Systematic transperineal ultrasound guided template biopsy of the prostate in patients at high risk.

PURPOSE: A negative biopsy result does not necessarily equate with cancer in specific high risk groups. We describe an alternative systematic biopsy technique for evaluating this subgroup of patients. MATERIALS AND METHODS: From March 1997 to May 1999 a total of 88 men underwent systematic ultrasound guided biopsy using the transperineal template technique. All patients had undergone at least 1 and 75 (85%) had undergone 2 or more previous sets of biopsies. In addition, study inclusion required high risk parameters, including prostate specific antigen (PSA) velocity greater than 0.75 ng./ml., PSA greater than 10 ng./ml. or previous prostatic intraepithelial neoplasia on biopsy, and/or atypical small cell acinar proliferation. RESULTS: Cancer was identified in 38 of the 88 men (43%) in this high risk subgroup undergoing repeat biopsy. A mean of 15.1 previous biopsy cores had been obtained. The most common biopsy grade was 6 (range 4 to 9). Adenocarcinoma was identified in the transition zone area in 29 of 38 cases (76%), including 15 (39%) in which disease was detected in the transition zone only. Persistent PSA acceleration greater than 0.75 ng./ml. was the major indicator for transperineal template biopsy in 83 of the 88 patients (94%). The only significant independent variable predictive of positive biopsy was prostate volume. Mean prostate volume in the positive and negative biopsy groups was 48 and 73 gm., respectively (p <0.001). Complications were rare and self-limiting, consisting primarily of hematuria and urinary retention requiring overnight catheterization in 2 patients. CONCLUSIONS: Systematic transperineal template biopsy of the prostate is a safe and precise repeat biopsy technique in patients who remain at high risk for adenocarcinoma.

Vesicourethral reconstruction in radical retropubic prostatectomy: an alternative technique.

PURPOSE: We review an alternative method of vesicourethral reconstruction in patients undergoing radical retropubic prostatectomy for adenocarcinoma of the prostate. MATERIALS AND METHODS: A total of 91 consecutive patients were prospectively evaluated for an alternative technique for vesicourethral reconstruction which incorporates specific principles of direct suture anastomosis and the modified Vest technique. Perioperative and postoperative complications were reviewed. RESULTS: Total continence was reported in 80 of 91 patients (87.9%). Persistent moderate to severe incontinence was present in 1 patient and anastomotic stricture was identified in 7 (7.7%). Prolonged urinary extravasation was rare. CONCLUSIONS: This method of vesicourethral reconstruction appears to offer an efficient, reproducible alternative to direct suture anastomosis with acceptable complication rates.

Renal plasmacytoma: Mayo Clinic experience and review of the literature.

Extramedullary plasmacytoma arising in the kidney is rare. Only 8 cases have been reported. Recently, we noted the ninth case, the second case seen at the Mayo Clinic. Clinically, the tumor mimics a renal cell carcinoma or a transitional cell carcinoma of the renal pelvis.

Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen.

The prostate cancer detection rate from screening by digital rectal examination and tactilely guided prostate biopsy is approximately 1.7%. Among 1,807 men a detection rate of 14.6% was achieved in a clinical urological practice by physician-conducted prostate ultrasonography, digital rectal examination and determination of serum prostate specific antigen. Results are presented in 5-year increments as well as for the group as a whole. The possible benefit to be derived from an improved detection rate is undetermined. Recommendations are made regarding the clinical use of these diagnostic modalities.

Comparison of techniques for vesicourethral anastomosis: simple direct versus modified Vest traction sutures.

Radical retropubic prostatectomy has become a mainstay surgical procedure in the treatment of cancer of the prostate. There has been controversy, however, regarding the most appropriate method of vesicourethral reconstruction. We examined the records of 692 consecutive patients who underwent a radical retropubic prostatectomy from 1978 through 1984 at the Mayo Clinic. Of these, 416 patients underwent a modified Vest procedure, and in 276 patients a direct simple anastomosis was fashioned. In comparing these two methods, our review showed no substantial difference in complications, including the rate of urinary incontinence.

Perioperative and postoperative complications from bilateral pelvic lymphadenectomy and radical retropubic prostatectomy.

The complications experienced by 692 consecutive patients who underwent bilateral pelvic lymphadenectomy and radical retropubic prostatectomy from 1978 through 1984 were analyzed. Four patients (0.6 per cent) died in the perioperative or early postoperative period. Pulmonary embolus developed in 19 patients (2.7 per cent) and severe to total urinary incontinence occurred in 34 (5 per cent). Our large series suggests that radical retropubic prostatectomy with staging bilateral pelvic lymphadenectomy can be performed in a safe manner with minimal postoperative morbidity.