1/219. Combined radical retropubic prostatectomy and rectal resection.OBJECTIVES: To present our experience with a small series of men who underwent simultaneous radical retropubic prostatectomy and rectal resection. methods: Three men with newly diagnosed prostate cancer were found to have concurrent rectal tumors requiring resection. All three men underwent non-nerve-sparing radical retropubic prostatectomy and abdominoperineal resection (APR) or low anterior resection (LAR) of the rectum at the same operation. In the 2 patients undergoing APR, the levators were approximated posterior to the urethra, and the bladder was secured to the pubis. The patient undergoing LAR had urinary diversion stents placed and a diverting transverse loop colostomy. RESULTS: All 3 patients had excellent return of urinary continence. One patient required reoperation in the early postoperative period for small bowel adhesiolysis and stoma revision. Another patient had a mild rectal anastomotic stricture and a bladder neck stricture; both were successfully treated with a single dilation. No other significant complications occurred in these patients. CONCLUSIONS: Radical retropubic prostatectomy can safely be performed with partial or complete rectal resection in a single operation. A few minor modifications of the standard radical retropubic prostatectomy in this setting are suggested.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
2/219. carcinosarcoma of the prostate.We present a rare case of carcinosarcoma of the prostate occurring in a 60-year-old white male. This diagnosis was initially missed after a transurethral resection of the prostate (TURP) had been performed to alleviate the patient's urinary obstructive symptoms. After recurrence of symptoms within a short period, another TURP was performed and the diagnosis of carcinosarcoma was then established. The patient then underwent a radical cystourethroprostatectomy with bilateral lymphadenectomy and ileal conduit diversion. carcinosarcoma of the prostate is a very aggressive disease that often has a poor prognosis, especially when it has spread out of the prostate. Surgical removal of the prostate seems to be the best option for treatment in the select group of patients in which the disease remains confined to the prostate.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
3/219. Prostate brachytherapy in patients with prior evidence of prostatitis.PURPOSE: To refute a misconception that a prior history of prostatitis is a contraindication to prostate brachytherapy. methods AND MATERIALS: Five patients with clinical or pathologic evidence of prior prostatitis were treated with transperineal brachytherapy. Four of the patients received a single i.v. dose of ciprofloxacin (500 mg) intraoperatively. Postimplant antibiotics were not given. The pretreatment biopsy slides were reviewed. RESULTS: Two of the five patients developed postimplant urinary retention requiring short-term catheterization, and both resolved spontaneously. One patient developed what appeared to be an exacerbation of his chronic prostatitis. CONCLUSION: We continue to recommend prostate brachytherapy for the treatment of clinically organ-confined cancer, with no concern about prior clinical or pathologic evidence of prostatitis.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
4/219. Balloon dilation of posterior urethral stricture secondary to radiation and cryotherapy in a patient with a functional artificial urethral sphincter.Severe urethral stricture disease as an isolated entity can be a management dilemma. In the patient described here, this problem was associated with prior external-beam radiation and cryosurgical ablation of the prostate, and a functional artificial urethral sphincter (AUS) had been placed. An attempt to relieve partial urinary obstruction while preserving AUS function led to successful balloon dilation proximal to the sphincter cuff.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
5/219. Malignant phyllodes tumor of the prostate.phyllodes tumor of the prostate is rare. We have recently experienced a case of phyllodes tumor of the prostate in a 57-year-old man who complained of urinary retention for 1 year. The epithelial components were positive reactivity for prostate specific antigen. The stromal cells showed nuclear atypia with increased mitotic activity. The tumor was diagnosed as a malignant phyllodes tumor as it invaded into the urinary bladder and rectum, and grew rapidly immediately after operation. We describe the morphological features and immunohistochemical findings of malignant phyllodes tumor and review the literature.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
6/219. nephrotic syndrome due to membranous nephropathy associated with metastatic prostate cancer: rapid remission after initial endocrine therapy.A case of severe nephrotic syndrome (urinary protein excretion 12.9 g/day) due to membranous nephropathy associated with untreated prostate cancer and multiple bone metastases is described. A combination of initial endocrine treatment and steroid therapy resulted in normalization of prostate-specific antigen levels followed by a rapid decrease of urinary protein excretion within 4 months. No proteinuria was subsequently detected. Seven months after the initiation of therapy, the patient remained well with complete clinical remission from the nephrotic syndrome. This rapid achievement of remission may have been due to tumor shrinkage by androgen ablation in addition to steroid therapy of the membranous nephropathy. The nephrotic syndrome is a rare complication of prostate cancer, and, to the best of our knowledge, no previous cases have been reported of membranous nephropathy as one of the first disease manifestations.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
7/219. Epidural compression of the cauda equina caused by vertebral osteoblastic metastasis of prostatic carcinoma: resolution by hormonal therapy.A 59 year old man with prostatic carcinoma developed epidural compression of the cauda equina caused by bony expansion from a vertebral osteoblastic metastasis. For medical reasons he could not undergo radiation or surgery. Hormonal therapy alone relieved his low back pain and restored ambulation and urinary function. Postmyelography CT showed that the bony expansion from the vertebra had completely disappeared after treatment. This is the first report of remarkable improvement due to hormonal therapy alone.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
8/219. A case of nephrogenic diabetes insipidus caused by obstructive uropathy due to prostate cancer.Nephrogenic diabetes insipidus (DI) secondary to chronic urinary tract obstruction is a rare disease. The exact cause is unknown but it is likely that increased collecting duct pressures cause damage to the tubular epithelium, resulting in insensitivity to the action of arginine-vasopressin (AVP). A 77-year-old man complaining of polyuria and polydipsia was treated with alpha glucosidase inhibitor under the impression of polyuria due to diabetes mellitus. But his symptoms did not improve. water deprivation and AVP administration study revealed that the patient had nephrogenic DI. urinary tract obstruction due to an enlarged prostate was suggested as a principal cause of nephrogenic DI. The patient underwent transurethral resection of the prostate and bilateral subcapsular orchiectomy. After surgery, the urine osmolarity was normalized and the patient became symptom-free. We report a case of nephrogenic DI due to obstructive uropathy which was cured by surgery eliminating obstruction.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
9/219. Incidental prostate cancer: the importance of complete prostatic removal at cystoprostatectomy for bladder cancer.patients with invasive bladder cancer could be at a higher risk for a second malignancy such as an unsuspec- ted prostate cancer. We report a case of muscle-invasive transitional cell carcinoma of the urinary bladder with incidental adenocarcinoma of prostate, and review the literature to highlight the importance of complete prostatic removal to prevent residual disease.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
10/219. Combined antegrade and retrograde endoscopic approach for the management of urinary diversion-associated pathology.BACKGROUND: Endourologic management of stones and strictures in patients with a urinary diversion is often cumbersome because of the absence of standard anatomic landmarks. We report on our technique of minimally invasive management of urinary diversion-associated pathology by means of a combined antegrade and retrograde approach. patients AND methods: Five patients with urinary diversion-associated pathology were treated at our institution between May 1997 and October 1998. Their problems were: an obstructing ureteral stone in a man with ureterosigmoidostomy performed for bladder extrophy; two men with a valve stricture in their hemiKock urinary diversions; an anastomotic stricture in a man with an ileal loop diversion; and a long left ureteroenteric stricture in a man with a right colon pouch diversion. After percutaneous placement of an guidewire across the area of interest, the targeted pathology was accessed via a retrograde approach using standard semirigid or flexible fiberoptic endoscopes. Postoperative follow-up with intravenous urography, differential renal scan, or both was performed at 3 to 24 months (mean 12 months). RESULTS: The combined antegrade and retrograde approach allowed successful access to pathologic areas in all patients. holmium laser/Acucise incision of stenotic segments or ballistic fragmentation of stones was achieved in all cases without perioperative complications. None of the strictures with an initially successful outcome has recurred; however, in one patient, the procedure failed as soon as the internal stent was removed. The patient with the ureteral calculus remains stone free, and his ureterosigmoidostomy is patent without evidence of obstruction on his last imaging study, 24 months postoperatively. CONCLUSIONS: Combined antegrade and retrograde endoscopic access to the area of interest is our preferred method of approaching pathologic problems in patients with a urinary diversion. An antegrade nephrostogram provides better delineation of anatomy, while through-and-through access enables rapid and easier identification of stenotic segments that may be hidden by mucosal folds. Furthermore, this approach allows the use of larger semirigid or flexible endoscopes in conjunction with more efficient fragmentation devices, resulting in enhanced vision from better irrigation. Finally, an initial endoscopic approach may be preferred because its failure does not compromise the success of future open surgery.- - - - - - - - - - ranking = 4.5keywords = urinary (Clic here for more details about this article) |
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