Ultrasonography as an aid in the diagnosis and management of surgical diseases of the pelvis: special emphasis on the genitourinary system.
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Technological advances, particularly the advent of the gray scale technique, has greatly extended the application and usefulness of this modality to clinical diagnoses and surgery. The ultrasonic beam uniquely provides anatomical profiles in the transverse (cross-sectional) and sagittal (longitudinal) planes of the body. Intra-rectal and intra-vaginal ultrasonic probes have provided unique definition of both the normal and pathologic anatomy of the pelvic organs. The present report is drawn from a continuing experience with ultrasonography of the genitourinary system with an update of current technological advances. Ultrasonography has proven especially valuable in the following clinical applications: 1) Early diagnosis of cancer (especially of the prostate); 2) Accurate staging of cancer of the bladder and prostate; 3) Monitoring of the response of the pathologic process to therapy. (+info)
Estrogen receptor expression in prostate cancer and premalignant prostatic lesions.
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Estrogens have been implicated in prostatic cancerogenesis and tumor progression. The mechanisms underlying estrogen signaling in human prostate tissue, however, remain poorly understood. Using immunohistochemical and in situ hybridization (ISH) techniques, the present study demonstrates the classical estrogen receptor (ERalpha) in premalignant lesions and prostatic adenocarcinoma through the various stages of the disease. Conversely, the novel characterized ERbeta subtype was undetectable in human prostate tissue. High-grade prostatic intraepithelial neoplasia revealed ERalpha mRNA and protein expression in 28% and 11% of cases evaluated. Focal ER immunoreactivity was detected in a minority of low- to intermediate-grade adenocarcinoma. High-grade (primary Gleason grade 4 and 5) tumors revealed ER protein expression in 43% (62% respectively) of cases. The most significant ERalpha gene expression on mRNA and protein levels was observed in hormone refractory tumors and metastatic lesions, including lymph node and bone metastases. Results of the current study suggest that estrogens can affect prostatic cancerogenesis and neoplastic progression through an ER-mediated process in human prostate tissue. (+info)
Transurethral deroofing of midline prostatic cyst for subfertile men.
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We evaluated the efficacy of transurethral deroofing of a midline prostatic cyst in subfertile men with one or more of the following semen abnormalities: decreased ejaculatory volume, decreased sperm motility and oligo- or azoospermia. Results from treatment of a series of 11 subfertile men with a midline prostatic cyst by transurethral deroofing of the cyst are presented. Five patients showed an improvement of seminal volume. Only one patient demonstrated an improvement of sperm count. Sperm motility was not influenced. No relationship was found between positive outcome following operation and either size of the cyst or dilatation of the seminal vesicles. Spontaneous pregnancies did not occur after transurethral deroofing of the midline prostatic cyst. In conclusion, our study suggests a poor efficacy of transurethral deroofing of a midline prostatic cyst in subfertile men with the above mentioned semen abnormalities. (+info)
Prostatic and central nervous system histoplasmosis in an immunocompetent host: case report and review of the prostatic histoplasmosis literature.
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Histoplasmosis is a common cause of systemic mycosis in areas of the United States where it is endemic. Central nervous system and genitourinary histoplasmosis is rare, especially in immunocompetent hosts. We describe a case of disseminated histoplasmosis in a normal host that was associated with cerebral and prostatic histoplasmosis presenting as fever of undetermined origin, weight loss, and severe debilitating altered mental status. The patient subsequently developed acute renal failure that manifested as obstructive uropathy during antifungal therapy with amphotericin B. Transurethral resection of the prostate resulted in improved renal function during continuation of amphotericin B therapy. Pathological analysis of the prostate revealed necrotizing granulomas with intralesional fungal organisms. Blood and urine cultures were positive for Histoplasma capsulatum. Diagnostic issues and management are discussed. Treatment resulted in return of normal cognitive and motor function. This case is compared with the 8 previously reported cases of H. capsulatum prostatitis. (+info)
Can percent free prostate-specific antigen reduce the need for prostate biopsy?
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BACKGROUND: In a recent multicenter study, percent free prostate-specific antigen (PSA) enhanced the specificity of PSA testing in prostate cancer screening. OBJECTIVE: To determine whether the percent free PSA could be as effective in reducing the need for biopsy in a managed care setting as in an academic setting. SETTING: Kaiser Permanente Northwest Region (Portland, Oregon) and Kaiser Permanente Oakland/Berkeley (California). DESIGN: Prospective blinded study conducted by using Hybritech Tandem PSA and Hybritech Tandem free PSA assays (Beckman Coulter, Inc., Fullerton, California). PARTICIPANTS: 250 men (63 with prostate cancer and 187 with benign prostate conditions) who were older than 40 years of age, had a PSA level of 4.0 to 10.0 ng/mL, and had a histologically confirmed diagnosis. MAIN OUTCOME MEASURES: Sensitivity and specificity of percent free PSA. RESULTS: The median percent free PSA values for patients with cancer (free PSA, 13%) significantly differed from that for patients without cancer (free PSA, 17%) (P = 0.001). When a free PSA cutoff of 25% was used, the sensitivity was 97% (95% CI, 92% to 100%) and the specificity was 13% (CI, 8% to 18%). These results were not significantly different from those obtained in the multicenter study (95% sensitivity, 20% specificity for a free PSA cutoff of 25%). CONCLUSION: The results obtained in a managed care organization were similar to those obtained at large university medical centers and show that the percent free PSA can be used to enhance the specificity of PSA testing for prostate cancer. (+info)
Treatment of prostatitis.
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The term prostatitis is applied to a series of disorders, ranging from acute bacterial infection to chronic pain syndromes, in which the prostate gland is inflamed. Patients present with a variety of symptoms, including urinary obstruction, fever, myalgias, decreased libido or impotence, painful ejaculation and low-back and perineal pain. Physical examination often fails to clarify the cause of the pain. Cultures and microscopic examination of urine and prostatic secretions before and after prostatic massage may help differentiate prostatitis caused by infection from prostatitis with other causes. Because the rate of occult infection is high, a therapeutic trial of antibiotics is often in order even when patients do not appear to have bacterial prostatitis. If the patient responds to therapy, antibiotics are continued for at least three to four weeks, although some men require treatment for several months. A patient who does not respond might be evaluated for chronic nonbacterial prostatitis, in which nonsteroidal anti-inflammatory drugs, alpha-blocking agents, anticholinergic agents or other therapies may provide symptomatic relief. (+info)
Health issues in men: part I: Common genitourinary disorders.
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Common genitourinary health issues that arise in the care of male patients include prostatitis, benign prostatic hyperplasia, urogenital cancers, premature ejaculation and erectile dysfunction. Bacterial infections are responsible for only 5 to 10 percent of prostatitis cases. Benign prostatic hyperplasia is present in 90 percent of men by the age of 85. Common urogenital cancers include prostate cancer, transitional cell carcinoma of the bladder and testicular cancer. Although an estimated 10 percent of men eventually develop prostate cancer, screening for this malignancy is one of the most controversial areas of health prevention. Premature ejaculation occurs in as many as 40 percent of men. Treatment with tricyclic antidepressants, selective serotonin reuptake inhibitors, counseling or behavioral therapy may be helpful. Erectile dysfunction affects up to 30 percent of men between 40 and 70 years of age. Stepped therapy is a useful approach to this common malady. Good treatment results have been obtained with orally administered sildenafil and intraurethrally administered alprostadil. (+info)
Successful closure of a recto-prostatic fistula.
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Recto-prostatic fistula is a rare complication of prostatic surgery, occurring usually because surgical planes are not appreciated. We describe a combined abdomino-perineal approach for the repair of a large recto-prostatic fistula with the interposition of omentum and gracilis without formally closing the fistula in layers. (+info)