Ovarian metastasis from a urachal adenocarcinoma primary in a young female

Metastasis to the ovary from a bladder primary is extremely rare with limited case reports. The most common primary sites arise from stomach, colon or renal origin and usually occur from 40 years of age onwards. We report a case of an 18-year old woman with a right sided Krukenberg tumour from a bladder primary. This patient is much younger than any other case report of Krukenberg tumour and reiterates the need for early excision of urachal masses in all age groups.

A prospective audit of the 10-year outcomes from low dose-rate brachytherapy for early stage prostate cancer

AIM

New Zealand men diagnosed with early stage prostate cancer need to know what outcomes to expect from management options.

METHODS

Between 2001 and 2016, 951 men were treated with low dose-rate brachytherapy (permanent iodine-125 seed implantation) by the Wellington Prostate Brachytherapy Group based at Southern Cross Hospital, Wellington. At follow up after treatment, men had their PSA measured and were scored for urinary, bowel and sexual side effects. RESULTS: Median follow-up of men was 7.9 years (range 2.0-16.3 years). Ten-year PSA control was 95% for the 551 men with low-risk prostate cancer and 82% for the 400 men with intermediate-risk prostate cancer. Adverse effects were generally minor and short-term only. Temporary urinary obstruction developed soon after the implant in 2.6% men, and the 10-year cumulative risk of urethral stricture was 2.6%. Erectile dysfunction developed in 29% men, two-thirds of whom had a good response to a PDE5 inhibitor. Most men returned to a normal routine within four days of the implant.

CONCLUSION

LDR brachytherapy is a highly effective low-impact treatment option for New Zealand men with early stage prostate cancer.

Patterns of failure after iodine-125 seed implantation for prostate cancer

PURPOSE

To determine the site of relapse when biochemical failure (BF) occurs after iodine-125 seed implantation for prostate cancer.

MATERIALS AND METHODS

From 2001-2009, 500 men underwent implantation in Wellington, New Zealand. Men who sustained BF were placed on relapse guidelines that delayed restaging and intervention until the prostate-specific antigen (PSA) was ⩾20 ng/mL.

RESULTS

Most implants (86%) had a prostate D90 of ⩾90%, and multivariate analysis showed that this parameter was not a variable that affected the risk of BF. Of 21 BFs that occurred, the site of failure was discovered to be local in one case and distant in nine cases. Restaging failed to identify the site of relapse in two cases. In nine cases the trigger for restaging had not been reached.

CONCLUSIONS

If post-implant dosimetry is generally within the optimal range, distant rather than local failure appears to be the main cause of BF. Hormone treatment is therefore the most commonly indicated secondary treatment intervention (STI). Delaying the start of STI prevents the unnecessary treatment of men who undergo PSA 'bounce' and have PSA dynamics initially mimicking those of BF.

Chlorhexidine in urethral gel: Does it cause pain at flexible cystoscopy?

OBJECTIVES

To investigate the effect of chlorhexidine gluconate in urethral local anesthetic gel on patients undergoing outpatient flexible cystoscopy. We postulated that chlorhexidine was contributing to the pain and urgency that occurs during and after cystoscopy.

METHODS

A prospective randomized single-blinded study was conducted. A total of 141 patients undergoing outpatient flexible cystoscopy participated in the study. They were randomized to receive 10 mL of 2% lignocaine gel with 0.05% chlorhexidine gluconate (group 1, n = 72) or 10 mL of 2% lignocaine and aqueous gel mixture (group 2, n = 69). Pain scores were recorded on a numerical visual analog scale from 0 to 10.

RESULTS

The groups were well matched for the purposes of comparison. The mean pain scores were not significantly different between groups 1 and 2 at the insertion of the scope (2.1 versus 2.2, P = 0.7), during cystoscopy (1.8 versus 1.9, P = 0.759), and immediately after cystoscopy (1.4 versus 0.8, P = 0.06). However, a significant difference was found in the mean pain scores between groups 1 and 2 during the first void (1.8 versus 1.0, P = 0.031) and after the first void (2.4 versus 1.2, P = 0.007). A significant increase occurred in the reported levels of urgency after cystoscopy in group 1 (P = 0.018). No difference was found in the level of culture-proven symptomatic infection.

CONCLUSIONS

Chlorhexidine appears to contribute to significant levels of pain and urgency after outpatient flexible cystoscopy.

Allergy to chlorhexidine gluconate in urethral gel: report of four cases and review of the literature

Chlorhexidine is a bis-biguanide molecule widely used in many preparations as a disinfectant and an antiseptic. We describe four confirmed cases of allergy to chlorhexidine gluconate in urethral gel and review the existing published reports. Pertinent issues in the treatment and investigation of these patients are discussed.

Congenital adrenal hyperplasia: preliminary observations of the urethra in 9 cases

PURPOSE

Congenital adrenal hyperplasia is the most common cause of androgen mediated virilization of the genitourinary tract in females. In our study relative lengths of the internal genital duct structure were compared with the degree of virilization of the external genitalia.

MATERIALS AND METHODS

The records of 9 consecutive female patients with a median age of 2.6 years with congenital adrenal hyperplasia were studied. There were 4 normal females with a median age of 7.4 months who had a voiding cystourethrogram for urinary tract infection used as controls. The patients with congenital adrenal hyperplasia were stratified into groups as having mild, moderate or severe virilization based on preoperative photographs of external genitalia. By lateral voiding cystourethrograms the length of the proximal urethra, vagina and urogenital sinus was measured and standardized against the femoral metaphysis. The relative length of these internal genital structures was compared to the degree of virilization of the external genitalia.

RESULTS

There were 4 cases classified as normal, and 2 mildly, 4 moderately and 3 severely virilized. The urogenital sinus appeared to lengthen, with increasing virilization of the external genitalia. There was no trend for the proximal urethra to shorten with increasing virilization. The vagina also seemed to shorten with increasing virilization.

CONCLUSIONS

Our results suggest that the vagina enters the urogenital sinus at a fixed distance from the bladder neck. With increasing virilization, the majority of urethral lengthening occurs primarily distal to the vaginal opening, that is urogenital sinus lengthening.

Infantile null cell acute lymphoblastic leukaemia (ALL) presenting with cerebellar tonsillar herniation

We report a child with ALL who presented with acute neurological collapse and coning of the cerebellar tonsils as a result of massive brain infiltration by leukaemic cells. Such severe involvement of cerebral parenchyma by leukaemic cells is rare and cerebellar tonsillar herniation has not been reported. CNS parenchymal involvement with leukaemia is demonstrated using MRI and, for the first time, cranial US.