The significance of histological analysis following laser transurethral resection of the prostate.

PURPOSE: Monopolar transurethral resection of the prostate is the gold standard for the treatment of benign prostatic hyperplasia. However, due to the associated risks of bleeding and TUR syndrome, laser prostate surgery is gaining popularity. We perform thulium-laser vaporesection of the prostate (TmLRP), where histological samples are generated in every case. We determined postoperative incidence and significance of prostate cancer detection, by retrospective histological examination of our cases. METHODOLOGY: Between October 2006 and August 2012, 223 patients underwent TmLRP by a single surgeon in our institution. With a background of a benign DRE, and no suspicion of CaP, histological results were studied. RESULTS: Mean age was 71 years (range 46-91), mean PSA was 4.1 ng/mL (range 0.1-20). 4.9% (11/223) had cancer prostate (CaP) diagnosed, with mean PSA of 6.9 ng/mL (range 0.7-14). Of these: 91% (10/11) had pT1b disease while 9% (1/11) had pT1a disease. Gleason score was 6 in 28% (3/11); 7 in 36% (4/11); 8 in 18% (2/11); 9 in and 18% (2/11). CONCLUSION: 4.9% of patients had unexpected CaP, with significant disease in 4.4% (pT1b) and 3.6% (Gleason score ≥7). Hence, patients should be advised of the small risk of missing significant unsuspected CaP after laser prostatectomy.

The Efficacy of Transrectal Ultrasound Guided Biopsy Versus Transperineal Template Biopsy of the Prostate in Diagnosing Prostate Cancer in Men with Previous Negative Transrectal Ultrasound Guided Biopsy.

PURPOSE: We have previously demonstrated that transperineal template prostate biopsy (TPTPB) has a significantly higher cancer detection rate compared to transrectal ultrasound guided (TRUS) biopsy in biopsy naive men with a PSA < 20 ng/mL. We, therefore, performed a prospective study to determine whether TPTPB is still superior to TRUS biopsy in the detection of prostate cancer in men with persistently elevated PSA after one previous negative set of TRUS biopsies. MATERIALS AND METHODS: 42 patients with a background of one previous negative set of TRUS biopsy, persistently elevated PSA (but < 20 ng/mL) and benign feeling digital rectal examination (DRE) underwent simultaneous standard 12-core TRUS biopsy and 36-core TPTPB under general anaesthesia. We determined the prostate cancer detection rate between the two diagnostic modalities. RESULTS: Mean age was 65 years (range: 50-75), mean prostate volume was 59 cc (range: 21-152), mean PSA is 8.3 ng/L (range: 4.4-19), mean time difference between the study and the previous TRUS biopsy was 33 months (range: 1-150) with mean PSA velocity of 0.7 ng/mL/year (range: 0-8). Out of the 42 patients, 22 (52%) had benign pathology. Of the 20 patients (48%) diagnosed with prostate cancer, 4 (10%) had positive results in both TRUS biopsy and TPTPB, 1 (2%) had positive result in TRUS biopsy with negative TPTPB, while 15 (36%) had negative TRUS biopsy with positive TPTPB. Hence, TRUS biopsy detected cancer in 5/42 (12%) patients versus (19/42) 45% detected by TPTPB (P < 0.01). 13/19 (68%) of cancers detected by TPTPB had Gleason score ≥7. A total of 82/141 (58%) of positive cores was found in the anterior zone. One patient (2%) experienced urosepsis, 2 (5%) temporary urinary retention, 14 (34%) mild haematuria and 13 (32%) haematospermia. CONCLUSION: TPTPB still shows a significantly higher prostate cancer detection rate compared to TRUS biopsy (12% versus 45%, P < 0.01) in men with a previous set of negative TRUS biopsy, persistently elevated PSA (but < 20 ng/mL) and benign feeling prostate on DRE.

A case of Fournier's gangrene in a young immunocompetent male patient resulting from a delayed diagnosis of appendicitis.

We discuss the case of a 28-year-old male patient presenting to our department with an atypical history of acute scrotal swelling on a background of abdominal pain. He was diagnosed with a perforated appendicitis and Fournier's gangrene.

Efficacy of a mobile lithotripsy service: a one-year review of 222 patients.

OBJECTIVE: Extracorporeal shockwave lithotripsy (ESWL) is the management of choice for ureteric and renal stones 20 mm or smaller, with a stone clearance rate of up to 89%. This study determined whether such a high success rate could apply to centres using mobile ESWL, by reviewing the performance at one centre that provides such a service. MATERIAL AND METHODS: Between July 2011 and July 2012, 222 patients (median age 51 years, range 18-90 years) underwent one to five sessions of ESWL for ureteric and renal stones (mean size 15 mm, range 4-22 mm). Stone clearance was regarded as residual fragments 2 mm or smaller after completion of sessions. RESULTS: In total, 110 out of 222 patients (49%) were clear of stones. Stones were radiopaque in 198 (89%) and radiolucent in 24 patients (11%), with clearance rates of 48% and 63%, respectively. Regarding size, 36 (16%) were 1-5 mm, 144 (65%) 5-10 mm, 28 (12%) 10-15 mm, eight (4%) 15-20 mm and six (3%) larger than 20 mm, with clearance rates of 61%, 55%, 18%, 13% and 50%, respectively. In total, 173 (78%) were renal stones and 49 (22%) ureteric, with respective clearance rates of 49% and 51%. For kidney stones, 15 (9%) were in the upper, 32 (18%) in the mid, 75 (43%) in the lower pole and 51 (30%) in the pelvis, with clearance rates of 52%, 59%, 49% and 41%; for ureteric stones, 32 (65%) were in the upper, 10 (20%) in the mid and seven (15%) in the lower ureter, with clearance rates of 47%, 70% and 43%, respectively. CONCLUSION: The performance of mobile ESWL was significantly poorer than expected, and this may be related to a lack of clinical ownership. The authors believe that such a service should be permanently placed on site.

Transperineal template prostate biopsies in men with raised PSA despite two previous sets of negative TRUS-guided prostate biopsies.

BACKGROUND: The possibility of prostate cancer as a cause for steadily rising PSA despite previously negative transrectal ultrasound (TRUS)-guided prostate biopsies is a major concern. An initial negative TRUS-guided prostate biopsy does not necessarily exclude the presence of clinically significant prostate cancer. We determined the role of transperineal template prostate biopsy (TPTPB) in prostate cancer detection in men with raised PSA despite two previous sets of negative TRUS biopsies. METHODS: Between January 2008 and August 2012, a total of 122 men's records were reviewed after having 36-core TPTPB following two previous sets of negative TRUS biopsies despite raised PSA. A retrospective record of PSA levels, clinicopathological parameters and histological outcomes was made. RESULTS: Mean age was 63 years (range 49-77), and mean PSA was 18.0 (range 2.0-119.0). A total of 71/122 (58 %) men were diagnosed with prostate cancer on TPTPB. Of these, 28 (39 %), 34 (48 %), 5 (7 %), and 4 (6 %) had Gleason score 6, 7 (3 + 4), 7 (4 + 3), and 9 (4 + 5), respectively. The mean number of positive cores was 7 (range 1-22). Of these, only 15 (21 %) had ≤2 cores positive and Gleason score of 6. Of the 51 (42 %) men with a negative histology on TPTPB, 11 (22 %), 10 (19 %), and 30 (59 %) had atypical small acinar proliferation, high-grade prostatic intraepithelial neoplasia, or benign pathology. CONCLUSION: TPTPB is associated with a high rate of clinically significant prostate cancer diagnosis (58 %) in men with raised PSA despite two previous sets of negative TRUS biopsies.

Is TURBT able to cure high risk recurrent superficial or muscle invasive bladder cancer: factors resulting in pT0 radical cystectomy specimens.

PURPOSE: In 76% of radical cystectomy patients there is discrepancy between the initial stage at transurethral resection and the final pathological stage of the cystectomy specimen. More specifically in contemporary series the absence of tumor at radical cystectomy specimens (stage pT0) is estimated at 5-25%. Our aim was to determine which factors contributed to the absence of tumor in our series of radical cystectomy patients. MATERIALS AND METHODS: Fifty one patients were submitted to radical cystectomy in our department over the last 10 years (January 2002-January 2012). A thorough analysis of the patients' files with no residual tumor on the cystectomy specimen (pT0) was performed. Possible factors contributing to such a result were described and a systematic analysis of the relevant literature was performed. RESULTS: Five patients had a pT0 stage after radical cystectomy. Four of them had transitional cell carcinoma and one of them had squamous cell carcinoma of the bladder on the initial transurethral resection. None of the tumors presented lymphovascular invasion. Four patients are still alive and one died 45 months postoperatively from a cardiac cause. CONCLUSIONS: Four factors were identified in our study to contribute towards a pT0 cystectomy result. Those included the absence of lymphovascular invasion, the completeness of transurethral resection, the experience of the surgeon and the use of a standardized technique for the transurethral resection. The time to cystectomy in our series did not have a negative effect on pT0 final pathology result.

Is TURBT able to cure high risk recurrent superficial or muscle invasive bladder cancer: Factors resulting in pT0 radical cystectomy specimens

Purpose In 76% of radical cystectomy patients there is discrepancy between the initial stage at transurethral resection and the final pathological stage of the cystectomy specimen. More specifically in contemporary series the absence of tumor at radical cystectomy specimens (stage pT0) is estimated at 5-25%. Our aim was to determine which factors contributed to the absence of tumor in our series of radical cystectomy patients. Materials and Methods Fifty one patients were submitted to radical cystectomy in our department over the last 10 years (January 2002-January 2012). A thorough analysis of the patients' files with no residual tumor on the cystectomy specimen (pT0) was performed. Possible factors contributing to such a result were described and a systematic analysis of the relevant literature was performed. Results Five patients had a pT0 stage after radical cystectomy. Four of them had transitional cell carcinoma and one of them had squamous cell carcinoma of the bladder on the initial transurethral resection. None of the tumors presented lymphovascular invasion. Four patients are still alive and one died 45 months postoperatively from a cardiac cause. Conclusions Four factors were identified in our study to contribute towards a pT0 cystectomy result. Those included the absence of lymphovascular invasion, the completeness of transurethral resection, the experience of the surgeon and the use of a standardized technique for the transurethral resection. The time to cystectomy in our series did not have a negative effect on pT0 final pathology result. .