[Local staging with magnetic resonance imaging after neoadjuvant hormonal therapy for prostate cancer]

We retrospectively studied the staging accuracy of magnetic resonance (MR) imaging after neoadjuvant hormonal therapy (NAH) for 21 localized prostate cancers. MR imaging was performed using a 1.5-Tesla magnetic resonance system with a pelvic phased array coil. T2-weighted MR images were obtained on axial and coronal planes, and T1-weighted MR images using the dynamic technique with Gd-DTPA bolus enhancement were obtained in axial planes for each patient. On T2-weighted imaging, the signal intensity of the normal tissue in the peripheral zone became lower after NAH. Therefore, it was more difficult to detect residual malignant lesions in many cases than before NAH. The accuracy of T staging for prostate cancer after NAH in MRI was 71%. The accuracy, sensitivity, and specificity of the extracapsular invasion was 76%, 0% and 94%, respectively, and those of the seminal vesicular invasion 85%, 0% and 100%, respectively. While 2 of the 4 patients judged as downstaged cases in MRI showed corresponding pathological findings, 5 of the 21 cases (23.8%) were underdiagnosed. Local staging with only MRI for prostate cancer after NAH seems to have limits in applicability.

[Cystolithotripsy for bladder stones: comparison of holmium:YAG laser with Lithoclast as a lithotripsy device]

From March 1995 to March 1999, endoscopic lithotripsy of bladder stones was done for 33 patients. We used Holmium:YAG laser for the initial 23 patients, and the Swiss Lithoclast for the recent 10 patients. We compared the safety and efficacy of the two modalities. Both lithotriptors were safe and effective to fragment the bladder stones. All the patients became stone-free at one session. However, we needed to use the Holmium:YAG laser in one patient to disintegrate the larger fragments after Lithoclast. For a big stone, Holmium:YAG laser is preferable.

Complete disruption of the female urethra

PURPOSE

We report a rare condition of complete rupture of the bladder neck with an anterior vaginal laceration secondary to blunt pelvic trauma in a 19-year-old woman.

METHODS

Management consisted of a suprapubic cystostomy, followed by end-to-end anastomosis 3 days later.

RESULTS/CONCLUSIONS

After 6 months, the patient is continent without any urinary disturbances.

[Clinical experience of extracorporeal shock wave lithotripsy with lithodiagnost M for upper urinary tract stones]

Between August 1995 and March 1997, 197 patients underwent 257 treatments for 217 stones by extracorporeal shock wave lithotripsy (ESWL) using a Lithodiagnost M (Philips, Holland). There were 149 males and 48 females with an average age of 50.6 years, ranging from 15 to 85 years. There were 53 stones located in the renal pelvis and calices (R2), 20 stones at the pelvi-ureteric junction (PUJ) (R3), 101 stones in the upper ureter (U1), 15 stones in the middle ureter (U2) and 28 stones in the lower ureter (U3). The average number of sessions was 1.18 and the average number of shock waves per stone was 3,546. Efficacy was evaluated 3 months after the final ESWL. The success rate was 95.4% (207/217), with complete disappearance of stones in 71.4% (155/217) and residual stones of less than 4 mm diameter in 24% (52/217). No severe complications, except for subcapsular renal hematoma in one patient, were observed. These results indicate that almost all upper urinary tract stones can be successfully treated by ESWL monotherapy.

Adrenocortical adenoma producing 18-hydroxycorticosterone

A 30-year-old man presented at our hospital with microscopic hematuria. Ultrasonography and computed tomography scanning revealed a right adrenal mass measuring 20 x 20 mm. The tumor was asymptomatic, but there was obvious accumulation on the right side when scintigraphy was performed with radioactive iodine (131I)-labeled adosterol. Endocrinology studies showed elevation of the plasma cortisol and renin concentrations, while the plasma aldosterone level was low. Right laparoscopic adrenalectomy was done on July 4, 1994. Histologic examination showed an adrenocortical adenoma. Serum levels of adrenocortical hormones were measured before and after surgery, and the tissue content for the same hormones was determined in the resected tumor. The hormonal studies showed that the tumor produced 18-hydroxycorticosterone.