Androgens and bladder outlet obstruction: a correlation with pressure-flow variables in a preliminary study

OBJECTIVES To determine the relationship between androgens, lower urinary tract symptoms (LUTS) and urodynamic variables of bladder outlet obstruction (BOO) in patients with LUTS/benign prostatic hyperplasia (BPH), as androgens are important in the pathogenesis of LUTS. PATIENTS AND METHODS Twenty-five men with symptomatic BPH were enrolled in the study and had a complete urodynamic investigation, establishing BOO. Age, prostate-specific antigen level, prostate volume and postvoid residual volume were recorded and the International Prostate Symptom Score (IPSS) was estimated. Detrusor pressure at maximum flow (P(det)Q(max)), at urethral closure (PdetCl, the pressure at the end of urinary flow) and maximum detrusor pressure (P-detmax) was recorded, while detrusor overactivity (DO) was noted when present. Blood samples were collected to measure total testosterone (T), and free T (FT) was calculated. Patients were grouped according to FT levels as low (< 72 pg/mL) and normal (FT >= 72 pg/mL). RESULTS Ten patients had a low FT level, with a mean (SD) of 54.3 (16.5) pg/mL, and 15 a normal level of FT, of 90.5 (11) pg/mL. FT was negatively correlated with PdetCl, and P(det)Q(max); the mean PdetCl and P(det)Q(max) differed significantly between patients with low and normal FT levels. Fourteen patients had DO and they had significantly lower levels of FT than those with no DO. All patients with a FT level of < 60 pg/mL had DO, and the presence of instability differed significantly from the rest of the group. CONCLUSIONS Low T levels in clinical BOO correlated negatively with PdetCl and P(det)Q(max), while promoting DO. Androgen seems to have an ameliorating role in lower urinary tract function

Burned-out testicular tumor with retroperitoneal lymph node metastasis: a case report

Abstract Introduction A burned-out seminoma of the testis is an exceptionally rare clinical entity, with few reports found in the literature. Case presentation A case of burned-out tumor of the testis in a 31-year-old man is reported. The tumor presented as a retroperitoneal mass with histological characteristic of a seminoma. The testes on clinical examination were normal, and a suspicious lesion in the scrotum was only identified after ultrasound. Incision of the abdominal mass was decided, followed by orchectomy. Histological examination of the testis revealed a suspicious lesion with characteristics of spontaneous regression of germ cell tumors. Conclusion We describe one of very few cases worldwide, where spontaneous regression of a primary testicular tumor occurred after demonstration of retroperitoneal lymph node metastasis, a phenomenon known as burned-out seminoma, which is hard to recognize and incompletely characterized by physicians.</p