Adenoma of the posterior urethra: 131 case report.
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AIM: A case-report on adenoma of the posterior urethra. METHODS: In 131 cases of adenoma of the posterior urethra, aged 17-79 (mean: 36.4) years, a detailed medical history was taken and urinalysis, urethroscopy, and prostatic specific antigen (PSA) immunohistochemical staining were performed. They were then treated with transurethral resection (TUR) or transurethral electric coagulation (TUEC). RESULTS: Hemospermia occurred in 51% of the cases, hematuria in 38%, blood overflow from the urethral orifice in 6%, and dysuria in 5%. The position of the tumor was at or around the verumontanum. The appearance of the tumor was similar to those of a papilla, a villus, a dactyl or polyp, or simply an engorgement. The tumor contained glandular alveoli and adeno-epithelial cells. PSA immunohistochemistry was positive in the cytoplasm and nucleus of the adeno-epithelial cell. One hundred and tweenty-nine cases were cured after TUR or TUEC, while 2 patients recurred and were operated again. CONCLUSION: Adenoma of the posterior urethra is a common cause of hemospermia and hematuria in young men. Urethroscopic examination and biopsy are the principal diagnostic measures. TUR or TUEC are believed to be the treatment of choice with a short-term recurrence rate of around 1. 5%. (+info)
Morphological and clinical observations of patients with early bladder cancer treated with total cystectomy.
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In 21 cases, early bladder cancer was detected by urine cytology, although not by cystoscopy, and was treated by total cystectomy. The neoplasms, all transitional cell carcinomas of moderate to high degrees of anaplasia, were entirely in situ in 17 of the 21 patients; in 4, although mainly in situ, the tumors showed additional minimal microinvasion. Widespread mucosal involvement was demonstrated in every case by step-sectioning, and extension into the prostatic ducts occurred in 7 of the 19 male patients and into the mucosa of one or both distal ureters in 12 patients. Premalignant atypia of the mucosa was also widespread and direct intramucosal spread of cancer cells was a significant factor, particularly along the prostatic ducts and ureters. The duration of significant symptoms (follow-up for 9 years before cystectomy in several cases and for 8 years in 1 histologically proved case) suggests that the evolution of these tumors may be considerably longer than previously documented. (+info)
Urethral recurrence following neobladder in bladder cancer patients.
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Risk factors of urethral recurrence after neobladder in bladder cancer patients were studied. Between 1977 and 2001, 73 patients (male 58, female 15) underwent neobladder as a treatment for bladder cancer. The observation time after cystectomy ranged from 2 to 254 months (median 60.5). Ten (17.2%) of 58 male patients had urethral recurrence and of the 10, 8 patients had multiple bladder cancers including bladder neck. Urethral recurrence was found by macrohematuria, follow-up cystourethroscopy, and inguinal lymph node swelling. Only one who complained of macrohematuria had positive urinary cytology. Of 58 male patients, 5 underwent total nephroureterectomy for renal pelvic or ureteral cancer before radical cystectomy, and 3 of the 5 had urethral recurrence. Two of 10 patients with urethral recurrence died with cancer, and they had renal pelvic or ureteral cancer. The five-year cause specific survival was 83% for patients with urethral recurrence, and 79% for those without urethral recurrence, respectively. Urethral recurrence did not have a significant effect on survival. The patients with multiple bladder cancers including bladder neck, and renal pelvic or ureteral cancer before radical cystectomy, have high risks for urethral recurrence. Urinary cytology has limited value for the detection of urethral recurrence. (+info)
Oncogenic human papillomavirus type 16 is associated with squamous cell cancer of the male urethra.
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Human papillomaviruses (HPV), especially genotypes 16 and 18, are probable effectors of human urogenital malignancies. Although the male urethra is a proposed reservoir of HPV transmission, the association between HPV and squamous cell carcinoma (SCC) of the male urethra has not been studied. The highly sensitive technique of polymerase chain reaction with type-specific HPV 16 and 18 primers and general primers, including nine other genotypes was used to survey a series of SCC of the male urethra for the prevalence of an association with HPV. Archival surgical specimens from 14 patients were analyzed, and primary, recurrent, and metastatic lesions from 4 (29%) patients contained HPV 16 DNA. No other HPV genotype (6b, 11, 13, 18, 30, 31, 33, 35, 45, 51) was detected. Complete concordance for the presence of HPV in primary and recurrent or metastatic disease was demonstrated. These findings strongly suggest that HPV type 16 is associated with a substantial subset of SCCs of the male urethra. Analysis of clinical data revealed that HPV-positive tumors had a significant predilection for location in the pendulous urethra versus the bulbar urethra. Survival data analysis showed that the presence of HPV more closely correlated with prolonged survival than did tumor location. The presence or absence of HPV 16 DNA defines two subsets of SCC of the male urethra which differ in the site of occurrence and, possibly, progression. (+info)
Anterior urethral recurrence of superficial bladder cancer: its clinical significance.
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The aim of this study was to reveal the clinical features of anterior urethral recurrence in patients with superficial bladder cancer, and to determine the appropriate treatment. Three hundred and three patients with superficial bladder cancer, who were newly diagnosed and initially treated conservatively in our hospital between 1965 and 1990, were followed for at least 5 years and their clinical outcomes were analyzed. Clinical factors, including anterior urethral recurrence, were evaluated statistically regarding tumor progression. Eight patients (2.6%) had anterior urethral recurrence following superficial bladder cancer. Twenty-four patients (7.9%) had tumor progression and 149 (49.2%) had tumor recurrence. In a multivariate analysis using a logistic model, anterior urethral recurrence was the most important factor, followed by histological grade. Four of 5 patients who were treated for anterior urethral recurrent tumors by transurethral resection showed progression and died of the cancer within one year. Two of the remaining three patients who underwent radical cysto-urethrectomy at the time of anterior urethral recurrence survived. Anterior urethral recurrence following superficial bladder cancer is a predictor for rapid subsequent malignant progression. Once there is anterior urethral recurrence, radical intensive therapy, including radical cysto-urethrectomy, should be carried out immediately. (+info)
Suspicious urinary cytology with negative evaluation for malignancy in the diagnostic investigation of haematuria: how to follow up?
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AIMS: To define the natural history of patients with suspicious urinary cytology and negative initial evaluation for malignancy in the investigation of haematuria. PATIENTS AND METHODS: Data from the hospital information support system on urinary cytology examinations carried out at one centre were audited over a period of 24 months. There were 102 patients who had suspicious urinary cytology for malignant cells with negative initial evaluation. Follow up investigations, treatment, and final outcome were noted. RESULTS: There were 102 patients with suspicious urinary cytology and negative initial evaluation for malignancy in 24 months, with a mean follow up of 15.7 months. Seventy patients had no obvious pathology on initial investigations. Forty one patients were found to have urological malignancies (29 bladder, eight ureteric, and four prostate) on follow up. All patients diagnosed as having urothelial malignancies on follow up had either persistent suspicious cytology (29) or recurrent haematuria (eight). The mean duration for appearance of lesions was 5.6 months (range, 3-12 months). Three patients had suspicious digital rectal examination and biopsies confirmed adenocarcinoma of the prostate. One patient had urinary retention and transurethral resection of prostate showed prostatic adenocarcinoma. The presence of suspicious cells on repeat urine analysis was the only significant factor in predicting the presence of urothelial tumours (p = 0.002). CONCLUSION: Patients with persistent suspicious/positive cytology or recurrent haematuria need further evaluation and follow up. Asymptomatic patients or patients with obvious benign pathology do not require repeat evaluation. Careful urological evaluation, including prostate, should be carried out in these patients. (+info)
Carcinogenic susceptibility to N-bis(2-hydroxypropyl)nitrosamine (DHPN) in rasH2 mice.
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To evaluate the susceptibility of rasH2 mice to N-bis(2-hydroxypropyl)nitrosamine (DHPN), a potent carcinogen targeting the lung, liver, thyroid, and kidney, male, 6-week old, rasH2 mice and wild-type littermates (non-Tg mice) were given DHPN in drinking water at 0, 20 or 200 ppm, and 0 or 200 ppm, respectively, for 26 weeks. The experiment using rasH2 mice given 200 ppm DHPN and non-Tg mice given 200 and 0 ppm DHPN was completed at 20 weeks, since mortality in these groups was remarkably increased due to hemangiosarcomas of the liver. Histologically, tumors developed in the lung and liver in both rasH2 and non-Tg mice treated with DHPN. In addition, proliferative lesions were observed in the forestomach, urethra, and excretory duct of salivary glands in rasH2 mice given 200 ppm DHPN. RT-PCR analysis showed no marked difference in expression of mRNAs for the transgene and the endogenous mouse ras gene between the whole lung tissue containing a neoplasm and normal lung tissue. Our results suggest that rasH2 mice are highly susceptible to DHPN, the target organs including the forestomach, salivary gland and urethra, which have not been found to develop tumors in previous long-term carcinogenicity studies of DHPN in rats and mice. (+info)
Ureteral endometriosis and coexistent urethral leiomyoma in a postmenopausal woman.
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We report the case of a postmenopausal woman with a synchronous obstructing intrinsic endometrioma of the left ureter and a coexistent periurethral leiomyoma. Endometriosis in postmenopausal women is a rare clinical entity usually associated with exogenous estrogen use. Urethral leiomyomas are also rare, with only 40 cases reported in the literature. Ovarian hormones are believed to influence the growth of leiomyomas. We report the genitourinary presentation of 2 separate disease entities with known hormonal influence in a postmenopausal woman receiving estrogen replacement therapy. We believe the patient's hormonal milieu affected the development of her concurrent pathology. (+info)