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Objective: To compare the efficacy of short-term parenteral prophylaxis with piperacillin/tazobactam (P/T) with long-term oral prophylaxis with ciprofloxacin in preventing infective complications after transrectal prostatic biopsy (TPB)., Patients and Methods: Patients scheduled for TPB were randomized to receive P/T (2250 mg intramuscular) twice daily for 2 days (Group 1), or ciprofloxacin (500 mg orally) twice daily for 7 days (Group 2), beginning on the evening before the procedure in both groups. All patients received a 100-mL phosphate enema 3 h before TPB. Evaluation included self-recording of body temperature in the 3 days after TPB, and culture of mid-stream urine (MSU) samples taken before and 3 and 15 days after TPB. Patients with indwelling urethral catheters or taking antibiotics or immunosuppressive drugs were excluded, as were patients with positive MSU cultures before TPB., Results: Of the 138 evaluable patients, 72 received parenteral P/T and 66 oral ciprofloxacin. Bacteriuria (> 105 c.f.u./mL) after TPB occurred in two of 72 (2.8%) patients in Group 1 and in three of 66 (4.5%) patients in Group 2; this difference was not statistically significant (P > 0.1). However, of the five patients with bacteriuria, two were symptomatic and both were in Group 2. Pyrexia occurred in only one patient in Group 2 with symptomatic urinary tract infection, and required hospitalization. No other patient reported a body temperature openface> 37.5 degrees C or drug-related side-effects., Conclusions: This prospective study showed that short-term prophylaxis with P/T was associated with a low rate of asymptomatic bacteriuria, requiring no further treatment, whereas although the rate was similar on long-term prophylaxis with ciprofloxacin patients required further treatment, with one needing hospitalization. We recommend short-term prophylaxis with P/T despite its disadvantages of cost and parenteral administration.

(High intensity focused ultrasound) HIFU is a minimally invasive treatment based on thermal ablation of tissues which are warmed up to 85°C in the focal area. From May 2002 to March 2008, 145 patients with prostate cancer, aged 44 to 86 years (mean 74.4) underwent 170 HIFU treatments. Mean PSA was 28. 1 ng/ml (range 0, 1-143) and mean Gleason sum 6.3 (range 3-9). The prognosis subgroups were defined as low-risk in 29 patients (clinical stage T1-T2a, PSA < or = 10 ng/mL, and Gleason score lower than 7), intermediate-risk in 21 patients (clinical stage T2b or PSA 10 - 20 ng/mL, or Gleason score of 7), and high-risk in 95 patients (clinical stage > or = T2c, or PSA > 20 ng/mL, or Gleason score higher than 7). At a mean follow-up of 47.1 months, biochemical success rate (PSA constantly <0.5 ng/ml) was obtained in 84.0% of low and intermediate risk patients and in 43. 1% of high risk patients; post-treatment biopsies (6 months after treatment) revealed no residual tumor in 92.8% of low or intermediate risk patients and in 62.3 % of high risk patients. Complication included: asymptomatic urinary tract infection (17.5%), pros tatitis (2.9%), epididymorchitis (1.7%), hemorrhoidal pain (0.5%), hematuria (3.5%), prostatic urethra structures (7.6%%), bladder neck sclerosis (12.3%) and rectourethral fistula (0.5%). Light stress incontinence occurred in 4.1% of the patients and erectile dysfunction in 77.8%. HIFU seems to be a promising alternative and less invasive treatment modality with an encouraging success rate, at least in the short-term. [ABSTRACT FROM AUTHOR]

Nephroureterectomy with excision of a cuff of bladder remains the standard for managing upper tract transitional cell carcinoma, which could, in selected cases, be managed conservatively. In 10 years we have treated 67 reno-ureteral unities (r.u.u.) for urothehal tumors; 36 r.u.u. with low-stage and low-grade disease (28 patients, 8 with bilateral tumor and 2 solitary kidney), were treated by an endoscopic approach; in 34 cases (3 for high grade recurrences after conservative approach) nephroureterectomy was performed. In 36 r.u.u. treated by ureteroscopic approach, we observed 3 high-grade recurrences (nephroureterectomy) and 22 low-grade (G1-G2) recurrences. Each r.u.u. received an average of 2.08 ureteroscopic operative procedures. The patients were followed up fora mean of 47.6 months after initial treatment and currently they are all recurrence free. Nine patients (13,4%) with suspect tumor of the upper tract had no carcinoma in the ureteroscopic biopsy. Ureteroscopic approach of upper urinary tract urothelial tumors in the current literature has been used successfully, resulting in recurrence rates ranging from 31% to 65% and disease-free rates of 35% to 86%. Progression and metastatic rates are low and correlate with tumor grade. [ABSTRACT FROM AUTHOR]