MR imaging of the pelvic floor.

Pelvic floor disorders are a common clinical problem. Clinical evaluation frequently underestimates the extent of the disease. Fluoroscopic colpocystodefecography (CCD) is an established tool for diagnosing disorders of the rectum and recto- anal junction. It is however less performant when it comes to evaluate the complex pelvic floor mechanism in all its aspects. MR defecography allows to evaluate all the compartments of the pelvis without being invasive. This article describes the clinical setting, the MR technique and provides guidelines for interpretation of a MR defecography study.

Cystectomy and orthotopic ileal neobladder construction. Evaluation of continence and complications in a regional hospital.

INTRODUCTION: This study evaluates the outcome of orthotopic neobladder construction in a regional hospital setting. MATERIAL AND METHODS: Orthotopic ileal neobladders were constructed in 51 patients between 1990 and 2001. All complications were reported systematically and continence was evaluated in a standardized manner. RESULTS: One patient died perioperatively (2%). Early complications occurred in 56.9%. They were related to the neobladder in 21.6% and unrelated to the neobladder in 47.1%. 31.4% experienced complications in the late postoperative period. In 25.5%, these complications were neobladder related and in 11.8% they were not. After 1 year, daytime continence was 91.7% and nighttime continence 80.6%. Our results are comparable to those reported by others. CONCLUSION: We conclude that the construction of a Hautmann neobladder can be performed with acceptable results in a regional hospital. The democratization of recent bladder replacement techniques may offer more patients a better quality of life and prevent the formation of waiting lists. Radical treatment may then be opted for sooner and thus improve cancer-related survival.

Mitomycin C for metastatic prostate cancer: final analysis of a randomized trial.

BACKGROUND: Almost all patients that undergo hormonal manipulation for metastatic prostate cancer will ultimately progress because of hormone resistance. Therefore we assessed the effect of early addition of intravenous Mitomycin C to orchiectomy in patients with newly diagnosed metastatic prostate cancer. PATIENTS AND METHODS: 178 patients with histologically proven and previously untreated metastatic prostate cancer were included in a prospective, randomized multicenter trial. Randomization was done centrally between orchiectomy alone and orchiectomy with Mitomycin C. 148 patients were evaluable. RESULTS: At the final analysis 139 patients have deceased. The remaining 9 patients are still alive, but all present progression. There was no statistically significant difference in the real time to progression, or in the estimated cancer related and overall survival between both groups. Mean time to progression was 29 months in group 1 (orchiectomy alone), and 26 months in group 2 (orchiectomy and Mitomycin C) (p = 0.64). Mean time to cancer related death was 32 months and mean overall survival was 31 months in both groups. CONCLUSIONS: Mitomycin C has no beneficial effect when used in conjunction to orchiectomy in patients with newly diagnosed metastatic prostate cancer.

Ureteroscopic treatment of ureteric lithiasis. Analysis of 354 urs procedures in a community hospital.

INTRODUCTION: The optimal treatment of ureteric lithiasis continues to be a point of discussion, as there are different treatment modalities. Conservative treatment, EWSL, ureteroscopy (URS), percutaneous litholapaxy, and (laparoscopic) ureterolithotomy, all have there place in the treatment of ureteric lithiasis. In order to evaluate if ureteroscopy is a valuable alternative to ESWL in the treatment of ureteric lithiasis, an analysis of all the ureteroscopies performed in our institution was made and these results were compared with results (both ESWL and URS) described in literature. PATIENTS AND METHODS: During the period 1990 till 1997, 292 patients underwent in our institution in total 354 ureteroscopies for ureteric lithiasis. In all procedures a rigid 9 Fr. ureteroscope was used, together with laser lithotripsy or pneumatic lithotripsy as fragmentation device. RESULTS: Overall success rate in our series was 90.1%, with distal and middle ureteric stone location being more favorable (94% and 95%) than proximal location (73%). Overall complication rate was 7.6% (including minor complications, such as ureteral mucosal tear), for which open surgical intervention had to be performed in 2.3% of cases. CONCLUSIONS: Although invasive, ureteroscopy proved to be a very competitive alternative to ESWL, when treating ureteric lithiasis. Success rates are equal, if not better, using ureteroscopy when compared to ESWL. Complications of ureteroscopy are infrequent, but do exist. Therefore ureteroscopy should be performed by experienced urologists.

Endoscopical management of ureteral trauma.

Ureteric injuries are encountered with increasing frequency. Adequate definitions and etiologies are discussed. All treatment modalities are summarised with special attention for the use of JJ stents, the different endourological approaches and "urological pearls".

Radical prostatectomy and prognostic factors.

OBJECTIVES: Prognosis of patients who have been treated by radical prostatectomy, because of prostatic carcinoma, is dependent on a number of factors. In this study we try to determine these factors, their relationship with each other, their relationship with progression of disease and the prognostic value of this relationship. METHODS: "Progression" (or relapse) of disease is defined as clinical evidence of local or general recurrence and/or isolated elevation of postoperative PSA level more than 0.2 ng/ml (Hybritech) at two consecutive outpatient visits. In our institution, 62 radical retropubic prostatectomies were performed over a period of 66 months. Without any exclusion, these patients were included in the analysis (with respect to "progression"), which consisted of bi- and multivariate analyses, Kaplan-Meier estimations and multivariate survival analyses using the "Cox proportional hazards model". Median follow-up time was 32 months. RESULTS: "Progression" was seen in 24.5% of cases, after a median progression-free interval of 13 months. Overall survival and freedom from "progression" (FFP) after 32 months were respectively 98.11% and 81.11%. Significant relations can be demonstrated between on one side preoperative PSA level, and on the other side "progression". FFP after 32 months for pathological T3-T4NO-1 tumors is 67.12% compared to 100% for pathological T2 tumors; FFP after 32 months is 88.98% for Gleason score of resection specimen < 7 and 73.86% for Gleason score > or = 7. Age, preoperative PSA level, Gleason score of resection specimen, surgical margin and 1-month-postoperative PSA level have in our analysis significant value (p < 0.05) in predicting "progression". CONCLUSIONS: Most in the literature described predictive factors for "progression" are fairly well reproduced in our analysis. Elimination of bias from applied (neo-)adjuvant therapy and less heterogeneity of the study group would most certainly improve this reproducibility.

Interim results on a randomized trial of mitomycin C in combination with orchidectomy for newly diagnosed metastatic prostate cancer.

The interim results of a randomized trial comparing orchidectomy alone versus orchidectomy and mitomycin C in 178 newly diagnosed metastatic prostate cancer patients are presented. Of 148 evaluable patients 75 were treated with orchidectomy alone and 73 received adjuvant intravenous mitomycin C. Mean time to progression was 15 months in the orchidectomy group versus 14 months in the mitomycin C group. Interim analysis did not demonstrate a favorable effect of the combination with this chemotherapeutic agent compared to orchidectomy alone (P = .45).

Adenoid cystic carcinoma of the prostate.

A case of a patient with this extremely rare tumor is described. Adenoid cystic carcinoma of the prostate should be considered as a subtype of prostate adenocarcinoma. Since this tumor can be associated with a prostatic adenocarcinoma, it should be regarded as malignant.

Mitomycin C in combination with orchiectomy for newly diagnosed metastatic prostate cancer: preliminary results on a randomized trial.

The preliminary results of a randomized trial comparing orchiectomy versus orchiectomy and mitomycin C in 119 newly diagnosed metastatic prostate cancer patients are presented. Of 109 evaluable patients 57 were treated with orchiectomy alone and 52 received adjuvant intravenous mitomycin C. Mean interval to progression was 13 months in the orchiectomy group versus 11 months in the mitomycin C group. Preliminary analysis did not demonstrate a favorable effect of the combination with this chemotherapeutic agent compared to orchiectomy alone (p = 0.3).

Endopyelotomy. Evaluation of a limited experience.

Endopyelotomy is a recently developed endo-urological technique which gets to be standardised and gradually may replace the open pyeloplasty. Our technique is described and the early results are presented.

Syringocele, a rare lesion of Cowper's gland.

Syringocele are retentioncysts of Cowper's glands. First described by Fenwick, Maizels rediscovered them and made a very usefull classification. These cysts are more common than previously reported. They can be very obstructive for the urinary flow or cause no symptoms at all. Most are congenital. In our series we studied 5 patients with syringoceles. Treatment consisted in broad endoscopic unroofing. The results with this type of surgery are good. Follow-up showed all the patients to void well and to be free of other irritative symptoms.

Prophylactic chemotherapy with fosfomycin trometamol versus placebo during transurethral prostatic resection.

A prospective randomized controlled double-blind study was performed on 61 patients undergoing transurethral resection of the prostate. The first group of 31 patients received 3 g fosfomycin trometamol p.o. each on the evening before and after the operation; the second group of 30 patients received a placebo. Urine samples were taken by catheter puncture 24 and 48 h postoperative. After removal of the catheter (day 5) the first midstream urine was collected for culture, and from that moment on all patients were treated with a nitrofurantoin derivative for two weeks. Although the same strict antiseptic measures were standard practice for both groups, the incidence of early postoperative urinary tract infections was significantly lower for the fosfomycin trometamol group (0/31 versus 6/30 in placebo recipients). None of the patients suffered from a major symptomatic or complicated infection. There were no side effects registered.

Use of transrectal longitudinal sonography in the placement of a prostatic coil.

Patients with acute or chronic urinary retention, not suitable for operation, no longer need permanent transurethral or suprapubic catheters. The prostatic coil is an excellent alternative. A series of 25 patients is presented. The technique of placement is described in detail as well as the use of longitudinal transrectal sonography in the preparation and follow-up of patients with a coil.

Fournier's gangrene. Report of three cases and review of the literature.

Fournier's gangrene, or synergistic gangrene of the male external genitalia is a rapidly spreading necrotising infection of the penis and scrotum. Although not so frequent in our civilized world it is by no means rare. In early days it was characterised by a high mortality. Aggressive surgical debridement, broad spectrum antibiotics and plastic reconstructive technics have all contributed to a better survival of the patients.

Second-generation lithotripsy: a safe, noninvasive, ambulatory procedure.

A total of 600 patients underwent 696 treatments of extracorporeal shockwave lithotripsy (ESWL) during the period between June and November 1987. Our progressively increasing experience with the second-generation device shows that this new unit is as effective as the conventional one, and reveals several advantages. The focusing of the stone is easier; therapy time is shorter; general or regional anesthesia is no longer necessary; distal ureteral stones can be disintegrated, and adjuvant procedures are easily performed during the ESWL session. Of the last 400 patients of our series, 76% were treated on an outpatient basis without any major complications.

Actual approach to cystic nephroma.

Recent opinions on the pathology, diagnostic methods and treatment of cystic nephroma are presented. This will be illustrated by a review of 10 patients with known cystic nephroma, operated and followed by our department. There is clear evidence that cystic nephroma is a benign lesion of the kidney, although the existence of two types of lesions has not definitely been excluded. Sonography and computerized tomography are effective methods for the identification of the lesions preoperatively. In doing so a conservative surgical approach is the treatment of choice.