International journal of urology : official journal of the Japanese Urological Association
-
Recurrent disease following radical prostatectomy will occur in approximately 20% of patients, for whom the therapeutic options include surveillance, salvage radiotherapy, or hormonal therapy. This review will focus on the evidence for salvage radiotherapy. Efficacy results of 30-50% have been reported from multiple retrospective series, with minimal morbidity. ⋯ Other positive prognosticators are positive margins at radical prostatectomy, longer prostate-specific antigen doubling times, lower radical prostatectomy Gleason scores, and the absence of lymph node metastases. Current standard dosage is 64 Gy or slightly higher, although the optimal dosage has yet to be defined with prospective randomized trials. Salvage radiotherapy can provide a durable response when given early, and patients with recurrent disease should be considered for treatment or enrolment in clinical trials.
-
The prevention of venous thromboembolism is a major concern in cancer patients undergoing pelvic surgery. Radical retropubic prostatectomy is a common treatment for localized prostate cancer and has been identified as a high risk procedure for postoperative venous thromboembolism. However, most patients diagnosed with prostate cancer in the current era have clinically localized, low volume disease and the risk of venous thromboembolism is very low. ⋯ Pharmacological prophylaxis is known to increase the rate of lymph drainage and the rate of lymphocele formation. Evidence suggests that lymphocele may be an independent risk factor for venous thromboembolism in the postoperative period. These factors raise concern over current guidelines calling for routine use of pharmacological venous thromboembolism prophylaxis in radical retropubic prostatectomy especially when lymphadenectomy is performed simultaneously.
-
Single dose 1 g ceftriaxone for urogenital and pharyngeal infection caused by Neisseria gonorrhoeae.
To evaluate the efficacy of 1 g ceftriaxone in the treatment of urethritis, cervicitis and pharyngeal infection caused by Neisseria gonorrhoeae (N. gonorrhoeae) including the oral cephem-resistant strain with chimera penicillin-binding protein 2 (PBP-2) (cefozopran-resistant N. gonorrhoeae, CZRNG). ⋯ We report for the first time that ceftriaxone is effective in patients with gonococcal urethritis, cervicitis, and pharyngeal infection caused by CZRNG that has chimera PBP-2.
-
Anatomical anomalies in hypospadias are an abnormal ventral opening of the urethral meatus, abnormal ventral curvature of the penis and abnormal distribution of the foreskin around the glans with a ventrally deficient hooded foreskin. The techniques of hypospadias surgery continue to evolve. The current standard of care for hypospadias repair includes not only a functional penis adequate for sexual intercourse and urethral reconstruction offering the ability to stand to urinate, but also a satisfactory cosmetic result. ⋯ In cases of proximal hypospadias, one-stage repairs such as the Duckett repair or the Koyanagi repair have been well established, while two-stage repairs remain important alternatives. Whether dorsal plication or ventral lengthening should be used to correct penile curvature is still controversial, and long-term results are required. Efforts have been made in this decade to improve cosmetic appearance, constructing a slit-like meatus or performing foreskin reconstruction, and to prevent onerous complications.
-
Since catechol estrogens possess carcinogenetic potential, their detoxification may lead to reduced risk of carcinogenesis. Catechol-O-methyltransferase (COMT) catalyzes the O-methylation of catechol estrogens. The enzymatic activity of COMT has been shown to be governed by a functional single-nucleotide polymorphism represented by a G-to-A transition at codon 158, that results in a valine to methionine substitution; this variant form is associated with an up to 4-fold decrease in enzymatic activity. We attempted to investigate whether the Val158Met polymorphism of COMT was associated with the risk of prostate cancer. ⋯ Our results suggested that the Val158Met polymorphism of COMT was not associated with the risk of sporadic or latent prostate cancer in Japanese men.