Long-term outcome of kidneys with initially poor drainage or no drainage following pyeloplasty.

Pyeloplasty for congenital ureteropelvic junction (UPJ) obstruction enjoys a 90-95% success rate. Although treatment of the failed pyeloplasty has been addressed in the literature, management of the poorly draining or nondraining renal unit in the immediate postoperative period has not received any attention. For this purpose the medical records of 33 consecutive children (37 renal units) treated by dismembered pyeloplasty between 1986 and 1992 were reviewed. All of our pyeloplasties were stented and urine was diverted via a nephrostomy tube. All patients underwent a nephrostogram following stent removal 1 week postoperatively. These studies showed poor drainage, or no, across the newly reconstructed anastomosis in 7 of 37 renal units (19%). The ages of these 4 boys and 3 girls at the time of pyeloplasty ranged between 7 weeks and 5 years (mean 22 months). In four patients, good drainage occurred without intervention by 2-4 weeks postoperation. In two patients, percutaneous balloon dilation of the anastomosis via the intraoperatively placed nephrostomy tube was required at 3 and 6 weeks, respectively. The remaining patient failed percutaneous dilation, necessitating a ureterocalycostomy at 9 weeks following pyeloplasty. The long-term follow-up for the entire group of 33 children averaged 30 months and consisted of radionuclide diuresis renography in 84% of cases or intravenous pyelography in the remainder. All patients had excellent long-term outcomes as assessed by comparison of the postoperative studies with the baseline studies obtained preoperatively. Our results show that kidneys with initially poor drainage, or even no drainage, across the newly reconstructed anastomosis following pyeloplasty can be salvaged with an excellent long-term outcome comparable with that of the group with initially good drainage. In addition, intervention was necessary in only 43% of renal units with initial compromise and was facilitated by the intraoperatively placed nephrostomy tube. We recommend that percutaneous dilation be done at between 4 and 6 weeks postpyeloplasty, as the waiting period was long enough to allow for spontaneous improvement without precluding a successful outcome if drainage failed to occur. Ureterocalycostomy was rarely necessary.

Collagen cross-link metabolites in urine as markers of bone metastases in prostatic carcinoma.

The efficacy of radionuclide bone scans in monitoring metastatic bone activity remains controversial. Objective measurement of bone tumor burden would be useful for the evaluation of new therapies for metastatic carcinoma of the prostate. The recent discovery of the urinary excretion of pyridinoline (cross-link of mature collagen found in cartilage and bone) and deoxypyridinoline (collagen cross-link specific to bone) measured by high pressure liquid chromatography has provided sensitive specific indexes of cartilage and bone breakdown in rheumatoid arthritis, osteoporosis and metabolic bone diseases. We compared the urinary excretion of deoxypyridinoline,pyridinoline and hydroxyproline relative to urinary creatinine (nmol./mmol.creatinine) in 27 patients with benign prostatic hyperplasia (patient age 70.0 +/- 8.5 years, standard deviation), 29 with clinically confined prostate cancer (age 70.2 +/- 9.7 years), and 26 with prostate cancer and bone metastases (age 71.1 +/- 7.7 years). No diurnal variation of deoxypyridinoline or pyridinoline urinary excretion was detected in 5 patients with metastases. Urinary excretion of pyridinoline and deoxypyridinoline was significantly greater in patients with metastatic carcinoma of the prostate compared with patients with either benign prostatic hyperplasia (Mann-Whitney-Wilcoxon rank sum analysis, p < 0.00004 and 0.002, respectively) or localized prostate cancer (Mann-Whitney-Wilcoxon, p < 0.00001 and 0.00005, respectively). Urinary hydroxyproline levels failed to separate the 3 groups. Pyridinoline and deoxypyridinoline excretion in prostate cancer patients with metastases directly correlated with bone scan Soloway scores (r = 0.55, p < 0.005 and r = 0.57, p < 0.004 respectively), whereas serum prostate specific antigen did not (r = 0.36, p = 0.08). Serial measurements of pyridinoline and deoxypyridinoline progressively increased in 3 patients with clinical progression documented by new metastatic lesions by bone scan. Measurement of pyridinoline and deoxypyridinoline excretion cannot diagnose metastatic disease. However, these markers should be evaluated further for quantitative assessment of bone metastases.

Immunohistochemistry of the androgen receptor in human benign and malignant prostate tissue.

The role of the androgen receptor in the development and progression of prostatic carcinoma has not been defined. The development of androgen receptor antibodies has provided new opportunities for direct immunohistochemical analysis. We compared the androgen receptor staining characteristics of fresh human prostatic carcinoma with benign prostatic hyperplasia (BPH) using an avidin-biotin complex method. Cancer and BPH obtained from the same radical retropubic prostatectomy specimen in 10 prostate cancer patients (68.5 +/- 7.3 years old standard deviation) and BPH from 10 noncancer patients (71.5 +/- 7.7 years old) were incubated with AR52, a rabbit polyclonal antibody against a synthetic androgen receptor peptide. Nuclei within each section were graded for intensity of androgen receptor staining (0-absent, 1-weak, 2-moderate or 3-strong) and the percentage (0 to 100%) of nuclei sampled staining at each of these intensity levels was determined. A total intensity score (0 to 300) was the summation of the products of each intensity score (0 to 3) and their corresponding percentages. Cancer sections (166 +/- 69) stained less intensely and more heterogeneously than BPH in cancer patients (246 +/- 41, Student's t test p < 0.05) and noncancer patients (225 +/- 39, p < 0.05). The decreased intensity and greater heterogeneity of androgen receptor staining in cancer tissue may implicate a quantitative or functional difference in androgen receptor between prostatic carcinoma and BPH.

In vitro high resolution 1H-spectroscopy of the human prostate: benign prostatic hyperplasia, normal peripheral zone and adenocarcinoma.

1H-spectra at 360 MHz from perchloric extracts of 35 human prostate specimens were obtained. First, we sought to define what peaks can be assigned in vitro, and thus, potentially seen in vivo. Second, we sought to try to discriminate between adenocarcinoma, normal peripheral zone and benign prostatic hyperplasia using spectral fingerprints. Thirteen samples of adenocarcinoma, 11 samples of benign prostatic hyperplasia, and 11 samples of normal contralateral peripheral zone were analyzed by obtaining a ratio from the maximum area of each major peak and the area of an added standard (3-trimethyl-silyl-propionic acid). There was a significantly larger benign prostate hyperplasia citrate standardized peak area when compared to the adenocarcinoma citrate standardized peak area for each patient (P < 0.05). However, the citrate standardized peak areas from the normal peripheral zones were not significantly different from those found in the adenocarcinomas. Four out of 13 cases of stromal hyperplasia had similarly low levels of citrate as their respective gland's adenocarcinoma. We also found a sharp peak at 2.05 ppm that was seen in 4 out of 13 adenocarcinoma samples and in only 1 out of 13 of the benign prostate hypertrophy samples which has tentatively been assigned to N-acetyl neuraminic acid. Further studies are required to assess whether low citrate levels alone can serve to exclusively diagnose adenocarcinoma of the prostate.