11/244. Feasibility and acute toxicities of radioimmunoguided prostate brachytherapy.PURPOSE: We present a technique that fuses pelvic CT scans and ProstaScint images to localize areas of disease within the prostate gland to customize prostate implants. Additionally, the acute toxicity results from the first 43 patients treated with this technique are reviewed. methods AND MATERIALS: Between 2/97 and 8/98, 43 patients with clinical stage II prostate adenocarcinoma received ultrasound-guided transperineal implantation of I-125 or Pd-103 seeds. The median patient age was 70 years (range 49-79). Prior to treatment, the median Gleason score and prostate-specific antigen (PSA) were 6 (range 3-8) and 7.5 (range 1.8-16.6 ng/mL), respectively. The median follow-up was 10 months (range 2.9-20.4 months). RESULTS: The median PSA value at 10 months is 0.7 ng/mL. Significant acute complications within the first month following implantation included 13 Grade I urinary symptoms, 24 Grade II urinary symptoms, 6 Grade III symptoms, and no Grade IV complications. Beyond 4 months, complications included 12 Grade I urinary symptoms, 17 Grade II urinary symptoms, 1 Grade III, and 1 Grade IV complications. CONCLUSIONS: The image fusion of the pelvic CT scan and ProstaScint scans helped identify regions within the prostate at high risk of local failure, which were targeted with additional seeds during implantation.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
12/244. A case of spinocerebellar ataxia accompanied by severe involvement of the motor neuron system.We report a sporadic case of spinocerebellar ataxia accompanied by later but severe involvement of the motor neuron system. A 72-year-old man began to show ataxia and dysarthria at age 66 years. Neurological examinations revealed saccadic eye movement, slurred speech, truncal ataxia, pyramidal sign, and urinary disturbance. Neither history of alcoholism nor hereditary factors were found. He developed muscular atrophy of the lower and upper extremities and limb ataxia within three years. Superficial and deep sensations were diminished in both feet four years after onset. Thus, he presented with cerebellar ataxia, bulbar sign, upper and lower motor neuron symptoms, sensory disturbance, and autonomic sign after six years at age 72. The level of serum, creatine phosphokinase (CPK) was increased, and muscle biopsy showed marked neurogenic change. magnetic resonance imaging (MRI) revealed mild cerebellar and pontine atrophy. Although the combination of spinocerebellar ataxia and motor neuron disease is very rare, the present case suggests the inter-relation of the spinocerebellar and motor neuron systems, and presents peripheral neuropathy as a subtype of multisystem atrophy.- - - - - - - - - - ranking = 0.25keywords = urinary (Clic here for more details about this article) |
13/244. Retrovesical desmoplastic small round cell tumor in a patient with urinary frequency.A 21-year-old man with urological symptoms was found to have a large abdominal tumor in the retrovesical space between the bladder and the rectosigmoid colon. Radiologic findings revealed little evidence confirming the diagnosis. A transrectal biopsy failed to disclose the histopathologic origin of the tumor. An exploratory laparotomy with a complete surgical resection was impossible, so a wedge biopsy was performed. Combined histologic and immunohistochemical findings revealed the features of desmoplastic small round cell tumor (DSRCT). Despite subsequent multi-agent chemotherapy, the patient died as a result of the growing tumor and liver metastasis. There have been only two prior reports of this neoplasm in the urological literature.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
14/244. Chronic perineal pain and lower urinary tract dysfunction--a clinical feature of the "gulf war syndrome"?A Persian gulf war veteran presented to the University Neuro-urology service for management of severe chronic perineal pain. The overall physical and neurological exam was unremarkable. However, the rectal exam and the urodynamic study revealed a severe pelvic floor dysfunction. A neuro-behavioral approach is recommended and discussed.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
15/244. Pelvic neurilemmoma.A case of a 37-year-old man admitted to our Department of internal medicine for medical evaluation of hypertension is reported. The patient had a 4-year history of oscillating hypertension prior to admission, however, with no major subjective complaints, except for pollakisuria. Clinical and biochemical assessment revealed no damage to target organs. Laboratory parameters showed normal values, except for hyperlipidemia. On routine ultrasonography of the pelvis confirmed a pelvic tumor of uncertain etiology, with no abdominal lymph node enlargement. No signs of metastasis were found. The patient was transferred to the Department of Surgery, where the tumor was removed in toto. Histopathologic analysis of the tumor, 11 x 8 x 8 cm in size, composed of cellular and mixoid areas with traces of collagenous connective tissue, necrosis, and tiny calcifications with scattered palisading nuclei and Verocay bodies, pointed to the diagnosis of a benign tumor, i.e. neurilemmoma. Postoperatively, the patient's subjective state was excellent, with normal blood pressure values, and without pollakisuria. A very large space-occupying lesion was responsible for compression of the neighboring organs, especially urinary bladder, resulting in pollakisuria. To our knowledge, pelvic localization of neurilemmoma, particularly a large one, is rare.- - - - - - - - - - ranking = 0.25keywords = urinary (Clic here for more details about this article) |
16/244. Early-stage ovarian carcinoma presenting with irritative voiding symptoms and urge incontinence.The detection of ovarian cancer remains a major challenge for gynecologists, as the majority of cases are symptomatically silent until regional metastases or ascites have occurred. This report examines a case of early-stage ovarian adenocarcinoma presenting with irritative voiding symptoms and urge incontinence, all of which resolved fully following surgery. We also report on the frequency of lower urinary tract symptoms leading to the detection of early-stage ovarian cancer, within a cohort of 52 consecutive patients surgically treated at our institution. lower urinary tract symptoms may trigger the diagnosis of early ovarian cancer in up to 11% of surgically managed patients at our institution. To our knowledge there are no previous reports of early ovarian cancer causing transient irritative voiding symptoms or urge incontinence. This report highlights the importance of considering ovarian neoplasm as a relatively uncommon but critically important etiology accounting for these common female urologic complaints.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
17/244. leiomyoma of vesicovaginal septum causing urinary retention.A case of leiomyoma of the vesicovaginal septum causing acute urinary retention and an unusual radiographic filling defect in the flood of the bladder is presented. This is a rare lesion which can be the source of confusion. It has similar microscopic appearance to lesions which the patient had previously in the esophagus and stomach, left labia, and the uterus. Microscopically, all of the tumors were benign.- - - - - - - - - - ranking = 1.25keywords = urinary (Clic here for more details about this article) |
18/244. Painful ejaculation and urinary hesitancy in association with antidepressant therapy: relief with tamsulosin.Painful ejaculation has been reported in association with a variety of antidepressants such as the tricyclic antidepressants (TCAs, e.g. clomipramine, imipramine, desipramine, protriptyline, amoxapine), the selective serotonin reuptake inhibitors (SSRIs, e.g. fluoxetine), venlafaxine and the MAOIs. Apart from lowering the dose and changing the antidepressant, no strategies are available to treat this side effect. In this paper, painful ejaculation following the administration of reboxetine is described in two patients. Both patients were treated concomitantly with the selective alpha(1A)-adrenoceptor antagonist, tamsulosin. A re-challenge was performed in one patient. The Hamilton depression Rating Scale (HAM-D), the American Urological association symptom index, a (dis)satisfaction item score and the Udvalg for Kliniske Undersoegelser (UKU-side effect rating scale) were used to assess the treatment. Tamsulosin rapidly and completely resolved the painful ejaculation and urinary hesitancy in both patients. A re-challenge in one patient resulted in a prompt reappearance of both side effects. Tamsulosin resolved the problem of painful ejaculation in these patients; however, larger studies are needed to confirm these results.- - - - - - - - - - ranking = 1.25keywords = urinary (Clic here for more details about this article) |
19/244. Pseudomalignant spindle cell proliferation of the urinary bladder: an unusual cause of voiding symptoms in a young patient.A case of an unusually large pseudomalignant spindle-cell proliferation (or inflammatory pseudotumor) of the urinary bladder in a young man is presented. The only symptom was urinary frequency. The clinical and radiologic evaluation (ultrasonography, computed tomography, and magnetic resonance imaging) revealed a massive tumor (11 x 7.5 x 5.5 cm) arising from the bladder wall that was eventually resected without compromising bladder function. Although the histologic findings initially suggested a sarcoma, the immunohistochemical findings were consistent with that of an inflammatory pseudotumor. The patient remained asymptomatic, without evidence of recurrence, after 12 months of follow-up. awareness of this inflammatory pseudotumor and its immunophenotypic characteristics is important to avoid an erroneous diagnosis and unnecessarily aggressive therapy.- - - - - - - - - - ranking = 1.5keywords = urinary (Clic here for more details about this article) |
20/244. Idiopathic chronic urinary retention in the female.The clinical features in 14 female patients with chronic urinary retention unassociated with extrinsic or obvious intrinsic obstruction or neurological disease are described. Management, results and histological findings are presented and discussed in relation to the clinical findings.- - - - - - - - - - ranking = 1.25keywords = urinary (Clic here for more details about this article) |
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