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Aim: To evaluate prospectively the role of endorectal magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) in detecting peripheral zone tumour in patients with total prostate-specific antigen (PSA) values≥4ng/ml and one or more negative transrectal ultrasound (TRUS) biopsy rounds. Material and methods: Fifty-four consecutive men (mean age 65.4±5.2 years, mean total PSA 10.8±7.5ng/ml), underwent a combined MRI-MRS examination with endorectal coil. MRI included transverse, coronal, and sagittal T2-weighted and transverse T1-weighted fast spin-echo sequences. MRS data were acquired using a double spin-echo point resolved spectroscopy (PRESS) sequence. A 10-site scheme was adopted to evaluate the prostate peripheral zone. A peripheral prostatic site was classified as suspicious if low intensity signal was present on T2-weighted images and/or if the choline+creatine/citrate ratio was >0.86. Following MRI-MRS all patients were submitted to a standard 10-core biopsy scheme to which from one to three supplementary samples were added from suspicious MRI and/or MRS sites. In per-patient analysis findings were considered true-positive if biopsy positive patients were classified as suspicious, irrespectively of lesion site indication. Results: Prostate cancer (PC) was detected in 17 of 54 patients (31.5%); median Gleason score was 6 (range 4–8). On a per-patient basis sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were respectively 100, 64.9, 56.7, 100, and 75.9% for MRI; 82.2, 70.3, 57.7, 92.9, and 75.9% for MRS; and 100, 51.4, 48.6, 100, and 66.7% for combined MRI-MRS. In all the 17 PC patients, combined MRI-MRS correctly indicated the sites harbouring cancer, whereas both MRI and MRS gave erroneous indications in two patients. Conclusion: The results of the present study show that MRI alone might be able to select negative patients in whom further biopsies are unnecessary. The combination of MRI and MRS might be able to drive biopsies in suspicious sites and increase the cancer detection rate. Further studies are required to confirm these data. [Copyright &y& Elsevier]

Background : The objectives of this study were to evaluate the effectiveness, the patients compliance and tolerability to bacillus Calmette-Guérin (BCG) intravesical instillation after transurethral resection of bladder tumor (TURBT) for stage Ta-T1, grade G1-G3 transitional cell carcinoma (TCC) of the urinary bladder. Methods : Between January 1995 and May 2002, 127 patients (110 males and 17 females) aged between 40 and 81 years (mean±SD: 66.5±8.4 years) with Ta-T1, G1-G3 TCC of the urinary bladder were treated by TURBT and adjuvant intravesical instillation with BCG. The following details were recorded and evaluated: the disease-free survival rates, the tumor recurrence, age, gender, morphology, the size and number of tumors and side effects of BCG instillation. Results : 80 (63%) and 47 patients (37%) initially presented with multifocality and monofocality, respectively, were analyzed. Follow-up periods were 3-48 months (median, 18 months) for 110 of the 127 patients enrolled. At 3 months follow up, 40 multifocality patients (59.7%) and 27 monofocality patients (40.3%) were disease free. At 18 months follow-up, tumor disease-free survival rate was 63% while at 48 months intravesical recurrence was noted in 43 patients (39.1%). We had 47 patients with side effects by BCG instillation in disease free patients and 15 in the disease positive ones. Twenty seven patients (40.3%) of the disease free patients vs. 28 patients (65.1%) in the disease positive ones had no side effects. For side effects of therapy 28.3% of the patients were withdrawn while 32.2% for recurrence of disease. Conclusion : These findings confirm that intravesical instillation with BCG combined with TURBT is effective and safe for the treatment of bladder cancer. This treatment facilitates bladder preservation by reducing recurrences and delaying the progression in many patients. Longer follow-up studies of this treatment are required. [ABSTRACT FROM AUTHOR]

Background: The objectives of this study were to evaluate the effectiveness, the patients compliance and tolerability to bacillus Calmette-Guérin (BCG) intravesical instillation after transurethral resection of bladder tumour (TURBT) for stage Ta-T1, grade G1-G3 transitional cell carcinoma (TCC) of the urinary bladder. Methods: Between January 1995 and May 2002, 127 patients (110 males and 17 females) aged between 40 and 81 years (mean ± SD 66.5 &plusm; 8.4 years) with Ta-T1, G1-G3 TCC of the urinary bladder were treated by TURBT and adjuvant intravesical instillation with BCG. The following details were recorded and evaluated: the disease-free survival rates, the tumour recurrence, age. gender, morphology, the size and number of tumours and side effects of BCG instillation. Results: Eighty (63%) and fourty seven (37%) patients were presented multifocality and monofocality at the baseline, respectively. Follow-up periods were 3-48 months (median, 18 months) for 110 of the 127 patients enrolled. At 3 months follow-up 40 multifocality patients (59.7%) and 27 monofocality patients (40.3%) were disease free. At 18 months follow-up, tumour disease-free survival rate was 63% while at 48 months we had 44 drop out and intravesical recurrence was noted in 43 patients (39.1%). We had 47 patients with side effects by BCG instillation in free disease patients and 15 in the not disease free ones, Twenty-seven patients (40.3%) of the disease free patients had no side effects versus 28 patients (65.1%) in the not disease free ones. Of the patients, 28.3% were withdrawn for the side effects of therapy while 32.2% were discontinued for recurrence of disease. Conclusion: These findings confirm that intravesical instillation with BCG combined with TURBT is effective and safe for treatment of bladder cancer. This treatment facilitates bladder preservation by reducing recurrences and delaying the progression in many patients, however, further experience and longer... [ABSTRACT FROM AUTHOR]

: AimTo evaluate the results of treatement of erectile dysfunction (ED) in kidney transplant recipients before and after the advent of sildenafil.: Materials and methodsFrom 1981 through 2002, 971 male patients of mean age 53.4 years received a renal graft. Erectile dysfunction (ED) was investigated in all patients at the first urologic visit posttransplantation. Psycho-sexual support was offered to all patients. Before sildenafil use (1998), our diagnostic approach was complex. From 1998 we tested: serum levels of testosterone, prolactin, and glucose with penile duplex ultrasonography and NPT reserved for selected cases.: ResultsFrom 1981 through 1998, 365 male kidney transplant recipients (45%) reported ED. Only 169 patients chose to be treated: 27 responded to psycho-sexual therapy; 3 received testosterone with benefit; 133 had a good results from intracavernosal injection of vasoactive drugs; and 6 received a penile prosthesis. Since 1998, 126 patients reported ED (78.3%). Only 78 chose treatment: 24 patients had a satisfactory response to sildenafil (65% with 50 mg and 35% with 100 mg). PGE1 alone or in combination with papaverine and phentolamine produced a good response in 37 patients; 17 patients did not respond to pharmacotherapy; and 5 received a tricomponent penile prosthesis without complications. The side effects of sildenafil and PGE1 therapy were similar to those reported in the literature.: ConclusionsED is an important problem in male renal transplant recipients. Cultural resistance to treatment is common. However, treatment with sildenafil citrate and intracavernosal self-injection of PGE1 are well accepted, and prosthetic devices may help in resistant cases. [Copyright &y& Elsevier]