Leah P. McMann

THE PREVALENCE OF TESTICULAR MICROLITHIASIS IN AN ASYMPTOMATIC POPULATION OF MEN 18 TO 35 YEARS OLD

PURPOSE Testicular microlithiasis is an imaging entity of the testicle thought to be a marker of testicular cancer. To our knowledge the prevalence of testicular microlithiasis in an asymptomatic population at risk for testicular cancer is unknown. We report an ultrasound screening study done to establish the prevalence of testicular microlithiasis in an asymptomatic population. MATERIALS AND METHODS Healthy men 18 to 35 years old from the annual Army Reserve Officer Training Corps training camp volunteered for study. A screening genitourinary history was obtained, and physical examination and screening scrotal ultrasound were performed. We defined testicular microlithiasis as more than 5 high intensity signals on ultrasound with each signal larger than 2 mm. We categorized testicular microlithiasis into microcalcifications that were scant-5 to 25 per side, moderate-greater than 25 per side but no areas of near confluence and too numerous to count. In all subjects with testicular microlithiasis tumor markers were also measured. RESULTS Of 1,504 evaluated men with a mean age of 22.4 years, 84 (5.6%) had testicular microlithiasis, including 45 of 1,053 white (4%), 21 of 149 black (14.1%), 6 of 71 Hispanic (8.5%), 3 of 54 Asian or Pacific Island (5.6%) men and 9 of 174 (5.2%) who claimed no race affiliation. Tumor markers were normal in all subjects with testicular microlithiasis. CONCLUSIONS Testicular microlithiasis occurs in more than 5% of healthy young men. In contrast, testicular cancer develops in 3/100,000 to 5/100,000 men or 1,000-fold less often. The relative prevalence of testicular microlithiasis with respect to testicular cancer, increased prevalence in minorities, bilateral distribution, and inverse geographic distribution of men with testicular microlithiasis and testicular cancer represent evidence against an association of the 2 conditions. This study indicates that testicular microlithiasis is a common finding in asymptomatic men that may not be related to testicular cancer.

Oral Ketoconazole for Prevention of Postoperative Penile Erection: A Placebo Controlled, Randomized, Double-Blind Trial

PURPOSE Patients undergoing penile surgery often have postoperative erections that can be painful and may interfere with wound healing. In retrospective studies ketoconazole has been shown to decrease the number and pain of postoperative erections. We conducted a prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of ketoconazole in the prevention of postoperative erections. MATERIALS AND METHODS Patients undergoing penile reconstructive surgery were randomized to receive ketoconazole (400 mg 3 times a day) or placebo starting 2 days before surgery and continuing for 7 days after surgery. We recorded the number and characteristics of each erection on a standardized log. Liver function tests were drawn before and after surgery. RESULTS Of the 40 patients enrolled 20 were randomized to the ketoconazole group and 20 to placebo. In the ketoconazole group 81.25% reported postoperative erections compared to 83% in the placebo group. Of those patients who had postoperative erections 85% in the ketoconazole group reported painful erections compared to 80% in the placebo group. These differences were not statistically significant (p >0.99). In the ketoconazole group 3 patients (15.8%) withdrew early because of nausea and 1 in the ketoconazole group had a transient increase in liver function tests. CONCLUSIONS To our knowledge this is the only prospective, double-blind, placebo controlled study to evaluate the use of ketoconazole in the prevention of postoperative erections. While prior retrospective reports showed promise for this medication, our study suggests that ketoconazole is not effective in preventing postoperative erections.

Preoperative Albumin Is Predictive of Early Postoperative Morbidity and Mortality in Common Urologic Oncologic Surgeries.

Micro‐Abstract Using the American College of Surgeons National Surgical Quality Improvement Program database, we explored the relationship between preoperative albumin status and postoperative outcomes in cystectomies, nephrectomies, partial nephrectomies, prostatectomies, and transurethral resection of bladder tumors. Hypoalbuminemia correlated with increased morbidity and mortality, not only in large cases such as cystectomies, but in smaller cases such as transurethral resection of bladder tumors. These findings will assist with preoperative planning and counseling. Introduction: Multiple studies have linked preoperative nutrition status to postoperative outcomes. This relationship has been little studied in urology. We used a standardized, national, risk‐adjusted surgical database to evaluate 30‐day outcomes of patients undergoing common urologic oncologic procedures as they related to preoperative albumin. Methods: The American College of Surgeons National Surgical Quality Improvement Program is a risk‐adjusted dataset analyzing preoperative risk factors, demographics, and 30‐day outcomes. From 2005 through 2012, we identified a total of 17,805 patients who underwent prostatectomy, nephrectomy, partial nephrectomy, cystectomy, or transurethral resection of bladder tumor (TURBT). Hypoalbuminemic patients were compared with those with normal preoperative albumin, and 30‐day outcomes were evaluated. Logistic regression analyses were used to estimate odds ratios for mortality and complication rates. Results: Evaluation of the cohort noted significantly increased overall morbidity, serious morbidity, and mortality in the hypoalbuminemic group (P < .01 for all procedures). Hypoalbuminemia was associated with a significantly higher 30‐day mortality in major procedures such as cystectomy, and in smaller procedures such as TURBT (P < .01). Hypoalbuminemia was associated with a 6.4% 30‐day mortality in the TURBT group compared with 0.6% in those with normal albumin (P < .0001). These findings remained significant after adjustment for other risk factors. Conclusions: The large sample size, standardized data definitions, and quality control measures of the American College of Surgeons National Surgical Quality Improvement Program database allow for in‐depth analysis of subtle but significant differences in outcomes between groups. Serum albumin is a strong predictor of short‐term postoperative complications in the urologic oncology patient.

Primary Adenocarcinoma of the Rete Testis: Improved Staging Accuracy With CT-PET

A case of adenocarcinoma of the rete testis in a 54-year-old man is presented. Most such patients harbor metastatic disease, even in clinically localized presentations. CT-PET may provide improved diagnostic sensitivity over conventional CT in this setting.

Bilateral fibrous pseudotumors of the tunica albuginea in a pediatric patient

Fibrous pseudotumor, previously named nodular fibrous periorchitis, is a very rare disease entity in the pediatric patient. This is the first reported case of bilateral synchronous fibrous pseudotumors in the testes of a pediatric patient.

Sonographic Evaluation of Hydronephrosis in the Pediatric Population Is Well-Tempered Sonography Necessary?

Standardized protocols exist for diuretic renography. There are no specific guidelines regarding hydration before renal sonography. This study assessed the importance of the hydration status by sonographic measurements of the anteroposterior diameter and its effect on Society for Fetal Urology (SFU) hydronephrosis grading.

Upper Urinary Tract Abnormalities: A Case of Bilateral Kidneys Within a Left-sided Omphalocele

Children with omphalocele, exstrophy, imperforate anus, and spinal defects complex present with the most severe form of birth defects in the exstrophy-epispadias spectrum. Prenatal diagnosis is difficult, but improved survival over the past several decades makes understanding the potential anatomic manifestations imperative for expeditious and appropriate surgical care. The upper urinary tract is often normal in children with omphalocele, exstrophy, imperforate anus, and spinal defects complex, but malposition of one of the kidneys has previously been reported. We present the first case of bilateral kidney herniation into the omphalocele sac.

Impact of Race in Using PSA Velocity to Predict for Prostate Cancer

OBJECTIVE To assess whether race is a significant factor in the ability of prostate-specific antigen velocity (PSAV) for predicting high-grade prostate cancer (HGPC). METHODS Records of men who underwent prostate biopsy between January 2003 and December 2007 were retrospectively reviewed to collect demographic data, self-reported race, prostate-specific antigen (PSA) data, and pathology results. PSAV was calculated using linear regression. Subjects were stratified by the presence or absence of HGPC. Median PSA and PSAV values were compared within each racial group using receiver operating characteristic analysis and Student t test. RESULTS Static PSA was significantly higher in Caucasian men with HGPC (4.81 vs. 8.3 ng/mL, p = 0.0000001) while PSAV was also higher in men with HGPC (0.639 vs. 1.15 ng/mL/yr, p = 0.081). Static PSA in Asians did not perform well in predicting HGPC (5.3 vs. 9.42 ng/mL, p = 0.11), but fared much better than PSAV (0.51 vs. 0.93 ng/mL/yr, p = 0.27). PSA in African Americans did not significantly predict HGPC (6.27 vs. 7.7 ng/mL, p = 0.474), but PSAV showed a stronger trend toward significance (0.615 vs. 1.54 ng/mL/yr, p = 0.068). CONCLUSIONS PSAV may complement static PSA in African Americans and help identify early stage aggressive cancers.

Ovotesticular Disorders of Sexual Development: A Case of Hernia Uteri Inguinalis.

Ovotesticular disorders of sexual development result in the presence of both testis and ovarian tissue. Most commonly, gonadal structures in the scrotum or inguinal canal are comprised of testis tissue. The presence of a uterus within an inguinal hernia sac in a phenotypically male patient is referred to as hernia uteri inguinalis. This condition has rarely been reported in patients with ovotesticular disorders of sexual development. We present a patient with rare mosaicism in combination with an unusual location of Müllerian duct structures within an inguinal hernia sac.

Testicular Cystic Walthard Cell Nest in a 7-Month-Old.

Walthard cell nests have previously been reported arising from paratesticular structures; however, this is the first reported case of an intratesticular Walthard cell nest. We report our experience with this lesion which is interesting not only because of its extreme rarity but also because of the proposed histogenesis of such lesions.