Myeloid sarcoma of the periprostatic tissue and prostate: Case report and review of literature.

Myeloid sarcoma (MS) is a rare extramedullary tumor composed of immature cells of myeloid lineage that destroy the original tissue architecture in which it is found. It is most commonly identified in patients with acute myelogenous leukemia, and less often in myelodysplastic syndromes (MDSs) and other myeloproliferative disorders. It is most commonly reported in the periosteum, bone, skin, and lymph nodes but has been reported in many other sites of the body. Herein, we describe a case of MS involving the periprostatic tissue and review of literature of MS of the prostate. Our patient was initially diagnosed with MDS and was in remission following successful treatment. Six months later, the patient was diagnosed with prostate adenocarcinoma, and MS of the periprostatic tissue was incidentally discovered in the postprostatectomy pathology specimen. An extensive review of literature from 1997 to 2014 revealed a total of eight cases of MS involving the prostate. Of the eight cases of MS of the prostate, four were primary MS (absence of a history of leukemia) and four were secondary MS. Three received local radiation to the prostate with relief of obstructive symptoms, and one of them had a repeat prostate biopsy negative for leukemic cells. Despite being a rare entity, MS should be considered as a differential diagnosis of soft tissue masses, especially in patients with a history of hematological malignancies.

Breast metastases from a malignant peripheral nerve sheath tumor of the kidney: An unusual presentation.

Malignant peripheral nerve sheath tumors (MPNSTs) are extremely rare soft tissue sarcomas of ectomesenchymal origin. They are commonly seen in association with neurofibromatosis type 1 (NF-1), but can also occur without a history of NF (isolated MPNST). MPNSTs are most commonly located on the extremities (brachial and sacral plexus), head and neck, and trunk regions and are rarely reported in genitourinary organs. These tumors are aggressive, with a high recurrence rate and distant metastases. MPNST involving the kidney is extremely rare, and review of the literature using PubMed from 2001 to 2014 revealed eight cases of MPNST involving the kidney (seven, primarily involving the kidney and one metastatic MPNST of the kidney). Herein, we describe a case of breast metastases from an MPNST of the kidney without a history of NF-1. The patient was initially diagnosed with a spindle cell neoplasm of the kidney with peripheral nerve sheath differentiation. Eventually, the patient developed a right breast mass that was diagnosed as metastatic MPNST. The patient refused any kind of treatment and died 6 months later in hospice care.

Antibiotic pretreatment of hydrogel ureteral stent.

PURPOSE: To compare bacterial adhesion to hydrogel-coated and uncoated ureteral stents. The antimicrobial activity of coated and uncoated stents treated with commonly used antibiotic solutions also was evaluated. MATERIALS AND METHODS: Hydrogel coated and uncoated stent segments were dipped in different antibiotic solutions (ciprofloxacin, gentamicin, and cefazolin). Normal saline was used as the control. The segments were incubated in separate broths of Escherichia coli and Enterococcus faecalis to reach the log phase. They were sonicated to free the bacteria, and colony-forming units were determined after 48 hours. To evaluate antibacterial activity, hydrogel-coated and uncoated stent segments were dipped in the above-mentioned antibiotic solutions. Normal saline was used as the control. Segments were incubated in separate Mueller-Hinton agar plates inoculated with E. coli or Enterococcus faecalis, and the zones of inhibition were determined at 24 hours. The duration of antibacterial activity for each bacterium-antibiotic combination also was studied. RESULTS: Hydrogel coating did not significantly reduce bacterial adhesion. Zones of inhibition around stent pieces dipped in antibiotic solutions differed with the organism and the antibiotic. Cefazolin produced a significantly larger zone of inhibition with hydrogel-coated stent, but the duration of antibacterial activity was similar to that of uncoated stent. Hydrophilic coating significantly increased the duration of antibacterial activity of ciprofloxacin and gentamicin. CONCLUSION: Hydrogel coating on the surface of ureteral stents does not prevent or reduce bacterial adhesion. However, after antibiotic treatment, stents exhibit antibacterial activity in the local environment at greater intensity and for a longer time, depending on the bacterium-antibiotic combination.

Multiple retained needles: an unusual complication of intracavernous self-injection.

Intracavernous self-injection of pharmacologic agents is an effective method of treatment of erectile dysfunction. Intracorporeal needle breakage is a rare complication of intracavernosal self-injection. We report an unusual case of multiple retained needles in a 44-year-old man who presented with penile edema after intracavernous self-injection complicated by needle breakage. The patient was treated with nonoperative therapy and observed on a course of antibiotics to which he responded favorably. He continued to have good erectile function. We also present a review of the reported data and recommend a treatment strategy for the management of retained intracorporeal needles.

Patient satisfaction and clinical efficacy of the new perineal bone-anchored male sling.

OBJECTIVE: We retrospectively evaluated the safety, efficacy and patient satisfaction following the male sling procedure for stress urinary incontinence. MATERIALS AND METHODS: Forty-six patients, with a median age of 67 years, underwent the perineal male sling procedure for stress urinary incontinence. Radical retropubic prostatectomy was the commonest etiology of SUI. The male sling was placed over the bulbar urethra, through a perineal incision and anchored with the help of bone screws inserted in the pubic rami. Efficacy and treatment satisfaction were evaluated with the help of the validated UCLA/RAND questionnaire and questions addressing treatment satisfaction. Patients were defined as "cured" if they were dry or "improved" if utilizing 1-2 pads per day (based on response to question 1 of the UCLA/RAND questionnaire. Responses to questions 4 and 5 of the UCLA/RAND were utilized to determine the impact of the procedure on urinary leakage and urinary function postoperatively. Complications if any were noted. RESULTS: One patient developed infection and two developed short-lasting perineal/buttock pain. Significantly, no patient developed urethral erosion. At a mean follow-up of 24 months, 34 patients were either dry (17/46, 37%) or utilizing only 1-2 pads per day (17/46, 37%), giving a cure/improvement rate of 74%. On evaluating the response to questions 4 and 5 of the UCLA/RAND questionnaire, 72% patients stated that urinary leakage and function were a "small to no problem". Moreover, 59% patients were moderately or completely satisfied with the procedure and 11% stated they were halfway satisfied with the procedure giving an overall satisfaction of 70%. A similar percentage felt that the treatment halfway or completely met their expectations. CONCLUSIONS: At a mean follow-up of 24 months, the male sling procedure appears to be effective in the management of male SUI with a success rate of 74%. Moreover, it is safe as evidenced by the absence of any major complications such as urethral erosion. Finally, it is associated with a 70% patient satisfaction.

Fate of the retained reservoir after replacement of 3-piece penile prosthesis.

PURPOSE: We evaluated patients who underwent surgery for implant malfunction to determine whether retaining the reservoir was associated with an increased risk of erosion or infection. We also reviewed the literature to study possible risk factors for reservoir erosion. MATERIALS AND METHODS: We reviewed the records of 85 patients who underwent 98 procedures for replacement of a malfunctioning 3-piece penile implant. Of these patients 13 underwent 2 replacement procedures. At the time of primary surgery the reservoir was placed in either the retropubic space or extraperitoneally in the lower lateral abdomen if the patient had undergone prior pelvic surgery. During surgery for replacement of the malfunctioning implant the cylinders and pump were removed, and the reservoir of the original 3-piece device was retained. During followup patients were assessed for implant function and the development of any complication such as infection and/or reservoir erosion into the bladder or bowel. RESULTS: Infection developed in 1 patient and implant malfunction occurred in 13 but no patient had erosion of the retained reservoir. All 85 patients had a functioning implant at a mean followup of 50 months (range 12 to 148). Review of the literature suggests that prior pelvic surgery and infection are major risk factors for reservoir erosion. CONCLUSIONS: Retaining the reservoir during replacement of malfunctioning 3-piece implants is not associated with a significant risk of erosion and routine removal is not necessary. Prior pelvic surgery and infection appear to be risk factors for reservoir erosion.

New perineal bone-anchored male sling: lessons learned.

OBJECTIVES: To identify factors affecting outcome after the male sling procedure for stress urinary incontinence. METHODS: A total of 46 incontinent men, with a mean age of 67 years, underwent perineal bone-anchored male sling placement. Three titanium bone screws with preattached pairs of No. 1 polypropylene sutures were placed directly into the medial aspect of each inferior ramus of the pubic bone. To compress the urethra, three different types of materials were used: absorbable biomaterial, silicone-coated polypropylene mesh, or a composite graft. Patient characteristics, incontinence etiology and severity before surgery, prior collagen injections, and type of material used were assessed, and the association with the outcome of the male sling procedure was determined. RESULTS: The procedure was successful in 35 (76%) of 46 patients at a mean follow-up of 18 months (range 6 to 30). Nineteen patients were totally dry and 16 had improved 50% or more compared with before surgery. Failure occurred in 11 patients (24%). Patients who received a composite graft or mesh alone had a better outcome compared with the absorbable sling group (97% and 75% versus 0%, respectively, P = 0.001). The severity of pretreatment incontinence also had a negative impact on the outcome. CONCLUSIONS: Patients with mild-to-moderate incontinence and the use of a composite graft had the best outcomes after the perineal bone-anchored male sling.

Urethroplasty in patients older than 65 years: indications, results, outcomes and suggested treatment modifications.

PURPOSE: Despite an aging population, the results of urethroplasty in elderly patients have not been extensively reported. We performed a multi-institutional review of urethroplasty results in 70 elderly males to determine outcomes. MATERIALS AND METHODS: We reviewed all urethroplasties performed on males older than 64 years with at least 6 months of followup at 4 medical centers. Stricture type varied and included anastomotic urethroplasty (44%), penile fasciocutaneous onlay flap (31%), Johanson urethroplasty (stage 1, 6%, stages 1 and 2, 4%), buccal mucosa grafts (7%), foreskin grafts (6%) and meatoplasty (1%). RESULTS: Stricture recurred in 11 (16%) patients, but was managed with a single direct visual internal urethrotomy or dilation in 5 of 11 patients, yielding a final success rate of 91%. Recurrent strictures were more common after fasciocutaneous flaps (7 of 22 cases, 32%) than end-to-end urethroplasty (2 of 31 cases, 6%, p <0.05). Compared to patients younger than 65 years there were more treatment failures, but this was not statistically significant. Perioperative complications were uncommon. Moderate bladder outlet obstructive symptoms developed in 3 patients due to benign prostatic hyperplasia. Notably 6 patients treated previously for post-radiation strictures did well without complications. CONCLUSIONS: Older men tolerate urethroplasty and these data indicate that therapy should not be withheld solely on the basis of age. The potential for impaired flap blood supply in this population is suggested but has not been proven. Benign prostatic hyperplasia must be considered in those patients who have decreased stream after stricture repair.

Antibiotic soaked hydrophilic coated bioflex: a new strategy in the prevention of penile prosthesis infection.

OBJECTIVES: To find conditions that reduce the susceptibility of penile prostheses to infection, we studied the effect of coating the surface of polyurethane (Bioflex) with a hydrophilic material with and without antibiotics in decreasing bacterial colony counts both in vitro and in experiments in rats. MATERIALS AND METHODS: The in vitro experiment was performed using seven strips each of polyvinylpyrrolidone (PVP)-coated and uncoated polyurethane. These strips were dipped in saline for 5 minutes followed by incubation in a suspension of Staphylococcus epidermidis (SE) for a period of 10 minutes. Colony counts were determined after sonication of strips. For the in vitro experiments, 60 rats were used. Thirty animals each had uncoated or coated polyurethane implanted subcutaneously. In each group, strips were implanted after dipping them in either saline (N = 15) or an antibiotic solution (N = 15) consisting of 1 g/L vancomycin and 160 mg/L gentamicin. A bacterial suspension containing SE was then directly introduced into the subcutaneous pockets of all the animals prior to closure. After 7 days, strips were explanted along with 0.5 x 0.5 cm of surrounding tissue, and sonicated. Colony counts were performed on each sonicate. The data were analysed using Student's t-test. A P-value less than or equal to 0.05 was considered to be statistically significant. RESULTS: The in vitro study demonstrated a statistically significant (41%) reduction in the colony count of SE within the coated polyurethane strips compared to the uncoated Bioflex strips (150 +/- 44.7 CFU vs. 253 +/- 45.0 CFU, respectively, P-value < 0.05). Animal studies showed that bacterial CFU was highest in the uncoated Bioflex strip (29 +/- 24.5 CFU), followed by uncoated Bioflex with antibiotic treatment (24 +/- 28.1 CFU), coated Bioflex (17 +/- 25.2 CFU) and coated Bioflex with antibiotic treatment (13 +/- 16.1 CFU). Antibiotic treatment of coated Bioflex caused a significant reduction in the bacterial CFU compared to uncoated Bioflex (13 +/- 16.1 vs. 29 +/- 24.5 CFU, respectively, P = 0.04). This represents a 55% reduction in the bacterial count. While the reduction in the bacterial count in the coated Bioflex strip was not statistically different from that in the uncoated strip, a trend towards significance was noted with a 41% reduction (P > 0.05) in bacterial count in the coated Bioflex group compared to uncoated Bioflex. CONCLUSIONS: In conclusion, in vitro studies demonstrate a significant (41%) reduction in the colony count of SE in PVP-coated polyurethane compared to uncoated polyurethane. In vivo study in rats showed that antibiotic treatment of PVP-coated Bioflex resulted in a statistically significant reduction (55%) in colony count of SE compared to uncoated Bioflex.

Comparison of satisfaction rates and erectile function in patients treated with sildenafil, intracavernous prostaglandin E1 and penile implant surgery for erectile dysfunction in urology practice.

PURPOSE: We compared erectile function status and satisfaction rates in patients who received treatment for erectile dysfunction (ED) with sildenafil, intracavernous prostaglandin E1 (ICI) and penile implant surgery (IPP). MATERIALS AND METHODS: A total of 138 consecutive patients who received treatment for ED between April 2000 and April 2001 were considered candidates for study. Mean followup was 19.54 months. Of the patients 27 were not available for followup and 26 were not on any form of treatment. Of the patients receiving treatment for ED 85 were administered the Erectile Dysfunction Inventory for Treatment Satisfaction (EDITS) questionnaire and the Erectile Function Domain (EFD) of the International Index of Erectile Function questionnaire. Three treatment groups were identified, including 31 patients on sildenafil citrate, 22 on ICI and 32 who underwent IPP. Mean total EDITS, EDITS Index and EFD scores in the 3 groups were considered for statistical evaluation. RESULTS: There was no statistical difference in the total EDITS (25.59 versus 27.06, p = 0.48), EDITS Index (58.16 versus 61.15, p = 0.49) or EFD (22.91 versus 20.26, p = 0.12) score between the groups on ICI and sildenafil citrate, respectively. Total EDITS, EDITS Index and EFD scores were significantly higher in patients who underwent IPP than those on sildenafil citrate (36.09 versus 27.06, p <0.001, 82.03 versus 61.51, p <0.001 and 27.88 versus 20.26, p <0.001, respectively). Total EDITS, EDITS Index and EFD scores were significantly higher in patients who underwent IPP than those on ICI (36.09 versus 25.59, 82.03 versus 58.16 and 27.88 versus 22.91, respectively, all p <0.001). CONCLUSIONS: At a mean followup of 19.54 months patients who underwent penile implant surgery had significantly better erectile function and treatment satisfaction than those receiving sildenafil citrate and intracavernous prostaglandin E1.

Cigarette smoking induces apoptosis in rat testis.

In a previous studywe demonstrated the deleterious effect of cigarette smoke on spermatogenesis in the testis of peripubertal Sprague-Dawley rats. In this study we investigated the development of apoptosis as a possible contributing factor to the pathogenic mechanism underlying these effects. Peripubertal rats were exposed to cigarette smoke with the Walton Horizontal Smoking Machine. Similarly, age-matched control rats were exposed to room air with the smoking machine. Rats from both groups were sacrificed after 45 days of treatment and the testes were removed. Testes were stained utilizing the terminal deoxynucleotidyl transferase dUTP nick end-labeling (TUNEL) staining technique. DNA fragmentation was further evaluated using gelectrophoresis. There was a significant increase in the incidence of apoptosis in the treated group compared to the control group as demonstrated by the larger amount of tubules containing > or = 3apoptotic bodies in the smoke-exposed group, that is, 36% versus 14% in the control group (p < 0.05). Agarose gel electrophoresis demonstrated the DNA ladder in the treated group but not in the control animals. In conclusion, chronic cigarette smoke induces apoptosis in the rat testis. Apoptosis may be one of the pathogenic mechanisms responsible for defective spermatogenesis in the rat following chronic cigarette smoking.