Reinier Opsomer

Long-Term Results and Late Recurrence After Endoureteropyelotomy: A Critical Analysis of Prognostic Factors

Of 102 consecutive endoureteropyelotomy cases followed for 1 to 10 years (mean 5) late recurrence was observed in 13% and long-term success was achieved in 73%. Of 67 cases with an available preoperative angiogram a strong association was noted between the existence of a vessel crossing the ureteropelvic junction and high grade hydronephrosis, and final failure and/or recurrence: long-term success rate was 39% when both factors were present and it was 95% when neither factor was present. Therefore, we recommend that the presence of a vessel should be determined preoperatively since it significantly influences the outcome.

Pudendal cortical somatosensory evoked potentials.

To determine normal reference latencies pudendal cortical somatosensory evoked potentials were evaluated in 20 healthy volunteers. The dorsal nerve of the penis or clitoris was stimulated electrically and the cortical response was recorded from the CZ-2 point (2 cm. behind the central vertex). Reproducible responses were obtained and reference values were established.

Free to total prostate-specific antigen (PSA) ratio improves the discrimination between prostate cancer and benign prostatic hyperplasia (BPH) in the diagnostic gray zone of 1.8 to 10 ng/mL total PSA.

OBJECTIVES Improved discrimination between prostate cancer (PC) and benign prostatic hyperplasia (BPH) is clearly needed. Our aim in this study was to evaluate whether the free to total prostate-specific antigen (PSA) ratio would be useful in the gray zone of 1.8-10 ng/mL total PSA range. METHODS In a consecutive series of 435 clinic patients referred for prostate evaluation, 308 had a total PSA < 10 ng/mL (92 had PC and 216 BPH). Free and total PSA were measured, and the free to total PSA ratio calculated. RESULTS Total PSA values were significantly different between the two groups. For the 200 patients with a total PSA < 6 ng/mL, no significant difference in total PSA values were seen (P = 0.411), whereas free to total PSA ratios remained statistically different (P < 0.001). Receiver operating characteristic (ROC) curve analysis comparing the performances of total PSA over the ratio of free to total PSA showed a clear advantage for the ratio at all sensitivity levels. CONCLUSIONS These data demonstrate that in a significant number (n = 308) of prostatic patients in the diagnostic gray zone of 1.8-10 ng/mL total PSA, the routine use of free to total PSA might be advantageous in discriminating between cancer and benign hyperplasia. This advantage remained for total PSA < 4 ng/mL. Further study is warranted to confirm these findings in an unselected population.

Free to total prostate-specific antigen (PSA) ratio is superior to total-PSA in differentiating benign prostate hypertrophy from prostate cancer

Serum prostate‐specific antigen (PSA) exists in different molecular forms, and their respective concentration has been proposed as a useful tool to improve discrimination between benign prostatic hypertrophy (BPH) and prostate cancer (PC).

Le traitement par voie transdermique

L’oxybutynine entraine un relâchement musculaire de la vessie en se fixant principalement au niveau des recepteurs muscariniques M3 du detrusor, empechant ainsi la stimulation par l’acetylcholine. L’oxybutynine transdermique penetre dans la circulation par diffusion passive au niveau de la couche cornee de la peau. Cette voie d’administration permet d’eviter la metabolisation gastrique et hepatique et ainsi de reduire la production de metabolites responsables d’effets secondaires. Le patch delivre de l’oxybutynine pendant 3 a 4 jours apres son application cutanee. La concentration plasmatique maximale d’oxybutynine est atteinte apres 24 a 48 heures d’une simple application. L’oxybutynine transdermique reduit de maniere significative le taux d’incontinence urinaire avec une efficacite comparable a la tolterodine et l’oxybutynine par voie orale Le traitement par voie transdermique est en general bien tolere. Des reactions cutanees locales sous forme de prurit ou d’erytheme ont ete rapportees.

Undetectable prostate-specific antigen in aging men.

Undetectable prostate-specific antigen was found in three aging men despite the absence of any prostatic surgery or exogenous hormonal deprivation. Clinical and elementary hormonal workup revealed the presence of secondary hypogonadism. This finding confirms the hormonal dependency of this prostatic marker and may, in some cases, explain the discrepancy between prostatic volume and the value of serum prostate-specific antigen.