RESUMEN
Luteinising hormone releasing hormone (LHRH) analogues are routinely used in the treatment of patients with advanced prostate cancer. This randomised crossover trial was conducted to compare patient comfort and tolerability between two commonly used LHRH analogues: goserelin acetate and leuprorelin acetate. A total of 50 patients were randomised into two groups, each receiving 6-monthly injections of leuprorelin acetate (a liquid presentation) and goserelin acetate (a depot pellet) and crossing over between treatments. Patients completed a simple visual analogue score for the discomfort felt from the injections. An analysis of variance model was used, and the results found that patients do tolerate leuprorelin acetate (0.589) better than goserelin acetate (1.343) (P < 0.001, CI = 95%).
Asunto(s)
Antineoplásicos Hormonales/administración & dosificación , Antineoplásicos Hormonales/efectos adversos , Goserelina/administración & dosificación , Goserelina/efectos adversos , Leuprolida/efectos adversos , Neoplasias de la Próstata/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Antineoplásicos Hormonales/uso terapéutico , Estudios Cruzados , Preparaciones de Acción Retardada , Goserelina/uso terapéutico , Humanos , Inyecciones Subcutáneas/efectos adversos , Leuprolida/administración & dosificación , Leuprolida/uso terapéutico , Masculino , Persona de Mediana Edad , Dolor/etiologíaRESUMEN
OBJECTIVE: To quantify incidence of erectile dysfunction (ED) and the associated risk factors in men attending community clinics in a large population in Wales, UK. SUBJECTS AND METHODS: Of 4060 men who were invited to attend 11 community clinics, primarily to check for prostate disease, 2025 (aged 55-70 years) attended. Of these, 2002 men answered a questionnaire about personal details, medical, family and sexual history, and detailed alcohol and smoking habits. All had their serum prostate-specific antigen (PSA) analysed and those referred for investigation of prostatic disease underwent serum testosterone analysis. RESULTS: Complete ED was reported by 265 men (13.2%), and was closely related to age (r = 0.19, P < 0.001) and medication (r = 0.2, P < 0.001). ED occurred in 6.9% of men aged 55-60 years, 12.5% aged 61-65 and 22.2% of those aged 66-70. Patients taking diabetic medication had the highest relative risk for ED and 11.3% of men with ED were taking nitrates. The numbers of years of smoking had the third closest correlation with impotence (r = 0.16, P < 0.001). A low serum testosterone level was a poor predictor of ED and increasing serum PSA levels did not influence the distribution of ED. CONCLUSION: About 13% of these men aged 55-70 years had complete ED; if this value is extrapolated to the whole of the UK, this equates to almost half a million men being unable to achieve any erections. The estimate would be much greater if those with milder forms of ED are included.
Asunto(s)
Disfunción Eréctil/epidemiología , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Análisis Multivariante , Análisis de Regresión , Fumar/epidemiología , Gales/epidemiologíaRESUMEN
This study sought to identify whether a true relationship exists between benign prostatatic hyperplasia (BPH) and erectile dysfunction (ED). In a community-based study, 427 men underwent transrectal ultrasound (TRUS), uroflow studies and a questionnaire concerning erectile function. ED had a significant correlation to age (r = 0.19, P < 0.001). But comparisons of prostate volume and analysis of maximum flow rate showed no significant difference between three erectile functional groups; ranging from no ED to complete ED, (one way analysis of variance). However when these two parameters were correlated to age a significant association was found to exist (log prostate volume; r= 0.26, P < 0.001, log maximum flow rate; r= -0.13, P= 0.02). Prostate size and uroflow studies show no correlation with ED, but ED and BPH had a significant correlation with ageing. This makes a direct association between male ED and BPH unlikely but supports the theory that the association between the two pathologies could be due instead to the common link of ageing.
Asunto(s)
Disfunción Eréctil/etiología , Próstata/patología , Hiperplasia Prostática/complicaciones , Anciano , Envejecimiento , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Hiperplasia Prostática/patología , OrinaRESUMEN
OBJECTIVES: To determine the incidence of testicular microlithiasis in men presenting for testicular ultrasonography, to identify any associated pathology (with particular reference to testicular neoplasia) and to report the follow-up of those patients in whom testicular microlithiasis was identified. PATIENTS AND METHODS: In this retrospective study, the results of all testicular ultrasonography undertaken between July 1995 and March 1998 in a district general hospital were reviewed. The records of all patients diagnosed ultrasonographically to have testicular microlithiasis were retrieved and the pathology database was accessed for all testicular tumours diagnosed in the same period. RESULTS: During the study period 2215 scans were taken; 34 cases of testicular microlithiasis were identified, giving an incidence of 1.4%. Thirty-one testicular tumours were removed during the same period. Of the 34 cases with testicular microlithiasis, five had histologically confirmed testicular tumours (15%). The incidence of testicular tumours in the scans showing no microlithiasis was 26 in 2181 (1.1%). The differential incidence of tumours in the two groups is statistically significant (P < 0.001, chi-square analysis). Patients with testicular microlithiasis but no tumour were followed up for a median (range) of 41 (19-54) months; no interval tumours have developed to date. CONCLUSION: This study confirms an incidence of testicular microlithiasis comparable with that in other reported series, albeit in a selected population. There was a strong association between testicular microlithiasis and testicular tumours. Whether this is a causal relationship has yet to be determined. Careful clinical and ultrasonographic follow-up of these patients is therefore recommended until the significance of testicular microlithiasis is clear.
Asunto(s)
Cálculos/epidemiología , Enfermedades Testiculares/epidemiología , Adulto , Anciano , Cálculos/diagnóstico por imagen , Distribución de Chi-Cuadrado , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Enfermedades Testiculares/diagnóstico por imagen , Ultrasonografía , Reino Unido/epidemiologíaRESUMEN
PURPOSE: We evaluate the pharmacodynamics, pharmacokinetics and tolerability of a sustained release depot formulation of avorelin, a new potent super agonist of luteinizing hormone-releasing hormone receptors, in patients with prostate cancer. MATERIALS AND METHODS: A total of 60 patients were randomized to receive a 10 mg. (31) or 15 mg. (29) avorelin subcutaneous depot. Serum testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and plasma avorelin were measured regularly until depot exhaustion. RESULTS: Of the 10 mg. group patients 3 withdrew from the study after 31 to 35 weeks due to disease progression. Of the 15 mg. group patients 1 did not complete the study for logistical reasons. After the expected flare in serum testosterone, LH and FSH during week 1, medical castration (testosterone concentration less than 1.735 nmol./l.) was achieved within 4 weeks of depot injection. Median duration of testosterone suppression was 40 weeks in the 10 mg. (95% confidence interval 35 to 42) and 39 in the 15 mg. (37 to 43) group. The reduction in serum LH was similar to that of testosterone, while that of FSH was less pronounced. Plasma avorelin was proportional to the dose and correlated with serum testosterone. Normalization of serum prostate specific (4 ng./ml. or less) at 6 months was achieved in 80 and 88% of the 10 and 15 mg. groups, respectively. During the (7 to 20-month) observation period 94 and 86% of the 10 and 15 mg. groups, respectively, complained of adverse events mainly related to androgen suppression (hot flushes, decreased libido and impotence) or the nature of the disease (skeletal pain). In each group 3 patients had serious adverse events requiring hospitalization for reasons unrelated to avorelin treatment. The depot was well tolerated locally. CONCLUSIONS: Subcutaneous depot formulations of avorelin were well tolerated and had protracted inhibitory effects on pituitary gonadotropin secretion in patients with prostate cancer. Testosterone suppression was maintained for more than 6 months in all patients. Avorelin depots could be the first luteinizing hormone-releasing hormone agonist formulation to be administered at 6-month intervals.
Asunto(s)
Prolina/análogos & derivados , Neoplasias de la Próstata/tratamiento farmacológico , Receptores LHRH , Adulto , Anciano , Anciano de 80 o más Años , Preparaciones de Acción Retardada , Humanos , Masculino , Persona de Mediana Edad , Prolina/farmacología , Prolina/uso terapéutico , Factores de TiempoAsunto(s)
Tiempo de Internación , Prostatectomía , Humanos , Masculino , Periodo Posoperatorio , GalesRESUMEN
Renal excursion during breathing is inevitable and is a cause of poor localization during extracorporeal shock-wave lithotripsy (SWL), which in theory might lead to poor treatment results. Eighty-one patients underwent lithotripsy treatment with and without the use of an image enhancement system designed for use with the Dornier MPL9000 lithotripter. This device contains a memory incorporated into a separate differential grayscale monitor, which allows the stone image to be stored. Shockwave release is enabled only when this image corresponds to the real-time image on the lithotripter ultrasound monitor. No improvement in success rates was found using this system, although upper-pole stones appeared to be fragmented more successfully. Overall, the results were favorable in both groups after a single treatment. Further work is needed to establish whether image enhancement is capable of improving the success rates and reducing the side effects of lithotripsy by better targeting.
Asunto(s)
Aumento de la Imagen , Litotricia/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Litotricia/instrumentación , Masculino , Persona de Mediana Edad , UltrasonografíaRESUMEN
OBJECTIVE: To determine the completeness of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: The prostate volume of 432 patients was measured by transrectal ultrasonography (TRUS) before they underwent a TURP performed by one of three consultant urological surgeons. The prostate tissue collected at resection was weighed, multiplied by 1.2 to compensate for 'shrinkage', and the amount of tissue removed expressed as a percentage of the pre-operative prostate volume determined by TRUS (resection ratio). The patients were categorized into groups based on pre-operative prostate size. RESULTS: The mean weight of prostate tissue resected was 25.6 g. Resection ratios increased with prostate size, with the largest occurring in prostates of 71-110 g. The surgeon did not resect more than 50% of the gland volume in any group. CONCLUSION: This study counters the theory that a complete resection of the prostate is routinely achieved. The endoscopic appearances probably imply a complete resection of the adenoma but a considerable volume of the gland remains. This has important implications for the detection of prostate carcinoma at TURP and for the staging of the disease.
Asunto(s)
Prostatectomía/métodos , Hiperplasia Prostática/cirugía , Endoscopía , Humanos , Masculino , Tamaño de los Órganos , Estudios Prospectivos , Próstata/patología , Hiperplasia Prostática/diagnóstico por imagen , Hiperplasia Prostática/patología , UltrasonografíaRESUMEN
Thirty-six radical prostatectomies were performed over an 8-year period; 25 suitable patients (70%) presented with symptoms of bladder outflow obstruction. In 15 cases (44%), initial digital rectal examination was not indicative of malignancy. The primary tumour was understaged pre-operatively in 17 patients (48%). In 14 cases (41%) the pre-operative biopsy grade was different from the grade assigned to the tumour following radical prostatectomy. Radical prostatectomy is being performed with increasing frequency: trends in morbidity have been identified.
Asunto(s)
Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Adulto , Anciano , Disfunción Eréctil/etiología , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Prostatectomía/efectos adversos , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/patología , Incontinencia Urinaria/etiologíaRESUMEN
Crossed fused renal ectopia is an uncommon condition and cases of malignant tumours in such anomalies are exceedingly rare. The first case where simultaneous involvement of both moieties and perirenal fat by tumour occurred is reported here. A comparison of the appearances of radiological investigations with the anatomical specimen is presented, as is a literature review of this topic.
Asunto(s)
Carcinoma de Células Renales/patología , Neoplasias Renales/patología , Riñón/anomalías , Anciano , Humanos , MasculinoRESUMEN
The aim of this research was to establish a small animal model for the functional and morphological study of post-irradiation bladder dysfunction. Young adult female Wistar rats were X-irradiated with single doses of 10, 15, 20 or 25 Gy. Filling cystometry was performed to assess changes in reservoir function: the volume infused to produce a rise in intravesical pressure of 5 cmH2O was calculated as an index of compliance. A biphasic reduction in this index was noted in animals receiving 15-25 Gy; the first reduction developed at about 4 weeks, and the second started at 3-4 months and persisted at 6 months. Bladder tissue was taken at this time (6 months post-irradiation) for morphological study. Histological examination demonstrated an increased mast cell density in the irradiated bladders, but was otherwise non-specific; fibrosis was discernible in only half of the 18 animals studied. Electron microscopy showed focal degeneration of smooth muscle cells, and in some areas there was selective degeneration of unmyelinated axon profiles. The biphasic reduction in the compliance index is consistent with the timing of the symptoms of the acute and late irradiation reactions reported by radiotherapy patients. Changes in axon profiles and mast cell density may be of functional significance.
Asunto(s)
Traumatismos Experimentales por Radiación , Enfermedades de la Vejiga Urinaria/etiología , Animales , Modelos Animales de Enfermedad , Relación Dosis-Respuesta en la Radiación , Femenino , Microscopía Electrónica , Ratas , Ratas Wistar , Vejiga Urinaria/patología , Enfermedades de la Vejiga Urinaria/patologíaRESUMEN
Seven patients with renal cell carcinoma involving the inferior vena cava underwent surgical resection between 1975 and 1991. Pre-operative staging defined five patients with stage T3bNoMo disease, one patient with stage T3bN1Mo, and one patient with stage T3bNoM1 disease. At operation one patient had tumour thrombus filling the right atrium. Two patients had tumour thrombus within the intrahepatic vena cava and four infrahepatic tumour thrombus. The mean follow-up is 34.4 months (median 40 months). Four patients have been followed for over 4 years. Three of these patients are survivors, two have remained disease-free since their initial surgery. The other patient had a liver resection at 49 months for a solitary metastases; he is currently disease free. One patient died at 38 months from a gastrointestinal haemorrhage. Three patients are 12 months or less postoperation. Operative mortality was zero. The mean postoperative hospital stay was 14.7 days. Data suggests that 3-10% of renal cell carcinomas will involve the inferior vena cava. The small number of patients in this series suggests that many patients with renal cell carcinoma involving the inferior vena cava are not referred for surgical assessment. These patients are potential surgical candidates. Their survival after surgical resection, excluding the group with extension of tumour thrombus into the hepatic cava or above, is not reduced when compared with other patients with renal carcinoma.
Asunto(s)
Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Células Neoplásicas Circulantes , Trombosis/cirugía , Vena Cava Inferior/cirugía , Adulto , Anciano , Carcinoma de Células Renales/complicaciones , Carcinoma de Células Renales/diagnóstico , Carcinoma de Células Renales/mortalidad , Carcinoma de Células Renales/patología , Femenino , Humanos , Neoplasias Renales/complicaciones , Neoplasias Renales/diagnóstico , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Células Neoplásicas Circulantes/patología , Nefrectomía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Radiografía , Trombosis/diagnóstico , Trombosis/etiología , Trombosis/mortalidad , Trombosis/patología , Ultrasonografía , Vena Cava Inferior/diagnóstico por imagenRESUMEN
A single urine sample was obtained from each of 38 patients before and immediately after treatment with a Wolf Piezolith 2300. Each sample was analysed for crystals using scanning electron microscopy and X-ray energy dispersive spectroscopy. In all cases it was possible to make a stone diagnosis prior to treatment and there was 100% correlation between the pre- and post-treatment diagnosis. All stones smaller than 90 mm2 on plain X-ray cleared with piezoelectric lithotripsy alone, regardless of composition. Larger stones composed of calcium oxalate were all successfully fragmented, but 5 of 15 mixed or phosphate stones failed to respond.
Asunto(s)
Litotricia , Cálculos Urinarios/terapia , Adolescente , Adulto , Anciano , Niño , Cristalización , Cistinuria/orina , Femenino , Humanos , Masculino , Microscopía Electrónica de Rastreo , Persona de Mediana Edad , Análisis Espectral , Cálculos Urinarios/orinaRESUMEN
The infiltration of pelvic lymph nodes by carcinoma of the prostate or carcinoma of the bladder is an important factor in disease staging. Until now, this could be accurately assessed only by means of open surgery, an undesirable option as an investigation. Recent advances in laparoscopic instruments and camera systems have allowed the performance of laparoscopic pelvic lymph node dissection. A series of dissections in 14 patients is reported.
Asunto(s)
Escisión del Ganglio Linfático/métodos , Neoplasias de la Próstata/patología , Neoplasias de la Vejiga Urinaria/patología , Anciano , Humanos , Laparoscopía , Ganglios Linfáticos/patología , Metástasis Linfática/patología , MasculinoRESUMEN
Improvements in instruments and camera systems have allowed the development of operative techniques for laparoscopic pelvic lymph node dissection. A series of dissections in 20 patients is reported. The mean operation time was 1 h and 40 min. When the nodes appeared malignant, a node biopsy was sent for frozen section. If this was positive, the dissection went no further. In three patients it was necessary to complete the operation by open surgery. A mean number of five lymph nodes was dissected per side. After laparoscopic dissection, all patients were discharged the morning after surgery. The operation is possible without making great demands on hospital bed occupancy and the patient has a comfortable and speedy return to normal activity. Using laparoscopic techniques, node dissection becomes a more appealing option as an investigation and staging procedure.
Asunto(s)
Carcinoma/cirugía , Laparoscopía , Escisión del Ganglio Linfático/métodos , Neoplasias de la Próstata/cirugía , Neoplasias de la Vejiga Urinaria/cirugía , Femenino , Hemostasis Quirúrgica , Humanos , Laparoscopios , Laparoscopía/métodos , Escisión del Ganglio Linfático/instrumentación , Metástasis Linfática , Masculino , Estadificación de Neoplasias , PelvisRESUMEN
Seventeen patients with bladder neck obstruction due to benign prostatic hypertrophy have been treated with the Neodymium: YAG laser. We review our experience since the first patient was treated in September 1990. Using a prototype deflecting gold alloy tip on a quartz laser fibre (Lateralase TM), we ablated obstructing prostatic adenoma and constricting bladder neck tissue. Experience with this technique has enabled a patient population to be defined in whom laser therapy for prostatic obstruction may be effective. The treatment is relatively simple, speedy and attended by virtually no blood loss. Laser ablation therapy may offer some advantages over conventional transurethral resection of the prostate (TURP) in a selected subgroup of patients. The advent of new delivery systems may make laser ablation therapy a practical alternative to TURP.
Asunto(s)
Terapia por Láser/métodos , Hiperplasia Prostática/cirugía , Anciano , Anciano de 80 o más Años , Humanos , Terapia por Láser/instrumentación , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Próstata/cirugía , Hiperplasia Prostática/complicaciones , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Obstrucción del Cuello de la Vejiga Urinaria/cirugía , Retención Urinaria/etiologíaRESUMEN
Two British centres have published the radiation doses received during percutaneous nephrolithotomy (PCNL). Their results were disparate. This study was performed to establish the likely exposure of the eyes and fingers of an experienced urological surgeon who creates the track into the kidney and also performs the endoscopic operation. In addition, some radioprotective gloves were evaluated. Provided that specific precautions, including a judicious use of screening, are taken, the current dose limits are unlikely to be exceeded. However, a 30% reduction in the dose limits is probable. Wearing routine radiation badges under a lead apron is an inadequate method of monitoring exposure: urologists should press for more active assistance from radiation protection officers in the monitoring of procedures in theatre and the use of ultrasound should be encouraged.