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Staging for prostate cancer often includes bone scanning and computerized tomography (CT). We systematically reviewed the published evidence for these tests.We searched MEDLINE for articles on these investigations in newly diagnosed cases of prostate cancer. Data were pooled based on prostate specific antigen (PSA), grade and tumor stage.Among 23 studies examining the role of bone scan metastases were detected in 2.3%, 5.3% and 16.2% of patients with PSA levels less than 10, 10.1 to 19.9 and 20 to 49.9 ng/ml, respectively. Scanning detected metastases in 6.4% of men with organ confined cancer and 49.5% with locally advanced disease. Detection rates were 5.6% and 29.9% for Gleason scores 7 or less and 8 or greater, respectively. Among 25 studies CT documented lymphadenopathy in 0 and 1.1% of patients with PSA less than 20 and 20 ng/ml or greater, respectively. CT detection rate was 0.7% and 19.6% in patients with localized and locally advanced disease, respectively. Detection rates in patients with Gleason scores 7 or less and 8 or greater were 1.2% and 12.5%, respectively. These risks were typically much greater on pathological evaluation.Patients with low risk prostate cancer are unlikely to have metastatic disease documented by bone scan or CT. Therefore, these investigations should not be standard practice. However, patients with PSA 20 ng/ml or greater, locally advanced disease, or Gleason score 8 or greater are at higher risk for bone metastases and should be considered for bone scan. CT may be useful in patients with locally advanced disease or Gleason score 8 or greater but appears not to be of benefit in patients with increased PSA alone.

External vacuum devices are being used increasingly for the management of erectile dysfunction. There is limited information regarding the effect of vacuum devices on penile blood flow and potential for ischemic penile injury. The penile xenon washout rate was measured before and after application of 2 vacuum systems in 15 subjects. Compared to flaccid state measurements the xenon washout rate did not change significantly with the Synergist Erection System but it was significantly reduced with the Osbon ErecAid System. However, the degree and duration of decrease in penile blood flow that may result in ischemic changes are unknown.

We report 4 cases of prostatorectal fistula following 125iodine interstitial radiotherapy. While 125iodine interstitial radiotherapy has become a popular form of treatment for localized prostate cancer, it is not without potential serious complications. Transurethral resection may be contraindicated before or after 125iodine therapy for prostate tumor.

Spermatic venography was performed in 140 patients; the main indications were subfertility and abnormal spermatogenesis. Of these 140 patients, 113 had positive examinations, with 33 of them having bilateral varicoceles. Of 146 total varicoceles demonstrated, 42 were found on the right side; the advantage of using the jugular vein approach in both the diagnosis and percutaneous treatment of these cases is stressed. Of the 146 varicoceles, 128 were successfully occluded using spring coils. Because of the frequency of bilateral subclinical varicoceles, spermatic venography and percutaneous embolization is recommended in all men with subfertility and oligoteratoasthenospermia.

• The acute scrotum in the pediatric patient frequently presents a diagnostic dilemma for even the most experienced clinician. In an effort to improve testicular salvage in equivocal cases, immediate surgical intervention has been recommended, despite a large number of unnecessary explorations. Evaluating the sodium pertechnetate Tc 99m radioisotopic scan in 46 boys, we found this study to be a rapid, reliable, sensitive, and noninvasive test that allows the selection of those patients who require immediate surgical intervention. (Am J Dis Child1982;136:831-835)