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OBJECTIVE: To assess the effect of a nutritional supplement containing vitamin E, selenium, vitamin C and coenzyme Q10 on changes in serum levels of PSA in patients with hormonally untreated carcinoma of the prostate and rising serum PSA levels. METHODS: Eighty patients were randomised to receive a daily supplement with either vitamin E, selenium, vitamin C, coenzyme Q10 (intervention group) or placebo over 21 weeks. Serum levels of PSA were assessed at baseline (-2, -1, 0 weeks) and after 6, 13, 19, 20 and 21 weeks. Mean changes in log serum level of PSA, testosterone, dihydrotestosterone, luteinizing hormone and sex hormone binding globulin over 21 weeks between the verum and the placebo group were compared by analysis of covariance. RESULTS: Seventy patients completed the study (36 verum; 34 placebo). Compliance was >90% in all patients. In the intervention group, plasma levels of vitamin E, selenium and coenzyme Q10 increased significantly over the 21 weeks study period. No significant differences in serum levels of PSA, testosterone, dihydrotestosterone, luteinizing hormone or sex hormone binding globulin (p>0.2) were observed between the intervention and control group. CONCLUSION: Our results indicate that supplementation of a combination of vitamin E, selenium, vitamin C and coenzyme-Q10 does not affect serum level of PSA or hormone levels in patients with hormonally untreated carcinoma of the prostate.

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OBJECTIVES: To determine the efficacy, evaluate the safety and assess side-effects (swelling, haematoma and pain) of percutaneous vas occlusion compared with vasectomy in Dutch men. PATIENTS AND METHODS: Vas occlusion and vasectomy procedures (attempted in 58 and 50 men, respectively) were conducted at the University Hospital Maastricht. The men returned 1 week after the procedure, underwent a clinical examination and completed a questionnaire assessing subjectively any pain, swelling and haematoma. The men were asked to return for semen analysis at 6 and 12 weeks and, if necessary, for additional analyses until they were azoospermic. RESULTS: The vas occlusion procedure was completed on both vasa in 49 of the 58 men (84%) in whom it was attempted. Significantly more (P < 0.001) men were azoospermic after vasectomy (48 of 50) than after vas occlusion (only four). Men undergoing vas occlusion reported significantly less pain (P = 0.02), swelling (P = 0.01) and haematoma (P = 0.04) after the procedure than did men undergoing vasectomy. CONCLUSION: Men undergoing vas occlusion would not have been able to rely on the method for contraception. From this study, vas occlusion, at least in its current form, is an unsuitable method of male contraception. Not only was the efficacy poor, but constraints in delivering the method in its current state would probably limit its utility, especially in situations where resources are limited.

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Anastomotic strictures and urinary incontinence are severe complications after a radical prostatectomy. We report on two patients suffering from both complications. We treated the anastomotic stricture with a Urolume Wallstent and inserted an AMS 800 artificial sphincter prosthesis 4 to 6 months later for treating urinary incontinence. Finally, the patients were fully continent with no evidence of recurrent strictures.

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BACKGROUND: The histologic composition of prostate adenoma seems related to the development of clinical benign prostatic hyperplasia (BPH). Therefore, a new noninvasive prediction model as an alternative for biopsies was investigated. METHODS: In 19 patients, the data of a routine preoperative workup for transurethral resection (TURP) and of an additional MRI-examination were related to the results of morphometry on TURP-tissue. RESULTS: Statistical analysis identified age of the patient and MRI-volumetrics of the prostate adenoma as best predictors of the epithelial fraction, with a 95% confidence interval of at least 5% (range, 9-14%) (R2 = 50%). CONCLUSIONS: This prediction model is sufficiently accurate to categorize a population of patients into histologic subgroups. It seems very likely that this method will be of use as an investigative tool in medical trials to provide insight into the pathogenesis of clinical BPH and into treatment strategies for the individual patient.

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Oral norfloxacin prevented Gram-negative bacilluria in female patients with hip fractures, who needed medium-term transurethral catheterization. This was shown in a placebo-controlled double-blind study of 34 patients. Seventeen of these received a suspension containing 200 mg norfloxacin and 500 mg amphotericin B, twice daily. In the placebo group, six cases of Gram-negative bacilluria had occurred by day 7, as compared with no cases during a median time of catheterization of 23 days in the group on medication. Bacteriuria, either by Gram-positive cocci or by Gram-negative bacilli, was observed in 50% of patients on placebo by day 7; in the treatment group this was the case by day 17 (P less than 0.001). Subsequent bacteriuria with Gram-positive cocci was eliminated by nitrofurantoin (50 mg qid) within four days. Norfloxacin is very suitable for the prevention of Gram-negative bacilluria, because it decontaminates Gram-negative bacilli from the bowel, reaches high concentrations in urine and rarely produces resistant variants.

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