Spectroscopic view of life and work of the Nobel Laureate Sir C.V. Raman.

Raman spectroscopic and microscopic techniques have been used for nondestructive characterization of tissues and to differentiate benign and malignant tissues. The discovery of the principles of spectroscopy is credited to Sir C.V. Raman of India, who in 1930 brought the Nobel Prize in Physics to the East side of Suez. We present the life and work of Sir C.V. Raman with brief review of the uses of Raman spectroscopy in urology.

A randomized, controlled trial comparing lidocaine periprostatic nerve block, diclofenac suppository and both for transrectal ultrasound guided biopsy of prostate.

PURPOSE: Lidocaine periprostatic nerve block (PPNB) provides good procedural pain relief for transrectal ultrasound (TRUS) prostatic biopsy. However, post-procedural pain can be significant. The addition of diclofenac suppository (DS) to lidocaine PPNB might provide additional, particularly post-procedural pain relief. We assessed the procedural and post-procedural pain relief for TRUS biopsy provided by DS, and the combination of DS and lidocaine PPNB compared with lidocaine PPNB alone. MATERIALS AND METHODS: A total of 165 patients were randomized into 3 groups, namely group 1-lidocaine PPNB, group 2-DS and group 3-a combination of lidocaine PPNB and DS. In all patients 12 core biopsy was performed. Pain/discomfort at various intervals after the procedure was recorded on a visual analogue scale of 0 to 10 cm. RESULTS: Biopsy pain was significantly lower in patients who received lidocaine alone or in combination compared with DS alone (median 1.95, IQR 1.08 to 3.12, 3, IQR 1.25 to 5.47 and 1.8, IQR 0.85 to 3.0, respectively, p = 0.018), while evening pain scores were significantly lower in patients who received DS alone or in combination compared with that in patients who received lidocaine alone (median 1.25, IQR 0.38 to 3.0, 0.3, IQR 0.03 to 1.08 and 0.4, IQR 0 to 1.0, respectively, p = 0.001). There were no significant differences in pain/discomfort due to the probe (p = 0.107), that 1 hour after biopsy (p = 0.076) and that on the day after the procedure (p = 0.165). There were no significant differences in hemorrhagic or infective complications among the groups. CONCLUSIONS: The combination of lidocaine PPNB with DS provides additional pain relief during and after prostatic TRUS biopsy.

Importance of TURP in diagnosing prostate cancer in men with multiple negative biopsies.

OBJECTIVE: Patients with persistently elevated PSA and multiple negative TRUS guided 12-core biopsies, present a clinical conundrum. We evaluated the efficacy of transurethral biopsy and/or resection in abetting prostate cancer diagnosis. PATIENTS AND METHODS: Eleven patients who had prostate cancer diagnosed only on TURP following TRUS guided (24-48 cores) negative biopsies, including five who underwent radical prostatectomy were assessed. Extent and site of tumour was analysed in relation to the TURP cavity. RESULTS: Mean age was 61.8 years (PSA range: 3.8-20.9 ng/ml.). Patients had TURP for worsening LUTS with chippings diagnosing invasive prostate cancer. Organ confined anterior prostate cancer was diagnosed in five who had radical prostatectomy. CONCLUSION: Anteriorly directed transurethral biopsies and/or TURP help in the diagnosis of prostate cancer in patients with multiple negative biopsies. Patients with anterior prostate cancer tend to have organ-confined disease even with higher PSA.

Effect of peripheral biopsies in maximising early prostate cancer detection in 8-, 10- or 12-core biopsy regimens.

OBJECTIVE: To assess the cancer detection rate per individual core biopsy in a 12-core protocol and develop an optimal biopsy regimen for detecting early prostate cancer. PATIENTS AND METHODS: The study included 445 new patients who had a 12-core transrectal ultrasonography (TRUS)-guided prostatic biopsy over a 40-month period. The 12- core biopsy protocol included parasagittal sextant and six peripheral biopsies. The cancer detection rate per individual core was evaluated to give an optimal biopsy protocol. RESULTS: Prostate cancer was detected in 142 patients (31.9%). Parasagittal sextant biopsy would have failed to detect 40 (28.2%) of the cancers. Among the various possible biopsy protocols, the optimum 10-core biopsy strategy excluding the parasagittal mid-zone biopsies from the 12-core protocol achieved a cancer detection rate of 98.6%. CONCLUSION: The cancer detection rate increased from 71.8% for parasagittal sextant biopsies to 88.7% by adding peripheral basal biopsies (8-biopsy protocol); 98.6% of cancers in the series would have been detected with a 10-biopsy strategy omitting the parasagittal mid-zone biopsies. Thus we recommend a 10-core protocol incorporating six peripheral biopsies in patients with elevated age- specific prostate-specific antigen levels (2.6-10.0 ng/mL) for maximising cancer detection.

The benefits of radical prostatectomy beyond cancer control in symptomatic men with prostate cancer.

OBJECTIVE: To evaluate lower urinary tract symptoms (LUTS) and the symptom-associated quality of life (QoL) after radical prostatectomy. PATIENTS AND METHODS: We carried out a prospective study (January 1999 to March 2001) of 50 consecutive men initially assessed in the nurse-led prostate assessment clinic for their LUTS and subsequently diagnosed to have localized prostate cancer. They had a radical retropubic prostatectomy and were assessed before, 3 and 6 months after surgery with a self-administered International Prostate Symptom Score (IPSS) and QoL questionnaires, and measurements of urinary flow rate and postvoid residual urinary (PVR) volumes. Finally, each patient completed a self-administered continence questionnaire at 6 weeks, 3 and 6 months after surgery. RESULTS: In men with moderate to severe LUTS before surgery there were significant improvements in total IPSS, symptom-associated QoL, mean peak flow rate and PVR (P < 0.05). However, in eight men with mild LUTS, although there was a 33% improvement in the total symptom score, it was not statistically significant. Thirty-eight patients reported complete continence, nine had infrequent stress leaks only on heavy physical activity, and the remaining three used < 2 pads/day for protection before heavy physical activity at 3 months after surgery. CONCLUSIONS: Radical prostatectomy provides major benefits to men with LUTS besides cancer control. These data are important in counselling patients about the treatment options, especially in view of the current enthusiasm for brachytherapy and conformal radiotherapy, which may worsen LUTS.

Modified puncture technique for reduction of paraphymosis.

PATIENTS AND METHODS: A total of 45 patients underwent reduction of paraphymosis at LN Hospital, Delhi, India and Leighton Hospital, Crewe, UK from August 1991 to September 1999 using the multiple puncture and glans squeeze technique. These were divided into 3 grades: grade 1, paraphymosis without engorgement of glans; grade 2, paraphymosis with engorgement of glans; and grade 3, paraphymosis with associated skin changes (non-pitting oedema, cheese-cutting of the shaft of the penis or erosions). RESULTS: Grade 1 (6) patients were reduced by simply pulling the foreskin back into the normal position. Grade 2 (37) patients were reduced by the above-mentioned technique. Grade 3 (2) patients could not be reduced by this technique and the band had to be divided. CONCLUSIONS: Difficult paraphymosis with gross engorgement of the glans can be successfully reduced by this technique as long as the skin changes are not marked.

Grading of benign prostatic obstruction can predict the outcome of transurethral prostatectomy.

PURPOSE: We investigate whether urodynamic grading of benign prostatic obstruction and detrusor contractility predicts the outcome of transurethral prostatectomy. MATERIALS AND METHODS: A total of 53 patients who were suitable candidates for transurethral prostatectomy completed an assessment protocol before and 3 months after surgery, which included International Prostate Symptom Score, uroflowmetry, ultrasonography (prostatic size and residual urine volume) and standard pressure flow study. The results of the pressure flow study were analyzed to grade obstruction (unequivocal, equivocal or no obstruction) and detrusor contractility (weak or normal) using our simplified pressure flow nomogram. RESULTS: Analysis of the pressure flow study data demonstrated that the efficiency of detrusor contraction was weak in 6 of 27 men with unequivocal, 11 of 23 with equivocal and 2 of 3 with no obstruction. Treatment outcome was significantly better in patients with unequivocal obstruction and normal detrusor contractility. Treatment failure occurred in 80% of patients with equivocal obstruction and impaired detrusor contractility, and 100% of the unobstructed group. Urodynamic grading of obstruction and detrusor contractility predicted treatment outcome with a sensitivity of 87%, specificity 93% and positive predictive value 95%. CONCLUSIONS: Urodynamic grading of benign prostatic obstruction and detrusor contractility can reliably predict treatment outcome and, therefore, enable the urologist to identify a subgroup of patients who would not benefit from surgery.

Hepatosplanchnic haemodynamics and renal blood flow and function in rats with liver failure.

BACKGROUND: Massive liver necrosis, characteristic of acute liver failure, may affect hepatosplanchnic haemodynamics, and contribute to the alterations in renal haemodynamics and function. AIMS: To investigate the relation between hepatosplanchnic haemodynamics, including portal systemic shunting, and renal blood flow and function in rats with acute liver failure. METHODS: Liver failure was induced in male Wistar rats by intraperitoneal injection of 1.1 g/kg of D(+)-galactosamine hydrochloride. The parameters assessed included; systemic, hepatosplanchnic, and renal blood flow (57Co microsphere method); portal-systemic shunting and intrarenal shunting (consecutive intrasplenic, intraportal, or renal arterial injections of 99mTc methylene diphosphonate and 99mTc albumin microspheres); arterial blood pressure and portal pressure; renal function; and liver function (liver function tests and 14C aminopyrine breath test). RESULTS: Progressive liver dysfunction was accompanied by the development of a hyperdynamic circulation, a highly significant decrease in renal blood flow and function, and an increase in intrarenal shunting 36, 42, and 48 hours after administration of D-galactosamine. The alterations in renal blood flow and function were accompanied by significant increases in portal pressure, portal venous inflow, and intrahepatic portal systemic shunting in galactosamine treated rats compared with controls. There was a significant correlation between changes in renal blood flow and changes in portal pressure, intrahepatic portal systemic shunting, and deterioration in liver function (r = 0.8, p < 0.0001). CONCLUSIONS: The results of this study suggest that both increased intrahepatic portal systemic shunting and hepatocyte impairment may contribute to alterations in renal haemodynamics and function.

The role of an advanced thermotherapy device in prostatic voiding dysfunction.

OBJECTIVES: To investigate the efficacy of an advanced transurethral thermotherapy (TUMT) device (T3, Urologix) using urodynamic analysis in addition to the standard evaluation protocol in patients with symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Fifty men with symptomatic BPH were assessed using the AUA symptom score, uroflowmetry and ultrasonography (to determine prostatic volume and residual urinary volume) before and 6 weeks, 3, 6 and 12 months after thermotherapy. TUMT was delivered using a focused microwave energy system for 1 h in each patient, treated on an out-patient basis. Video pressure flow studies with advanced urodynamic analysis were also performed before and 3 months after treatment. RESULTS: The mean AUA symptom score decreased by 63%, the mean peak flow rate increased by 64% and the post-void residual volume decreased by 30% 3 months after treatment; this improvement was maintained at one year after treatment. Advanced urodynamic analysis showed that 52% of the patients had a decreased severity of obstruction. Furthermore, the efficiency of detrusor contraction improved in 86% of the patients. The improvement in the symptom score, flow rate and residual urine was significantly better in patients with marginal obstruction than in patients with unequivocal obstruction. CONCLUSION: Urodynamic analysis can predict the treatment outcome of TUMT and the results of thermotherapy are significantly better in patients with marginal prostatic bladder outflow obstruction.

Quantification of voiding dysfunction in patients awaiting transurethral prostatectomy.

PURPOSE: We investigated the role of advanced urodynamic analysis in the diagnostic evaluation for transurethral resection of the prostate. MATERIALS AND METHODS: A total of 62 consecutive patients awaiting transurethral resection of the prostate with the American Urological Association symptom score of more than 12, peak flow rate less than 13 ml. per second and significant residual urine underwent routine video pressureflow studies with advanced urodynamic analysis to quantify outflow function. Postoperative outcome was assessed at 3 months by symptom scores, uroflowmetry and ultrasonography (residual urine). RESULTS: The parameters used in the diagnostic evaluation for transurethral resection of the prostate did not correlate with urodynamic diagnosis of unequivocal obstruction. Weak detrusor contractility (without significant obstruction) accounted for voiding dysfunction in 50% of the patients. The results of transurethral resection of the prostate were significantly better in patients with unequivocal compared to equivocal obstruction. Furthermore, patients with unequivocal obstruction but weak detrusor contractility had a significantly poorer treatment outcome. CONCLUSIONS: Advanced urodynamic analysis in the diagnostic evaluation of patients with symptomatic benign prostatic hyperplasia can predict treatment outcome and, therefore, allows the urologist to choose the most appropriate therapeutic option for individuals.