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Manoharan M, Ayyathurai R, Soloway MS. Radical cystectomy for urothelial carcinoma of the bladder: an analysis of perioperative and survival outcome. BJU Int 2009; 104:1227-32. [PMID: 19519764 DOI: 10.1111/j.1464-410x.2009.08625.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review the outcomes in a large group of patients treated with radical cystectomy (RC) for urothelial cancer (UC) of the bladder, by one surgical team. PATIENTS AND METHODS In all, 504 patients had RC for UC of the bladder between 1992 and 2007; 432 met the inclusion criteria and were analysed for survival and disease recurrence. RESULTS Of the 432 patients, (mean age 69 years; mean follow-up 38 months, range 1-172), 240 (56%) and 179 (41%) had an ileal conduit and orthotopic neobladder for urinary diversion, respectively. The mortality rate within 30 days of RC was 2%; 105 (24%) patients developed local and/or distant recurrence with a mean interval of 13.6 months. The overall survival, recurrence-free survival (RFS) and disease-specific survival (DSS) at 5 years was 58%, 64% and 74%, respectively, and 43%, 62% and 68% at 10 years. The 5-year RFS and DSS for those with organ-confined, node-negative tumours was 81% and 91%, compared to 46% and 56% in those with extravesical extension and lymph node-negative tumours. The RFS and DSS of patients with lymph node metastasis at 5 years was 29% and 40%, respectively. CONCLUSION Our study reaffirms that RC with bilateral pelvic lymph node dissection offers a reasonable possibility of disease control at 5 years, with a DSS of 74%. However, there is a need for an earlier diagnosis and effective systemic therapy if additional gains in survival are to be delivered.
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Bird VG, Carey RI, Ayyathurai R, Bird VY. Management of renal masses with laparoscopic-guided radiofrequency ablation versus laparoscopic partial nephrectomy. J Endourol 2009; 23:81-8. [PMID: 19118475 DOI: 10.1089/end.2008.0087] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Laparoscopic-guided radiofrequency ablation (LRFA) has been introduced as a minimally invasive nephron-sparing management option for renal tumors. Many patients who desire treatment present with multiple comorbidities, which poses a therapeutic challenge. Our purpose is to determine if multipass LRFA is comparable, in terms of surgical risk and immediate postoperative outcomes, to laparoscopic partial nephrectomy (LPN). PATIENTS AND METHODS A retrospective study identified 36 and 33 patients who underwent LRFA and LPN, respectively. Perioperative demographic data, tumor characteristics, and follow-up data were evaluated. Statistical analysis was performed using the Student t test and chi-square analysis. RESULTS Age, American Society of Anesthesiology score, and Charlson Comorbidity Index were significantly higher in the LRFA group than the LPN group (P < 0.001). Average tumor size was 2.8 cm and 3.1 cm for the LRFA and LPN groups, respectively. There were no significant differences in change between the preoperative and postoperative creatinine/glomerular filtration rate values or perioperative complication rates for the groups. Estimated blood loss and length of stay were significantly lower for the LRFA group than the LPN group (P < 0.05). Follow-up ranged 6 to 23 months and 6 to 58 months for the LRFA and the LPN groups, respectively. There has been no evidence of tumor recurrence in the follow-up period. CONCLUSIONS We present our initial report comparing patients undergoing LRFA v LPN for the management of renal tumors. Our preliminary results with our experience with multipass laparoscopic-guided RFA demonstrate that this technique can be safely used in an elderly, higher risk population. Long-term follow-up is needed to determine oncologic efficacy.
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Kava BR, De Los Santos R, Ayyathurai R, Shirodkar S, Manoharan M, Soloway MS. CONTEMPORARY OPEN NEPHRON SPARING SURGERY IS ASSOCIATED WITH DIMINISHED PERIOPERATIVE MORBIDITY, DESPITE MORE CHALLENGING SURGERY. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61337-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ayyathurai R, Luongo T, Nieder AM, Manoharan M, Soloway MS. OUTCOMES OF pT0 AT RADICAL CYSTECTOMY WITHOUT NEOADJUVANT THERAPY. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ayyathurai R, Jayathillake A, Soloway CT, Soloway MS, Manoharan M. DOES NOCTURNAL INCONTINENCE AFFECT THE HEALTH RELATED QUALITY OF LIFE (HRQOL) IN PATIENTS WITH ORTHOTOPIC ILEAL NEOBLADDER? J Urol 2008. [DOI: 10.1016/s0022-5347(08)60319-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sunkara R, Ayyathurai R, Nieder A, Manoharan M. Delayed local recurrence following radiation therapy for muscle-invasive bladder cancer emphasizing the need for lifelong surveillance: a case report. ScientificWorldJournal 2008; 8:166-8. [PMID: 18301817 PMCID: PMC5848628 DOI: 10.1100/tsw.2008.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a case of 68 years old gentleman who developed a delayed local recurrence, 30 years following curative radiation treatment for muscle invasive bladder cancer. This case emphasizes the importance of lifelong post treatment surveillance for bladder cancer.
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Ayyathurai R, Manoharan M, Nieder AM, Kava B, Soloway MS. Factors affecting erectile function after radical retropubic prostatectomy: results from 1620 consecutive patients. BJU Int 2008; 101:833-6. [PMID: 18190627 DOI: 10.1111/j.1464-410x.2007.07409.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report the return of erectile function in 1620 consecutive men after radical retropubic prostatectomy (RRP), chosen by half of men diagnosed with clinically localized prostate cancer, and the goal of which is to completely excise the tumour while preserving continence and erectile function. PATIENTS AND METHODS From January 1992 to October 2006, one surgeon performed RRP with a nerve-sparing technique where feasible. Men with erectile dysfunction before surgery, salvage RRPs, those not having a nerve-sparing procedure, neoadjuvant or adjuvant therapy within 6 months of RRP and a follow-up of <6 months were excluded from the analyses. Erectile function was evaluated by the surgeon when possible or by an annual questionnaire. Potency was defined as erectile function sufficient for intercourse with or without a phosphodiesterase-5 inhibitor. RESULTS Of 619 men who had a bilateral and of 178 who had a unilateral nerve-sparing RRP, 72% and 53%, respectively, were potent. When stratifying by age groups (<or=49, 50-59, 60-69 and >or=70 years) potency rates were 86%, 76%, 58% and 37%, respectively. Potency was more common after bilateral than unilateral nerve-sparing RRP in all age groups (P < 0.001). Age, bilateral nerve-sparing (odds ratio 2.9) and surgeon experience were associated with potency in a multivariate analysis. CONCLUSION Careful patient selection and meticulous surgical technique are essential to achieve the right balance between cancer control and morbidity. The patient's age, nerve-sparing RRP and the surgeon's experience were the significant predictors of return of potency after RRP.
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Bostrom PJ, Soloway MS, Manoharan M, Ayyathurai R, Samavedi S. Bladder cancer after radiotherapy for prostate cancer: detailed analysis of pathological features and outcome after radical cystectomy. J Urol 2007; 179:91-5; discussion 95. [PMID: 17997457 DOI: 10.1016/j.juro.2007.08.157] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE We reviewed outcomes and features in patients with bladder cancer who underwent cystectomy and had a history of radiation for prostate cancer. MATERIALS AND METHODS We performed a retrospective analysis of the University of Miami cystectomy database and identified 34 patients with a history of radiotherapy for prostate cancer. An age and stage matched control group was used to compare survival. Our entire male cystectomy population was used to compare clinicopathological features. RESULTS Mean age in the 34 patients with cystectomy was 75 years with a mean latency of 5 years from prostate cancer radiation. Radiotherapy was the primary treatment modality for prostate cancer in 32 of 34 patients and 2 received adjuvant radiation. Of the patients 86% received external beam radiation. Hematuria was the initial symptom in 86% of the cases. In 53% of the patients the initial diagnosis was muscle invasive bladder cancer. An ileal conduit was the method of urinary diversion in 33 cases. Major perioperative complications developed in 9% of the patients. There was 1 perioperative death, resulting in a mortality rate of 2.9%. Of the patients 54% presented with a locally advanced (pT3-4) tumor. Patients with a history of radiation therapy for prostate cancer had significantly poorer overall and bladder cancer specific survival than the matched control group. CONCLUSIONS Most bladder cancers in patients with a history of radiation for prostate cancer present as locally advanced tumors and patients have poorer survival than age and stage matched controls.
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Soloway MS, Soloway CT, Williams S, Ayyathurai R, Kava B, Manoharan M. Active surveillance; a reasonable management alternative for patients with prostate cancer: the Miami experience. BJU Int 2007; 101:165-9. [PMID: 17850361 DOI: 10.1111/j.1464-410x.2007.07190.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the outcome of patients diagnosed with 'low-risk' prostate cancer managed by active surveillance (AS). PATIENTS AND METHODS In all, 157 men with localized prostate cancer were followed on AS. The inclusion criteria for AS included: Gleason score of < or = 6, a serum prostate-specific antigen (PSA) level of < or = 15 ng/mL, stage < or = T2, low-volume disease and > 12 months of follow-up. The follow-up was rigorous, with PSA tests and a digital rectal examination every 3 months for 2 years, and a repeat biopsy 6-12 months after the initial diagnosis and yearly when indicated. Continuance of AS was based on the PSA doubling time, re-biopsy score, Gleason score, tumour volume, stage progression and patient preference. RESULTS In all 99 patients met the inclusion criteria; their mean age at diagnosis was 66 years, their mean PSA level 5.77 ng/mL and the mean follow-up 45.3 months. On initial repeat biopsy, 63% had no cancer and 34% had a Gleason sum of < or = 6. Eight patients were treated (three with hormones; five with curative intent); two had radical prostatectomy (one had pT2c pNO Gleason 7 disease); three had radiotherapy. The probability is that 85% would remain treatment-free at 5 years; no patient died from prostate cancer. The PSA doubling time and clinical stage at diagnosis were predictive of progression. CONCLUSION Patients who are followed on AS must be selected using narrowly defined inclusion criteria and closely followed with a standard regimen of PSA testing, digital rectal examination and repeat biopsy.
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Ayyathurai R, Gomez P, Luongo T, Soloway MS, Manoharan M. Prostatic involvement by urothelial carcinoma of the bladder: clinicopathological features and outcome after radical cystectomy. BJU Int 2007; 100:1021-5. [PMID: 17784885 DOI: 10.1111/j.1464-410x.2007.07171.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To review the long-term outcome of prostatic involvement in patients with bladder cancer (BC) treated with radical cystectomy (RC), as urothelial carcinoma (UC) involving the prostate occurs in such patients, and prostatic invasion by UC is by transmural invasion (contiguous), or when UC develops from the epithelium of the prostatic urethra (not contiguous). PATIENTS AND METHODS Between 1992 and 2006, 351 men had RC for BC by one surgeon at our centre; they were stratified into those with contiguous or non-contiguous disease, based on prostatic stromal involvement. Relevant clinical and pathological data were collected and the survival analysed. RESULTS In all, 24% (78/320) of the patients who had RC had prostatic involvement; 29 (9%) and 49 (15%) had contiguous and non-contiguous involvement, respectively. In the non-contiguous group, there was stromal and non-stromal UC involvement in 18 (37%) and 31 (63%), respectively. The overall 5-year survival of contiguous, non-contiguous and no prostatic involvement was 6%, 57% and 66% (P < 0.001). The 5-year overall survival of stromal and non-stromal UC was 26% and 74% (P = 0.008). There was no statistical difference in survival between contiguous and non-contiguous stromal involvement (P = 0.58). CONCLUSIONS Prostatic UC with no stromal involvement did not alter the survival predicted by the primary bladder stage. Stromal involvement of the prostate has a poor prognosis regardless of the mode of invasion.
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Ayyathurai R, Vyas S, Manoharan M, Luongo T, Soloway M. MP-18.08: Incidental prostatic neoplasia in patients undergoing radical cystoprostatectomy: does it affect the overall prognosis? Urology 2007. [DOI: 10.1016/j.urology.2007.06.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Manoharan M, Luongo T, Vyas S, Ayyathurai R, Soloway M. POS-03.59: Prospective randomized trial comparing transverse (pfannenstiel) and vertical incisions for patients undergoing radical retropubic prostatectomy. Urology 2007. [DOI: 10.1016/j.urology.2007.06.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Manoharan M, Ayyathurai R, De Los Santos R, Soloway M, Ciancio G. POD-03.03: Surgical management and outcome of renal cell carcinoma with level III IVC thrombus: a single center experience. Urology 2007. [DOI: 10.1016/j.urology.2007.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Manoharan M, Ayyathurai R, Nieder AM, Soloway MS. Modified Pfannenstiel approach for radical retropubic prostatectomy: a 3-year experience. Prostate Cancer Prostatic Dis 2007; 11:74-8. [PMID: 17440438 DOI: 10.1038/sj.pcan.4500969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A modified Pfannenstiel approach for radical retropubic prostatectomy (RRP) has been described previously. We present our experience with this approach for performing a RRP over the past 3 years. Between January 2003 and July 2006, 544 consecutive RRPs by modified Pfannenstiel approach between January 2003 and July 2006 were performed. We analyzed blood loss, transfusions, use of drain, pain score, analgesia and hospital stay. Patients were followed up at 6 weeks, three monthly for a year and six monthly thereafter. All clinical and operative variables were entered into a database and analyzed. A total of 544 men underwent RRP with median follow-up of 11 (s.d.+/-10.5) months. The mean age was 60 (s.d.+/-7) years. About 83, 91 and 95% of patients had nerve sparing, bladder neck preservation and a lymph node dissection, respectively. Fifty-three patients had a concurrent inguinal hernia repair through the same incision. Mean estimated blood loss was 431 (s.d.+/-267) ml. The pathological staging distribution was T2, 82%; T3a, 9%; and T3b, 9%. The mean pain score at days 1 and 7 were 3.7 (s.d.+/-2.5) and 3.3 (s.d.+/-3), respectively. The median hospital stay was 36 h (s.d.+/-24). About 5.5% have had biochemical recurrence. At 12 months 97% were continent and 46% potent. RRP using a modified Pfannenstiel approach offers safety and efficacy. It facilitates repair of associated inguinal hernia through the same incision.
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Ayyathurai R, Civantos F, Soloway MS, Manoharan M. Basal cell carcinoma of the prostate: current concepts. BJU Int 2007; 99:1345-9. [PMID: 17419700 DOI: 10.1111/j.1464-410x.2007.06857.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ayyathurai R, Manoharan M, Nieder AM, Soloway MS. 558: Factors Affecting Potency Following Radical Retropubic Prostatectomy: Results from 1620 Consecutive Patients. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30798-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Luongo T, Ayyathurai R, Nieder AM, Manoharan M, Soloway MS. 1665: Lymphovascular Invasion in Bladder Cancer - Is it an Important Prognostic Indicator? J Urol 2007. [DOI: 10.1016/s0022-5347(18)31853-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Manoharan M, Vyas S, Ayyathurai R, Nieder AM, Soloway MS. 572: Radical Cystectomy in Octogenarian: Is Routine Post Operative Intensive Care Monitoring Necessary? J Urol 2007. [DOI: 10.1016/s0022-5347(18)30812-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Samavedi S, Manoharan M, Ayyathurai R, Reyes MA, Soloway MS. 1517: Radical Cystectomy for Bladder Cancer Secondary to Radiation for Carcinoma Prostate - IS it Associated with Poorer Prognosis? J Urol 2007. [DOI: 10.1016/s0022-5347(18)31718-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ayyathurai R, Manoharan M, Gomez P, Luongo T, Soloway MS. 1662: Contiguous and Non-Contiguous Prostatic Urethral Transitional Cell Carcinoma- does It Impact the Survival? J Urol 2007. [DOI: 10.1016/s0022-5347(18)31850-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Williams SK, Luongo T, Ayyathurai R, Manoharan M, Soloway MS. 1411: 10-Year Outcome after Radical Prostatectomy for Pathologic Gleason Score ≥ 8. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31612-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Manoharan M, Ayyathurai R. Radical cystectomy for urothelial cancer of the bladder: contemporary advances. MINERVA UROL NEFROL 2007; 59:99-107. [PMID: 17431374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Radical cystectomy (RC) is an effective curative treatment for high grade and muscle invasive bladder cancer. Other treatments such as chemoradiation and transurethral resection of bladder tumor as monotherapy are generally not considered as effective as RC. RC is a major surgical procedure associated with significant morbidity and mortality. However, over the last decade significant advances have been made in different aspects of RC, including perioperative care, instrumentation and surgical techniques which has dramatically improved the outcome following RC. Different approaches including open, laparoscopic and robotic approaches are used to perform a RC. Devices such as vascular staplers and ligasure have decreased the blood loss and the need for transfusion. In this article, we review relevant literature and discuss various advances made in an attempt to improve outcome following RC.
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Manoharan M, Ayyathurai R, Nieder AM, Soloway MS. Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study. Prostate Cancer Prostatic Dis 2007; 10:283-7. [PMID: 17310259 DOI: 10.1038/sj.pcan.4500955] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hemospermia is known to be associated with transrectal ultrasound-guided prostate biopsy (TRUS-PB). The true incidence of hemospermia, its duration and implications are not well established. We performed a prospective observational study involving patients undergoing TRUS-PB for suspected prostate cancer at our institution. Sixty-three eligible men were included in the study. Most men (84%) undergoing TRUS-PB, who were able to ejaculate, experienced hemospermia, which was associated with some degree of anxiety. The mean duration of hemospermia was 3.5 (+/-1.7) weeks. The number of ejaculations before the complete resolution of hemospermia was 8 (+/-6.7). None of the clinical and pathological factors was a significant predictor of the duration of hemospermia. Patients should be adequately counseled before TRUS-PB to avoid undue anxiety and alterations in sexual activity.
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Ayyathurai R, Webb DB, Rowland S, Stephenson TP, Thomas AJ. Humoral hypercalcemia of penile carcinoma. Urology 2007; 69:184.e9-10. [PMID: 17270652 DOI: 10.1016/j.urology.2006.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2006] [Revised: 08/01/2006] [Accepted: 10/05/2006] [Indexed: 10/23/2022]
Abstract
Hypercalcemia is a common life-threatening complication associated with several genitourinary malignancies. Parathyroid-related peptide has been shown to cause hypercalcemia in several solid tumors but rarely in penile cancer. We report a case of advanced penile cancer with hypercalcemia and associated dysphagia. Treatment is clinically challenging and should be definitive as soon as the patient has been stabilized. Serum calcium measurement can be used for monitoring the outcome and follow-up in such patients. Dysphagia is a rare but potential symptom of hypercalcemia, but additional studies are needed to prove this association.
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Rajasundaram R, Ayyathurai R, Narayanan S, Maw A. Botulinum toxin A and chronic anal fissures – a literature review. Eur Surg 2006. [DOI: 10.1007/s10353-006-0268-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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