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Background: Marital status has been implicated as a prognostic factor in bladder cancer survival. However, few studies have explored potential mechanisms through which this might occur. Methods: The study identified 19 982 bladder cancer patients from the SEER-Medicare database (1992–8) and constructed sex-specific Cox proportional hazard models to assess the relation between marital status and 5-year survival, while sequentially adding covariates to test possible mechanisms. Results: Multivariable Cox analyses suggest that at every stage, married men had better survival than unmarried men independent of age, race, ecologic socioeconomic status, comorbidities, any or aggressive treatment (assessed separately), and accessing a teaching hospital (hazard ratio (HR) 0.80; 95% confidence interval (CI) 0.74 to 0.87). Among women with stages II–IV bladder cancer, age and the presence of comorbid conditions explained the association between marital status and survival. However, among those diagnosed with stage I bladder cancer, none of the covariates explained the association between marital status and decreased mortality (fully adjusted HR 0.72; 95% CI 0.62 to 0.84). Conclusion: The lack of evidence of mediation through treatment, overall health, SES, or quality of healthcare institution among married men and women with stage I disease suggests they may be benefiting from something other than these factors, perhaps practical or social support.

Chronic prostatitis/chronic pelvic pain syndrome remains an enigmatic medical condition. Creation of the National Institutes of Health-funded Chronic Prostatitis Collaborative Research Network (CPCRN) has stimulated a renewed interest in research on and clinical aspects of chronic prostatitis/chronic pelvic pain syndrome. Landmark publications of the CPCRN document a decade of progress. Insights from these CPCRN studies have improved our management of chronic prostatitis/chronic pelvic pain syndrome and offer hope for continued progress.

Members of the Chronic Prostatitis Collaborative Research Network (CPCRN) met in a 1-day symposium to review recent findings and to debate unanswered issues in the diagnosis and management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The meeting was focused on producing an overview summary statement that would, as nearly as possible, represent the consensus views of the attendees. As discussed below, the participants agreed that a history, physical examination, and urinalysis/urine culture are mandatory for the evaluation of all patients presenting with CP/CPPS, with other assessments categorized as recommended or optional, depending on the history and physical findings. Observations and suggestions regarding first- and second-line therapies are also offered, with the recognition that randomized, placebo-controlled trials to guide selection of therapies for chronic nonbacterial prostatitis are currently lacking.

Background Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men is principally defined by pain in the pelvic region lasting more than 3 months. No cause of the disease has been established, and therapies are empirical and mostly untested. Antimicrobial agents and alpha-adrenergic receptor blockers are frequently used. Objective To determine whether 6-week therapy with ciprofloxacin or tamsulosin is more effective than placebo at improving symptoms in men with refractory, long-standing CP/CPPS. Design Randomized, double-blind trial with a 2 x 2 factorial design comparing 6 weeks of therapy with ciprofloxacin, tamsulosin, both drugs, or placebo. Setting Urology outpatient clinics at 10 tertiary care medical centers in North America. Patients Patients were identified from referral-based practices of urologists. One hundred ninety-six men with a National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score of at least 15 and a mean of 6.2 years of symptoms were enrolled. Patients had received substantial previous treatment. Measurements The authors evaluated NIH-CPSI total score and subscores, patient-reported global response assessment, a generic measure of quality of life, and adverse events. Interventions Ciprofloxacin, 500 mg twice daily; tamsulosin, 0.4 mg once daily; a combination of the 2 drugs; or placebo. Results The NIH-CPSI total score decreased modestly in all treatment groups. No statistically significant difference in the primary outcome was seen for ciprofloxacin versus no ciprofloxacin (P = 0.15) or tamsulosin versus no tamsulosin (P > 0.2). Treatments also did not differ significantly for any of the secondary outcomes. Limitations Treatment lasting longer than 6 weeks was not tested. Patients who had received less pretreatment may have responded differently. Conclusion Ciprofloxacin and tamsulosin did not substantially reduce symptoms in men with long-standing CP/CPPS who had at least moderate symptoms.

Members of the Chronic Prostatitis Collaborative Research Network (CPCRN) met in a 1-day symposium to review recent findings and to debate unanswered issues in the diagnosis and management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The meeting was focused on producing an overview summary statement that would, as nearly as possible, represent the consensus views of the attendees. As discussed below, the participants agreed that a history, physical examination, and urinalysis/urine culture are mandatory for the evaluation of all patients presenting with CP/CPPS, with other assessments categorized as recommended or optional, depending on the history and physical findings. Observations and suggestions regarding first- and second-line therapies are also offered, with the recognition that randomized, placebo-controlled trials to guide selection of therapies for chronic nonbacterial prostatitis are currently lacking.

We report an unusual cause of leptomeningeal MR enhancement, amyloid, along the surfaces of the spinal cord and brain stem and in the spinal subarachnoid space, with sacral intradural and epidural deposition. Type I familial amyloid polyneuropathy may cause amyloid deposition along the leptomeninges of the spinal cord and brain in addition to the visceral organs and the peripheral somatic and autonomic nerves.

Treatment of nonbacterial chronic prostatitis/chronic pelvic pain syndrome continues to be a challenge for the treating physician. However, results from studies on the use of alpha-blockers seem to show some promise. Further studies on this class of drugs in the treatment of this condition are recommended.

Introduction Black patients have lower bladder cancer survival rates than White patients, but previous studies have not been able to explain this difference. Recent work has found that racial disparities in bladder cancer survival persist after adjusting for sex, age, and tumour characteristics. The objective of this study was to assess the association of insurance status, comorbidities, marital status, the receipt of radical cystectomy and being qualified for federal assistance (a marker for low individual-level SES) with disparities in bladder cancer survival. Methods We identified 15 666 (592 Black and 15 074 White) bladder cancer cases diagnosed between 1992 and 1999 (follow-up through 2003) from the SEER-Medicare database, and constructed relative survival models to assess 5-year survival disparities. Results The relative survival ratios (RSR) for Black patients vs White patients were as follows: unadjusted, RSR 2.22 (95% CI 1.90 to 2.59), adjusting for year of diagnosis, registry, age, sex, stage, and grade, RSR 1.54 (95% CI 1.32 to 1.81); additionally adjusting for comorbidity score, marital status, and receipt of radical cystectomy, RSR 1.45 (95% CI 1.25 to 1.70); additionally adjusting for SES, RSR 1.26 (95% CI 1.08 to 1.48). Lower comorbidity score, being married, higher SES and receipt of radical cystectomy were independently associated with increased bladder cancer survival. Conclusions Racial disparities persist after adjusting for comorbidity score, marital status, receipt of radical cystectomy and SES in this insured population. As the SES variable used in this study does not capture the diversity across the SES gradient and it is strongly associated with race, further studies investigating the influence of SES and its correlates may provide further explication of this disparity.

We describe a simple preoperative clinical test to determine whether a ureterocele that is unroofed will cause reflux postoperatively. The method is outlined and explained, and clinical examples are presented.

Satisfactory intrascrotal position of the testicles was achieved by dividing the spermatic vessels, leaving the vas deferens intact, in 3 patients with undescended testes. A postoperative scrotal scan provided objective means of evaluating the adequacy of testicular circulation. To determine the efficacy of various procedures for orchiopexy for undescended testes we suggest that postoperative evaluation include radionuclide imaging of the scrotum.

The value of corpus cavernosography in the management of conditions other than Peyronie’s disease is discussed. The procedure should be done under fluoroscopic control.