George E. Deshon

Efficacy of one dose fluoroquinolone before prostate biopsy

OBJECTIVES To demonstrate the efficacy of a simple preparation for prostate biopsy (PBX) and to determine its potential cost savings. METHODS One hundred fifty consecutive PBXs were performed using a Fleet enema and a single oral dose (300 mg) of ofloxacin as the pre-PBX preparation. RESULTS Of the 150 PBXs we performed, only 1 (0.67%) patient developed a urinary tract infection. CONCLUSIONS A simple and inexpensive pre-PBX preparation proved to be successful in preventing infectious complications and is presented as a potential model for inclusion in clinical pathways for diagnosing adenocarcinoma of the prostate.

Mucinous adenocarcinoma of the prostate

A case of mucinous adenocarcinoma of the prostate that was diagnosed with the aid of prostate-specific antigen immunoperoxidase staining is reported. Focal areas of the tumor, which were morphologically similar to the remainder of the tumor, stained with neuron-specific enolase by an immunoperoxidase technique and with the Grimelius stain. This tumor is best thought of as a variant of the classic acinotubular adenocarcinoma of the prostate with well-differentiated cells that secrete mucin, rather than as a completely different type of cancer, as proposed previously.

Management of urinary tract in children with epidermolysis bullosa

Epidermolysis bullosa is a group of rare genetic disorders characterized by noninflammatory blistering lesions of the skin occurring after minor mechanical trauma. In association with junctional epidermolysis bullosa, a syndrome of pyloric atresia has occasionally been noted in the literature. Several infants who had this combined disorder have been reported to have severe genitourinary tract involvement. Most of these patients have died at an early age because of severe urinary tract involvement. We describe a rare survivor who was initially treated with urinary diversion. Subsequent attempts at undiversion of this patient were unsuccessful. He is presently stable following rediversion. The entities of e. bullosa and e. bullosa/pyloric atresia are reviewed with emphasis on urologic associations.

Triamterene stone: advantage of crystallographic analysis.

Microscopic crystallographic analysis of renal calculi provides clinically useful information concerning the pathogenesis of stone disease and is, therefore, superior to conventional chemical analysis of stones. The advantages of crystallography, performed at a centralized, experienced stone-analysis center, are highlighted by the recent discovery of triamterene deposits in kidney stones. Deposits of other medications and their metabolites have also been uncovered. Two case reports are presented, the clinical implications of these and related findings are discussed.

Endometrioid carcinoma of prostate

A prostatic tumor that was excised from a sixty-two-year-old man was found histologically to resemble papillary endometrial carcinoma. A specimen of this prostatic endometrioid carcinoma tested positive for prostate-specific antigen and focally positive for mucin, confirming the prostatic epithelial origin of the tumor. A review of the literature indicates that tumors of this type are best approached as a standard acinar adenocarcinoma of the prostate.

Furosemide-induced disturbances of renal function in patients undergoing TURP

Furosemide remains the drug of choice for patients with the transurethral resection syndrome. Furosemide is often used intraoperatively to treat patients suspected of having excessive irrigant absorption. To examine the efficacy of such therapy, a randomized study was performed in which furosemide was administered to patients undergoing routine transurethral resection of the prostate (TURP) to determine the effect of furosemide on electrolyte and fluid volume conservation in these patients. Seven patients treated with furosemide on completion of TURP had a statistically significant delayed drop in serum sodium values after normal initial values (139 mEq/L to 134 mEq/L). Seven untreated control patients did not have a similar drop in sodium values, and the difference between groups was significant. We suggest that furosemide be used with caution in patients undergoing routine TURP, and when given it should be accompanied by the infusion of an isotonic balanced salt solution.

Role of surgery in management of acute bacterial epididymitis.

In this article we trace the history of the surgical management of epididymitis and define the role of surgery for these patients

Partial resection of symphysis pubis

i Resection of the symphysis pubis has been recas an aid to exposure for the repair disruption from pelvic trauma and f the membranous urethra. 1 Resec~mplete segment of the symphysis is ime consuming and labor intensive accompanied by troublesome bleedion of the posterior lip of the pubis ~ves an equal degree of exposure and avoids these problems. 2-~ We have used this technique ~for the past two years and believe it deserves Wider application including use in managing benign and malignant conditions of the prostate, strictures of the sphincter-active urethra not amenable to a perineal approach, and re~0nstructive procedures of the bladder neck.