Urodynamics and transurethral microwave thermotherapy.

In this paper the role and value of urodynamic measurements in symptomatic benign prostatic hyperplasia (BPH) patients selected for transurethral microwave thermotherapy (TUMT) reviewed. Although pressure-flow studies alone can diagnose benign prostatic obstruction, the level of acceptance of urodynamic investigations in BPH remains low, reportedly due to their cost and to their invasive and time-consuming nature. Furthermore, the observation that extremely different treatment modalities in BPH have nearly the same symptomatic outcome, independently of their influence on obstruction, has played a part in raising doubt as to the value of baseline urodynamics as a predictor of clinical success. Pre- and posttherapy urodynamic investigations in TUMT-treated patients have shown that urodynamic algorithms must be capable of distinguishing between compressive and constrictive types of obstruction to document the limited effects of low-energy TUMT on obstruction. Furthermore, it has been shown that urodynamics evaluated in this way seems to be the only predictor of the clinical success of TUMT when improvements in the objective parameters Qmax (peak uroflow) and residual urine are included in the definition of outcome.

Efficient pathway for early detection of prostate cancer concluded from a 5-year prospective study.

In a prospective study the statistical characteristics of digital rectal examination (DRE), transrectal ultrasound (TRUS), and serologic determination of prostate-specific antigen (PSA) were assessed in 1230 patients aged over 40 years. The sensitivity, specificity, and positive and negative predictive values were determined to be 80.3%, 69.7%, 58.9%, and 86.7%, respectively, for DRE; 76.5%, 62.3%, 52.3%, and 83.1%, respectively, for TRUS; and 87.9%, 49.6%, 48.5%, and 88.3%, respectively, for PSA (normal level, 4 ng/ml). The data clearly demonstrate the nonsuitability of each single measure for reliable early detection of prostatic carcinoma. Connection of the parameters in all possible combinations under various conditions demonstrated the superiority of the test "DRE and PSA > 4 ng/ml" over DRE as the "gold standard" and all other options. The use of this approach as the first-line raster of an algorithm (outlined herein) would allow the detection of prostatic malignancy with a specificity of 86.5% and a positive predictive value of 74.0%. Supplementing this screen with short-term controls in cases in which only one parameter is positive ("DRE or PSA > 4 ng/ml") might enable the detection of almost all patients with prostate cancer. TRUS did not provide any additional information.

Metastatic leydig-cell tumors of the testis - report of 4 cases and review of the literature.

Leydig cell tumours constitute 1-2% of all testicular cancers and only 10% of patients with Leydig cell tumours will develop metastatic disease. They are considered refractory to chemo- and radiotherapy. The management of metastatic disease and the effects of systemic therapy have only been described in case reports. We report on four patients with metastic Leydig cell tumours, one of which was accompanied with excess sex hormone production. One patient was rendered tumour free by the surgical resection of retroperitoneal lymph nodes. and remains without recurrence for 10+ months. The other three patients received systemic treatment due to inoperable metastatic disease. One patient with progressive abdominal and supraclavicular lymph node metastases achieved a minor remission after 4 cycles of cisplatin-based chemotherapy, lasting for ten months. A second response to carboplatin-based chemotherapy was achieved in this patient at progression. The other two patients died 9 and 21 months after diagnosis of metastatic disease and never responded to chemotherapy. A review of the different treatment options for metastatic Leydig cell tumours is given. Surgery, which might include the resection of retroperitoneal lymph nodes or solitary pulmonary metastases, seems to be the only curative modality. Radiotherapy has apparently no effect and responses to systemic chemo- or hormonal therapy are infrequent and usually of short duration.