Howard N. Fenster

An assessment of the use of intravesical potassium in the diagnosis of interstitial cystitis

PURPOSE We evaluated the use of intravesical potassium in the diagnosis of interstitial cystitis. MATERIALS AND METHODS A blinded test assessment on 39 consecutive subjects attending our urology clinic for the evaluation of symptoms consistent with interstitial cystitis was performed. The pain response to intravesical potassium and water as a control was measured. The response rate was compared to the results of cystoscopy using standard outcome measures associated with diagnostic test assessment. RESULTS The probability of having interstitial cystitis given a positive intravesical potassium test was 66%. This finding added no new useful information and would not be helpful with clinical decisions as the probability of having interstitial cystitis in this population was already 56% before the test. Similarly, if the test was negative then 46% or nearly half of the subjects were still likely to have interstitial cystitis. Therefore, a negative test would have no ability to rule out disease nor would it be useful in making clinical decisions about how to proceed with evaluation or therapy. Test characteristics were considered poor with a sensitivity of 69.5% and a specificity of 50%. Likelihood ratios (positive 1.39, negative 0.61) also indicated poor inclusion and exclusion capabilities. CONCLUSIONS The general use of intravesical potassium as a diagnostic test for interstitial cystitis is not validated. The diagnosis of interstitial cystitis must depend on the clinical presentation and endoscopic findings based on National Institutes of Health criteria.

The Correlation of Multichannel Urodynamic Pressure-Flow Studies and American Urological Association Symptom Index in the Evaluation of Benign Prostatic Hyperplasia

PURPOSE We correlated multichannel pressure-flow urodynamics and the American Urological Association (AUA) symptom index in the evaluation of benign prostatic hyperplasia. MATERIALS AND METHODS We evaluated 121 consecutive, symptomatic patients older than 55 years with the AUA symptom score and multichannel pressure-flow urodynamic studies. Testing was performed during a single session and the data obtained from 103 patients were plotted on the Schäfer nomogram for assessment of outflow obstruction. Linear regression statistical analysis was used to determine correlations. RESULTS There was no significant correlation between uroflowmetry and Schäfer curves (r = 0.173 to 0.326), uroflowmetry and AUA symptom scores (r = 0.134 to 0.153) and, most importantly, AUA symptom scores and Schäfer curves (r = 0.025 to 0.137). CONCLUSIONS We conclude that these modalities measure independent variables, and should not be linked in the evaluation and treatment decision of the patient with prostatism.

Disseminated intravascular coagulation in carcinoma of prostate: role of estrogen therapy

Advanced carcinoma of the prostate may present as disseminated intravascular coagulation and its sequelae. It is postulated that the slow release of thromboplastic material from tumor cells eventually overcomes normal homeostatic mechanisms. High-dose intravenous diethylstilbestrol diphosphate successfully reversed this coagulopathy in 2 cases of metastatic carcinoma of the prostate.

A prospective, double‐blind, randomized cross‐over study evaluating changes in urinary pH for relieving the symptoms of interstitial cystitis

To provide evidence for the clinical efficacy of changes in urinary pH on the pain associated with interstitial cystitis (IC).

Vasovasostomy — is the microscope necessary?

Many techniques for vasovasostomy have been described, with each author suggesting his technique as the most effective procedure. Theoretical considerations such as leakage of sperm, obstruction, and narrowing of anastomosis suggest that a stentless technique with exact approximation of mucosal edges results in improved success rates. Careful macroscopic surgery with loupes, fine suture material, and experience on the part of the surgeon will give good results and pregnancy rates of 50 per cent. The value of microsurgery, however, becomes obvious when the anastomosis is performed in the convoluted portion of the vas and the epididymis. The microscope allows more mobility in allowing one to determine if the patient had a block proximal to the vasectomy site and then bypass these blocks. The success of vasovasostomy depends greatly on the surgeons experience with the actual surgical technique. Although technique is of paramount importance, there are factors other than technique that determine the pregnancy rate. Factors important in the success of vasovasostomy, macro- and microscopic techniques, basic concepts, principles and techniques of the various procedures, and the merits and limitations of each procedure, will be discussed.

Carcinoma in the Befunctionalized Urinary Tract

AbstractCarcinoma developing in the lower urinary tract diverted from the urinary stream, although uncommon, does occur and must be sought carefully in the presence of intractable pyocystis. Our experience with this condition is presented with emphasis on early diagnosis and treatment.

Pathogenesis of Urinary Infection in Patients with Acute Spinal Cord Injury on Intermittent Catheterization

In a small pilot study urinary tract infection in patients with acute spinal injury was preceded by the establishment of Enterobacteriaceae on the introitus, glans and urethra. Those patients who retain the normal flora do not become infected. The first infection most commonly is by Escherichia coli with universal antibiotic sensitivities. Female patients with a history of urinary infections and male patients with a history of bacterial prostatitis are at risk for suffering recurrent infections. Saline or chlorhexidine gluconate pre-catheter preparation does not appear to relate to a continual status free of infection.

Transurethral electrovaporization of the prostate versus transurethral prostatic resection: a comparison of postoperative hemorrhage.

OBJECTIVES To determine the acute and delayed hemorrhage rate of transurethral electrovaporization of the prostate (TEVP) versus standard transurethral resection of the prostate (TURP). METHODS A retrospective review of 524 consecutive patients who underwent TURP and 302 consecutive patients who underwent TEVP was conducted. The indications for both procedures were identical and based on history, physical examination, American Urological Association symptom score, and uroflowmetry. Parameters of evaluation included the incidence of both initial and delayed hemorrhages, the time until a delayed bleed occurred, blood transfusion rates, and the average length of stay in hospital after a bleed. RESULTS The overall hemorrhage rate for TURP and TEVP was 4.8% and 4.0%, respectively. In the TURP group, there was a 1.1% incidence of acute bleeds and 3.6% incidence of delayed bleeds. For the TEVP group, 0.3% had an acute hemorrhage, and 3.6% were readmitted for clot retention. The average length of time from original discharge to readmission was 12.9 days for the TURP group with a mean repeat stay of 5.7 days. For the TEVP group, the average interval to readmission was 15.4 days with a stay of 3.1 days. CONCLUSIONS The overall rate of hemorrhage for the TEVP group was slightly lower than for the TURP group due to fewer acute bleeds. However, the incidence of delayed bleeds and clot retention between the two was identical at 3.6%. Because of improved hemostasis intraoperatively with similar functional results in the long term as shown by other investigators, we foresee TEVP continuing as a viable alternative to TURP.

Female bladder neck incision

Bladder neck resection or incision in the female is not a new urologic procedure; however, it has not been widely accepted because of poor results and complications. From January to December, 1986, ten such operations have been performed on females with obstructive uropathy. All had previous anti-incontinence procedures and postoperative obstruction developed. Bladder neck incisions rather than resections have been performed with encouraging results. Urologic presentation, urodynamic investigations, and details of the surgery are presented. Bladder neck incision is a valuable adjunct in the management of bladder neck obstruction in the female.

Pulse granuloma of urinary bladder associated with interstitial cystitis.

Pulse granulomas are uncommon, benign foreign body inflammatory reactions that typically occur in the oral cavity. They are exceedingly rare elsewhere. Here we describe a 35-year-old woman who presented with interstitial cystitis and was found to have an incidental bladder mass. Histological examination of the biopsy revealed a pulse granuloma. The salient histopathologic features include corrugated hyaline rings and amorphous hyaline conglomerations within the connective tissue stroma of the lamina propria, admixed with chronic inflammatory cells with multinucleated foreign-body type giant cells. To our knowledge this is the first reported case of a pulse granuloma in the urinary bladder.