Is there a role for magnetic resonance imaging in diagnosing colovesical fistulas?

OBJECTIVES

Colovesical fistula is a devastating complication, usually secondary to diverticulitis or colon cancer. Imaging plays a crucial role in delineating the underlying anatomy and identifying an etiologic factor. Barium enema, computed tomography, and cystoscopy have been the mainstays of investigation, but they have less than ideal sensitivity and specificity. This study assessed the role of magnetic resonance imaging (MRI) in the investigation of patients with probable colovesical fistulas.

METHODS

A total of 22 patients with presentations suspicious for enterovesical fistulas who underwent evaluation with axial T(1)-weighted and axial, coronal, and sagittal T(2)-weighted 1.5T MRI (body-phased array) were identified. Of the 22 patients, 19 underwent laparotomy and repair.

RESULTS

MRI correctly identified the presence of a fistula and defined the underlying etiology in 18 of 19 patients. Colovesical fistula was correctly excluded in 1 of 19 patients. The remaining 3 patients were either unfit for surgery or refused.

CONCLUSIONS

The results of our study have shown that MRI is an accurate method of evaluating patients with suspicion of colovesical fistulas, identifying the anatomy of the tract, as well as the etiology. This is not only useful for diagnosis, but also for surgical planning.

Use of tissue ink to maintain identification of individual cores on needle biopsies of the prostate

BACKGROUND

There is an increasing necessity to extract the maximum amount of information, beyond even a cancer diagnosis, from prostate biopsies. Thus, maintaining site-specific information regarding individual biopsy cores might be critical.

AIM

To evaluate the applicability of employing tissue ink to maintain the identity of individual prostatic biopsy cores.

METHOD

In this ongoing study, 12 core prostate biopsy specimens are sent to the laboratory in individual pots labelled according to anatomical site. The specimens are placed in two separate multi-compartment cassettes. They are inked with different colours to identify the site of origin from each lobe. The cassettes are then processed with a single paraffin block for each side; the six cores from each side can be mounted on a single slide.

RESULTS

The different colours used adhere well to the biopsy cores, thus maintaining the identity of each core. Six cores from each side are embedded in a single paraffin block and examined on a single slide, making it cost-effective, while maintaining high quality, accurate histopathological information.

CONCLUSION

Differential inking of prostate biopsy cores is an easily applicable method that is cost-effective and provides tumour location information. Prostate biopsy data archived to maintain individual core information might be used to determine applicability of such information to predict extra-capsular extension by correlating with imaging and radical prostatectomy findings, and for treatment planning.

Blood loss during and after transurethral resection of prostate: a prospective study

OBJECTIVES

Transurethral resection of prostate (TURP) is the gold standard treatment for symptomatic prostatic bladder outlet obstruction. Haemorrhage during and after TURP can lead to significant morbidity and mortality. The purpose of this study was to assess the influence of anaesthesia, operating time, weight of resected prostatic tissue and its histology on blood loss during and after TURP and to revisit the available body of evidence in the literature of urology.

MATERIALS AND METHODS

This is a prospective study of a cohort of 100 consecutive patients who had undergone TURP over a period of one year, where the data was collected on a performa specifically designed for the study, which included the type of anaesthesia administered, resection time, amount of blood lost during and after TURP, weight of the resected prostatic tissue and histology.

RESULTS

Sixty seven patients underwent TURP under spinal anaesthesia (SA) and 33 under general anaesthesia (GA). The median intraoperative (SA: 89.95 (5-936); GA: 105.40 (5-517) mls), postoperative (SA: 72.37 (15-387); GA: 136.43 (11-969) mls) and total (SA: 162.32 (29-1200); GA: 241.83 (21-1251) mls) blood losses were not significantly different between the two groups (95% C.I. -9.90 to 19.22, p= 0.46). The total operating time (SA: 29.70 (10-55); GA: 29.80 (10-65) minutes) and weight of resected prostate (SA: 21.90 (3-45); GA: 18.00 (4-60) gms) were similar between the two groups. There was a trend towards increased blood loss when BPH was associated with prostatitis (N=8). Of these, 3 patients required blood transfusion as compared to 1 patient in rest of the group, although this was not statistically significant (95% C.I - 67.2 to 1120.4, p = 0.87).

CONCLUSIONS

The intraoperative, postoperative and total blood losses related to TURP were not influenced by the type of anaesthesia, resection time, weight of the resected prostate and the histology.

Differential gene expression in the peripheral zone compared to the transition zone of the human prostate gland

Gene expression profiles may lend insight into whether prostate adenocarcinoma (CaP) predominantly occurs in the peripheral zone (PZ) compared to the transition zone (TZ). From human prostates, tissue sets consisting of PZ and TZ were isolated to investigate whether there is a differential level of gene expression between these two regions of this gland. Gene expression profiling using Affymetrix Human Genome U133 plus 2.0 arrays coupled with quantitative real-time reverse transcriptase-PCR was employed. Genes associated with neurogenesis, signal transduction, embryo implantation and cell adhesion were found to be expressed at a higher level in the PZ. Those overexpressed in the TZ were associated with neurogenesis development, signal transduction, cell motility and development. Whether such differential gene expression profiles may identify molecular mechanisms responsible for susceptibility to CaP remains to be ascertained.

A prospective randomized study of self-dilatation in the management of urethral strictures

Over a 3-year period 51 patients with urethral strictures were treated by internal urethrotomy and then either randomly allocated to a course of post-operative dilatation or no dilatation. The patients in the self-intermittent dilatation (SID) group were shown how to pass a 16-F catheter through the stricture but not into the bladder. Complete follow-up was available in 44 patients, 32 of whom had new strictures while 12 had recurrent strictures. Of the patients with new strictures 13 (76%) in the SID group and 12 (80%) in the non-SID group achieved a satisfactory result (a flow rate > 12 ml per second) at one year (chi 2 = 0.18, P = 0.67). In the 12 patients with recurrent strictures 4 (66%) patients in the SID group and 1 (17%) patient in the non-SID group achieved a satisfactory result (chi 2 = 3.09, P = 0.079). In both groups results were not statistically significant. The technique of short-term postoperative self-dilatation does not seem to prevent recurrent strictures in patients treated with internal urethrotomy.

Use of the rectus abdominis myocutaneous flap in treating advanced carcinomas of the penis

OBJECTIVE

To examine the methods used to obtain skin closure after radical surgery for carcinomas of the penis, with special reference to the rectus abdominis myocutaneous flap.

PATIENTS AND METHODS

Over a 20 year period, 21 patients underwent surgery for carcinomas of the penis. Seven had advanced tumours, requiring radical surgery for complete local tumour control. The resulting wounds were repaired with scrotal skin transfer in three patients and with a rectus abdominis myocutaneous flap in the other four.

RESULTS

These methods of repair were a 100% reliable, all wounds being healed within 10 days.

CONCLUSIONS

Scrotal skin transfer is a simple and effective method of achieving wound closure. Where removal of the scrotum is required along with curative or palliative surgery, and after ilio-inguinal lymphadenectomy, a rectus abdominis myocutaneous flap is useful for skin closure.

Prostatic cancer presenting as dysphagia

Neurological dysfunction from base of skull metastasis of prostate cancer is rare. In this case, dysphagia was the presenting symptom and relief occurred after orchidectomy. Improvement of neurological symptoms usually occurs only after local radiotherapy.

Pathological and clinical associations of Ki-67 defined growth fractions in human prostatic carcinoma

Estimation of the growth fraction of 153 prostatic carcinoma specimens employing Ki-67 immunostaining was undertaken and its relationship to various clinical parameters investigated. In prostate specimens, the percentage of tumour nuclei expressing Ki-67 antigen was measured and assigned a Ki-67 score. It was observed that high Ki-67 scores were associated with the poorly differentiated tumours, the correlation of this proliferation marker with histological grade was found to be significant (P less than 0.001). No relationship was observed between the Ki-67 score of the primary tumour with either the patient's age or with the primary tumor stage (T category). The metastatic status of the patient at diagnosis and the Ki-67 score of the tumour were correlated (P less than 0.05), higher Ki-67 scores being associated with M1 disease. Life-table analysis of 86 patients who subsequently received androgen withdrawal therapy, was undertaken with reference to the various Ki-67 scores of their primary tumors. A statistically significant difference in survival times was observed in patients whose Ki-67 values were less than 1% (P less than 0.0001) when compared to those patients whose tumours expressed 1% and over Ki-67 positivity, the former having longer survival times. When patients were subdivided according to their metastatic status and similar life-table analyses were carried out, no statistical difference was found between survival times and Ki-67 scores in M0 staged patients. In the M1 population of patients, however, those patients whose tumours were negative for Ki-67 expression had significantly longer survival times than those patients whose tumours exhibited positive Ki-67 staining (P less than 0.01). Comparing M1 staged patients whose prostate tumor cells exhibited less than 1% Ki-67 positive nuclei with M1 staged patients whose prostate tumour cells contained 1% and higher Ki-67 stained nuclei, a significantly longer survival time was found in the former group of patients (P approximately 0.0001).