The Journal of urology
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The Journal of urology · Nov 1994
Multicenter Study Comparative Study Clinical TrialAccuracy of digital rectal examination and transrectal ultrasonography in localizing prostate cancer.
Not all prostate cancers are sonographically hypoechoic or palpable on digital rectal examination, and suspicious areas on transrectal prostatic ultrasonography or digital rectal examination often are not cancer. We present quadrant biopsy results from a multicenter prostate cancer screening study in which men were evaluated with prostate specific antigen (PSA) and digital rectal examination. If the PSA level was elevated (greater than 4.0 ng./ml., Hybritech Tandem assay) or digital rectal examination was suspicious quadrant biopsies were performed. ⋯ Of 251 patients with cancer 131 (52%) would have been missed if only the exact site of the hypoechoic lesion had been biopsied. We conclude that digital rectal examination and transrectal ultrasonography have limited accuracy in identifying and localizing prostate cancer. Our study emphasizes the importance of obtaining systematic biopsies if the PSA level is elevated, even in the absence of digital rectal examination or ultrasound anomalies.
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Nonbacterial prostatitis is a common clinical entity which is often difficult to diagnose and treat. Little is known with regard to the etiology and pathogenesis of this disease process. To develop an animal model and characterize the immune parameters of nonbacterial prostatitis, we harvested the prostates from SJL, AJ, Balb/c, C57bl/6 and C57bl/6 lpr mice. ⋯ Adoptive transfer studies demonstrated the prostatic inflammation to be at least in part immune mediated. We conclude that injection of syngenic prostate antigen induces prostatic inflammation similar to clinical nonbacterial prostatitis. Nonbacterial prostatitis may be an autoimmune process.
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The Journal of urology · Jul 1994
Comparative StudyThe management of patients with nonseminomatous germ cell tumors of the testis with serologic disease only after orchiectomy.
Management of patients with nonseminomatous germ cell tumors of the testis who have persistently elevated serum tumor marker levels (alpha-fetoprotein and/or human chorionic gonadotropin) following orchiectomy and no clinical evidence of disease is controversial. We reviewed our experience with 15 such patients at our cancer center between March 1977 and November 1991. ⋯ All group 1 patients required subsequent chemotherapy for retroperitoneal disease or persistent marker elevation, whereas only 1 of the 4 who received primary chemotherapy required later surgery. We conclude that tumor marker elevation in this setting is usually indicative of systemic tumor, which is best treated primarily by initial chemotherapy.
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The Journal of urology · Mar 1994
Case ReportsScrotal ultrasound for evaluation of subacute testicular torsion: sonographic findings and adverse clinical implications.
There is an increased use of scrotal ultrasound in the clinician's office and emergency room for the investigation of scrotal pain. The use of real-time scrotal ultrasound for the diagnosis of testicular torsion has been described in the literature. A false-negative ultrasound examination can postpone the diagnosis of torsion and result in testicular loss. ⋯ Treatment was not delayed in only 2 patients in whom the diagnosis of torsion was made initially by history and physical examination, and ultrasound was done for interest only. Misdiagnosis of intratesticular blood flow and some potential pitfalls of scrotal imaging by color Doppler ultrasound are discussed. We conclude that real-time scrotal sonography can be misleading in cases of subacute testicular torsion and, therefore, it should not be used in this clinical setting.
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The Journal of urology · Feb 1994
Case ReportsDorsal nerve block for management of intraoperative penile erection.
Intraoperative penile erection during general anesthesia can delay or prevent the completion of cystoscopic or penile surgical procedures. The dorsal penile nerve block is offered as a treatment for intraoperative erection. Advantages of this technique include less potential for cardiovascular complications and improved postoperative analgesia.