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Purpose: We determined the associations between comorbidity, and overall survival and bladder cancer specific survival after radical cystectomy., Materials and Methods: The Alberta Urology Institute Radical Cystectomy database is an ongoing multi-institutional computerized database containing data on all adult patients with a diagnosis of primary bladder cancer treated with radical cystectomy in Edmonton, Canada from April 1994 forward. The current study is an analysis of consecutive database patients treated between April 1994 and September 2007. Comorbidity information was obtained through a medical record review using the Adult Comorbidity Evaluation 27 instrument. The outcome measures were overall survival and bladder cancer specific survival. Cox proportional regression analysis was used to determine the associations between comorbidity, and overall survival and bladder cancer specific survival., Results: Of the database patients 160 (34%), 225 (48%) and 83 (18%) had no/mild comorbidity, moderate comorbidity and severe comorbidity, respectively. Compared to patients with no or mild comorbidity, multivariate Cox proportional regression analyses that included age, adjuvant chemotherapy, surgeon procedure volume, pathological T stage, pathological lymph node status, total number of lymph nodes removed, surgical margin status and lymphovascular invasion showed that increased comorbidity was independently associated with overall survival (moderate HR 1.59, 95% CI 1.16-2.18, p = 0.004; severe HR 1.83, 95% CI 1.22-2.72, p = 0.003) and bladder cancer specific survival (moderate HR 1.50, 95% CI 1.04-2.15, p = 0.028; severe HR 1.65, 95% CI 1.04-2.62, p = 0.034)., Conclusions: Increased comorbidity was independently associated with an increased risk of overall mortality and bladder cancer specific mortality after radical cystectomy.

Purpose: We determine the incidence of complications following outpatient scrotal surgery for the treatment of hydroceles and spermatoceles., Materials and Methods: A retrospective study of all patients undergoing hydrocelectomy or spermatocelectomy between April 1, 1997 and March 31, 1999 at 1 institution was performed. The hospital and office charts were reviewed, and postoperative complications (infection, persistent swelling, chronic pain) were recorded. The type of preoperative antiseptic preparation (iodine based versus chlorhexidine) and the presence or absence of surgical drains were also recorded., Results: A total of 161 patients were included in the study with an average age of 53.7 years. The overall complication rate was 19.2%. Infection/scrotal abscess formation occurred in 9.3% of patients, persistent swelling (treatment failure) in 9.3% and chronic pain in 0.6%. There was no significant difference in the complication rate when the preoperative preparations and the presence or absence of surgical drains were compared., Conclusions: The most common complications following scrotal surgery for hydroceles and spermatoceles are persistent scrotal swelling, inflammation and postoperative infection. Further prospective investigation is required to study factors such as the use of drains, preoperative and/or perioperative antibiotics and the type of surgical preparations, which may have a role in complication rates.

Objective: To examine current treatment options for benign prostatic hyperplasia with emphasis on randomized, clinical trials and our current management approach., Quality of Evidence: Benign prostatic hyperplasia remains difficult to define clinically or measure objectively. As a result, research has been fairly weak. With newer treatments, however, more definitive studies have been reported., Main Findings: Transurethral resection of the prostate remains the criterion standard for severe disease. Watchful waiting, medical management, or early surgical intervention are all valid options for moderate disease and should be tailored to the characteristics and desires of individual patients. Recent minimally invasive surgical techniques, such as microwave and laser surgery, have not yet achieved the quality of evidence to be generally recommended., Conclusions: Management of benign prostatic hyperplasia should be individualized to patients' circumstances and personal choices.

Objective: To evaluate early discharge from hospital with community-based care as an alternative to hospital-based care for patients who have undergone transurethral resection of the prostate (TURP)., Design: Prospective comparative study., Setting: A major urban hospital and the urban community., Patients: Of 198 patients who underwent TURP between Jan. 10, 1994 and Sept. 30, 1994, 81, discharged on postoperative day 1, received the caremap method of health care delivery at home. They were compared with 85 patients who were discharged on postoperative day 2 or 3 and received standard hospital-based care., Main Outcome Measures: Readmission to hospital, reuse of health care services, complications and patient satisfaction., Results: Comparison of the 2 groups revealed no significant differences in readmissions to hospital, reutilization of health care services or complications. Following these initial results, the early discharge program was expanded to include all acute care hospitals and the surrounding community., Conclusions: Postoperative care for TURP can be delivered in the home. A critical success factor was the ability to provide quality care in the community without adverse effects.

Objective: To establish which method of determining prostatic volume (transrectal ultrasound [TRUS] or magnetic resonance imaging [MRI]) and which calculation formula give the most exact and least variable results; to determine the size and the source of the variability: and to establish which method is the more sensitive to drug-induced changes in prostate volume., Patients and Methods: Prostatic size was estimated by TRUS and MRI in 21 patients treated medically (either active treatment or placebo) for benign prostatic hyperplasia. Each patient was examined at baseline, and after 3 months and 6 months of treatment. Prostatic volume was calculated at every visit using different formulae proposed in the literature., Results: With some of these formulae, including the classical ellipsoid formula, there was a strong correlation (r > 0.8) between TRUS and MRI volume estimates. For others the correlation was much weaker, suggesting unreliability. MRI gave a significantly larger volume than TRUS because of larger values for the cephalocaudal and anteroposterior diameters. For patients on placebo the visit-to-visit variability of the prostate volume was 10-12% of the mean volume, whether calculated by TRUS or MRI. Part of this variability was apparently due to natural variation of prostate size., Conclusion: The classical ellipsoid formula is adequate for determining prostate volume. MRI and TRUS give different volumes. Visit-to-visit variability is similar for both methods and is partly due to real, natural variation. MRI is better able than TRUS to detect drug-induced changes in prostate volume.

The authors reviewed retrospectively 1486 consecutive transurethral resections of the prostate (TURP) gland performed in a teaching hospital between 1985 and 1987. The death rate was 0.8% in an institution where senior residents were the primary resectionists in approximately 75% of TURPs. The results of this review are compared with those of a 1974 study of 2223 patients. They indicated that TURP was a reasonably well-tolerated surgical procedure in the training environment and was associated with lower mortality and morbidity and a shorter hospital stay for the patient than in the 1974 study. The authors believe that with proper supervision and instruction, resident urologists can obtain satisfactory results while gaining competence and experience in performing TURPs.

The Neodymium YAG laser energy source can be readily adapted for cystoscopic use by some simple modifications of existing urologic equipment. Both the fiberoptic resectoscope and a deflecting cystourethroscope have been adapted for this purpose. Fixation of the fiber tip 1 cm. from the target and use of a divergent beam of 36 degrees allows the delivery of standardized dosage to a relatively large bladder tissue volume. Animal experiments involving 35 mongrel dogs established that repetitive overlapping doses of 200 joules ech can successfully treat a large area of bladder resulting in a full thickness bladder wall injury. This technique has been used in 4 high risk patients with infiltrating bladder cancer without adverse sequelae. The ability to reliably produce a full thickness lesion may give this modality a therapeutic advantage over conventional cautery techniques especially for the treatment of residual infiltrative carcinoma.

We report 3 cases of primary transitional cell carcinoma of the bladder presenting during pregnancy. Only 10 such cases have been reported in the literature. Patient age ranged from 23 to 24 years at 15 to 24 weeks of gestation. Only 1 of the 3 patients presented with gross hematuria and this was initially mistaken as vaginal bleeding. Initial diagnosis in all cases was made with sonography. Diagnosis then was easily confirmed by cystoscopy and treatment was uneventful. Transurethral resection did not present a problem. All patients had single papillary superficial tumors (stage Ta, grades 1 and 2). Pregnancy was not affected in any case. Diagnosis and prompt treatment are emphasized.

The development and proliferation of modern radiotherapy techniques, and their application in the 1970s to the treatment of localized adenocarcinoma of the prostate have led to substantial improvement in therapy of this disease. However, treatment failures occur. Among these patients is a small subset who have local recurrence of disease confirmed by biopsy without evidence of metastatic disease, and who still are relatively young and healthy. We report on 7 patients who satisfy these criteria. All 7 patients underwent a salvage operation with removal of the prostate gland following attempted curative radiotherapy: 3 underwent cystoprostatectomy and urinary diversion, and 4 underwent radical prostatectomy. Operating times averaged 4.9 hours and average blood transfusion was 5.3 units. Postoperative hospital stay averaged 13 days. Significant morbidity included 2 patients with rectal lacerations (1 of whom suffered a rectourethroperineal fistula that closed spontaneously), 2 with temporary urinary incontinence, and 1 with idiopathic thrombocytopenia and pseudomembranous colitis. As illustrated by these patients salvage surgery is difficult and there is substantial morbidity. However, this treatment option with its potential for cure can be offered to patients as a reasonable and rational approach to the problem.

Two homosexual men positive for human immunodeficiency virus with evidence of acquired cellular immunodeficiency were diagnosed recently to have seminoma of the testis. One man has the acquired immunodeficiency syndrome with lymphopenia, a low CD4:CD8 ratio, condylomata accuminata, pneumocystis carinii and cerebral toxoplasmosis, and 1 has an acquired immunodeficiency syndrome related complex with generalized lymphadenopathy showing follicular hyperplasia on biopsy, recurrent Herpes simplex infections and lymphopenia but a supranormal CD4:CD8 ratio. Neither patient has a known risk factor for testicular seminoma. Our report provides supportive evidence for the presence of an increased risk of seminoma of the testis in patients with acquired immunodeficiency syndrome and acquired immunodeficiency syndrome related complex.