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  • 1
    Electronic Resource
    Electronic Resource
    Changes in resistive index following extracorporeal shock wave lithotripsy (1999)
    Melbourne, Australia : Blackwell Science Pty
    International journal of urology 6 (1999), S. 0 
    Details
    ISSN: 1442-2042
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract Background : Extracorporeal shock wave lithotripsy (ESWL) has replaced most surgical and endourologic forms of therapy for upper urinary tract stone disease. Despite its proved safety and efficacy, its adverse effects on renal function are still to be identified. A newer diagnostic technique, color Doppler ultrasonography, has brought a new insight into renal function. It enables precise evaluation of the renal vascular supply. Changes in intrarenal vascular resistance after ESWL were studied with Doppler ultrasound techniques. Methods : In 70 consecutive patients the resistive index (RI) was measured at an interlober artery before and 30 min after ESWL in the treated and contralateral kidneys. In 17 patients, a follow-up Doppler study was performed 1 week after ESWL. Results : In the treated kidneys, the RI significantly increased from 0.656 ± 0.053 (mean ± SD) at baseline to 0.682 ± 0.053 (P 〈 0.0001). There was no significant correlation of increase in RI with patient age (r = 0.010) or with pre-ESWL blood pressure (r = 0.002). Elderly patients (≥ 60 years old, n = 31) had higher RI levels on baseline than younger patients (〈 60 years old, n = 39). In 18 of the 31 (58.1%) elderly cases the RI were elevated to greater than 0.7, indicating pathologic changes. In younger patients, only 9 (23.1%) experienced increase in RI up to 0.7 or greater. The contralateral untreated kidneys showed significant change in RI before (0.664 ± 0.045) and after (0.679 ± 0.049) lithotripsy in elderly patients (P 〈 0.005). A follow-up Doppler study showed that the mean RI returned to pretreatment levels after 1 week. Conclusions : Because of higher RI levels on baseline, elderly patients have a higher risk of post-ESWL renal tissue damage than younger patients. Clinical implication of RI change in the contralateral kidneys in this study remains to be answered. The measurement of changes in RI with Doppler ultrasound techniques after ESWL may provide useful information for clinical diagnosis of renal tissue damage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1442-2042.1999.00097.x
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  • 2
    Electronic Resource
    Electronic Resource
    Laparoscopic nephropexy: Treatment outcome and quality of life (2004)
    Melbourne, Australia : Blackwell Publishing Ltd.
    International journal of urology 11 (2004), S. 0 
    Details
    ISSN: 1442-2042
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract Background:  The recent introduction of laparoscopic procedures has markedly altered urological surgery. Laparoscopic nephropexy has attracted the attention of urologists as a treatment for nephroptosis. Herein, we describe our experiences and quality-of-life outcome of laparoscopic nephropexy and discuss its indications and surgical techniques.Methods:  From May 1998 to February 2002, six female patients, ranging in age from 20 to 64 years (median age 39.8 years), with symptomatic nephroptosis underwent laparoscopic nephropexy. Mean preoperative downward kidney displacement was 2.25 vertebral bodies (range 2–2.5) and all affected kidneys were tilted at orthostasis. One patient underwent nephropexy through the transperitoneal approach and the remaining patients underwent nephropexy through the retroperitoneal approach. To evaluate surgical results, postoperative follow-up interview (pain visual analog scale and the short-form 36 (SF-36) health survey questionnaire) and objective examinations were performed.Results:  All procedures were accomplished without complication. Postoperative intravenous pyelography correctly confirmed fixed kidney in both supine and erect positions. All patients reported an improvement of symptoms approximately 1 month after nephropexy and no symptoms have recurred during the follow-up period (range 6.3–50.7 months). On the SF-36, two domains, including role limitations due to emotional problems (RE) and mental health (MH), exhibited significant improvement postoperatively (P = 0.0405 and P = 0.0351, respectively).Conclusions:  Laparoscopic, in particular retroperitoneoscopic, nephropexy yields excellent outcomes and greatly improves general health-related quality of life, particularly mental status, as a minimally invasive treatment for symptomatic nephroptosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1442-2042.2004.00730.x
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  • 3
    Electronic Resource
    Electronic Resource
    Ultrasensitive Assay of Prostate-Specific Antigen for Early Detection of Residual Cancer after Radical Prostatectomy (1998)
    Oxford, UK : Blackwell Publishing Ltd
    International journal of urology 5 (1998), S. 0 
    Details
    ISSN: 1442-2042
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objectives: Perhaps the greatest value of PSA determination in the treatment of prostate cancer is in determining persistent disease after a radical prostatectomy. We investigated the ability of an ultrasensitive PSA assay to detect residual prostate cancer in men at risk for recurrence after a radical prostatectomy. Methods: Using the Immulite third-generation PSA assay (detection limit, less than 0.003 ng/mL), and the standard IMx PSA assay, we determined PSA levels in 205 serum samples serially obtained from 34 men after a radical prostatectomy. The average days from surgery to serum sampling was 430 (range, 63 to 1 296). Patients were classified as having nonaggressive or aggressive cancers, based on clinicopathologic findings. A biochemical relapse was arbitrarily defined. Results: All 1 7 patients with nonaggressive cancers had PSA values of less than 0.02 ng/mL throughout the sampling period. Two of these patients (12%) had 2 or more consecutive PSA increases and were considered as a biochemical relapse. In contrast, 14 (82%) of 1 7 patients with aggressive cancers fit criteria of a biochemical relapse. All of the relapses were identified within 2 years after surgery. The IMx assay detected only 7 biochemical relapses during the same sampling period. Conclusions: Using the Immulite PSA assay, relapse detection times may be shortened allowing for most serological recurrences to be detected within 2 years after a radical prostatectomy. Patients with aggressive cancers may require frequent postoperative PSA determinations with a highly sensitive PSA assay which would allow early intervention when treatments for relapse are effective.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1442-2042.1998.tb00411.x
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  • 4
    Electronic Resource
    Electronic Resource
    Nerve-Sparing Retroperitoneal Lymph Node Dissection for Metastatic Testicular Cancer (1997)
    Oxford, UK : Blackwell Publishing Ltd
    International journal of urology 4 (1997), S. 0 
    Details
    ISSN: 1442-2042
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background:Nerve-sparing techniques are used during retroperitoneal lymph node dissection (RPLND) in patients with early stage testicular cancer to preserve postoperative ejaculatory function. Indications for the procedures have been extended to patients with a postchemotherapy retroperitoneal residual mass without compromising the efficacy of surgery. We report 6 cases diagnosed with metastatic testicular cancer who underwent nerve-sparing RPLND. Methods:Between January 1994 and March 1996, 6 patients with metastatic testicular cancer underwent nerve-sparing RPLND. Five of these patients received primary chemotherapy and had a retroperitoneal residual mass. Four patients underwent complete bilateral RPLND and 2 underwent unilateral template surgery. Results:After a mean follow-up of 18.7 months (range, 8 to 34), there have been no local recurrences and 5 (83%) patients report antegrade ejaculation. Conclusion:Nerve-sparing RPLND is applicable for selected patients with metastatic testicular cancer without increasing the risk of local recurrence. Ejaculatory function is preserved in the majority of patients, contributing to the improvement of the quality of life in men who require such surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1442-2042.1997.tb00291.x
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  • 5
    Electronic Resource
    Electronic Resource
    Acute normovolemic hemodilution for radical prostatectomy: Can it replace preoperative autologous blood transfusion? (2001)
    Melbourne, Australia : Blackwell Science Pty
    International journal of urology 8 (2001), S. 0 
    Details
    ISSN: 1442-2042
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract Background: Although preoperative autologous blood donation (PAD) is accepted as a standard of care for radical prostatectomy, it is costly, time-consuming and has risks associated with blood storage. Acute normovolemic hemodilution (ANH) is reported to be less expensive and to preserve blood components more effectively than PAD. In the present study, the efficacy and safety of these two autologous blood-collection techniques were compared.Methods: The study included 16 consecutive patients scheduled for radical prostatectomy. The first eight patients underwent conventional preoperative autologous blood donation of 400 mL 1 week before the operation (PAD group) and the second eight patients underwent acute normovolemic hemodilution followed by immediate operation (ANH group). All blood collected was transfused in the perioperative period. Preoperative and postoperative hematocrit levels in these two groups were compared.Results: There were no differences in preoperative hematocrit, time of operation or operative blood loss between the two groups. In the ANH group, 1080 ± 160 mL of blood were collected. The postoperative hematocrit level did not differ significantly between the groups. No patient in either group received allogeneic blood transfusion or experienced an adverse event directly related to blood transfusion.Conclusion: The two blood-conservation strategies resulted in similar postoperative hematologic outcomes. Given its advantages, which include lower cost, lower risk and higher convenience, ANH is one of the procedures that may replace conventional PAD for use in radical prostatectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1442-2042.2001.00272.x
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  • 6
    Electronic Resource
    Electronic Resource
    Value of Systematic Transition Zone Biopsy in the Detection of Prostate Cancer (1997)
    Oxford, UK : Blackwell Publishing Ltd
    International journal of urology 4 (1997), S. 0 
    Details
    ISSN: 1442-2042
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background:We evaluated routine transition zone biopsies for the detection of prostate cancer.Methods:Systematic sextant transrectal biopsies, including 2 systematic transition zone biopsies (sextant biopsy group), were performed on 196 consecutive patients. Biopsies were based on indications from digital rectal examination and/or a serum PSA level greater than 4.0 ng/ml. During the same period, 21 patients with persistently elevated PSA levels and earlier negative systematic biopsies also had the sextant biopsy (re-biopsy group). The sextant biopsy group was compared with 1 24 cases in our previous cancer detection program who had systematic quadrant biopsies targeted to the peripheral zone (quadrant biopsy group).Results:Between the sextant and quadrant biopsy groups, the difference in rate of cancer detection was not significant statistically. Of the sextant biopsy group, 64 (33%) demonstrated malignancy, including 9 (4.6%) with cancer found exclusively in the peripheral zone and 55 (28%) both in the peripheral and transition zones. No cancer was found exclusively in the transition zone. Of the re-biopsy group, all 4 cancers (19%) were detected in the transition zone, 2 of them exclusively in the transition zone.Conclusion:Routine transition zone biopsies did not increase the detection rate of prostate cancer. Systematic transition zone biopsies proved useful to the patients with persistently elevated PSA values and negative results in previous systematic peripheral zone biopsies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1442-2042.1997.tb00310.x
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  • 7
    Electronic Resource
    Electronic Resource
    Urinary undiversion for pelvic actinomycosis: A long-term follow up (1999)
    Melbourne, Australia : Blackwell Science Pty
    International journal of urology 6 (1999), S. 0 
    Details
    ISSN: 1442-2042
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: A 43-year-old woman who had been using intrauterine contraceptive devices for the past 10 years underwent an emergency operation for bowel and urinary obstruction.Methods/Results: Frozen section analysis showed undifferentiated adenocarcinoma. Incomplete tumorectomy, ileal resection, partial cystectomy, colostomy and bilateral ureterocutaneostomy were palliatively performed. Postoperatively, periodic acid-Schiff and Grocott–Gomori methenamine tests revealed Actinomyces and the final diagnosis was pelvic actinomycosis. Treatment with penicillin G administered intravenously relieved her symptoms and the lesion was dramatically improved. The patient underwent colostomy closure and urinary undiversion.Conclusions: Five years after urinary undiversion, the patient’s renal function has been maintained and she can void without incontinence and dysuria.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1442-2042.1999.00628.x
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  • 8
    Electronic Resource
    Electronic Resource
    Interstitial laser coagulation for management of benign prostatic hyperplasia: Long-term follow-up (2004)
    Melbourne, Australia : Blackwell Science Pty
    International journal of urology 11 (2004), S. 0 
    Details
    ISSN: 1442-2042
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Aim: We evaluated the long-term results of transurethral interstitial laser coagulation in the treatment of benign prostatic hyperplasia (BPH) with up to 9 years of follow up at the Kurashiki Central Hospital and determined the patient characteristics that predict a favorable outcome.Methods: From December 1993 to May 1997, a total of 82 patients were enrolled in the present study. Subjective and objective voiding parameters were collected from medical records and a self-administered questionnaire was sent to the patients. Kaplan-Meier plots were constructed to assess the risk of retreatment.Results: The mean follow-up period was 48.4 months (range, 3–108 months). A total of 59 patients (72%) did not need any additional treatment at 12 months and 30 patients (37%) did not require additional treatment during the entire follow-up period. A total of 29 patients (35%) were retreated during follow-up. Transurethral prostate resection (TURP) was performed in 18 patients (22%). The remaining 11 patients (13%) were offered additional pharmacotherapy. The minimum and median retreatment-free durations were 3 and 14 months, respectively. Seven patients died and 17 were lost to follow-up. Men aged 71 years or older had greater likelihood of requiring retreatment than those younger than 71 years (P = 0.0397). No significant differences were noted in the other baseline characteristics. Among postoperative parameters, a rate of decrease of the International Prostate Symptom Score of the patient of lower than 60% and a rate of decrease in patient quality of life of lower than 50% at 3 months were associated with greater likelihood of retreatment (P = 0.0083 and P = 0.0006, respectively).Conclusions: Interstitial laser coagulation is effective for the treatment of BPH. Good long-term results and an acceptably low retreatment rate render this modality an effective alternative to TURP, especially for younger patients. Short-term improvement of subjective symptoms was predictive of favorable long-term outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1442-2042.2004.00944.x
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  • 9
    Electronic Resource
    Electronic Resource
    Incidence of Lymph Node Metastasis and its Impact on Long-term Prognosis in Clinically Localized Prostate Cancer (1998)
    Oxford, UK : Blackwell Publishing Ltd
    International journal of urology 5 (1998), S. 0 
    Details
    ISSN: 1442-2042
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Pelvic lymph node dissection (PLND) is an important staging method for men with clinically localized prostate cancer. We report our experience with staging PLND and the impact of lymph node metastasis on long-term prognosis.Methods: One hundred forty-eight consecutive patients who underwent staging PLND for clinically localized prostate cancer were retrospectively studied. Patients were evaluated for the presence and number of lymph node metastases, treatment (prostatectomy vs. radiotherapy), and endocrine therapy, and analyzed with respect to disease progression and survival. The mean follow-up period was 52.9 months (range, 2.3 to 165.8 months).Results: Thirty-two patients (21.6%) had pelvic lymph node metastases, the incidence of which markedly decreased from 32.3% in 1982 to 1987 to 6.7% in 1994 to 1997. The intervals to disease progression and cancer death were significantly shorter in patients with positive lymph nodes (P 〈 0.001). In stage D1 disease, patients who underwent a radical prostatectomy tended to be free of progression longer than those receiving radiotherapy or conservative therapy (P= 0.0546). Other factors, such as early endocrine therapy, the extent of lymph node involvement and the Gleason score of the primary tumor did not predict disease progression or survival.Conclusion: These data suggest a decreasing trend in the incidence of lymph node metastasis in the PSA era. Although longer disease-free intervals were observed in radical prostatectomy-treated patients, the impact of an aggressive approach to stage D1 disease awaits further studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1442-2042.1998.tb00388.x
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  • 10
    Electronic Resource
    Electronic Resource
    Value of the Free to Total Prostate Specific Antigen Ratio and Prostate Specific Antigen Density for Detecting Prostate Cancer in Japanese Patients (1998)
    Oxford, UK : Blackwell Publishing Ltd
    International journal of urology 5 (1998), S. 0 
    Details
    ISSN: 1442-2042
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: This study evaluated the free to total serum prostate specific antigen (f/t PSA) ratio and prostate specific antigen density (PSAD) in detecting prostate cancer in Japanese males with a PSA level between 2.5 and 20.0 ng/mL in a community-based urology practice. Methods: Twenty-six patients with clinically localized prostate cancer and 44 patients with histologically-proven benign prostatic hyperplasia (BPH) were studied. The serum levels of free PSA (fPSA) and total (t) PSA were determined using a chemiluminescent enzyme immunoassay. The f/t PSA ratio was calculated by dividing the fPSA value by the total PSA value and was compared with the PSA and PSAD via the receiver operating characteristic (ROC) curves.Results: Patients with prostate cancer had a significantly lower f/t PSA ratio than patients with BPH. The PSAD was a superior diagnostic tool over PSA (P 〈 0.01) when analyzed by ROC curves. The f/t PSA ratio was also superior to PSA, but lacked significance (P=0.12), and similarly, the PSAD was superior, but not significant, to the f/t PSA ratio. Using a cut-off value of 0.1 9, the PSAD had a sensitivity of 81% and a specificity of 82%. With a cut-off value of 14.0%, the f/t PSA ratio had a sensitivity of 81% and a specificity of 66%.Conclusion: This study showed that PSAD alone improved cancer detection significantly better than PSA. However, it is still unclear whether the f/t PSA ratio is superior to PSA or PSAD in the discrimination between BPH and prostate cancer in Japanese male patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1442-2042.1998.tb00364.x
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