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Two of the papers in this section refer to surgical technique in cancer operations. In the first, authors from Innsbruck examine their rates of urinary extravasation after removing the catheter 10 days after radical retropubic prostatectomy; the rate was very low, the continence rates were excellent, and the rate of anastomic stricture was low. This is a large and well-studied group of patients.In the second of these papers, authors from Paris describe a technique of radical cystectomy where there is sparing of the prostate capsule and of the seminal vesicles, to preserve potency and improve continence. They found very little positive support in their results in favour of this technique, and felt it should have only a limited role.A study from Sacramento assesses a modified yeast assay as an aid to detect p53 gene mutations in localized prostate cancer. They found it to be superior to other methods, and felt that p53 mutations carried important prognostic implications.To evaluate the feasibility of urinary catheter removal 10 days after a radical retropubic prostatectomy (RRP) by assessing the incidence of urinary extravasation and its effect on postoperative stricture and continence rates.During a 4.5-year period, 619 patients undergoing RRP were evaluated. If no extravasation was detected on gravity cystography, the urinary catheter was removed 10 days after RRP. In patients with significant extravasation the catheter was left in place for 3 weeks. Overall stricture and continence rates were recorded in patients at 3, 6 and 12 months after surgery.There was extravasation during cystography in 29 patients (4.6%). At 3, 6 and 12 months, continence rates after catheter removal at 10 days were 74.9%, 87.9%, and 93.6%, respectively, while in the late-removal group they were 72.4%, 84.6% and 90.9%, respectively, with no significant difference between the groups. At 3 months the overall continence rate was 74.8% and at 12 months up to 93.5%. There was no difference in stricture rates between the groups, with an overall stricture rate of 0.7%.Catheter removal 10 days after RRP is feasible, giving excellent early and late continence rates, with low anastomotic stricture rates obtained using good surgical technique. Extravasation at 10 days was rare and with proper management did not influence the final results. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the incidence and outcome of prostate cancer in men younger than 45 years of age treated with radical retropubic prostatectomy after screening in an early prostate cancer detection program., Methods: Our study group comprised 19,302 men younger than 45 years old who participated in this program. The indications for prostate biopsy were a prostate-specific antigen (PSA) level of 1.25 ng/mL or greater and a percent-free PSA value of 18% or less. Patients with prostate cancer underwent nerve-sparing radical retropubic prostatectomy. Intraoperative and early postoperative complications, clinical and pathologic stage, Gleason score, and surgical margins were reviewed retrospectively. In addition, potency, continence, and biochemical recurrence were assessed at the last follow-up visit., Results: Of the study population eligible for prostate biopsy (1027 patients), only 175 (17%) consented to undergo the procedure (mean PSA 3.8 ng/mL). Twenty-eight men were diagnosed with prostate cancer, corresponding to 0.14% of the screened population and 16% of the biopsied patients. Twenty-six patients agreed to undergo radical retropubic prostatectomy. Pathologic examination revealed organ-confined disease in 22 (84.6%) and extraprostatic extension in 4 (15.4%). Positive surgical margins were seen in 2 patients (7.7%). The Gleason score was 7 or greater in 11 (42.3%) and 6 or less in 15 patients (57.7%). During a mean follow-up period of 15.8 months (range 3 to 36), all patients were continent, and 13 of the 16 patients with a follow-up of 12 months or longer were potent., Conclusions: In a large screening population younger than 45 years old, 16% of biopsied patients were positive for prostate cancer. These tumors were clinically significant but of a low stage and therefore potentially curable by surgery.

Urinary tract symptoms and, particularly, urinary incontinence are often chronic and complex conditions that cause diagnosis, treatment, and management problems. In many cases, psychosocial factors contribute to the development of a chronic condition. The authors investigated whether INTERMED, an instrument for assessing case complexity and health care needs, was able to identify such complex cases, to estimate the amount of comorbidity, and to predict clinical outcome for 31 consecutive patients suffering from urinary tract symptoms. To assess clinical outcome, the authors used the American Urologic Association Symptom Score, the Brief Symptom Inventory, and the Hospital Anxiety and Depression Scale. On the basis of the patients' INTERMED scores, the authors distinguished between low-complexity patients (INTERMED score <21, N=25, 80.6%) and high-complexity patients (INTERMED score >or=21, N=6; 19.4%). Low-complexity patients had fewer depressive and anxiety symptoms, less distress, and better clinical outcome at their 3-month follow-up than high-complexity patients. The data confirmed the ability of the instrument to detect patients at risk of complex urinary tract symptoms and to predict clinical outcome.