Magnetic resonance imaging and morphometric histologic analysis of prostate tissue composition in predicting the clinical outcome of terazosin therapy in benign prostatic hyperplasia.

PURPOSE: To determine whether magnetic resonance imaging (MRI) or quantitative color-imaged morphometric analysis (MA) of the prostate gland are related to the clinical response to terazosin. METHODS: Thirty-six male patients with symptomatic benign prostatic hyperplasia (BPH) with a serum prostate-specific antigen level of 4-10 ng/mL underwent MRI with body coil, transrectal prostate ultrasonography and biopsy prior to terazosin therapy. For MRI-determined stromal and non-stromal BPH, the ratio of the signal intensity of the inner gland to the obturator internus muscle was evaluated. Histologic sections were stained with hematoxylin and eosin. The MA of the specimens was performed by Samba 2000. Results of the two techniques were interpreted according to the terazosin therapy results. RESULTS: The mean stromal percentage was 60.5 +/- 18.0%. No statistically significant relationship was found between the clinical outcome of terazosin and the MRI findings. The MA results showed a significant relationship between the percentage of stroma and the percent change of the peak urinary flow rate, but not with the percent change of the international prostate symptom score after terazosin therapy (P < 0.05). CONCLUSION: Magnetic resonance imaging alone is not sufficient in predicting the response to terazosin therapy. Morphometric analysis of BPH tissue composition can be used in predicting the clinical outcome of terazosin therapy but it is suitable only in patients for whom prostatic biopsy is necessary in order to rule out prostate cancer.

What is the optimal treatment for lower ureteral stones larger than 1 cm?

PURPOSE: To compare the treatment options for lower ureteral stones larger than 1 cm. METHODS: The records of 449 patients with lower ureteral calculi larger than 1 cm were reviewed retrospectively. Of these patients 342 (76.1%) were treated with extracorporeal shock wave lithotripsy (ESWL) (group 1), 66 (14.7%) with pneumatic lithotripsy (PL) (group 2) and 128 (28.5%) with ureterolithotomy (group 3). Eighty-seven (19.5%) patients underwent any of the two treatment modalities because of unsuccessful primary treatment. RESULTS: The overall stone-free rates were 32.4, 90.9 and 95.3% for ESWL, PL and ureterolithotomy, respectively. These values were 84.4% for primary PL and 96.7% for primary ureterolithotomy. The re-treatment rate (46.4%) and secondary procedures were much more frequent in the ESWL group. There was no difference in the complication rates of the three groups. CONCLUSIONS: Pneumatic lithotripsy with ureteroscopy seems to be an appropriate treatment for larger ureteral stones. While ESWL can be tried as a first treatment option because of its noninvasive nature, lower success and higher re-treatment rates limit its usefulness. Ureterolithotomy is still a reasonable alternative for these large or unfragmented stones.

Comparison of the nuclear matrix protein 22 with voided urine cytology and BTA stat test in the diagnosis of transitional cell carcinoma of the bladder.

OBJECTIVE: To assess sensitivity, specificity, accuracy, positive predictive value and negative predictive value of nuclear matrix protein 22 (NMP22) test, BTA stat test and cytology in the urine of patients with a spectrum of urologic conditions, including bladder cancer. METHODS: A total of 140 patients (40 with bladder cancer) provided a urine sample which was divided into appropriate aliquots for each of the tests cited above. The endoscopist, pathologist, cytologist and the person performing BTA stat test and NMP22 test were blinded as to the results of the other tests. RESULTS: Receiver-operating characteristics curve interpretation determined that 12.0 U/ml was an optimal reference value for NMP22 to detect transitional cell carcinoma of the bladder in this patient group. Comparative results demonstrate a clear superiority of NMP22 and BTA stat tests in sensitivity in bladder cancer detection (p < 0.01), while cytology and NMP22 were better than BTA stat test in specificity (p < 0.05). CONCLUSIONS: NMP22 and BTA stat test results represented significant improvement over urinary cytology for detection of transitional cell carcinoma. The sensitivities of NMP22 and BTA stat tests for detection of transitional cell carcinoma in this group of patients were as much as twice that of cytology. When the cutoff value of urinary NMP22 was set at 12.0 U/ml, NMP22 was more accurate than the other tests (p < 0.05).

Extracorporeal shockwave lithotripsy in anomalous kidneys.

BACKGROUND AND OBJECTIVE: Extracorporeal shockwave lithotripsy (SWL) is accepted as first-line therapy for kidney stones. The aim of this study was to evaluate SWL therapy in patients with congenital urinary system anomalies. PATIENTS AND METHODS: A total of 120 patients with congenital urinary system anomalies and kidney stones who underwent SWL treatment were evaluated. Of these patients, 44 (37%) had horseshoe kidneys, 22 (18%) had rotation anomalies, 13 (11%) had pelvic kidneys, and 41 (34%) had ureteral duplications. The mean stone size was 2.09+/-0.71 (range 0.8-4.6) cm2, and a total of 232 sessions (1.93 sessions/patient) were applied. RESULTS: The overall stone-free rate after completion of the SWL treatments was 70% (84 patients). In horse shoe kidneys the stone-free rate was 68%, and sufficient fragmentation was achieved in another 21%. These values were 59% and 32%, respectively, for malrotated kidneys, 54% and 39% for pelvic kidneys, and 83% and 12% for ureteral duplications. The 10 patients in whom SWL treatment remained unsuccessful had horse-shoe kidneys (five cases), malrotated kidneys (two cases), pelvic kidney (one case), and ureteral duplication (two cases). Open surgery was performed in eight patients with renal anomalies, and ureteroendoscopic lithotripsy was performed in two patients with ureteral duplication. CONCLUSION: Shockwave lithotripsy is an effective and reliable treatment method in patients with congenital urinary system anomalies, especially when the stones are <2 cm. Patients with ureteral duplication had the overall best stone-free rates. However, patients who have stones > or =3 cm in horseshoe or malrotated kidneys and duplex systems seem to be better candidates for percutaneous nephrolithotomy or open surgery.

The relation of optical density of seminal plasma with serum FSH and LH levels in azoospermic patients.

The aim was to investigate the relation between optical density of seminal plasma, serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels in azoospermic patients and to establish criteria depending on optical density measurements in order to estimate serum FSH and LH levels. Optical density of seminal plasma and serum FSH and LH levels were measured in 45 azoospermic patients. The semen samples with an optical density (OD) of more than 0.5 showed normal levels of FSH and LH, while those with less than 0.5 were observed to have high levels of FSH and LH. The optical density of seminal plasma can be used in the prediction of serum FSH and LH levels in azoospermic patients.

Treatment of lower ureteral stones: extracorporeal shockwave lithotripsy or intracorporeal lithotripsy?

OBJECTIVE: In this study, 1121 patients with lower ureteral stones were evaluated to compare the effectiveness of extracorporeal shockwave lithotripsy (SWL) and ureteroscopy with three different lithotripsy modalities. METHODS: Of these patients, 726 were treated with SWL, whereas 430 underwent ureteroscopy, with pneumatic lithotripsy (PL), ultrasonic lithotripsy (USL), and electrohydraulic lithotripsy (EHL) performed in 125 (29.0%), 276 (64.2%), and 29 (6.8%) patients, respectively. Thirty-five patients underwent both types of treatment because of unsuccessful SWL therapy. RESULTS: In the SWL group, the stone-free rate was 42.2% and the fragmentation rate was 59.5%. These values were 96.8% and 98.4% for PL, 89.4% and 90.5% for USL, 93.1% and 96.5% for EHL, respectively. CONCLUSIONS: These data show that SWL was less effective than ureteroscopic lithotripsy (p < 0.001). The PL modality had the highest stone-free and fragmentation rate, and EHL had the highest complication rate (43.5%). Ureteroscopic lithotripsy is the most effective treatment choice in lower ureteral stones no matter which kind of energy is used, and PL is the most effective and least morbid approach.

Antibiotic prophylaxis for transrectal biopsy of the prostate: a prospective randomized study of the prophylactic use of single dose oral fluoroquinolone versus trimethoprim-sulfamethoxazole.

We investigated the efficacy of prophylactic use of single dose oral ofloxacin and trimethoprim-sulfamethoxazole regimens for transrectal prostate biopsy in 110 men. In the ofloxacin, trimethoprim-sulfamethoxazole and control groups, urinary infection was found in 2 (4.76%), 3 (6.66%) and 6 (26.08%) patients, respectively. Both of these antibiotic regimens produced a statistically significant reduction in urinary infection (p<0.02, p<0.05). Our study indicates that single dose fluoroquinolone or trimethoprim-sulfamethoxazole prophylaxis seems to be effective, practical and economical.

Extracorporeal shock wave lithotripsy for lower caliceal calculi.

OBJECTIVE: The aim of the study is to determine the effectiveness of extracorporeal shock wave lithotripsy (ESWL) therapy for isolated lower caliceal calculi. PATIENTS AND METHODS: We analyzed 165 patients who were treated with the Siemens Lithostar Plus on an outpatient basis between March 1993 and August 1997. The age of patients ranged from 17 to 70 (mean 39.11) years. The stone size varied from 4 to 42 mm, and patients who had stones larger than 21 mm had a double-J stent inserted prior to treatment. RESULTS: The overall stone-free rate at 3 months was 53.33%; whereas it was 61.79, 48.27, and 27.27% according to the stone size, /=21 mm, respectively. Complications were rare, including 2 pyelonephritis, 2 subcapsular hematoma formation, 24 renal colics and 8 stone streets, which were managed by ureteral stenting or additional ESWL and resulted in complete stone clearance. CONCLUSION: ESWL therapy is a reasonable and effective method for small lower caliceal stones, but due to its relatively low stone-free and high complication rates, percutaneous nephrolithotripsy or open surgery should be considered for stones larger than 21 mm.

Combination of pneumatic lithotripsy and transurethral prostatectomy in bladder stones with benign prostatic hyperplasia.

We present our experience with combined pneumatic lithotripsy and transurethral resection of the prostate (TURP) in 52 patients with bladder stone(s) and benign prostatic hyperplasia (BPH). All stones were fragmented with the pneumatic Swiss Lithoclast. Pneumatic lithotripsy and evacuation caused a mean increase of 16 minutes in operating time. No complications, other than mild hematuria, were observed intraoperatively because of pneumatic lithotripsy. We observed early and long-term complications related to the procedure in 13% of patients. The average hospital stay was 3.2 days. The combination of pneumatic lithotripsy and TURP appears to be an effective, safe, and economical treatment method for patients with bladder stone(s) and BPH.

Sertraline in the treatment of premature ejaculation: a double-blind placebo controlled study.

This study investigated the efficacy and the adverse effects of sertraline in the treatment of premature ejaculation (PE). Thirty-seven patients with PE were randomly assigned to receive either sertraline or a placebo. Of them 22 were given 50 mg of sertraline per day and the other 15 patients were given an identical placebo one per day. After 4 weeks, the latency to ejaculation in the sertraline group was found to be significantly longer than that of the placebo group (p<0.01). None of the patients discontinued therapy due to adverse effects. These results indicate that sertraline is an effective therapy for PE.

Correlation of nuclear p53 over-expression with clinical and histopathological features of transitional cell bladder cancer.

Forty-four pathologic specimens of 39 bladder cancer patients were analyzed immunohistochemically with D07 monoclonal antibody to detect over-expression of mutant p53 gene. The findings were interpreted by correlating with patient age, sex, cigarette smoking, number and macroscopic appearance of tumour, histological tumour grade, muscular invasion, vascular invasion, necrosis and urothelial atypia or dysplasia. Mutant p53 gene was over-expressed in 8 (18.2%) specimens. Statistically significant correlation with grade, vascular invasion, necrosis and patient sex was found with p53 over-expression. Available follow-up data were insufficient to draw a conclusion about the prognostic role of p53 over-expression. Prospective studies with larger number of patients are needed to define the exact place of nuclear p53 over-expression in transitional cell bladder cancer.

Nuclear p53 overexpression in bladder, prostate, and renal carcinomas.

BACKGROUND: The aim of this study was to examine nuclear p53 overexpression in transitional cell carcinoma of the bladder, adenocarcinoma of the prostate, and renal cell carcinoma. METHODS: Forty-four pathologic specimens from 39 bladder cancer patients, 41 prostatic adenocarcinoma, and 39 renal cell carcinoma specimens were analyzed immunohistochemically with D07 monoclonal antibody to detect the expression of the mutant p53 gene. Overexpression was said to occur when the number of positively-stained tumor nuclei were > or = 10% in each specimen. p53 overexpression was correlated with the clinical and histopathological features of these cancers. RESULTS: Nuclear p53 overexpression occurred in 18.2% of transitional cell bladder cancer specimens, 12.2% of prostate cancer specimens, and 17.9% of renal cell cancer specimens. Statistical analyses showed that grade, vascular invasion, and necrosis in bladder cancer, a high Gleason score in prostate cancer, and the 1-year mortality rate in renal cancer were significantly related with p53 nuclear overexpression (P < 0.05). CONCLUSION: Using the D07 monoclonal antibody, nuclear p53 overexpression is relatively uncommon in urologic malignancies, and moderately correlates with several histopathological and clinical features of urologic malignancies.