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Ninety-five percent of all urothelial carcinomas are located in the bladder and 5% in the upper urinary tract. Therefore, upper urinary tract urothelial carcinoma is relatively rare, with an incidence of 2.1-2.4 per 100,000 persons per year. Diagnosis is based on imaging, endoscopy, urine cytology and histology. Histopathological diagnosis of upper urinary tract tumours is essential for choice of therapy and follow-up, as both tumour grade and stage are important prognostic factors. Radical nephroureterectomy is the standard treatment, but has a direct effect on kidney function. For this reason, an increasing number of patients with low-risk tumours undergo kidney-sparing surgery to maintain kidney function. After kidney-sparing surgery intensive follow-up of the ipsilateral upper urinary tract is mandatory because of a five-year recurrence-free survival rate of 17-63%, depending on tumour grade. Current diagnostics all have their limitations. Nowadays, research focuses on improving diagnosis in order to be able to offer better individual treatment.

Objective: To assess the prevalence of lower urinary tract symptoms (LUTS) in men and its influence on quality of life., Design: Questionnaire investigation., Methods: Recruitment of subjects was conducted in 1998 in the municipality of Boxmeer. Men in the age range between 40-79 years were sampled from the Municipality Basic Administration System. Data on LUTS, quality of life, and health care seeking behaviour were collected with a postal questionnaire. Severity of LUTS was evaluated with the Dutch translation of the seven items of the International Prostate Symptom Score (IPSS), to which 6 questions were added regarding micturition frequency, dribbling, difficulty to start micturition, painful micturition, decreased force of stream since the age of twenty, and how long one could wait before micturition from the moment urge was noticed. The female partners of the respondents were asked to answer the questions as well., Results: 1233 men completed the questionnaire, a response of 70%. One-fifth of all participants reported moderate to severe symptoms. Dribbling, reduced force of stream and urgency appeared to be the three most prevalent symptoms. The prevalence of LUTS increased with age: 10% of men aged 40-49 reported moderate to severe symptoms (IPSS > 7) compared with 44% of men over 70. Twenty-nine per cent of the men with severe LUTS reported poor disease specific quality of life, while another 28% of these men reported excellent disease specific quality of life. All men with mild symptoms reported excellent quality of life. Nine percent of all men consulted a doctor because of LUTS, with a mean delay of 10 months. The LUTS frequencies among the female partners equalled those among the responding men., Conclusion: LUTS were common among men over forty and among their female partners. The prevalence increases with age. Ageing of the population may lead to increased numbers of men experiencing LUTS and to concomittant medicalization costs. It is therefore of great importance to realise that the impact of symptoms on the reported quality of life was not pronounced.

This paper presents the current diagnostics of patients with prostate related problems (lower urinary tract symptoms) who visit the urology clinic. The diagnostic triad for prostate cancer detection is presented, consisting of a serum Prostate-Specific Antigen test, a digital rectal examination to palpate the prostate, and transrectal ultrasound of the prostate to visualise internal structures and guide the urologist in taking biopsies. The results of the tests for a biopsied population of 232 patients illustrate the shortcomings of the individual tests in predicting the presence of a malignancy. Biopsies are needed to prove or rule out prostate cancer in case of a suspicion. Future developments in early detection of prostate cancer are directed to improve the clinical use of the current diagnostic triad, and to identify new diagnostic tools.

Objective: Determining the therapeutic efficacy of transurethral microwave thermotherapy (TUMT) in benign prostatic hyperplasia (BPH)., Design: Prospective., Setting: Department of Urology, University Hospital Nijmegen, the Netherlands., Method: In the outpatient clinic, 130 BPH patients (mean age: 65.9 years (SD: 6.9); mean prostatic volume 50.2 cm3 (SD: 18.4)) received TUMT in a single session lasting 60 min. The prostate was heated to above 45 degrees C by a microwave antenna in a urethral catheter, resulting in tissue necrosis. In the first year after treatment the Madsen symptom score, maximal flow, residual volume, prostatic volume and concentration of prostate-specific antigen in blood were collected., Results: After 1 year 98 patients could be evaluated; of the other 32, 16 withdrew from follow-up, 10 underwent transurethral prostate resection and 6, other treatment. The maximal flow increased by 1.2 ml/s (SD: 4.0). The residual volume decreased by 15.8 ml (SD: 55.6). Symptom scores improved by 5.9 points (SD: 5.0). A 50% increase in symptom score was seen in 49.5% of all patients; 24.3% showed no improvement of complaints. There was no change in prostatic volume, whereas PSA concentration showed a transient increase in the first week after TUMT. Preliminary results after 6 months' follow-up of a randomised placebo-controlled study in 50 patients showed subjective and objective improvement of miction., Conclusion: TUMT results in distinct subjective improvement. Urodynamic findings show a less pronounced improvement.