The significance of adult hematuria: 1,000 hematuria evaluations including a risk-benefit and cost-effectiveness analysis.

Between March 1976 and June 1985, 1,000 consecutive adults with asymptomatic gross or microscopic hematuria in the absence of proteinuria were evaluated urologically. Lesions that could account for the hematuria were detected in 88.3 per cent of the patients. Life-threatening lesions were diagnosed in 9.1 per cent of the patients, while lesions requiring at least observation were present in 22.8 per cent. The incidence of life-threatening lesions increased with age, with a sharp increase after age 50 years. Life-threatening lesions were more common in men (13.6 per cent) than in women (4.9 per cent). In general, as the degree of hematuria increased so did the yield of life-threatening lesions; however, there was no "safe" lower limit of hematuria. Of the patients with life-threatening lesions 18.6 per cent had at least 1 urinalysis with less than 3 red blood cells per high power field within 6 months of the diagnosis. The direct medical cost of a hematuria evaluation was $777. The difference in direct medical costs to diagnose and treat localized versus metastatic genitourinary cancer was $48,070 in 3 matched pairs of patients. In this study group 77 of 84 patients (92 per cent) diagnosed with genitourinary cancer had localized disease. A hematuria evaluation was cost-effective for all groups studied. A literature-based estimate of the life-threatening risks of diagnostic studies applied to the study data resulted in a 1.1 per cent life-threatening risk per hematuria evaluation. For all categories studied, except for women less than 40 years old with microscopic hematuria, the risk of a hematuria evaluation was less than the incidence of life-threatening lesions discovered as a result of the evaluation. Asymptomatic hematuria, whether gross or microscopic, is a significant finding and warrants evaluation from a risk-benefit and cost-effectiveness standpoint.

Emphysematous prostatic abscess: diagnosis and treatment.

We report an unusual case of an emphysematous prostatic abscess. Prostatic abscess is a difficult clinical diagnosis associated with lower urinary tract symptomatology and frequently diabetes mellitus. Computerized axial tomography and transrectal or transurethral ultrasonography can assist in making a specific diagnosis. Definitive treatment is complete surgical drainage, which is achieved by transurethral resection of the prostate. Wide spectrum, adjuvant antibiotic therapy should be given to assure coverage of anaerobic bacteria.

[Hemolysis in not the cause of the TUR-syndrome. The use of non-hemolytic solutions does not prevent its occurrence (author's transl)]. / Hämolyse ist nicht Ursache des TUR-Syndromes. Die Verwendung nichthämolysierender Spüllösungen kann es nicht verhindern

The TUR-syndrome has an acute and a delayed toxic modality. It occurs during the resection of large prostatic glands with long operative times and by perforation of the prostatic capsule. The TUR-syndrome is not caused by hemolysis by but disturbances of the serum electrolytes.

[How to prevent the TUR-syndrome (author's transl)]. / Zur Prophylaxe des TUR-Syndroms

The TUR-syndrome is due to the absorption of irrigating fluid free of electrolytes, producing hypervolemia, and dilutional hyponatremia, as well as hyperkalemia. Strict adherence to the above ten rules is necessary in preventing the TUR-syndrome. After using them for 30 years, we were able to avoid this complication without using non-hemolytic solutions nor limiting the operative time.

[The new iglesias resectoscope (author's transl)]. / Das neue Iglesias-Resektoskop

The new Iglesias resectoscope with continuous irrigation has been described. Advantages of this instrument include: no interruption of the TUR, better endoscopic vision, decreased and equally strong intravesical pressure, shorter operating time, less bleeding, easier teaching and performing of transurethral resections.