeloureteroplasty: a single institution's 3-year experience.

PURPOSE: To review our most recent experience with laparoscopic dismembered pyeloureteroplasty (LDP) as treatment for ureteropelvic junction (UPJ) obstruction. PATIENTS AND METHODS: All patient charts from March 1, 2000, through March 1, 2003, were reviewed to identify individuals who had undergone LDP. Twenty-two consecutive procedures were performed on 21 patients. The average patient age was 37 years (range 6-77 years). Multiple data points were collected, including patient age, presenting symptoms, degree of hydronephrosis, presence of crossing vessels, operative time (cystoscopy, retrograde pyelography, stent placement, and LDP), estimated blood loss (EBL), length of hospital stay (time to discharge home after preoperative admission), parenteral analgesic use, complications, and results of follow-up imaging studies and symptoms (including an analog pain scale). Mean and range values for quantitative data are reported. RESULTS: Twelve right and ten left renal units were operated on; in 12 UPJs, a crossing vessel was causative of the obstruction. The mean operative time was 291 minutes (range 180-500 minutes) and the mean intraoperative EBL was 63 mL (range 20-100 mL). There were no conversions to open surgery. The mean hospital stay was 40 hours (range 24-120 hours). The average number of parenteral analgesic doses before conversion to oral narcotics was 5 (range 1-10). Three patients had successful pyelolithotomies at the time of reconstruction with a 100% stone-free rate on postoperative imaging studies. The average time of follow-up evaluation was 199 days (range 31-705 days). All patients either had serial ultrasound examinations, diuretic intravenous urograms, or both for follow-up evaluation, which demonstrated improvement in hydronephrosis and renal drainage. All patients with pain preoperatively had resolution of their symptoms postoperatively. There were no intraoperative complications, seven early postoperative complications (three urinary tract infections, two hospital readmissions for ileus, one urine leak, and one delayed hemorrhage, presumably from a trocar site). CONCLUSIONS: Laparoscopic dismembered pyeloureteroplasty is safe and effective and associated with minimal morbidity.

Endoscopic surgery for renal calculi.

PURPOSE OF REVIEW: Endoscopic surgery plays an important role in the treatment of renal calculi, especially for the more complex cases. Recent advancements have improved the efficacy of procedures, and increasing surgeon experience is associated with low complication rates. This article will review recent literature pertinent to endoscopic surgery for renal calculi. RECENT FINDINGS: Endoscopic renal calculus removal is associated with up to >90% calculus clearance rates. This is true for both retrograde and percutaneous approaches. The added utility of flexible instrumentation and holmium laser therapy have contributed greatly to improving surgical success. With increased experience in endoscopic techniques, major complications occur in approximately 1% of patients. Most procedures are performed on an outpatient (retrograde) basis or a <23 h inpatient (percutaneous) basis. SUMMARY: Endoscopic surgery is safe, and the most efficacious therapy with low morbidity for renal calculi.