Verslag van die Amerikaanse en Britse urologie-kongresse, Junie 1991

Conference PaperThe original publication is available at http://www.samj.org.za[No abstract available]Publisher’s versio

Exstrophy of the testis

Among the anomalies of testicular descent exstrophy of the testis appears to be the most rare. We describe a full-term male newborn with the right testis and spermatic cord prolapsed from a skin defect at the neck of the scrotum. The cause of the anomaly is unknown.Articl

Renal trauma: Indications for imaging and surgical exploration

[No abstract available]Revie

Triptorelin in the treatment of prostate cancer: Clinical efficacy and tolerability

Triptorelin is a synthetic analog of gonadotropin-releasing hormone (GnRH; also known as luteinizing hormone-releasing hormone [LHRH]), which has enhanced receptor affinity, extended half-life and increased bioactivity. Triptorelin initially stimulates the pituitary gland, increasing serum luteinizing hormone and testosterone levels; however, after 3-4 weeks, the pituitary becomes refractory due to receptor desensitization and/or down-regulation, resulting in castration levels of testosterone in men and postmenopausal estradiol levels in women. Pharmacologic equivalence studies have shown that triptorelin, buserelin and goserelin are equally effective in down-regulating the pituitary-gonadal axis, and the new 3- and 1-month depot formulations of triptorelin have equal efficacy. In men with locally advanced or metastatic prostate cancer, administration of triptorelin leads to subjective improvement in lower urinary tract symptoms and pain, as well as objective responses such as decreased serum levels of acid and alkaline phosphatase and prostate-specific antigen, decreased prostate volume, and regression of skeletal metastases. Randomized clinical trials comparing triptorelin with bilateral orchidectomy have shown no significant differences in clinical response, survival or side effects. The time to subjective response was shorter in patients treated with orchidectomy, but there was a trend towards reduced psychologic morbidity in those treated with triptorelin. In randomized clinical trials comparing triptorelin with leuprolide (leuprorelin), two studies concluded that triptorelin induced a more rapid decrease in testosterone levels, although both drugs had similar clinical efficacy, whereas a third study concluded that triptorelin reduced testosterone levels less rapidly than, but maintained castration levels of testosterone as effectively as, leuprolide. The 9-month survival rate was significantly higher for triptorelin (97% vs 90.5% for leuprorelin). Neoadjuvant triptorelin treatment in localized prostate cancer prior to radical prostatectomy may reduce the incidence of positive surgical margins, but no survival advantage has been demonstrated. Neoadjuvant treatment before radiotherapy, by reducing prostatic volume, may decrease radiation-related complications, and may increase survival in a subset of patients with a Gleason score of 2-6. The most common adverse effects of triptorelin and GnRH agonists in general, are hot flushes, loss of libido, and impotence. The initial increase in serum testosterone levels - the 'flare' phenomenon - may lead to exacerbation of bone pain, paraplegia and (rarely) death in patients with a large tumor burden. Androgen deprivation leads to a reduction in bone mineral density of 3-5% per year, but it remains to be proven that this significantly increases the clinical fracture risk in patients with prostate cancer. In conclusion, the clinical efficacy and tolerability of triptorelin in the treatment of prostate cancer are similar to that of surgical castration and leuprolide. © 2005 Adis Data Information BV. All rights reserved.Revie

Commentary: Screening for prostate cancer

[No abstract available]Not

Early PSA decrease is an independent predictive factor of clinical failure specific survival in patients with localized prostate cancer treated with radiotherapy combined or not with androgen deprivation therapy

[No abstract available]Lette

Urinary tract infection associated with conditions causing urinary tract obstruction and stasis, excluding urolithiasis and neuropathic bladder

Purpose: The aim of this study was to examine urinary tract infection (UTI) associated with conditions causing urinary tract obstruction and stasis, excluding urolithiasis and neuropathic bladder dysfunction. Methods: An electronic literature search was performed using the key words urinary tract infection (UTI),benign prostatic hyperplasia (BPH), hydronephrosis, obstruction, reflux, diverticulum, urethra, and stricture. In total, 520 abstracts were reviewed, 210 articles were studied in detail, and 36 were included as references. Results: It is one of the axioms of Urological practice that urinary tract obstruction and stasis predispose to UTI. Experimental studies indicate that, whereas transurethral inoculates of bacteria are rapidly eliminated from the normal bladder, urethral obstruction leads to cystitis, pyelonephritis, and bacteremia. BPH is, next to urolithiasis, the most common cause of urinary tract obstruction predisposing to UTI. Urethral stricture remains a common cause of UTI in many parts of the world. Urinary stasis in diverticula of the urethra or bladder predisposes to UTI. Experimental studies have shown that, whereas the normal kidney is relatively resistant to infection by organisms injected intravenously, ureteric obstruction predisposes to pyelonephritis. It also causes renal dysfunction which impairs the excretion of antibiotics in the urine, making eradication of bacteria difficult. Conclusions: In patients with UTI and urinary tract obstruction, targeted antibiotic treatment according to urine culture should be complemented with urgent drainage (bladder catheterization, percutaneous nephrostomy or ureteric stenting) followed by definitive surgery to remove the cause of obstruction or stasis once infection is under control. © 2011 Springer-Verlag.Article in Pres

The use of prostate-specific antigen testing in men presenting with haematuria: Commentary

[No abstract available]Not

Evaluation of core and surface body temperatures, prevalence, onset, duration and severity of hot flashes in men after bilateral orchidectomy for prostate cancer

Objective: To assess the prevalence, onset, duration and severity of hot flashes in men after bilateral orchidectomy (BO) for prostate cancer, to evaluate body temperature changes during hot flashes and to determine whether an elevated temperature within a few days after BO can be caused by deprivation of androgen. Materials and Methods: Patients (n = 101) were questioned about the characteristics of their hot flashes after BO for prostate cancer. A subgroup of these men (n = 17) were instructed to record their oral and forehead temperatures during and at fixed intervals between hot flashes daily for 4 weeks. Results: The mean age was 71.6 years, mean follow-up after BO was 33.2 months. Hot flashes were reported by 87 men (86%) with previous spontaneous remission in 9 (10%). The median time between BO and the onset of hot flashes was 21 days (range 1-730), median number of hot flashes 3 per day (range 1-20), and median duration was 120 seconds (range 5 to 1800). There was no significant difference between median oral (36.4°C) and forehead (36.0°C) temperature in the normal state, but during hot flashes the median forehead temperature (37.0°C) was higher than the oral temperature (36.5°C) (p = 0.0004). Both median oral and forehead temperatures were higher during hot flashes (36.5°C and 37.0°C) than in the normal state (36.4°C and 36.0°C, respectively) (p 38°C within days after a BO is unlikely to be the result of androgen deprivation alone.Articl

Testicular function after torsion of the spermatic cord

[No abstract available]Short Surve