High- and low-risk prostate cancer treated with 3D CT-guided brachytherapy: 1-to 5-year follow-up.

PURPOSE: To provide a preliminary report of 301 patients treated for prostate carcinoma with three-dimensional CT-guided transischiorectal stereotactic brachytherapy using either iodine-125 or palladium-103 seeds as monotherapy. PATIENTS AND METHODS: Patients with clinical stage T1, T(2ab), or T(3ab) disease with prostate volumes 23 to 180 cm3 and serum prostate specific antigen (PSA) concentrations of 0.9 to 143 ng/mL had seeds placed 10 mm apart under CT guidance. No androgen blockade was used postoperatively, but 47% of the patients had hormonal therapy preoperatively. RESULTS: At 12 to 63 months (median 26 months) of follow-up, PSA concentrations had decreased to <2 ng/mL in 90% of the patients and to <1 ng/mL in 83%. Four patients underwent transurethral resection or incision at least 12 months after implantation; none became incontinent. Three patients had rectal ulceration that lasted for several months. CONCLUSIONS: Computed tomography-guided transischiorectal brachytherapy allows accurate placement of radionuclide seeds in prostate glands of all sizes. The early results, as judged by serum PSA, are encouraging.

The ultrastructural effect of distension on the neuromuscular apparatus of the urinary bladder.

The recent clinical success of distension therapy in the treatment of idiopathic detrusor hyperreflexia has prompted this ultrastructural study. The neuromuscular pathways of conduction in the rat and rabbit urinary bladder wall were examined using perfusion fixation techniques. The effects of short-term and prolonged distension were studied at frequent intervals for 4 months in treated and control animals. Prolonged distension did not alter either smooth muscle architecture or intercellular contact points. A transient phase of nerve degeneration in bladder muscle consisting of axonal swelling and lysis of organelles was observed. A quantitative estimate of nerve injury and regeneration was compiled using pooled histograms. Possible physiologic mechanisms of injury and clinical conclusions are discussed.

Anatomic effect of distention therapy in unstable bladder: new approach.

The recent clinical success of distention therapy in the treatment of the unstable bladder is reviewed. Bladder stability and increased capacity as measured by cystometry following distention therapy as well as relief of symptoms have prompted this anatomic study. The neuromuscular pathways of conduction in rat and rabbit bladder wall were examined following short-term (two-hour) and prolonged (six-hour) distention. Treated and control animals were studied at fixed intervals for four months. Prolonged distention did not alter either smooth muscle cell architecture or intercellular junctions. It did produce a transient phase of degeneration among the unmyelinated nerve fibers in the bladder wall consisting of axonal swelling and lysis of organelles. A quantitative estimate of nerve injury was compiled using pooled histograms. These results suggest that bladder stability following distention therapy may be related to nerve degeneration in the bladder wall.