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Objectives: To use pressure-flow urodynamic parameters to evaluate the outcome of patients with benign prostatic hyperplasia (BPH) who were treated with transurethral vaporization of the prostate (TUVP) using the Vaportrode., Methods: Forty consecutive patients (mean age 71.7 years) undergoing TUVP for treatment of symptomatic obstructive BPH or urinary retention were evaluated preoperatively and postoperatively with American Urological Association (AUA) Symptom Score, uroflowmetry, and pressure-flow multichannel urodynamic studies., Results: Twenty-nine patients were voiding preoperatively. Eleven patients presented with urinary retention and were analyzed separately. At 3-month mean follow-up, the AUA Symptom Score decreased from 20.7 to 7.2 (n = 26). Peak uroflow rate (Qmax) increased from 8.2 to 15.5 mL/s (n = 27), whereas detrusor pressure at maximal flow (Pdet) decreased from 95.0 to 44.7 cm H2O (n = 24), indicating relief of obstruction. Postvoid residual urine volume decreased from 181.8 to 37.3 mL (n = 27). At 1-year mean follow-up, the AUA Symptom Score was 5.6 (n = 15) and Qmax was 14.3 mL/s (n = 19). The overall complication rate was 17.5% and included meatal stenosis (n = 1), bulbar urethral stricture (n = 1), refractory detrusor hyperreflexia (n = 1), dystrophic bladder neck calcification (n = 1), prostatic synechial formation requiring revision (n = 2), and residual prostatic tissue requiring revision (n = 1)., Conclusions: This study provides objective evidence that TUVP is effective in providing prompt relief of bladder outlet obstruction with durable improvement in symptoms and flow rate with no acute morbidity. Accordingly, TUVP should continue to be considered as a minimally invasive surgical alternative to transurethral resection of the prostate.

Purpose: We evaluated the effects of an acute cerebrovascular accident on the lower urinary tract and correlated the site of cerebrovascular accident with findings on urodynamic study., Materials and Methods: A total of 45 men and 15 women underwent a complete urodynamic study with electromyography within 72 hours of a cerebrovascular accident. Patients were divided into 5 different groups based on urodynamic findings., Results: The majority of cortical and internal capsule lesions resulted in detrusor hyperreflexia. A total of 28 patients (47%) had urinary retention, mainly due to detrusor areflexia (75%). Of 20 patients with hemorrhagic infarcts 17 (85%) had areflexia, compared to only 4 of 40 (10%) with ischemic infarcts. All 6 patients with cerebellar infarction had detrusor areflexia., Conclusions: Our results confirm many previously reported findings. In addition, there was a specific correlation of cerebellar and hemorrhagic infarctions with detrusor areflexia.

Transurethral vaporization of the prostate (TUVP) is a promising new alternative modality for resection of obstructing adenomatous prostatic tissue. We evaluated the efficacy of TUVP for treatment of symptomatic benign hyperplasia (BPH) or urinary retention using pressure-flow analysis and other clinical measures. Twenty-seven men (mean age 72) with symptomatic BPH (N = 21) or urinary retention (N = 6) underwent TUVP using the VaporTrode loop. Patients were evaluated both preoperatively and postoperatively by subjective and objective criteria including AUA symptom score, uroflowmetry, postvoiding residual volume (PVR), and detrusor pressure (Pdet) at maximum flow. Complete follow-up data were available in 19 patients with an average follow-up of 9 weeks (range 4-32). The average symptom score was reduced from 19.9 to 5.58 (p < 0.0001). The average peak uroflow rate (Qmax) improved from 7.0 ml/sec to 18.1 mL/sec (p < 0.001). The average PVR was reduced from 163 mL to 14 mL (p < 0.003), and there was a similar reduction in Pdet at maximum flow from 96 cm H2O to 44 cm H2O (p < 0.001). The overall complication rate was 11%. These included meatal stenosis (N = 1), temporary urinary retention (N = 1), and residual prostate tissue causing obstruction (N = 1). In conclusion, TUVP with the VaporTrode yields a significant improvement in AUA symptom score, peak uroflow rate, PVR, and detrusor pressure at maximum flow, denoting relief of bladder outlet obstruction. This review of our experience with TUVP provides additional evidence for the use of the VaporTrode as a safe and effective alternative surgical modality for the treatment of symptomatic BPH.

A functionally oriented approach to acute stroke care should take place in conjunction with traditional medical management, because the medical care provided during the first days and weeks after a stroke affects the ultimate disability status of the patient.10 New onset voiding dysfunction after a stroke is a difficult problem for all involved in the care of the patient. Urinary incontinence and retention are socially unacceptable and can be very embarrassing for the patient. They can interfere with patient discharge and complicate patient rehabilitation.13 With the high incidence of stroke, geriatricians and urologists will come across many patients with this condition, and they must approach the problem of voiding dysfunction in concert if they expect to achieve the optimal outcome for the patient. Therefore, proper diagnosis and management of voiding dysfunction in the poststroke patient are important for improved patient well being, increased patient survival, and decreased disability as well as a reduction in the national health care expenditures.

Management of intrinsic sphincter deficiency (ISD) can be achieved by many techniques. Those patients suffering from urinary incontinence secondary to ISD have often undergone multiple prior procedures for management of incontinence; therefore, an ideal form of treatment would be one that is minimally invasive and safe without compromising efficacy. The bioinjectables have proved to be safe and effective for the management of ISD and offer a minimally invasive alternative that can be performed under local anesthesia. This form of therapy is especially advantageous for properly selected patients suffering from urinary incontinence caused by ISD. We review the properties, indications for use, and results of the bioinjectables used in the treatment of ISD.

As the population ages the incidence of many urologic diseases increases. The elderly patient often is afflicted with many other concomitant diseases in addition to the general deterioration in their overall health status that occurs as a part of the normal aging process. With new advances in technology, many less invasive techniques have become available to treat many of these conditions, thus making many more elderly patients candidates for surgery. In the geriatric population the anesthetic consideration for surgery is as important as the surgical consideration and good communication between the patient, the family, the urologist and the anesthesiologist can make the entire surgical experience a successful one and achieve the desired outcome.

A series of functional studies were performed to assess the potential role of the ras-related transformation suppressor gene, Krev-1, in suppressing prostate cancer cell growth. Three human prostate cancer cell lines, PC-3, TSU-Pr1, and DU-145 were transfected with a plasmid containing the Krev-1 cDNA and a neomycin resistance gene. Selected G418-resistant clones were isolated and expanded into cell lines. All cloned transfectants exhibited a significant reduction in their in vitro growth rates, i.e., longer doubling times, when compared to the parental cell lines. Molecular analysis of the Krev-1 cloned transfectants revealed that they all contained variable copy numbers of the Krev-1 gene and expressed high levels of Krev-1 mRNA transcript, as shown by Southern and Northern analysis, respectively. To determine whether the biological properties associated with tumorigenicity were changed in these Krev-1 transfectants, their growth characteristics were examined on the basis of their ability to a) form colonies in soft agar, and b) produce tumors in SCID mice. The majority of the Krev-1 transfectants from the PC-3 and TSU-Pr1 cell lines showed a substantially reduced ability to form colonies in soft agar and produced significantly smaller tumors when inoculated into SCID mice. In contrast, there was no significant reduction in the soft agar colony-forming ability or in vivo tumorigenicity of the DU-145 Krev-1 transfectants. These results suggest that the Krev-1 suppressor gene induces partial suppression of the malignant phenotype of human prostate cancer cells containing activated ras oncogenes.

Objective: Laparoscopic dissection of pelvic lymph nodes has become an accepted alternative to open lymphadenectomy for staging of genitourinary tumors. This study reviews the CT findings in patients with major complications detected after laparoscopic dissection., Materials and Methods: Of 85 patients who had laparoscopic dissection of pelvic lymph nodes at our institutions during a 3-year period, complications developed in 12 patients (14%), and eight of these had abdominopelvic CT studies done. CT findings and initial interpretations were correlated with follow-up surgical, clinical, or interventional radiologic findings in all cases., Results: Complications of laparoscopic dissection detected with CT included small-bowel obstruction due to herniation through the trocar site in the abdominal wall (n = 2), extensive hematoma of the abdominal wall or retroperitoneum (n = 2), urinary ascites or multiple urinomas due to ureteral laceration or transection (n = 2), and lymphocele compressing the bladder where the peritoneum was sealed after lymphadenectomy (n = 1). In one case, CT showed pneumoperitoneum but failed to show a perforation of the sigmoid colon., Conclusion: Major complications occurred after laparoscopic dissection of pelvic lymph nodes and were diagnosed on the basis of CT findings in seven of eight patients. Recognition of the CT appearances of hernia or hematoma at the insertion sites of the trocars or the laparoscope is important, as is detection of injury to bladder, ureter, bowel, or blood vessels. Symptomatic lymphoceles were infrequently detected, probably because of the use of free drainage into the peritoneal cavity after laparoscopic dissection.

We report 2 cases of small bowel obstruction following staging laparoscopic pelvic lymph node dissection for prostate adenocarcinoma. Short segments of ileum became incarcerated in the right lower abdominal trocar sites (10 mm.) in both patients. Laparotomy was done to repair the problem in both cases and in 1 small bowel resection was required because of strangulation. This complication can probably be prevented in the majority of cases by meticulous attention to trocar site closure at the termination of a laparoscopic procedure.

Fifty-four patients underwent staging laparoscopic pelvic lymphadenectomy under general anesthesia for prostatic carcinoma (49), bladder carcinoma (3), penile carcinoma (1), and lymphoma (1). Conversion to an open procedure occurred only once in the series, but three patients received secondary open operations (5.5%). Complications recognized intraoperatively included bladder perforation (2) and mesenteric hematoma (1). One bladder perforation was repaired laparoscopically. The other was treated with catheter drainage. The mesenteric hematoma was explored surgically and found to be minor. Major postoperative complications included bleeding (4) requiring transfusion in two patients. One hematoma became infected requiring percutaneous drainage. One patient required intubation due to chronic obstructive pulmonary disease (COPD). Ureteral injury (1) was recognized late and required a psoas hitch and ureteroneocystostomy. Two patients developed small bowel obstructions due to herniation through a trocar site, requiring operative correction. Minor postoperative complications included ileus (4), diarrhea (2), bronchospasm (1), transient obturator nerve palsy (1), electrocardiogram changes (1), and fever (1). The overall major complication rate was 16.7%, and the overall minor complication rate was 18.4%. In this series, a substantial learning curve was seen with regard to complications, but the series compared favorably with open lymphadenectomy.