[Percutaneous ablation of malignant kidney tumors in rabbits by low frequency radio energy].

Radio-frequency (RF) current has been used successfully to ablate normal human tissue. To investigate further the clinical application of this modality in tumors, we studied the potential of using RF percutaneously to destroy experimental kidney tumors. 35 outbred albino rabbits underwent direct-implantation of renal VX2 tumor during open surgery. After 21 days, ultrasonography was performed to show tumor presence and size. A shielded RF needle was designed to be inserted percutaneously through an introduction needle. An electrical insulation shield covering the RF needle was retractable, controlling the length of exposure of the RF needle inside the tissue. 22 days after tumor implantation, RF was applied via this special needle using a ZoMed International RF generator. In one group of rabbits the procedure was performed under direct vision during open surgery, while in another group treatment was percutaneous, the needle guided by palpation of the tumor. Rabbits were killed 3 days later and revealed 4-25 mm intra-tumoral RF-induced lesions. A direct relation was found between lesion size and the power and duration of RF applied (at 7.5 W, R = 0.48, and P = 0.32). Based on our preliminary results we can conclude that RF may have clinical applications in the near future for percutaneous local tumor control in parenchymal organs.

Transurethral needle ablation of the prostate for the treatment of benign prostatic hyperplasia: a collaborative multicentre study.

OBJECTIVE: To assess the efficacy and safety of transurethral needle ablation of the prostate (TUNA) for patients with symptomatic benign prostatic hyperplasia (BPH) in a multicentre trial. PATIENTS AND METHODS: Seventy-six patients were recruited from five centres; all were treated with the TUNA system consisting of a powered radiofrequency generator and a TUNA catheter. The patients were evaluated prospectively using the international prostate symptom score (IPSS), uroflowmetry, quality-of-life score, and other variables, and followed for a mean of 12 months after treatment. RESULTS: Sixty-eight patients were available for follow-up: TUNA produced significant improvements in the IPSS (median 22 before, to 7.5 after treatment). urinary flow rate (mean 8.7 before, to 11.6 mL/s after treatment) and quality-of-life score (median 5 before, to 2 after treatment) at 12 months. CONCLUSIONS: If these early promising results are maintained. In the medium to long term, TUNA therapy will be a useful low-morbidity alternative for patients with symptomatic BPH.

Transurethral hyperthermia for relieving obstructive voiding symptoms in patients with hormone refractory prostate cancer.

Transurethral thermal treatment has been used to relieve obstructive voiding symptoms in 10 patients with prostate cancer. All patients failed previous endocrine treatment for the relief of obstructing urinary symptoms. Temperature ranging from 46 degrees C to 47 degrees C was applied transurethrally using Thermex II thermal system. Treatment was given in a single session for a duration of 180 minutes on an outpatient basis without sedation. Mean duration of follow-up was 8.5 months (range 4-13 months). Maximal urine flow rate, post-voiding residual volumes and changes in subjective symptoms were used to assess treatment response. Removal of an indwelling catheter was possible in all 3 patients with chronic retention. Urinary infection (2 patients) and temporary retention (3 patients) were the only complications recorded. The preliminary results suggest that transurethral hyperthermia is a well-tolerated, safe and effective procedure for obstructive voiding symptoms in patients with hormone refractory prostate cancer. Longer follow-up and a larger group of patients is required to assess this alternative modality.

Percutaneous ablation of malignant liver tumor in rabbits using low radio frequency energy.

Radio frequency (RF) current has been used successfully to ablate normal human tissue. To further investigate the clinical application of this modality in tumors we studied the potential of using RF percutaneously to destroy experimental liver tumors. Thirty five outbred albino rabbits underwent liver VX2 tumor direct-implantation during open surgery. After 21 days ultrasonography was performed revealing tumor presence and size. A shielded RF needle was designed so that it could be inserted percutaneously through an introducing needle, and an electrical insulation shield covering the RF needle could be retracted to control the length of the exposed RF needle inside the tissue. Twenty two days after tumor implantation RF was applied via the aforementioned needle using a ZoMed International RF generator. In one group of rabbits the procedure was performed under direct vision during open surgery and on the other group treatment was applied percutaneously, guiding the needle by tumor palpation. Rabbits were killed 3 days later and pathology revealed 4 to 25 mm intratumoral RF induced lesions. A direct relation was found between lesion size, power and duration of RF application (At 7.5 W, r = 0.48, p = 0.032). Based on our preliminary results we may conclude that RF may have clinical application in the near future for percutaneous local tumor control in parenchymal organs.

The role of nuclear morphometry for predicting disease outcome in patients with localized renal cell carcinoma.

BACKGROUND: More than one-third of patients with localized renal cell carcinoma (RCC) will have disease progression after nephrectomy. Present histopathologic variables cannot accurately predict the outcome of individual patients. METHODS: Nuclear morphometry was performed by an image analyzer on histologic sections from 39 specimens of pathologic T1 and T2 classification RCC. All patients underwent radical nephrectomy and were followed for a mean of 7.6 years. A univariate analysis and then a multivariate stepwise regression method were used to correlate results with patients' outcome. RESULTS: The best predictors of disease free interval were mean nuclear elongation factor (MNEF) (P = 0.023), mean nuclear regularity factor (MNRF) (P = 0.034), and mean nuclear area (MNA) (N = 0.038). Univariate analysis identified a significant correlation between patient survival and MNEF (P = 0.009), MNRF (P = 0.020) and MNA (P = 0.023). Combination of MNEF and MNA was even more strongly associated with survival (P = 0.0013). Multivariate analysis revealed that MNA (P = 0.044) and MNEF (P = 0.045) correlated independently with survival. CONCLUSION: These results suggest that nuclear morphometry provides objective independent prognostic information for patients with localized RCC.

Acute scrotum caused by Henoch-Schönlein purpura, with immediate response to short-term steroid therapy.

The authors report a case of acute scrotum caused by Henoch-Schönlein purpura. It involved bilateral swelling of the epididymis and testes, which was documented by scrotal ultrasonography and which responded immediately to systemic steroid treatment.

Papaverine-phentolamine and prostaglandin E1 versus papaverine-phentolamine alone for intracorporeal injection therapy: a clinical double-blind study.

PURPOSE: A study was designed to compare intracorporeal injections of papaverine plus phentolamine (2-drug solution) and papaverine plus phentolamine and prostaglandin E1 (3-drug solution) for the treatment for impotence. MATERIALS AND METHODS: A total of 20 impotent patients received intracorporeal injections of the 2-drug or 3-drug solution alternately during 2 sessions, and the quality and duration of erections were assessed. RESULTS: Of the patients 73% achieved a full erection with the 3-drug solution compared to 28% with the 2-drug solution. The average duration of erections was 57 minutes and 33.6 minutes, respectively. The complication rate was similar for the 2 treatments. CONCLUSIONS: Papaverine plus phentolamine and prostaglandin E1 is superior to papaverine plus phentolamine alone for the treatment of impotence.

Testicular seminoma: clinical significance of nuclear deoxyribonucleic acid ploidy pattern as studied by flow cytometry.

PURPOSE: We evaluated the clinical significance of deoxyribonucleic acid (DNA) ploidy pattern as a predictor of prognosis in patients with testicular seminoma. MATERIALS AND METHODS: Flow cytometric nuclear DNA analysis was performed on archival specimens from 65 patients with pure seminoma who underwent radical orchiectomy between 1970 and 1992. RESULTS: A total of 42 specimens (65%) exhibited a DNA diploid pattern, while 23 (35%) were DNA aneuploid. Diploidy was manifested in 73% of the stage I tumors versus 31% of stage II cancers (p = 0.004). No correlation was found between ploidy and histological type, size or local extension of the tumor. Tumor progression was observed in 5 patients, exclusively displaying aneuploid histograms (p = 0.0017), and 3 of them subsequently died of the disease. CONCLUSIONS: DNA ploidy pattern may provide important prognostic information for patients with testicular seminoma.

Incidental appendectomy during urological surgery.

PURPOSE: To investigate the issue of incidental appendectomy during urological surgery we retrospectively studied its consequences in 2 groups of urological patients. MATERIALS AND METHODS: We studied 147 patients undergoing cystectomy and urinary diversion (group 1) and 200 undergoing primary retroperitoneal lymphadenectomy (group 2). Incidental appendectomy was performed in 122 (83%) and 114 (57%) patients, respectively. RESULTS: The incidence of infectious complications in group 2 was significantly higher among patients who underwent incidental appendectomy compared to those without appendectomy (9.6% and 2.3%, respectively, p = 0.032). No difference was noted among the patients in group 1 (10.6% and 12.0%, respectively, p = 0.51). CONCLUSIONS: When evaluating the prophylactic merits, incidental appendectomy can be performed safely during radical cystectomy and urinary diversion. It is probably contraindicated in patients undergoing retroperitoneal lymphadenectomy for testis cancer due to the apparent added risk of infectious complications.

Reconsidering the necessity of ipsilateral adrenalectomy during radical nephrectomy for renal cell carcinoma.

OBJECTIVES: Ipsilateral adrenalectomy is traditionally advocated as part of radical nephrectomy performed for renal cell carcinoma. The current study addresses the controversy of whether ipsilateral adrenalectomy should be performed routinely during radical nephrectomy. METHODS: A total of 225 patients were treated surgically for renal cell carcinoma over an 18-year period. Of these patients, 158 underwent nephrectomy and simultaneous ipsilateral adrenalectomy and the other 67 had sparing of the ipsilateral adrenal gland. A retrospective analysis of the medical records and assessment of the clinical and the pathologic data were performed. Rates of survival and progression were evaluated in a subgroup of 109 patients, further subdivided into 54 patients who underwent concomitant adrenalectomy and 55 patients with the ipsilateral adrenal preserved during surgery. RESULTS: Histopathologic abnormalities were detected in seven adrenal specimens (4.4%); however, only 3 patients (1.9%) had involvement of the adrenal by renal cell carcinoma. All cases of adrenal involvement were detected by the preoperative imaging modalities. Ipsilateral adrenalectomy did not improve the outcome in comparison to adrenal preservation. CONCLUSIONS: In view of the rarity of ipsilateral adrenal metastasis, the questionable prognostic merits of concomitant adrenalectomy, and the availability of accurate imaging modalities, we conclude that ipsilateral adrenalectomy is not necessary in the majority of the patients undergoing radical nephrectomy for renal cell carcinoma.

Ultrasonographic evaluation and clinical correlation of intratesticular lesions: a series of 39 cases.

OBJECTIVE: To assess the accuracy, specificity and sensitivity of ultrasonography (US) for diagnosing testicular tumours. PATIENTS AND METHODS: Ultrasonography of the scrotum was performed in 39 patients (mean age 20.3 years, range 3-61) referred to the hospital because of pain, tenderness, appearance of a mass in the scrotum or swelling of the scrotum after trauma. RESULTS: Intratesticular lesions were detected by US in 35 patients and four had no suspicious findings after surgical exploration of the scrotum based solely on clinical findings. In five patients the findings on US were compatible with neoplasm, but at surgery or follow-up, no tumour was found. In one case, the US findings suggested inflammation, but on exploration 3 weeks later, an embryonal cell carcinoma was found. CONCLUSIONS: While very sensitive in differentiating an intra-from an extratesticular lesion, and in ruling out a testicular tumour (sensitivity 96.6%), the US examination is less specific (specificity 44.4%) as the US pattern of different benign process may be similar to those of tumours. The positive predictive value (85.3%) and the accuracy (84.6%) imply that when an intratesticular lesion is detected on US, even when there is no clinical suspicion of neoplasm, exploration of the scrotum is indicated.

Radical retropubic prostatectomy in the treatment of localized prostate cancer: experience with 100 consecutive cases.

In recent years radical retropubic prostatectomy is used with increasing frequency to treat localized cancer of the prostate. We report our experience with 100 consecutive cases of prostate cancer that underwent this operation; there were no cases of mortality and a 7% rate of postoperative complications. More than 90% of the patients are socially continent postoperatively and 20% have retained sexual potency. Ninety-four percent of the patients are free of disease (mean follow-up period 18 months). In our opinion, such results support the use of radical retropubic prostatectomy for the treatment of localized prostate cancer in well-selected patients.

Controlled trial of high spermatic vein ligation for varicocele in infertile men.

OBJECTIVE: To determine whether high ligation is an effective treatment for infertile men with clinical varicocele. DESIGN: A randomized, controlled trial of high spermatic vein ligation was carried out. The patients were treated and observed for 3 years. SETTING: Infertility treatment clinic and andrology laboratory in a hospital. PATIENTS: Infertile men with abnormal semen analysis because of varicocele only. INTERVENTION: High ligation 1 year postrecruitment (group A) and at the beginning of the study (group B). RESULTS: Among the 20 couples in group A, 2 pregnancies (10%) were achieved within the 1st year of observation period. During the year after high ligation, there were 8 pregnancies (44.4%), and during the 2nd year after high ligation, there were 4 more pregnancies (22.2%). In group B, 15 pregnancies (60%) occurred within the 1st year after operation. Three pregnancies (12%) and 1 pregnancy (4%) occurred during the 2nd and 3rd year, respectively. After operation in all patients of both groups, there was significant improvement in semen parameters, regardless of pregnancy occurrence. The difference in pregnancy rate (PR) between the operated group B and nonoperated group A during the 1st year of study was found to be highly significant. CONCLUSIONS: It is concluded that in a population of infertile men presenting varicocele as the only demonstrable factor of infertility, the varicocele is clearly associated with infertility and reduced testicular function, and its correction by ligation improves sperm parameters and fertility rate. Furthermore, the highest PR in both groups occurred during the 1st year postoperation.

Intraoperative irrigation with bupivacaine for analgesia after orchiopexy and herniorrhaphy in children.

Effective postoperative analgesia is important, especially in pediatric surgery. The efficacy of intraoperative surgical wound irrigation with bupivacaine for postoperative analgesia was investigated in 90 children undergoing elective inguinoscrotal surgery. We found that this method effectively reduced postoperative pain and narcotic drug requirement. Bupivacaine irrigation was simple and complication-free. We believe that the irrigation of surgical wounds with bupivacaine should be a routine procedure in elective inguinoscrotal surgery in children.

Pitfalls in the detection of urinary extravasation following major urinary tract reconstructive surgery.

Urinary extravasation may complicate the postoperative course of urinary tract reconstructive surgery. Early diagnosis of extravasation is critical in the postoperative management. In this study we assessed prospectively the various diagnostic techniques employed in the detection and documentation of urinary extravasation in 76 consecutive patients who underwent major urinary tract reconstructive surgery. Assessment included measurements of the volume of the fluid obtained from the drains, analysis of serum to fluid creatinine ratio, detection of intravenously injected indigo dye and traditional radiographic evaluation. Urinary extravasation was detected in 7 patients (9.2%). Increased creatinine ratio had the highest diagnostic accuracy: 97.3%, sensitivity 71.4% and specificity 100%. Various radiological investigations had accuracy of 96%, sensitivity 85.7% and specificity 97.1%. The combined use of these methods detected all cases of urinary extravasation with sensitivity, specificity and total accuracy of 100%. Fluctuations in the volume of fluid in the drains and intravenous injection of indigo dye had lower accuracy, sensitivity and specificity and added very little to the workup. We conclude that radiological investigations and creatinine ratio analysis are highly accurate complementary methods for the early detection and monitoring of urinary extravasation following reconstructive urinary tract surgery.

Does the use of the ileocecal region in reconstructive urology cause persistent diarrhea?

The ileocecal region (ICR) is used extensively in reconstructive urological surgery. To evaluate whether resection of the ICR may cause protracted diarrhea, 50 patients undergoing ileocecal resection were studied. Fifty patients undergoing left colectomy for cancer were used as controls. No significant change in bowel habits was noted in the control group. Among patients undergoing ICR resection 42% had transient loosening of stools 2 weeks after surgery which improved within 3 months. Twelve months after surgery only 6 patients with solid stools preoperatively had loose stools, and none suffered diarrhea. In conclusion, in the patients studied after resection of the ICR diarrhea gradually resolved. More work is necessary to study other potential metabolic consequences of such resection.