Stanley J. Kandzari

Urinary Retention in Patients with BPH Treated with Finasteride or Placebo over 4 Years

Objectives: Knowledge regarding the incidence and prevalence of acute urinary retention and the ultimate outcome is very limited. The purpose of the present analysis was to document the natural history and outcomes of acute urinary retention (AUR) further specified as being either precipitated or spontaneous, and to evaluate the potential benefit of finasteride therapy.Materials and Methods: Three thousand and forty men with moderate to severe symptoms of BPH and enlarged prostate glands by digital rectal examination were enrolled into the 4–year placebo–controlled PLESS trial and were evaluated for occurrences of AUR and BPH–related surgery. Men in the study were seen every 4 months; discontinued patients were followed up 6 months after discontinuation and again at the end of the 4–year trial. Complete 4–year data on outcomes (occurrence of AUR or BPH–related surgery) was available for 92% of the enrolled subjects in each treatment group. An endpoint committee, blinded to treatment group and center, reviewed and categorized all study–related documentation relating to retention and surgery.Results: Over the 4–year period, 99 of 1,503 placebo–treated patients (6.6%) experienced one or more episodes of AUR in comparison with 42 or 1,513 finasteride–treated patients (2.8%; p<0.001). Approximately half of the episodes of retention were spontaneous and clearly BPH–related, while the other episodes were precipitated by another factor (PAUR). After spontaneous AUR, subsequent surgery was performed in 39 of 52 (75%) placebo–treated patients versus 8 of 20 (40%) finasteride–treated patients (p = 0.01). BPH–related surgery was less common in men who had a prior episode of PAUR (26% in the placebo group and 14% in the finasteride group).Conclusion: There is a continual risk of spontaneous and precipitated acute urinary retention in men with moderate to severe lower urinary tract symptoms and an enlarged prostate gland. Fewer patients who developed precipitated AUR than spontaneous AUR go on to need subsequent BPH–related surgery. Significantly fewer finasteride–than placebo–treated patients developed AUR, and among those men, fewer ultimately needed BPH–related surgery.

Impact of Stone Location on Success Rates of Endoscopic Lithotripsy for Nephrolithiasis

OBJECTIVES To determine whether stone location affects the stone-free rates of endoscopic lithotripsy for nephrolithiasis. METHODS From January 2002 to August 2006, 245 patients with 272 stones, ranging from 4 to 20 mm in size, underwent ureteroscopy (URS) with laser lithotripsy at West Virginia University Hospital. The patients were followed up postoperatively with noncontrast spiral computed tomography, abdominal plain radiography, renal ultrasonography, or retrograde pyelography. Patients were considered to have been treated successfully if they had no residual stones. All pediatric patients were excluded, as were all patients with stones greater than 2 cm. Also, patients who had undergone previous shock wave lithotripsy, percutaneous nephrolithotripsy, or URS by an outside urologist were excluded. RESULTS A total of 86 kidney stones were treated with URS and laser lithotripsy. Of these, 81 (94.2%) were successfully treated. Five patients (5.8%) had persistent stones. All 18 upper pole stones (100%) were cleared, 23 (95.8%) of 24 middle pole stones were cleared, and 40 (90.9%) of 44 lower pole stones were cleared (P = 0.338). CONCLUSIONS URS is an important tool for treating nephroureterolithiasis with excellent success rates and minimal morbidity. The results of our study have shown that stone location does not significantly affect stone clearance rates when performing endoscopic lithotripsy for intrarenal calculi.

Fibroepithelial polyps of ureter: A benign ureteral tumor

The authors believe that it is difficult to differentiate benign from malignant ureteral tumors unless the clinical course or cytologic diagnostics are grossly positive. Therefore, they are of the opinion that unless ones index of suspicion is low, treatment of ureteral tumors should be aggressive unless benignancy is assured. A case in point is reported, and 49 cases of nonepithelial polyps found in the literature are reviewed.

Secondary Testicular Tumors

A case of bilateral testicular metastases from carcinoma of the colon is reported. A review of the literature on secondary testicular tumors reveals their rarity and speculation is made as to the routes of metastases.

Neurogenic Bladder and the Tethered Spinal Cord Syndrome

We report 2 cases of the tethered spinal cord syndrome. Early clinical detection of this syndrome in children with bladder dysfunction should be followed by diagnostic myelography and immediate surgical release of the spinal cord. The pathophysiology of the syndrome is discussed.

Five-year survival following excision of renal cell carcinoma extending into inferior vena cava

Fifteen consecutive patients having radical nephrectomy and excision of tumor extension from the inferior vena cava for pathologic Stage 3A renal cell carcinoma were followed up for a minimum of five years. Survival was compared with patients having radical nephrectomy for Stage 2 or Stage 3 renal cell carcinoma in the same time interval. Five-year survival in the Stage 3A group (47%) was similar to that for patients with Stage 2 tumors (54%) and significantly better than Stage 3 patients with positive lymph nodes at surgery (12%). Renal cell carcinoma with venous extension has a reasonable prognosis after surgical excision and warrants an aggressive surgical approach.

Ureterosigmoidostomy followed by carcinoma of the colon

Adenocarcinoma of the colon developing as a late complication or ureterosigmoidostomy has been reported with increasing frequency. A patient is presented who developed adenocarcinoma of the colon 28 years after ureterosigmoidostomy for bladder exstrophy and 13 years after conversion of the ureterosigmoidostomy to an ileal conduit. The colonic tumor was documented at postmortem examination to be at the ureterosigmoidostomy site. Because of the potential late development of adenocarcinoma of the colon, careful follow‐up of patients with ureterosigmoidostomies, particularly those performed in children many years ago, is indicated.

Iodine 125 seed implants for prostatic carcinoma: Five- and ten-year follow-up

Between 1975 and 1985 132 patients underwent bilateral pelvic lymphadenectomy and insertion of Iodine 125 seeds for biopsy-proved localized carcinoma of the prostate. Surgical stages were A2 9 percent, B 64 percent, C 9 percent, and D1 18 percent. Operative mortality was zero. Short and long-term complications were less than 33 percent. Ten-year survival rates of evaluable patients for surgical Stages A2, B1, B2, and C1 were 75 percent, 70 percent, 48 percent, and 44 percent, respectively. For these patients, ten-year disease-free rates for Stages A2, B1, B2, and C1 were 67 percent, 36 percent, 60 percent, and 25 percent, respectively. Interstitial radiotherapy may play a role in the treatment of nonsurgical candidates with low volume and well- to moderately-differentiated adenocarcinoma of the prostate.

Epidermoid Cyst of Testis: A Report of 3 Cases

We report 3 cases of simple epidermoid cyst of the testis. These tumors often are mistaken clinically for malignancy. Conservative surgical treatment with preservation of the testis is desirable when preoperative ultrasound reveals a well demarcated cystic nodule confirmed by histological frozen sections.

Incarceration of penis by foreign body.

Abstract A case report of a remarkably long-term penile incarceration by a foreign body and its management and outcome are examined.