Localized staging of prostate carcinoma: comparison of transrectal ultrasound and magnetic resonance imaging.

To evaluate the usefulness of two new imaging modalities in the clinical staging of prostate cancer the following study was done. Twelve patients with biopsy-proved carcinoma of the prostate were evaluated preoperatively with magnetic resonance imaging (MRI) of the pelvis and transrectal ultrasound of the prostate. The main parameters evaluated were the ability of these two modalities to accurately predict capsular penetration and seminal vesicle involvement in these 12 patients: 10 went on to pelvic lymph node dissections, and 8 had radical retropubic prostatectomies. Thus the preoperative studies could be compared to the pathologic results. Based on our results we believe transrectal ultrasonography is more accurate in the assessment of seminal vesicle involvement and comparable to MRI in determining capsular penetration. Because of the lower cost of ultrasound we believe it to be both an economical and accurate way to preoperatively stage prostate carcinoma.

Experimental continent diversion.

Urinary diversion utilizing a continence-maintaining ileal valve has been performed in 12 canines. This procedure offers a simple surgical procedure and uses the diversion's internal fluid pressure to maintain continence. Of 12 canines with this continence-maintaining ileal valve, 11 remained continent at sacrifice. Operative complications were minimal and late complications occurred in 2 dogs. Histological evaluation of the diversionary tissues revealed slight changes in the mucosa of the ileal valve, with some flattening of the villi. This procedure may have a clinical role in urinary diversion for patients with pelvic malignancy or patients who need urinary diversion for other reasons.

The prophylactic use of clean intermittent catheterization in the treatment of infants and young children with myelomeningocele and neurogenic bladder dysfunction.

To examine the hypothesis that the prophylactic use of clean intermittent catheterization can prevent urinary tract deterioration in infants and young children with myelomeningocele a prospective controlled study was performed on 24 patients. Preliminary results indicate that more than 50 per cent of the patients with bladder sphincter incoordination managed by self-voiding had urinary tract deterioration. In contrast, in only 10 per cent of the patients treated prophylactically with clean intermittent catheterization did deterioration occur. We conclude that when bladder sphincter incoordination is diagnosed in children with myelomeningocele they are at a high risk for the development of future urinary tract injury. The prophylactic use of clean intermittent catheterization can actually prevent this deterioration and its use in this manner is recommended.