Postmicturition Dribble: A Physiological Phenomenon?

BACKGROUND: Postmicturition dribble (PMD) is a common condition in the male population. OBJECTIVES: Despite its common occurrence, there are only a few studies on this topic so far. The aim of this study was to investigate possible physiological aspects of PMD. METHOD: Seventeen men complaining of PMD and 10 healthy subjects were assessed via uroflometry, IPSS questionnaire, IIEF-5 questionnaire, and an adapted visual analogue scale (VAS) for ejaculation force -(0-10) and the amount of bother concerning PMD (0-10) were completed. In addition to that, a retrograde urethrography at 40 and 60 cm water column as pressure unit to measure the width of the bulbar urethra was performed, and the amount of PMD was measured with an adjusted pad test. RESULTS: The PMD group showed a significantly worse IPSS score, a lower Qmax rate in uroflowmetry, a worse IIEF-5 score, and a worse VAS score concerning ejaculation force. In both groups, worse IPSS levels correlated with a low bulbar urethral diameter at 40 and 60 cm water column. -Another correlation was found between a high maximum urine flow rate and a larger bulbar urethral diameter at 40 and 60 cm. Both groups showed urine loss after micturition, with no bother (VAS 0) in the control group, whereas the PMD group showed a VAS of 6. CONCLUSIONS: PMD should be regarded as a physiological occurrence in men rather than a disease by itself. Suffering is only to be expected in combination with other lower urinary tract symptoms.

Bladder cancer in nonagenarians: a multicentre study of 123 patients.

OBJECTIVE: To investigate the oncological outcome of nonagenarians with bladder cancer, as a substantial rise in bladder cancer in the old-old age group in the upcoming decades is expected, due to demographic changes and the peak incidence around the age of 85 years. The paucity of data of nonagenarians prompted us to investigate the outcomes of such patients. PATIENTS AND METHODS: A retrospective, multicentre study was designed to assess patient demographics, tumour patterns, treatment strategies and outcome in patients aged ≥90 years treated at participating centres. Patients entered either as de novo or as recurrent cancer. The study period ranged from 01.01.2006 to 31.12.2016. RESULTS: A total of 123 patients with a mean (range) age of 91 (90-99) years were recruited. The American Society of Anesthesiologists Physical Status Classification (ASA-score) distribution was as follows: II, 38%; III, 50%; IV, 12%; and the male to female ratio 2.4:1. The median (range) follow-up was 8 (1-132) months. In all, 60% of patients had a de novo cancer diagnosis. Histological findings revealed: pTa 39% (n = 48), pT1 28.5% (n = 35), and ≥pT2 33% (n = 40). Overall, 67.5% patients had no recurrence, 25.2% one and 7.5% two or more. pTa tumours (n = 48) recurred in 20 patients (42%), pT1 tumours (n = 35) in 12 (34%), and ≥pT2 tumours (n = 40) in six (15%). The median overall survival (OS) was 30.0 months for patients with pTa tumours, 14.0 months for pT1 tumours, and 6.0 months for ≥pT2 tumours. The overall mortality rate of patients with pTa tumours was 40%, with pT1 tumours at 60%, and ≥pT2 tumours 75%. The ASA-score also had a strong influence on median OS after stratification by ASA-score (II, 30 months; III, 12 months; IV, 4 months). CONCLUSIONS: In nonagenarians with bladder tumours, pTa/pT1/≥pT2 stages are almost evenly distributed and two-thirds of patients had no recurrence after transurethral resection of the bladder. The mean OS was 1.3 years, and 6 months for ≥pT2 tumours. Further case-series of patients in this specific age-group are required to identify the best management of this increasing proportion of patients with bladder tumours.

The Correlation of Prostate Volume and Prostate-specific Antigen Levels With Positive Bacterial Prostate Tissue Cultures.

OBJECTIVE: To compare prostate volume and prostate-specific antigen (PSA) levels with bacterial growth in prostate tissue cultures. MATERIALS AND METHODS: Fifty male patients who underwent transurethral prostate resection were investigated prospectively. Resection chips from the prostate gland were added to brain-heart infusion medium and incubated. PSA levels were determined preoperatively at our urology ward. The prostate gland volume was estimated by transabdominal ultrasound examination preoperatively. RESULTS: Persons with positive bacterial prostate tissue cultures have a greater prostate volume. This is significant in patients with and without histopathologic signs of prostatitis. Persons with positive bacterial prostate tissue cultures have higher PSA values. This is significant in patients without histopathologic signs of prostatitis. CONCLUSION: People with positive bacterial prostatic tissue culture have a higher prostate volume in comparison with patients with negative culture findings and show a tendency toward increased PSA levels as well.

Renal Autotransplantation in Metachronous Solitary Contralateral Ureteral Metastasis from Renal Cell Carcinoma: A Case Report.

Ureteral metastasis of renal cell carcinoma (RCC) is rare and usually confined to the ipsilateral ureter. In literature, about 50 cases have been reported so far. Of these, only 14 metastasized metachronously to the contralateral ureter.A seventy-one-year-old man was hospitalized with recurrent painless severe haematuria. Seven years previously, he had undergone radical nephrectomy of the right kidney due to a clearcell renal cell carcinoma (cRCC), Fuhrman grad 2. Intravenous urography and a retrograde ureterogram revealed a filling defect (25 mm) in the left distal ureter, which we expected to be an urothelial carcinoma. Biopsy was not possible, due to ureteral stricture. Diagnostic workup revealed no other sites of metastasis. To preserve kidney function and quality of life we refrainedfrom performing nephroureterectomy and opted for an autotransplantation of the solitary left kidney with ureteral reimplantation in the bladder. We resected the ureter and histopathologicial examination showed a metastasis of cRCC, Fuhrman grade 2.Postoperatively, the patient developed an acute postrenal failure, hence a nephrostomy and a bladder catherization were performed. After this, the patient improved significantly and the drains could be removed. Currently the patient is free of complaints. The residual and contralateral ureter is a potential metastatic site after RCC. Autotransplantation is an option forsurgical treatment.

Telephone - delivered quality of life after 365 male stress urinary incontinence (SUI) operations

ABSTRACT Objectives: To assess patient satisfaction and quality of life and factors that may be related to these outcomes. Materials and Methods: Between 2000 and 2008 a retrospective chart review and telephone survey of all surgeries for male SUI was performed. Average age at times of operation was 69.4 ± 7.4 (median 69). As part of the survey 270 of 365 patients were available (response rate: 74%). The average follow up time (from operation to telephone survey) was 34.8 ± 22.8 months (median 32). Results: Pad use per day improved significantly after operation from 6.23±5.3 to 1.61±2.92 pads/day (p=0.001). 74.7% (n=198) declared to be continent with one safety pad and 87.7% (n=236) confirmed the postoperative improvement of incontinence. 189 (70.5%) patients were “very satisfied” and “satisfied”. In 81% (n=218) the expectation in operation could be met, therefore 84.3% (n=226) would undergo it again and 90.3% (n=243) would recommend it to others. Lower age (rs=0.211), few postoperative pads per day (rs=0.58), high reduction of pads (rs=-0.35) and physical activity level (rs=0.2) correlate significantly with better satisfaction. Conclusions: Eighty-seven pint seven percent (87.7%) of our incontinence operations (n=236) lead to an improvement, which is independent from the number of prior incontinence operations and preoperative pad count. The postoperative quality of life remains constant over the observed follow up time. Certain subgroups of patients (younger age, high physical activity level, large reduction of pads) demonstrated superior satisfaction rates.

Telephone - delivered quality of life after 365 male stress urinary incontinence (SUI) operations.

OBJECTIVES: To assess patient satisfaction and quality of life and factors that may be related to these outcomes. MATERIALS AND METHODS: Between 2000 and 2008 a retrospective chart review and te¬lephone survey of all surgeries for male SUI was performed. Average age at times of operation was 69.4 ± 7.4 (median 69). As part of the survey 270 of 365 patients were available (response rate: 74%). The average follow up time (from operation to telepho¬ne survey) was 34.8 ± 22.8 months (median 32). RESULTS: Pad use per day improved significantly after operation from 6.23±5.3 to 1.61±2.92 pads/day (p=0.001). 74.7% (n=198) declared to be continent with one safety pad and 87.7% (n=236) confirmed the postoperative improvement of incontinence. 189 (70.5%) patients were "very satisfied" and "satisfied". In 81% (n=218) the expectation in operation could be met, therefore 84.3% (n=226) would undergo it again and 90.3% (n=243) would recommend it to others. Lower age (rs=0.211), few postoperative pads per day (rs=0.58), high reduction of pads (rs=-0.35) and physical activity level (rs=0.2) correlate significantly with better satisfaction. CONCLUSIONS: Eighty-seven pint seven percent (87.7%) of our incontinence operations (n=236) lead to an improvement, which is independent from the number of prior in¬continence operations and preoperative pad count. The postoperative quality of life remains constant over the observed follow up time. Certain subgroups of patients (younger age, high physical activity level, large reduction of pads) demonstrated su¬perior satisfaction rates.

Diversity of Bacterial Urine and Prostate Gland Tissue Cultures in Patients Undergoing Transurethral Prostate Gland Resection.

INTRODUCTION: The objective of this study was to identify the types of bacterial colonization of the prostate gland tissue and urine pre- and postoperatively in patients undergoing a transurethral resection (TUR) of the prostate gland. In addition, clinical symptoms and histopathological findings were included. MATERIAL AND METHODS: Forty three patients were investigated. Urine test strips and urine cultures were taken pre- and postoperatively and intraoperatively prostate resection chips were taken for culture. RESULTS: A positive bacterial culture was found in 20 of 43 (46.5%) patients. Preoperatively, a positive bacterial culture was found in 12 patients and postoperatively in 7 patients. Thirteen patients showed a positive culture of the prostate gland tissue. No patient showed the same bacterial isolates in all 3 samples. Postinterventionally, 6 patients of the group with positive bacterial cultures developed complications. From the group of patients without bacterial growth, only one patient developed a postoperative complication. CONCLUSION: The bacterial colonization in the 3 different cultures showed an inhomogeneous spectrum of bacteria without a reproducible pattern. Nevertheless, it clearly demonstrates that the group with a positive culture is at great risk to develop postoperative complications.

[An incidental finding of retrocaval extraadrenal pheochromocytoma]. / Das retrocavale extraadrenale Phäochromozytom als Zufallsbefund.

As part of diagnostic work-up of a 71-year-old patient with resistant hypertension, an extraadrenal mass was found. After further imaging and biochemical evaluation an extraadrenal pheochromocytoma was diagnosed and after alpha-receptor blockade was removed via posterior approach laparoscopically in the course. The pheochromocytoma is a rare catecholamine-producing tumor with an incidence of 1-2 per 100 000. In about 1-25 % it is located extraadrenal. Establishing the diagnosis is dependent on the demonstration of significant catecholamine excess. Afterwards imaging with CT or MRI should be performed. After administration of alpha-blockers, the complete surgical resection is the treatment of choice.

Laparoscopic treatment of a spontaneously ruptured kidney (wunderlich syndrome).

Spontaneous, nontraumatic retroperitoneal hemorrhage or Wunderlich syndrome (WS) is a rare but potential life-threatening condition. In most patients a bleeding renal neoplasm is the cause of the retroperitoneal hematoma. The management of this condition includes a conservative approach in the hemodynamically stable patients and active treatment in the unstable patients. Active treatment includes angioembolization or surgery. If angioembolization is not available open surgery is in most cases the preferred approach. We present a patient with a spontaneously ruptured kidney due to a central renal angiomyolipoma, which was treated by laparoscopic nephrectomy.