Search

Summary— Seminal vesicle cysts may arise from inflammation or obstruction of the seminal vesicle or from embryological remnants such as the mullerian duct. Surgical removal has been proposed as the treatment of choice. A 19-year-old boy presented with abdominal pain and constipation. Investigations revealed a 14-cm multiloculated cyst arising from the right seminal vesicle and a small stone lodged at the orifice of the ipsilateral ejaculatory duct. Following endoscopic removal of the stone the mass decreased in size considerably and 2 months later transrectal ultrasound and magnetic resonance imaging showed normal seminal vesicles and no evidence of the cyst. This case strongly supports an obstructive aetiology for this cyst and we would suggest that, in similar cases, full assessment of the ejaculatory apparatus should be carried out to exclude an obstructive cause before embarking on major surgery.

A consecutive series of 143 ultrasound guided biopsies of the prostate have been analysed. In 84 patients, in whom carcinoma was suspected by both digital examination and ultrasound, 49 cancers were confirmed histologically. In 29 patients in whom digital examination suggested cancer but ultrasound was normal, 2 cancers were confirmed. In 20 patients with a normal digital examination but a suspicious ultrasound appearance, no cancers were proven.

Objective To determine the completeness of transurethral resection of the prostate (TURP). Patients and methods The prostate volume of 432 patients was measured by transrectal ultrasonography (TRUS) before they underwent a TURP performed by one of three consultant urological surgeons. The prostate tissue collected at resection was weighed, multiplied by 1.2 to compensate for ‘shrinkage’, and the amount of tissue removed expressed as a percentage of the pre-operative prostate volume determined by TRUS (resection ratio). The patients were categorized into groups based on pre-operative prostate size. Results The mean weight of prostate tissue resected was 25.6 g. Resection ratios increased with prostate size, with the largest occurring in prostates of 71–110 g. The surgeon did not resect more than 50% of the gland volume in any group. Conclusion This study counters the theory that a complete resection of the prostate is routinely achieved. The endoscopic appearances probably imply a complete resection of the adenoma but a considerable volume of the gland remains. This has important implications for the detection of prostate carcinoma at TURP and for the staging of the disease.

Serum prostatic specific antigen (PSA) and ultrasound-determined prostatic volume (UPV) were measured in 50 patients with histologically proven benign prostatic hyperplasia (BPH) and in 40 patients with histologically proven prostatic cancer of whom 17 had evidence of distant metastases (M1) and 23 did not (M0). A good correlation between log PSA and UPV was demonstrated in the BPH group and rearrangement of the linear regression equation allowed calculation of a single variable--the log PSA corrected to a standard prostate volume for any given individual. A volume-corrected PSA correctly identified all patients with M1 disease and greatly improved but did not eliminate overlap of M0 disease with BPH. Reduction of serum PSA to a single volume-corrected variable will allow the introduction of practical and optimum protocols for the management of patients with prostatic enlargement.

Summary— The development of microradiography of the prostate gland has provided a new approach to investigating the origin and structure of benign hyperplasia. It has demonstrated that benign prostatic hyperplasia is usually microadenomatous in structure, although reticular types do occur. It originates at the lateral boundary of the periurethral muscle in the position of the transitional zone. In contrast, stromal nodules are homogeneous and amorphous in structure and develop at the site of the short straight urethral ducts within the periurethral muscle.

One hundred and thirty-seven patients underwent optical urethrotomy and have been followed up over a period of 3 years. The overall improvement rate was 66%. The results were unrelated to the length of history, the number of previous dilatations or the site of the lesion. However, traumatic strictures did significantly less well than the others. Although the procedure can be repeated, the chance of failure following the third or subsequent urethrotomy was much greater than after the first or second procedure. Urethrotomy for post-prostatectomy membranous strictures was followed by incontinence in 31% of patients. Otherwise the procedure was safe and should be the first choice of treatment for most patients with urethral strictures.

Summary— One hundred cadaver prostates were examined by per-rectal ultrasound and the findings correlated with the microradiographic and histopathological features of whole sections taken at the levels of scanning. The normal gland consists of both periurethral muscle and glands. The periurethral muscle has little structure on microradiography and is therefore hypoechoic (low amplitude echoes) on ultrasound scanning. The gland itself, both central and peripheral zones, has a lattice appearance on microradiography (reticular structure) and therefore produces mid-range amplitude echoes on ultrasound. Benign hypertrophy develops at the edge of the periurethral muscle and is microadenomatous in structure. This produces mid-range amplitude echoes which are coarser than in the normal gland. Associated calcification has a characteristic distribution around the adenomas. Cancer produces an amorphous structure resulting in loss of ultrasonic echoes (hypoechoic). In a few cancers irregular calcification is present, resulting in high echoes in the ultrasound scan (hyperechoic) which are not in the typical benign distribution. The internal structure of the prostate was therefore demonstrated in its histopathological states by the technique of microradiography and seen to relate to its representation by ultrasound.

Summary— The clinical and endocrine response to a depot preparation of the LH-RH analogue ICI 118630 (Zoladex) was assessed in 55 untreated patients with advanced prostatic cancer. Whereas gonadal androgen suppression was achieved in all patients, subjective and objective clinical response occurred in only 69%, indicated by a relief of bone pain, a decrease in the size of the primary tumour and lymph node metastases and improvement in bone scan appearances. A third of these patients, however, subsequently showed progression of their disease. Serious side effects were not encountered in this study. The depot formulation is a simple, safe and convenient method of administering Zoladex and offers an alternative treatment for metastatic prostatic cancer.

Summary— A technique for examining cadaver prostates by per-rectal ultrasonography has been developed. The ultrasonic plane was defined and corresponding sections taken for microradiographic and histopathological examination. The technique has enabled a comparison to be made of the structural changes that occur in the prostate in disease states and the corresponding ultrasonic features.

Summary— Sixty men (7 normal, 53 with prostatic disease) underwent transrectal ultrasonic scanning of their prostates in order to assess the technique and evaluate its reliability in the detection and staging of prostatic cancer. The prostatic capsule was clearly seen in 58 men; non-integrity of the capsule occurred only in those with proven cancer (17 cases). An ultrasound diagnosis of cancer was made for 32 of 33 men with proven disease and it was shown that ultrasound demonstrated anterior perforations of the capsule in 6 out of 18 men with tumours that had been judged by rectal palpation to have been confined to the prostate. It is concluded that transrectal ultrasound is a promising technique of imaging the prostate, particularly in relation to selection of patients for biopsy and for checking staging of cancer carried out by digital assessment of the prostate.

Summary— Three hundred and fifty-two patients have been examined by per-rectal ultrasound and histological confirmation of the diagnosis was obtained in 242 cases. Per-rectal ultrasound compared favorably with digital palpation both as a method of diagnosing prostatic cancer and also as a method of staging a primary tumour. Confirmation of the accuracy of this technique as a method of staging was gained by a study involving the use of cadaver material. Repeat examinations on patients with prostatic carcinoma have shown that per-rectal ultrasound is an ideal method for monitoring response of the primary tumour to treatment.

Androgen receptors were assayed in nuclei prepared from human benign hypertrophic prostate tissue obtained at retropubic prostatectomy by transurethral resection (TURP) and by cold punch resection. Androgen receptor was not detected in 70% of the transurethrally resected samples, and in those cases where receptors were observed they showed no correlation with enucleated samples. However, androgen receptors were detected in all cold punch resected samples and enucleated tissue with similar concentrations evident in samples from the same gland. These results suggest that prostate specimens collected by TURP are not suitable for androgen receptor analysis, whereas the technique of cold punch resection yields prostate samples that are more reliable for a correct evaluation of androgen receptor content.

Summary— A study was made of 100 cadaveric prostates (71 benign glands and 29 invaded by adenocarcinoma) using a technique that enabled per-rectal ultrasonography to be carried out and their volumes measured by computed planimetry. These volumes were compared directly with the actual volumes of the glands measured after dissection from the cadaver specimens. A high degree of correlation was obtained for the measurement of benign glands (r= 0.982) and glands containing cancers confined within the capsule (r= 0.961). Estimation of the size of cancers unconfined to the gland was poor and measurement was not possible with 3 malignant prostates that had extended beyond the prostatic capsule so that the ultrasonic boundary could not be defined.