Cemil Yagci

Computerized Tomography for Detecting Perivesical Infiltration and Lymph Node Metastasis in Invasive Bladder Carcinoma

Objectives: Computerized tomography (CT) is used in the preoperative staging of invasive bladder carcinoma. We evaluated the role of CT for detecting perivesical invasion and lymph node metastases in patients who had undergone radical cystectomy and pelvic lymphadenectomy for invasive bladder carcinoma. Patients and Methods: We retrospectively analyzed the clinical and pathological data of 100 patients with invasive bladder carcinoma who had undergone radical cystectomy. The preoperative CT images were reevaluated and interpreted by one uroradiologist blinded to the final pathological results for evidence of extravesical tumor extension or lymph node metastases. Results: Of the 100 patients, CT showed extravesical tumor involvement in 57. Of these 57 cases, 22 displayed no evidence of extravesical tumor involvement in the final pathological analysis. In 6 cases, although perivesical invasion was identified in the final pathological analysis, preoperative CT showed no evidence of extravesical tumor involvement. Regarding extravesical tumor spread, the differences between CT and pathological stages were statistically significant (p < 0.001). CT was highly suggestive of lymph node metastases in 9 cases, but only 4 were pathologically confirmed. On the other hand, in 9 patients pelvic lymph node metastasis were pathologically diagnosed, but there was no evidence of lymphadenopathy on CT. Regarding lymph node involvement, there was moderate concordance between CT and pathological findings (p = 0.003, κ = 0.29 ± 0.14). Conclusion: CT has limited accuracy in detecting perivesical infiltration and lymph node metastasis in invasive bladder carcinoma. The information provided by CT is insufficient and we urgently need more reliable staging techniques.

Virtual cystoscopy in the evaluation of bladder tumors

OBJECTIVE The objective of this study was to investigate the value of contrast material-filled virtual cystoscopy in the detection of bladder tumors. MATERIALS AND METHODS Thirty-nine patients who had recent diagnosis or were followed up due to priory history of bladder tumor underwent virtual cystoscopy. After the intravenous injection of contrast medium, the bladder was examined with helical computed tomography (CT) scan. The data were transferred to a workstation for interactive navigation using surface rendering. Two radiologists independently interpreted the axial and virtual images, and discrepancies were resolved by consensus. The results of virtual cystoscopy were compared with the findings of conventional cystoscopy. RESULTS Forty-nine of 54 bladder lesions detected with conventional cystoscopy in 33 patients were also shown on virtual images. On virtual cystoscopy, three of the seven lesions 5 mm or smaller in diameter could be identified. There were no false-positive findings. The sensitivity of the technique was 96.2% for polypoid tumors and 88.9% for sessile lesions. When axial and virtual images were evaluated together, the sensitivity rate increased to 94.4%. CONCLUSION Bladder tumors can be diagnosed noninvasively using contrast medium-filled virtual cystoscopy. Evaluation of both the axial and virtual images increases the sensitivity of the technique.

Efficacy of transrectal ultrasonography in the evaluation of hematospermia.

OBJECTIVE To assess the efficacy of transrectal ultrasonography (TRUS) in the evaluation of hematospermia. MATERIAL AND METHODS This study included 54 patients with hematospermia. Patients age range was between 25 and 75 years (mean=49.7 years). All patients were evaluated by TRUS using a biplane transducer and a Toshiba SSA-270A device. RESULTS TRUS revealed one or more abnormalities in 51 patients (94.5%). Prostatic calcifications were found in 23 patients, ejaculatory duct calculi in 21, dilated ejaculatory ducts in 18, benign prostatic hyperplasia in 18, dilated seminal vesicles in 12, calcifications in seminal vesicles in 11, ejaculatory duct cyst in 6, prostatitis in 6, and periurethral Cowper gland mass in 1. CONCLUSION TRUS is a noninvasive, safe method for the investigation of causes of hematospermia. We believe that it should be the first radiological investigation to be performed in patients presenting with hematospermia.

The value of transrectal ultrasound guided needle aspiration in treatment of prostatic abscess

INTRODUCTION Prostatic abscess (PA) is a very uncommon disorder. The value of transrectal ultrasound (TRUS) guided aspiration in the treatment of PA has not been clearly defined. We present our experience with six such patients. MATERIALS AND METHODS Between July 1997 and December 2002, six patients with PA were diagnosed by TRUS and treated by TRUS guided needle aspiration in our department. PA was defined as hypoechoic, inhomogeneous, thick walled fluid collection. TRUS guided needle aspiration of the abscess was performed transrectally in all patients with a 20-cm long 18 gauge Chiba needle. Successful treatment criteria were defined as clinical improvement in symptoms and decrease of more than half of the estimated abscess volume on follow up TRUS control. Patients with continuing clinical symptoms were defined as treatment failures. RESULTS The most common TRUS finding was detection of a hypoechoic area with inhomogeneous structures, which was determined in all patients (100%). In some patients irregular contour and heterogeneous areas were additionally described. TRUS guided needle aspiration treatment of PA was successful in five of six patients (83.3%). In one patient treatment failed and the abscess recurred 3 weeks after the procedure. As this patient had additionally a bladder outflow obstruction, transurethral resection of the prostate was performed instead of a repeat procedure. There were no complications associated with the procedure. CONCLUSIONS In conclusion, TRUS has an important value in diagnosis and treatment of PA. TRUS guided aspiration is an effective and minimally invasive treatment modality for PA which causes no serious complications.

The role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the primary staging of rectal cancer

BackgroundIn this study we aimed to determine the need for 18F-flourodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the preoperative staging of rectal carcinoma in our large patient group according to level and location of tumor.MethodTotally, 97 patients diagnosed with primary rectal adenocarcinoma between May 2009 and July 2011 were included in the study. Preoperative staging was performed by evaluating contrast-enhanced thoracic, abdominal, and pelvic computed tomographies. After staging by conventional methods, all patients underwent an 18F-FDG PET/CT. In all cases, the relationship between 18F-FDG uptake and gender, tumor height at the anal canal, localization in the rectal wall, plasma carcinoembryonic antigen levels, histopathological tumor type, and tumor stage were examined.ResultsWhile the ceCT was normal in 4 (4%) patients, it was positive for the rectum in 93 (95%), pelvic lymph nodes in 22 (22%), and distant metastases in 14 (14%) (liver (8), lung (8), bone (2), distant lymph nodes (6), and uterus (1)). Using computed tomography, disease stages were determined as stage 0, 1, 2, 3, and 4 in 4, 8, 48, 23, and 14 patients, respectively; 18F-FDG PET/CT was normal in two (2%) patients. The mean SUVmax of FDG-positive rectal tumors was calculated as 17.31 ± 9.37. Additionally, 18F-FDG uptake was seen in pelvic lymph nodes in 15 (15%) patients and in distant organs in 24 (24%) patients (liver (9), lung (12), bone (5), distant lymph nodes (11), uterus (1), and sigmoid colon (1)). According to an 18F-FDG PET/CT, 2, 7, 47, 20, and 21 patients were staged as stage 0, 1, 2, 3, and 4, respectively. In 14 patients (14.4%), the stage of the disease was either changed, and there was a need to make adjustments to the patient’s treatment strategy (n = 10), or the type of operation was changed (n = 4). In seven patients (0.7%), findings from 18F-FDG PET/CT images did not require any changes of the treatment plan.ConclusionF-FDG PET/CT provides new findings in addition to conventional techniques in the staging of primary rectal cancer. These findings could change the patients’ treatment strategies.

DETERMINATION OF TRANSITION ZONE VOLUME BY TRANSRECTAL ULTRASOUND IN PATIENTS WITH CLINICALLY BENIGN PROSTATIC HYPERPLASIA: AGREEMENT WITH ENUCLEATED PROSTATE ADENOMA WEIGHT

PURPOSE Accurately estimating transition zone volume is important for the medical or surgical management of symptomatic benign prostatic hyperplasia and determination of prostate specific antigen density of the transition zone. We evaluated whether preoperative transrectal ultrasound measurements of the transition zone predict enucleated adenoma weight. MATERIALS AND METHODS We measured transition zone volume preoperatively using transrectal ultrasound and the prolate ellipsoid method in 50 patients with presumed benign prostatic hyperplasia who underwent suprapubic prostatectomy. Transition zone volume corresponds to the adenoma. Enucleated adenoma weight was then correlated with preoperatively determined transition zone volume. RESULTS As measured by transrectal ultrasound, mean transition zone volume plus or minus standard deviation was 80.88 +/- 37.42 cc (range 31 to 200). Mean enucleated adenoma weight was 68.70 +/- 36.26 gm. (range 18 to 180). There was a statistically significant correlation of estimated transrectal ultrasound volume of the transition zone with enucleated prostate adenoma weight (r = 0.95, p <0.001). However, when prostate adenoma weight was determined using the formula, prostate adenoma weight = -6.00 + 0.92 x transition zone volume, we noted a significant difference in mean prostate adenoma weight and mean transition zone volume (p <0.001). Since the regression coefficient of transition zone volume was significantly different from 1, we identified no agreement of prostate adenoma weight with estimated transrectal ultrasound volume of the transition zone. CONCLUSIONS These data reveal a significant difference in mean prostatic adenoma weight and mean transition zone volume. Although transition zone volume measurements are well described, clear agreements on such measurements should be obtained to determine transition zone volume more precisely.

Cross-sectional imaging in ureter tumors: Findings and staging accuracy of various modalities

We present cross-sectional imaging findings in eight patients with ureter tumors. Eight patients were examined by computed tomography (CT), seven by ultrasonography (US), and five by magnetic resonance imaging (MRI). All the lesions were detected by the three modalities. All modalities were accurate in excluding the periureteral invasion and lymphadenopathy in Stages 1 and 2 tumors. While CT and MRI identified the periureteral invasion and lymphadenopathy in four patients with advanced tumors, US failed to show the local invasion in three of four patients. Nevertheless, enlarged retroperitoneal lymph nodes could be detected sonographically in the three Stage 4 tumors. CT and MRI appear to have a high diagnostic sensitivity and staging accuracy in ureter tumors. Although US detects ureter tumors efficiently, this technique seems to be unreliable in showing local invasion in a substantial number of patients.

A computational study on the characteristics of airflow in bilateral abductor vocal fold immobility

To evaluate airway sufficiency and airflow dynamics in a group of patients who underwent a posterior transverse laser cordotomy (PTLC) procedure.

Testicular Microlithiasis Associated with Seminoma: Gray-Scale and Color Doppler Ultrasound Findings

Testicular microlithiasis associated with seminoma was found in a 32-year-old infertile man. Gray-scale and color Doppler ultrasound findings are discussed and a brief review of the literature is presented.

Clitoral metastasis from transitional cell carcinoma of the renal pelvis: CT and MRI findings

Metastatic tumors of the clitoris are extremely rare. We report a case of clitoral metastasis in a 75-year-old woman who was treated for transitional cell carcinoma of renal pelvis 2 years ago. The computed tomography and magnetic resonance imaging findings are presented with a short review of the literature. To the best of our knowledge, clitoral metastasis originating from transitional cell carcinoma of the renal pelvis has not been reported in the English language literature.