The surgical management of Peyronie’s Disease

Peyronie's disease (PD) is an acquired benign connective tissue disorder that involves the tunica albuginea of the penis and can cause penile deformity and shortening. Because this condition is frequently associated with cardiovascular risk factors, a degree of erectile dysfunction is frequently present. The surgical management of PD should be offered once the acute phase of the disease has settled and the deformity is stable

CONTINENCE AND POTENCY RATES FOLLOWING RADICAL PROSTATECTOMY VERSUS RADIATION THERAPY IN MEN WITH T3 PROSTATE CANCER. 10 YEAR FOLLOW UP

Introduction & Objectives: To evaluate oncological and functional outcomes of radical prostatectomy and radiation therapy in men with cT3 prostate cancer and to analyse independent factors allowing an accurate patient selection. Material & Methods: Between 1993 and 2006 a total of 695 patients with cT3 Prostate cancer and PSA < 25ng/ mL were treated either by radiation therapy (n=302) with the MD Anderson scheme (78 Gy and hormone therapy, XRT+HT) or radical prostatectomy with lymphadenectomy (n=393)(RPE). Treatment allocation was strictly selected for each centre to avoid selection bias. Follow up was routinely done at 3 month intervals. Progression free survival and cancer specific survival was calculated for each group and a neural network created to investigate the impact of grade, PSA and age. In addition continence (<1 pad) and potency rates were evaluated. With respect PSA, lower PSA(<4) performed worse than men with intermediate PSA, whereas young men clearly had the worse outcome. When comparing treatment strategies, radiation+HT was equal to RPE in men with GS<7, PSA 4-10 and close to RPE in men older than 60. Otherwise RPE performed better in terms of DSS and CSS. Conclusions: Men with cT3 prostate cancer do represent an inhomogeneous cohort. Men < 60 years, PSA < 4 or PSA >10 and GS >7 show better DSS and CSS with radical prostatectomy versus radiation therapy at 5 and 10 years follow up. Continence and potency results were equal and strongly age dependent

Multiple Injuries to the Lower Urinary Tract: Two Cases and Comparison with the EAU Guidelines

Blunt trauma to the lower urinary tract is usually associated with pelvic fractures. The European Association of Urology (EAU) provides guidelines to diagnose and treat these injuries. The guidelines summarise the available evidence and provide recommendations on diagnosis and treatment of these patients. Therefore, these guidelines are important adjuncts to the urologist and emergency physician in the clinical decision-making. However, strict adherence to the guidelines is not always easy or possible because of concomitant injuries obscuring the clinical picture. This is illustrated by two case reports of concomitant injuries of the lower urinary tract (bladder with urethral injury). The clinical decisions will be discussed point by point and should serve as a practical teaching moment for the reader

Indications for saturation biopsies of the prostate: Where do we stand?

Introduction & Objectives: Recent results of the European Prostate Cancer Detection study (EPCDS) and the 3 dimensional reconstruction of cancers detected on first and repeat biopsy suggested that cancers detected on repeat biopsy were located in more dorso-lateral (para-rectal) and apical location. The Vienna nomograms further identified the optimal number of cores required. The purpose of this study was to evaluate the value and legacy of saturation biopsies (22 cores) versus a novel modified biopsy protocol. Material & Methods: A total of 593 patients were evaluated in 8 European University centers. 212 patients with a total PSA (2.5-10 ng/mL) and an initial negative biopsy underwent a repeat saturation biopsy. A second group of 382 consecutive patients underwent repeat biopsy with a novel modified biopsy protocol using the Vienna nomograms and aiming at the apical and dorso-lateral regions. Uniand multivariate statistical analysis using the SAS system (CARY, North Carolina) and ROC curves were performed to compare cancer detection rates and distribution. Results: Cancer detection rate on first biopsy was 28.7%. Cancer detection rate on saturation repeat biopsy was 22.8%. Using the novel biopsy protocol, cancer detection rate upon repeat biopsy was 18.7%. As compared to patients diagnosed with PCa after the first set of biopsies, patients diagnosed after the second set had larger total prostate (tot vol.) and transition zone volumes (TZ vol.) (45.2 ± 11.0cc vs 33.7 ± 9.6cc, p = 0.0001 and 22.0 ± 6.5cc vs. 11.8 ± 8.3cc, p = 0.0001). These findings were identical to cancers detected on first and repeat biopsy with the saturation and modified protocol (p = 0.33). Morbidity of both the saturation and modified protocol biopsies were identical (p = 0.12), however significantly higher than with the standard octant biopsy protocol (p = 0.003). Using the cumulative logistic plot analysis the probability of a positive first/repeat biopsy core was analyzed. The dorsolateral biopsy cores (p = 0.001), followed by the apical (p = 0.02) and transition zone biopsy cores (p = 0.04) were the most common sites of cancer on repeat biopsy. On multivariate analysis, patients with HG-PIN on first biopsy, PSA > 8 ng/mL, tot vol. >50 cc, TZ vol 20-40cc, TZ/PZ ratio < 0.4 and a negative prior history of biopsies had a significantly higher detection rate on saturation biopsy. Conclusions: Saturation biopsy and modified biopsy protocols using volume/age charts resulted in a 69-78% improvement of the cancer detection rate on repeat biopsy as compared to standard repeat biopsies technique. However, saturation biopsies were not necessary in all patients with negative initial biopsies. Saturation biopsies were beneficial in patients with HG-PIN on first biopsy, PSA > 8 ng/mL, tot Vol >50 cc, TZ vol 20-40cc, TZ/PZ ratio < 0.4 and a negative prior history of biopsies resulting in a further 37% increase in detection rates