George Fournier

The Value of Prostate Specific Antigen and Transrectal Ultrasound Guided Biopsy in Detecting Prostatic Fossa Recurrences Following Radical Prostatectomy

The combination of prostate specific antigen (PSA) and transrectal ultrasonography was used to detect recurrent cancer in the prostatic fossa after radical prostatectomy. A total of 43 patients with persistently elevated PSA levels and negative bone scintigraphy following radical prostatectomy underwent digital rectal examination and transrectal ultrasonography. Ultrasound findings were considered suspicious if the scan showed any unusual hypoechoic tissue adjacent to the bladder neck, retro-trigone or peri-anastomotic site. Of 22 patients (51%) with biopsy proved cancer 21 (95%) had positive transrectal ultrasonography, while digital rectal examination was able to detect cancer in only 10 (45%). Among transrectal ultrasonography detected recurrences 15 (68%) were detected at the initial biopsy and 7 (32%) at repeat biopsies. Our study shows that the combination of PSA and transrectal ultrasonography provides a more effective method than digital rectal examination and PSA to detect biopsy proved cancer following radical prostatectomy.

Utility of preoperative serumprostate-specific antigen concentration and biopsy Gleason score in predicting risk of pelvic lymph node metastases in prostate cancer

Objectives. To determine the accuracy of the preoperative serum concentrationof prostate-specific antigen (PSA) plus the Gleason pathology score of biopsy specimens in predicting the presence of disease in the pelvic lymph nodes in patients with prostate cancer.

Transurethral evaporation of prostate (TUEP) with Nd:YAG laser using a contact free beam technique: Results in 61 patients with benign prostatic hyperplasia

OBJECTIVE This prospective study was undertaken to evaluate the safety and efficacy of neodymium:yttrium-aluminium-garnet (Nd:YAG) laser for treatment of symptomatic benign prostatic hyperplasia (BPH). METHODS A total of 61 patients at a mean age of 71.6 years with symptomatic bladder outlet obstruction due to BPH underwent transurethral evaporation of prostate (TUEP) using Nd:YAG laser. Twelve of the patients were experiencing acute retention. Pre- and postoperative evaluation consisted of American Urological Association (AUA) symptom questionnaire and a sexual function questionnaire, uroflowmetry, postvoid residual urine, electrolytes, blood urea nitrogen, creatinine, hematocrit, and prostate volume estimation by transrectal ultrasound. TUEP was achieved by employing a side-firing Nd:YAG laser fiber with a durable quartz reflector and high-power density (Ultraline, Heraeus LaserSonics, Milpitas, CA) that was used in a contact mode. RESULTS All patients have been evaluated for three months, 26 for six months, and 7 for twelve months. Mean prostatic size was 41.1 g. The mean improvement in symptom scores at one, three, six, and twelve months was 69.8 percent, 70.9 percent, 76.0 percent, and 70.9 percent, respectively (P = < 0.0001). The mean increase in maximum uroflow at one, three, six, and twelve months was 63.4 percent, 66.7 percent, 41.94 percent, and 164.52 percent, respectively (P = < 0.0001). There was no instance of significant fluid absorption or bleeding. The duration of postoperative catheterization was two days in 43 patients, three to seven days in 16 patients, and two to three weeks in 2 patients. There were no deaths. All patients evaluated by TRUS at six months had open channeling defects. Videocystoscopy performed in 16 patients at two to three months postoperatively revealed tissue slough. At repeat cystoscopy in these patients at six months, the prostatic fossa was completely healed with no evidence of tissue slough. CONCLUSIONS It is concluded that the technique of TUEP using Nd:YAG laser is safe and, in preliminary results, appears apparently effective in the management of BPH.

High resolution scrotal ultrasonography: a highly sensitive but nonspecific diagnostic technique.

We compared surgical and pathological findings to those of preoperative scrotal ultrasonography in 50 consecutive patients undergoing surgical exploration for testicular trauma, tumors or benign atraumatic conditions. An inhomogeneous parenchymal echo pattern was the single most reliable predictor of a parenchymal abnormality. Large scrotal hematomas may preclude adequate visualization of the parenchyma and early testicular torsion may exhibit a normal parenchymal echo pattern. Except for early torsion, no false negative predictions of the state of the parenchyma were made.

Peyronie’s Plaque: Surgical Treatment with the Carbon Dioxide Laser and a Deep Dorsal Vein Patch Graft

We describe a procedure for ablation of Peyronies plaque using the carbon dioxide laser, which allows one to remove all palpable evidence of plaque while at the same time avoiding the creation of a large defect in the tunica albuginea requiring coverage with a large graft. The plaque is removed by making either a longitudinal or transverse incision in the plaque with a focused carbon dioxide laser beam from a hand held probe, and evaporating the plaque substance from the undersurface by tangentially directing the laser beam. It is possible to remove large dystrophic calcifications from within the plaque and to augment the repair in the area of greatest curvature using the deep dorsal vein as a patch graft. In cases of narrow plaques relaxation incisions and venous patch grafting alone are usually sufficient to correct the deformity. Our experience with 12 patients is summarized and 2 cases are reported in detail to illustrate the versatility of the procedure.

Impact of prostate cancer screening on health-related quality of life in at-risk families

OBJECTIVES To describe the impact of prostate-specific antigen (PSA) screening on the health-related quality of life (HRQOL) and anxiety of men with a family history of prostate cancer. METHODS We asked 334 brothers or sons of men with prostate cancer who agreed to undergo PSA testing to fill out HRQOL questionnaires. The questionnaires were the RAND SF-36 (generic HRQOL) and State-Trait Anxiety Inventory (anxiety-specific). Participants completed the questionnaires at the time of screening, while waiting for the results, and after receiving normal results. Sociodemographic and HRQOL variables were entered into a logistic regression model to identify factors associated with the deterioration of HRQOL, defined as a decrease of at least one standard error of measurement. Only men with normal PSA results were considered. RESULTS Among 334 candidates, 273 underwent PSA measurement and 220 candidates with a PSA of 4 ng/mL or less returned completed questionnaires. Of these, in 20% their anxiety moderately deteriorated and in 20% their HRQOL minimally deteriorated during the screening process. Factors associated with HRQOL deterioration included age between 50 and 60 years, having more than two relatives with prostate cancer, an anxious personality, a high level of education, and having no children presently living at home. CONCLUSIONS Screening with normal PSA results is accompanied by a minimally to moderate deterioration of HRQOL in some subjects. The identification of such individuals before screening provides opportunities to improve their HRQOL during the screening process.

Urethral anastomotic healing after radical retropubic prostatectomy: Impact of positive urethral margin

OBJECTIVES To determine the time course of urethral anastomotic healing after radical retropubic prostatectomy and its relationship to a positive margin at the anastomosis, the type of suture used, and the incidence of bladder neck contracture. METHODS In 119 consecutive patients a pericatheterogram was performed at 15.5 +/- 0.5 days postoperatively. A second pericatheterogram was obtained at 22.3 +/- 0.7 days for those anastomoses that were not healed, and a third pericatheterogram at 32.1 +/- 2.5 days for the remainder. Maxon sutures were used for 63 anastomoses, Dexon for 14, and chromic catgut for 42. RESULTS Sixty-five anastomoses (55%) were healed at the first pericatheterogram and 104 (87%) by 22 days. Microscopic tumor at the apical cut end of the prostate was found in 20% of specimens; the healing period for these patients was 21.0 +/- 2.0 days compared with 21.1 +/- 0.8 days for those with a negative margin. The healing time for Maxon, Dexon, and chromic catgut was 21.6, 24.6, and 19.5 days, respectively. Of the 108 evaluable patients, in 10 (9.3%) significant bladder neck contracture developed at a mean of 15 weeks; 6 (10.7%) were associated with Maxon anastomoses, 1 with Dexon (8.3%), and 3 (7.5%) with chromic sutures. Five of 10 bladder neck contractures were in 11 patients with previous prostate surgery (45%). CONCLUSIONS The presence of microscopic tumor at the urethral margin did not increase the risk of extravasation. There was no correlation between extravasation and bladder neck contracture, but less extravasation was associated with chromic sutures. Previous transurethral resection appeared to be a risk factor for the development of bladder neck contracture.

Nd:YAG laser transurethral evaporation of the prostate (TUEP) for urinary retention

Little information is available regarding the effectiveness of laser prostatectomy in patients with urinary retention from benign prostatic hyperplasia since there is no paper specifically dealing with laser prostatectomy in patients in urinary retention.