Testosterone supplementation and prostate cancer, controversies still exist

Late onset hypogonadism is a common condition in aging males. The population of men who can be potentially treated with testosterone supplementation is growing. Controversy that surrounds testosterone replacement therapy is due to generally undefined lower limits of normal testosterone level and high prevalence of hypogonadal symptoms in elderly population and the non-specific nature of these symptoms. Incidence of prostate hyperplasia and occult prostate cancer in elderly are both high. The risk that testosterone treatment would trigger prostate cancer was not fully recognized. The aim of this mini review is to present a risk of carcinogenesis within the prostate related to testosterone treatment

Transoesophageal echocardiography reduces invasiveness of cavoatrial tumour thrombectomy

The traditional approach to cavoatrial thrombus excision requires median sternotomy, cardiopulmonary bypass with or without hypothermia and circulatory arrest and is associated with significant morbidity and mortality. We describe a transoesophageal echocardiography guided balloon catheter assisted technique for cavoatrial thrombectomy that avoids thoracotomy, extracorporeal circulation and circulatory arrest as an alternative to traditional methods. A 74-year-old man presented with a right solid renal mass confined to the kidney with thrombus extension through the right renal vein and the inferior vena cava into the right atrium. A right radical nephrectomy with cavoatrial thrombectomy under transoesophageal echocardiography guidance was successfully achieved using a balloon catheter-assisted technique with minimal intra-and postoperative morbidity. Cavoatrial tumour thrombectomy can be successfully performed without cardiopulmonary bypass, hypothermia and circulatory arrest

Prevalence, bother and teatment behavior related to lower urinary tract symptoms and overactive bladder among cardiology patients

Purpose: The aim of this study was to measure, at the population level, the prevalence, bother, and treatment-related behavior for lower urinary tract symptoms (LUTS) and overactive bladder syndrome (OAB) in a large cohort of cardiology patients. Methods: This report is a further analysis of data from LUTS POLAND, a computer-assisted telephone survey that reflected the entire Polish population, stratified by age, sex, and place of residence. LUTS and OAB were assessed by a standardized protocol, the International Continence Society definitions, and validated questionnaires. In addition, all participants provided information regarding their behavior as it related to LUTS treatment. Results: Overall, 6005 participants completed interviews, and 1835 (30.6%) had received treatment by cardiologists. The prevalence of LUTS was 73.3% for cardiology participants compared with 57.0% for respondents who were not treated by cardiologists (p < 0.001). There were no differences between men and women in LUTS prevalence for cardiology patients. Nocturia was the most prevalent LUTS. LUTS were often bothersome, and storage symptoms were more bothersome than voiding or postmicturition symptoms. The prevalence of OAB syndrome was 50.7% in cardiology patients, higher than in noncardiology participants (36.6%, p < 0.001), and more women were affected than men. Only one-third of cardiology patients who reported LUTS were seeking treatment for LUTS, and most of them received treatment. There were no differences between persons living in urban and rural areas. Conclusions: LUTS and OAB were highly prevalent among cardiology patients. Although LUTS were often bothersome in this unique population, we found that the seeking of treatment for LUTS was minimal. These results highlight the need for cooperation between cardiologists and urologists

Testosterone replacement therapy in obese males

Controversy surrounds testosterone replacement therapy in obese ageing due to no generally accepted lower limits of normal testosterone level and high prevalence of hypogonadal symptoms in the ageing male population and the non-specific nature of these symptoms. Late onset hypogonadism is a clinical and biochemical syndrome associated with advancing age, often coexisting with obesity and metabolic syndrome. High fat and carbohydrates (fructose) consumption is responsible for development of obesity and metabolic syndrome which is one of risk factors for hypogonadism in older men. High fructose intake has been shown to cause dyslipidemia and to impair hepatic insulin sensitivity. Obesity and lack of physical activity negatively influence testosterone level. Low testosterone level should be regarded as an effect of obesity, but reverse relationship has not been proved yet. The management of late-onset hypogonadism symptoms has to be treated by a change of a life style and prevented with healthy nutrition and physical activity. The question related to rational indications for testosterone replacement therapy in obese males seems to be still actual

A complex case of abdominal pain in a patient with pelviureteric junction obstruction

Pelviureteric junction (PUJ) obstruction is a condition frequently encountered in both adult and pediatric patients. Congenital abnormalities and crossing lower-pole renal vessels are the most common underlying pathologies in both men and women. This report presents a case of a young woman who was complaining of intermittent abdominal pain in whom right-sided hydronephrosis was diagnosed. The patient was scheduled for a laparoscopic right-sided Anderson-Hynes pyeloplasty. During the procedure a partly extraperitoneal appendix, with extensive adhesions to the posterior abdominal wall abutting on the ureter just below the obstructed PUJ, was identified. The patient underwent dismembered laparoscopic Anderson-Hynes pyeloplasty with concurrent appendectomy for likely dual pathologies being responsible for her symptoms

Is determination of transition zone volume by transrectal ultrasound in patients with clinically benign prostatic enlargement sufficiently reliable in the clinical setting?

INTRODUCTION: Controversies exist regarding the accuracy of transrectal ultrasound (TRUS) determination of transition zone volume (TZV) when compared with enucleated adenoma weight. AIM: To determine the accuracy and reliability of measurements of the TZV by TRUS, by comparing preoperative radiological findings with the enucleated prostate adenoma volume, measured by fluid displacement volumetry (FDV), after retropubic prostatectomy performed by the Millin method, and, moreover, to evaluate changes in the surgical capsule size in the intermediate postoperative period. MATERIAL AND METHODS: We measured TZV preoperatively using TRUS and postoperatively with FDV in 112 patients who underwent retroperitoneal prostatectomy for benign prostatic hyperplasia (BPH). RESULTS: The TRUS volume correlated well with specimen volumes (r = 0.945, p < 0.0001). The median (quartile 1, quartile 3) absolute error was 7.35 ml (4.15 ml, 9.28 ml) and the median percent error was 9.12% (4.75%, 14.98%). Percent error, but not absolute error, was significantly related to TRUS TZV (p < 0.001 and 0.217, respectively). Adenomas > 80 cc were associated with lower percent error. The median volume of the residual prostate tissue measured 3.5 years after prostatectomy was 92.65 cc (65.75 cc, 109.58 cc), whereas the median volume of the surgical capsule, depending on the equation used for its calculation, was 24.80 cc (16.25 cc, 37.37 cc) and 31.43 cc (23.14 cc, 43.32 cc). CONCLUSIONS: The TRUS TZV correlated well with values determined by FDV. It can be reliably used in clinical management of BPH

Evaluation and management of male lower urinary tract symptoms : treatment patterns and guidelines in a correlation study among Polish urology consultants

Introduction: In March 2013, the European Association of Urology (EAU) released a new edition of the guidelines on management of male lower urinary tract symptoms (LUTS), including benign prostatic obstruction. The objective of this study was to evaluate how well the EAU guidelines have been implemented in day-to-day practice by Polish urologists. Material and methods: A structured questionnaire, which explored how urologists diagnose and manage male lower urinary tract symptoms, was emailed to all certified, actively practicing urologists from a list provided by the Polish Urological Association. Results: The questionnaire return rate was 33.7% (135/400). Overall, the median (quartile 1; quartile 3) frequency of correct answers was 65.0% (58.0%; 69.0%). Analysis of the association of availability and acceptance of the EAU guidelines with question answers showed no pattern. A multivariate regression model showed a positive correlation with regards to correct answers given in the survey and doctors’ participation in international congresses (p = 0.018, r = 0.181). Basket analysis showed the strongest association for those who failed to correctly answer the questions regarding diagnosis of LUTS and overactive bladder (OAB) (support = 27.41%, confidence = 86.05%). Conclusions: Although there is a significant degree of adherence to the 2013 EAU guidelines, some discrepancies between urologists’ practice and the recommendations regarding diagnosis and treatment of male LUTS do exist. The data obtained provide valuable benchmarks and also identify possible interventions that may improve the standard of care in this population of patient