Can intravesical prostatic protrusion predict bladder outlet obstruction even in men with good flow?

Objective:Men with benign prostate hyperplasia(BPH)with good urinary flow may still have bladder outlet obstruction(BOO).Intravesical prostatic protrusion(IPP)has been shown to be able to predict BOO.We aim to investigate the use of IPP to predict BOO in men with good urinary flow.Methods:One hundred and fourteen consecutive men(>50 years old)presenting with lower urinary tract symptoms suggestive of BPH were recruited in 2001 and 2002.They were evaluated with serum prostate specific antigen(PSA),uroflowmetry and transabdominal ultrasound measurement of IPP and prostate volume(PV).Pressure-flow urodynamic studies were performed on all men and BOO was defined by BOO index>40.Men with Qmax
12.0 mL/s were considered to have good flow.Results:Among the 114 men,61 patients had good urinary flow.Their median age,PV and Qmax were 66 years,32.9 mm3 and 14.5 mL/s respectively.14/61(23.0%)patients had BOO and their distribution of IPP were as follows:Grade 1 e 0/20(0%)obstructed,Grade 2 e 6/22(27.3%)and Grade 3 e 8/19(42.1%).Sensitivity of Grade 2/3 IPP for BOO was 100% while specificity of Grade 3 IPP was 76.6%.The area-under-curve(AUC)for IPP was greater than that for PV(0.757 vs.0.696).Conclusion:Even in men with good flow,high grades of IPP were more likely to have BOO and hence,may be a useful adjunct to predict BOO.

Patients with small prostates and low-grade intravesical prostatic protrusion e A urodynamic evaluation

Abstract Objective:Despite high-grade intravesical prostatic protrusion(IPP)being closely related to bladder outlet obstruction(BOO),up to 21%of patients with low IPP remain obstructed.This study evaluates the characteristics and urodynamic findings of men with small prostates and low IPP.Methods:One hundred and fourteen men aged>50 years old with lower urinary tract symptoms(LUTS)were assessed with symptoms,uroflowmetry,serum prostate-specific antigen(PSA),transabdominal ultrasound measurement of prostate volume(PV),IPP and post-void residual urine(PVRU).All patients underwent pressure flow studies.Patients with PV<30 mL and IPP
10 mm were examined for parameters correlating with BOO or impaired detrusor contractility.Results:Thirty-six patients had PV<30 mL and IPP<10 mm.Nine patients(25.0%)had urodynamic BOO,all with normal bladder contractility.Fourteen patients(38.9%)had poor detrusor contractility and all had no BOO.PV,PVRU and IPP were significantly associated with BOO,with IPP showing greatest positive correlation.Both Qmax and IPP were significantly associated with detrusor contractility.At 5-year follow-up,most patients responded to medical therapy.Only three out of nine patients(33.3%)with BOO eventually underwent surgery,and all had a high bladder neck seen on the resectoscope.Only one patient(7.1%)with poor detrusor contractility eventually required surgery after repeat pressure flow study revealed BOO.Conclusion:In men with small prostates and low IPP,the presence of BOO is associated with higher PV,PVRU and IPP,and most respond well to medical management.BOO can possibly be explained by elevation of the bladder neck by a small subcervical adenoma.

Perioperative anticoagulation and open distal corpora cavernosa shunt in the management of a case of stuttering idiopathic persistent childhood ischaemic priapism

Childhood priapism is a rare entity and there is currently no consensus regarding its contemporary management.The use of perioperative anticoagulation and open distal corporaglandular shunt procedure in the management of childhood priapism has not been reported in the literature.We present a stuttering case of a 13-year-old boy who presented with idiopathic ischaemic priapism lasting 13 h in duration,which recurred despite corporal aspiration and alpha-adrenergic agonist injections,percutaneous distal shunt surgery,and revision of percutaneous distal shunt surgery.He was eventually successfully managed with perioperative subcutaneous enoxaparin,oral aspirin and clopidogrel in conjunction with an Al-Ghorab shunt,which led to sustained detumescence but with spontaneous morning erections.In paediatric patients with sustained childhood priaprism failing stepwise treatments,an Al-Ghorab shunt with perioperative anticoagulation is a viable option.

Will not bagging an excised tumour immediately during partial nephrectomy possibly result in tumour seeding?A case report

Partial nephrectomy is now a standard approach for small renal masses and tumour recurrences after partial nephrectomy are uncommon.In the absence of spillage,port site recurrences are most commonly reported.We report a case of tumour recurrence near the surgical site as well as beyond the posterior renal fascia and Gerotas fascia in a 60-year-old woman who underwent robot-assisted partial ne-phrectomy for a 4.6 cm suspicious left renal tumour despite the absence of gross tumour spillage or rupture intraoperatively.Histology showed a 5 cm clear cell renal cell carcinoma with negative surgical margins,nuclear grade 4 with focal malignant rhabdoid differentiation.The practice of not bagging the specimen immediately after tumour excision especially for higher risk tumours should be reviewed as there may be inadvertent microscopic spillage of tumour cells.