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Objective: To evaluate the effect on potency rates after surgery of applying local steroids to the neurovascular bundles (NVBs) of the prostate after bilateral nerve-sparing radical retropubic prostatectomy (BNS-RRP)., Patients and Methods: Sixty potent men undergoing BNS-RRP for clinically localized prostate cancer were prospectively randomized equally into two groups. In group 1, 10 mL of betamethasone cream 0.1% was applied locally to both NVBs, and group 2 had only the usual BNS-RRP with no corticoid cream. Complications and potency were evaluated at 3, 6 and 12 months in all patients and compared between the groups., Results: At 12 months, 57% and 60% of patients were potent in group 1 and 2, respectively; the respective mean International Index of Erectile Function (5-item) scores were 14.76 and 15.43 (P = 0.59). Potency rates at 3, 6 and 12 months were not significantly different between the groups, and the continence rates at 12 months were also similar, with 93% and 90% of patients in groups 1 and 2 being continent, respectively. Ten and five patients in groups 1 and 2, respectively, required a blood transfusion (P = 0.23). There were no fistulae, wound dehiscence or rectal perforations. One patient in group 2 presented 4 months after RRP with a bladder neck contracture., Conclusions: Local application of betamethasone does not improve or expedite the recovery of erectile function after BNS-RRP, but there were no complications associated with its use.

Background: We aimed to assess the feasibility, safety, and outcome of the sigmoidorectal (Mainz II) pouch for urinary diversion in patients with invasive bladder cancer., Methods: Twenty-nine patients (25 men and four women), aged 65-76 years, who had undergone radical cystectomy and the sigmoidorectal pouch procedure for invasive bladder cancer were included in this study. Postoperative evaluations included metabolic testing, standard laboratory screening, renal ultrasonography, pouchography, and intravenous urography or pouchoscopy when indicated., Results: The median operative time was 175 min. Urine leakage was encountered in two patients (6.8%), deep vein thrombosis in one (3.4%), and ileus necessitating surgery in another one. Two patients developed pyelonephritis due to ureterocolonic stricture, which was treated with antegrade balloon dilatation. No local relapses of bladder cancer were found. All patients were continent during the day, but one patient was occasionally incontinent during the night. In the long term, six patients (20.6%) developed metastatic disease, and five patients (17.2%) died because of cancer-related causes. Overall survival was 100, 96 and 60% at 1, 2 and 3 years after the operation, respectively. The mean survival was 36.8 +/- 1.9 months, which was statistically significantly associated with the M stage (P < 0.001), but not with the T (P = 0.091) or N (P = 0.081) stages., Conclusions: The sigmoidorectal (Mainz II) pouch seems to be a feasible, safe and effective method for continent urinary diversion. It is able to provide good quality of life, and ensure good overall survival rates.

Purpose: We evaluated the impact of a bladder perforation during transurethral resection of superficial bladder tumor on extravesical tumor recurrence and patient prognosis. We also defined potential risk factors for extravesical recurrence prospectively giving emphasis to the management of the perforation., Materials and Methods: The medical records of 3,410 patients were reviewed. Parameters recorded included patient age and sex, tumor stage, grade, number, size and location at the time of perforation, the type of bladder perforation (extraperitoneal vs intraperitoneal) and the way the perforation was managed (open surgical repair vs conservative treatment). Logistic regression analysis was used to identify risk factors for extravesical recurrence. Cox regression analysis was used to compare cancer specific survival., Results: A total of 34 cases of bladder perforation were recorded, 4 patients were treated with open surgery and 30 treated conservatively. The 4 patients who underwent open surgery presented with extravesical recurrence after a mean followup of 7.5 months. The remaining 30 patients had no evidence of extravesical recurrence after a mean followup of 60 months (p <0.001). Of the patients with extravesical relapse 3 died of disease. The surgical management of bladder perforation was the best predictor of extravesical recurrence (p <0.001, r = 1.13), followed by an intraperitoneal localization of the perforation (p =0.0003, r = 0.67) and tumor size (p =0.01, r = 0.42)., Conclusions: Surgical repair of a bladder perforation during transurethral resection of bladder tumor increases the risk of extravesical tumor cell recurrence and negatively affects patient prognosis.

Nearly a decade has passed since the hypothesis that the insulin-like growth factor (IGF) signalling cascade is involved in prostate carcinogenesis. Recent research has outlined the association of circulating IGF-1 and prostate cancer risk, and studies have elucidated the implication of the IGF network in the early stages of prostate carcinogenesis. Moreover, it has been suggested that IGF-1 induces ligand-independent activation of the androgen receptor and enhances the expression of matrix metalloproteinase-2 and urokinase plasminogen activator. Furthermore, progression to androgen independence has been linked to deregulation of the IGF-1-IGF-1-receptor axis. Here, we report on updated studies that contribute to the unravelling of the IGF 'circuitry' in prostate cancer cells, with the anticipation that relevant pharmacological 'rewiring' might offer novel therapeutic regimens.

Introduction: Open-ended straight ureteral stents are typically used for the support of the ureteroileal anastomosis during the creation of an orthotopic 'S-pouch' ileal neobladder. The use of double J stents as an alternative in this setting is evaluated., Materials and Methods: Medical charts from 43 patients undergoing radical cystectomy with formation of an ileal 'S-pouch' neobladder were retrospectively evaluated. In 30 patients (group A), a 6-Fr open-ended straight ureteral catheter was used to stent the ureteroileal anastomosis, while a double J stent was used for the same reason in 13 patients (group B). The ureteral catheter was removed 15 days after the procedure while the double J stent 3 weeks postoperatively. Hospital stay, early and late complications were evaluated for both groups during a mean follow-up period of 22.5 and 19.6 months respectively., Results: Stricture of the ureteroileal anastomosis was observed in 2 (6.6%) and 1 (7.6%) patient of groups A and B respectively. All complications presented with similar rates, except for an increased but not statistically significant incidence of urethrovesical anastomotic leakage and early urinary tract infections in group B. Hospital stay was significantly (p<0.005) shorter for patients of group B (9.9 vs. 15.2 days)., Conclusions: The use of double J stents to support the ureteroileal anastomosis can be used as an alternative to open-ended ureteral stents. With double J stents a shorter hospital stay was achieved with similar complication rates but a higher incidence of upper urinary tract infections., (Copyright (c) 2005 S. Karger AG, Basel.)

Leydig cell tumors are the most frequent non-germ cell tumors of the testis, accounting for 1-3% of all testicular tumors. They present most commonly as a testicular mass or with endocrine symptoms. We report three new cases of Leydig cell tumors that presented in different forms. The relevant literature is reviewed and the management of these tumors is discussed.

Ganglioneuroma is a rare benign tumor, usually seen in children and young adults, arising in the central nervous system. Most of the noncranial ganglioneuromas are located in the posterior mediastinum and the retroperitoneum. We report the first case of a primary, adult paratesticular ganglioneuroma that presented as a paratesticular mass. The patient underwent surgical intervention for diagnostic and therapeutic purposes.

Undescended testis is one of the most common disorders in Down's syndrome. We present an extremely rare case of torsion of an inguinal undescended testis in a 35-year-old patient with Down's syndrome. Surgical exploration revealed a rotated gangrenous testis, radical orchiectomy was performed, and pathological examination confirmed the diagnosis of testicular torsion.

Torsion of the testis is the most common urological emergency and should be included in the differential diagnosis of scrotal trauma. Clinical suspicion of testicular torsion is a serious indication for prompt surgical exploration of post-traumatic acute scrotum. A case of post-traumatic testicular torsion, which resulted in orchiectomy, is presented and literature is reviewed.

Objective: To present epidemiologic, clinical and laboratory features, treatment and outcome of patients suffering from Brucella melitensis-induced epididymo-orchitis, in comparison with cases of nonspecific epididymo-orchitis. Distinction between these two entities is essential, as treatment and outcome are entirely different., Methods: In this retrospective study, records of 17 patients serologically diagnosed as suffering from B. melitensis epididymo-orchitis were reviewed in comparison with 141 cases of non-Brucella epididymo-orchitis. All patients presented consecutively at a tertiary hospital in southwestern Greece, from 1991 to 2000. Statistical analysis was performed using the chi-square test., Results: B. melitensis epididymo-orchitis differed from nonspecific epididymo-orchitis, due to its high occupational risk, seasonal pattern, gradual onset (P<0.01), longer duration, typical undulatory fever (P<0.05), absence of serious leukocytosis (P<0.05) and lower urinary tract symptoms, and relatively minimal local signs of florid inflammation (P<0.01). Oral medication with doxycycline and rifampicin for 6 weeks was effective, and no relapses or serious side effects were recorded during the follow-up period., Conclusions: B. melitensis-induced epididymo-orchitis is a recognized clinical problem in endemic regions, requiring early detection and appropriate medication. Clinicians encountering epididymo-orchitis should consider the likelihood of brucellosis and initiate anti-Brucella medication upon clinical diagnosis and not only after serologic confirmation.

Purpose: Although open pyeloplasty remains the gold standard for treating ureteropelvic junction obstruction, endourology and laparoscopy have revolutionized the management of upper tract stenosis. We present our diagnostic and minimally invasive therapeutic algorithm for the treatment of ureteropelvic junction obstruction., Materials and Methods: A total of 13 females and 9 males with a mean age of 34.2 years suffering from ureteropelvic junction obstruction were treated with percutaneous endopyelotomy or laparoscopic dismembered pyeloplasty and followed for 47 to 61 months (mean 53.8) and 47 to 62 months (mean 52.5), respectively. Diagnosis was based on findings of ultrasound, excretory urography, furosemide washout renogram and retrograde ureteropyelography. In cases of ureteral kinking color duplex sonography and spiral computerized tomography were performed. In 14 patients with intrinsic stenosis percutaneous endopyelotomy was performed, while the remaining 8 patients (5 with crossing vessels, 2 with an extremely distended pelvis and 1 with a 2.5 cm. stricture) were treated with a laparoscopic dismembered Anderson-Hynes pyeloplasty., Results: In the endopyelotomy group (success rate 92.8%), mean operation time was 1.2 hours, estimated blood loss was 152 ml., unit doses of analgesics were 5.4 tablets, days of hospitalization were 4.2 and time to return to normal activities was 15.7 days. In the laparoscopic group (success rate of 100%) the aforementioned variables were 3.5 hours (p <0.05), 150 ml., 6.3 tablets, 5 and 17.8 days, respectively. Long-term followup excretory urography and/or diuretic renal scan demonstrated improvement in all patients., Conclusions: Percutaneous endopyelotomy should be the treatment of choice for intrinsic ureteropelvic junction obstruction. Laparoscopic dismembered pyeloplasty, although technically challenging, provides excellent results for extrinsic or complicated ureteropelvic junction stenosis.

In this article, we describe a case of colonic ischemia masquerading as colonic carcinoma in a 75-yr-old female. Although this clinical diagnostic problem has been described before, it is rather unusual that the clinical, roentgenographical, endoscopic, and even histopathologic evaluation could not exclude carcinoma with certainty.

We describe a case of a 70-year-old patient with sudden onset of gait ataxia, headache, dizziness and dysarthria. Magnetic resonance imaging revealed a solitary lesion in the left cerebellar hemisphere with strong and irregular enhancement of the contrast medium, surrounded by extensive edema. Rectal examination revealed an abnormally enlarged and stiff left prostate lobe, and ultrasound-guided transrectal biopsies showed prostate adenocarcinoma of mild differentiation. Neurosurgical intervention and histopathologic examination revealed metastatic prostate adenocarcinoma. The patient underwent orchiectomy and was given antiandrogens. He is still alive and closely followed. According to the literature, prostate cancer presenting as a solitary cerebellar metastasis is an extremely rare clinical problem.