Factors influencing development of trans urethral resection of prostate (TURP) syndrome in benign prostatic hyperplasia patients with various co morbid medical illness: a prospective study

Background: The aim of this prospective study is to analyse the factors influencing development of trans urethral resection of prostate (TURP) syndrome in benign Prostatic hyperplasia patients with various co morbid medical illness in Thanjavur Medical College Hospital, from February 2015 to January 2017.Methods: This prospective study was done among 38 benign hyperplasia prostate patients with various co morbid medical illness underwent TURP. Pre-operative and post-operative serum sodium levels correlated with signs and symptoms developed in various prostate gland sizes, resection times and volume of irrigation fluids.Results: Sodium level has gone down to 14 meq/L, gone up to 2 meq/L post-operatively. Major fluctuations in serum sodium was seen in prostate size more than 50 grams, resection time more than 40 mints, irrigant volume more than 24 litres. Mean sodium decrease was increased when gland size was increased, resection time was increased, irrigant volume was increased.Conclusions: In renal insufficiency patients, it is safe to complete the procedure within 40 minutes and restrict irrigant volume 15 litres, in coronary artery disease patients it is safe to restrict irrigant fluid volume less than 20 litres. In Diabetes Mellitus patients, it is safe to restrict irrigant fluid volume less than 24 litres. In hypertensive patients, it is safe to restrict the resection time less than 45 minutes. In patients with Diabetes and hypertension, it is safe to restrict the resection time less than 40 minutes and irrigant fluid less than 20 litres

Between a Short‑term and a Long‑term Antimicrobial Prophylaxis in Prostate Biopsy: The Applicability in a Low‑resource Setting

Background: Transrectal needle biopsy of the prostate (TNBP) is a common urological procedure with some attendant infective  complications. Although most urological surgeons give antibiotic prophylaxis, there is, however, no consensus on the duration. This study compares the outcome of a three‑day and seven‑day antibiotic prophylaxis in TNBP. Materials and Methods: One hundred and twenty men who met the inclusion criteria were recruited and randomized into two equal groups. The patients in Group I received oral ciprofloxacin and metronidazole for three days and Group II received the same drugs for seven days. The antibiotics were commenced 2 h before the biopsy. Urine samples were taken for microscopy, culture, and sensitivity before the biopsy in all patients. For patients in group I, urine microscopy, culture and sensitivity were done on days 5 and 10 after biopsy, and on days 10 and 14 after biopsy for group II patients.  Infective complications were determined by the presence of fever and positive urine cultures post-biopsy. Results: This comparative  prospective study was done between June 2016 and November 2017. Groups I and II had comparable infective complication rates (11.70% for Group I and 3.30% for Group II) (P = 0.212). However, diabetics did better on a seven‑day regimen (P < 0.001). Escherichia coli was the most common organism isolated (63.2%). Cephalosporins were the most effective antibiotics in post-biopsy infections in this study. Conclusion: Three‑day oral ciprofloxacin and metronidazole are effective for prophylaxis in TNBP. However, a seven‑day regimen is better in diabetics before a prostate biopsy. The cephalosporins are a good option in the management of post-biopsy infections caused by quinolone‑resistant organisms

Diffusion-weighted MRI, (11)C-choline PET and (18)F-fluorodeoxyglucose PET for predicting the Gleason score in prostate carcinoma

Objectives To evaluate the accuracy of transrectal ultrasoundguided (TRUS) biopsy, diffusion-weighted (DW) magnetic resonance imaging (MRI), ¹¹C-choline (CHOL) positron emission tomography (PET), and 18F-fluorodeoxyglucose (FDG) PET in predicting the prostatectomy Gleason risk (GR). Methods The study included 21 patients who underwent TRUS biopsy and multi-technique imaging before radical prostatectomy. Values from five different tests (TRUS biopsy, DW MRI, CHOL PET, FDG PET, and combined DW MRI/ CHOL PET) were correlated with the prostatectomy GR using Spearman’s ρ. Tests that were found to have significant correlations were used to classify patients into GR groups. Results The following tests had significant correlations with prostatectomy GR: TRUS biopsy (ρ=0.617, P =0.003), DW MRI (ρ=–0.601, P =0.004), and combined DW MRI/CHOL PET (ρ=–0.623, P =0.003). CHOL PET alone and FDG PET only had weak correlations. The correct GR classification rates were 67 % with TRUS biopsy, 67 % with DW MRI, and 76 % with combined DW MRI/CHOL PET. Conclusions DW MRI and combined DW MRI/CHOL PET have significant correlations and high rates of correct classification of the prostatectomy GR, the strength and accuracy of which are comparable with TRUS biopsy. Key Points • Accurate determination of the Gleason score is essential for prostate cancer management. • DW MRI ± CHOL PET correlated significantly with prostatectomy Gleason score. • These correlations are similar to that between TRUS biopsy and prostatectomyJoe H. Chang, Daryl Lim Joon, Sze Ting Lee, Chee-Yan Hiew, Stephen Esler, Sylvia J. Gong, Morikatsu Wada, David Clouston, Richard O, Sullivan, Yin P. Goh, Henri Tochon-Danguy, J. Gordon Chan, Damien Bolton, Andrew M. Scott, Vincent Khoo, Ian D. Davi

Prostate-Specific Antigen, Digital Rectal Examination and Transrectal Ultrasonography: A Meta-Analysis for This Diagnostic Triad of Prostate Cancer in Symptomatic Korean Men

We conducted a meta-analysis using results from the Korean literature to determine whether prostate-specific antigen (PSA) or digital rectal examination (DRE) or transrectal ultrasonography (TRUS) provides a better diagnostic outcome for possible prostate cancer patients. An extensive literature search of MedRIC database et al. (1980 to 2003) was performed using the medical subject headings "PSA", "DRE", "TRUS" and "prostate cancer". Of the 108 articles that we retrieved, 13 studies (2,029 subjects) were selected for this meta-analysis. The criteria for quality evaluation were as follows: the study subjects must have been compared clinically for suspected prostate cancer, and the articles must have included individual data about sensitivity and specificity for this diagnostic triad based on the biopsy results as a reference standard. For the quantitative meta-analysis process the Hasselblad method was utilized. The pooled sensitivity and specificity for a PSA level greater than 4 ng/mL were 91.3% and 35.9%, respectively; and those for a PSA level greater than 10 ng/mL were 77.3% and 67.5%, respectively; and those for DRE were 68.4% and 71.5%, respectively; and those for TRUS were 73.6% and 61.3%, respectively. According to the results in a fixed effect model for PSA criteria, the estimates of d for PSA4 and PSA10 were 0.8517 [95% confidence interval (CI): 0.6694, 1.0340] and 1.0996 (95% CI: 0.9459, 1.2534), respectively. Also, according to the results using a random effect model for both DRE and TRUS criteria, the estimates of d for DRE and TRUS were 0.8398 (95% CI: 0.7169, 0.9627) and 0.8002 (95% CI: 0.6714, 0.9289), respectively. The detection rate for combination testing of PSA, DRE and TRUS for the diagnosis of prostate cancer jumped further to 68.3% or to 76.8%. In conclusion, this study suggests that this diagnostic triad for prostate cancer was noneffective when they were used separately. Therefore, we recommend that the urologists should use PSA together with DRE and TRUS for the primary diagnosis of prostate cancer in men with lower urological symptoms

Affecting Factors of Prostate Volume in Forensic Autopsied Decedents

Because decedents undergoing forensic autopsies would have behaved normally before death, prostate volume according to age group can be confirmed with forensic autopsy materials. The objectives of this study were to first confirm the current prostate volume by age and then determine diseases that can influence prostate volume using forensic autopsy materials. Prostate specimens were collected from forensic autopsies performed at Shiga University of Medical Science, Japan, between January 2015 and December 2019. Overall, 207 decedents were included in the study. Prostate volume was measured by the Archimedes\u27 principle. Concomitant diseases were determined by the past medical histories and autopsy results. The mean crude prostate volume was 29.1 ± 10.3 mL (range, 2.8-88.0 mL). The crude prostate volume increased with age. The mean corrected prostate volume (divided by body surface area) was significantly higher in patients with atherosclerosis than in those without. However, multiple regression analysis revealed that only age influenced the corrected prostate volume. Age was the only significant influencing factor for prostate volume. We propose applying age estimation using prostate volume for forensic medicine purposes. Because prostate volume was not influenced by concomitant disease, it would be valuable to estimate the decedent\u27s age using the prostate volume

Prostate cancer : population-based screening and markers for long-term clinical outcome

In 1988 and 1989 a large screening study for prostate cancer was launched in Stockholm, Sweden. At the time approximately 27 000 men between 55 and 70 years of age resided within a defined area of southern Stockholm. 2400 men were randomly selected to participate in the trial and those accepting (n=1782), were examined with digital rectal exam (DRE), transrectal ultrasound (TRUS) and a PSA test. If DRE or TRUS indicated suspicious findings or if PSA levels were 10 ng/mL or greater quadrant core biopsies of the prostate were performed. Additionally, the screening algorithm employed stipulated reexamination with DRE and TRUS if PSA concentrations were between 7 ng/L and 10 ng/mL. The initial screening yielded 65 cases of prostate cancer. In this thesis the screening material have been assessed after 20 years (paper I) and 30 years (paper II-IV). In paper I the result of the one-time screening was evaluated after linking the background population, the participants of the study and the invited but not participating cohort to the Swedish cause of death registry and the Swedish cancer registry. Estimating the possible cancer-specific mortality reduction using the Poisson regression model resulted in no difference in prostate cancer-specific mortality between the screened population and the unscreened population, IRR= 0.97 (0.71-1.23; 95% CI). Paper II evaluated the association between the androgen DHT and prostate cancer incidence and mortality. High levels of DHT protected from lethal prostate cancer HR= 0.44 (0.25‐0.77; 95% CI), p=0.004 after 30 years of follow up. The association remained significant both for men seemingly heathy at time of inclusion HR=0.25 (0.07‐0.88; 95% CI), p= 0.032 and for those with a recently diagnosed cancer HR= 0.50 (0.26‐0.94; 95% CI), p=0.031. In paper III the threshold for PSA was examined and the proportions of its isoforms – free/bound PSA that is indicative for low, or negligible risk for prostate cancer death. The associations between both PSA and the ratio free/bound PSA and lethal prostate cancer were strong at long-term follow up. A baseline PSA of 2 ng/mL or less combined with ratio free/bound PSA of 0.25 or greater indicated a very low long-term risk for prostate cancer death and further screening in this cohort can be abstained or continued with lower frequency. In paper IV thawed serum from 330 men including 36 men with lethal prostate cancer was analysed. The aim was to estimate association between elevated levels of the enzyme Thymidine kinase (TK1), a phosphorylation enzyme important in DNA synthesis, and future risk for prostate cancer-specific mortality and overall mortality. The analyses were performed with a commercially available western blot kit. Preliminary estimates indicate that high levels of TK1 is associated with an increased risk for overall mortality irrespective of whether death occurred shortly after blood draw or after a period of follow up

Ecografía transrectal, tacto rectal y PSA en el diagnóstico del cáncer de próstata en el área de Madrid análisis de efectividad

Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía II, leída el 02-02-2001Depto. de CirugíaFac. de MedicinaTRUEpu