Search

To review the findings of testicular ultrasonography (US) in patients referred for testicular symptoms including pain, swelling and infertility, and to determine the prevalence of testicular microlithiasis (TM) and ist relevance to the development of testicular cancer.Records of 3,026 patients referred for testicular US between 1994 and 1999 were evaluated. The indications for testicular US diagnosis, management and relevant histological details were obtained from medical records. Patients with TM had an annual sonographic follow-up unless they had testicular cancer, in which case follow-up repeat US with clinical reviews was more frequent.TM was found in 54 patients (1.77%; median age 34 years, range 12-83 years). The median follow-up was 36 months (range 12-18 months). Sixteen of these patients had testicular malignancy (30%). The remaining 38 patients had hydrocele and epididymal cysts (14), varicocele (7), epididymitis (2) and small testes (8), with 14 patients having no other pathology. One patient with a small testis developed a seminoma while under surveillance. Another patient with metastatic embryonal-cell carcinoma at initial diagnosis was found to have a seminoma 4 years following chemotherapy. The relative risk of testicular tumours in the presence of TM was 13.2 (confidence interval 8.3-21.5).TM can no longer be regarded simply as a benign condition because of its association with testicular malignancy. In our series, 2 patients (5.2%) developed interval testicular cancers during follow-up US. There is no convincing evidence to suggest that TM might be premalignant. In rare instances of radiologically indeterminate cases, biopsy of the testis may be necessary.

To evaluate the long-term results of Stamey's and Gittes' procedures for genuine stress incontinence.72 needle procedures (34 Stamey; 38 Gittes) performed by a single surgeon between 1988 and 1994 were retrospectively reviewed. All patients had genuine stress incontinence on preoperative video-urodynamics. Review was at 3 months and thereafter clinically determined. Update information was gained by a patient satisfaction questionnaire.Data were available for 9 years for the Stamey group (mean 8.4 years) and 6 years for the Gittes' (mean 5.3 years). At 3 months, 93% were dry. There was a gradual attrition with 38% of the Stamey and 14% of the Gittes patients remaining dry or improved at 5 years. At 9 years, only 28% of the Stamey patients maintained their improvement. 26% of the original cohort underwent a second procedure. All patients who had repeat needle operations have failed. 48 questionnaires (67%) were returned. Only 25% of patients expressed satisfaction with their operation.Early success rates with endoscopic bladder neck suspension are replaced by long-term failures. The durability is poor with an ongoing recurrent incontinence rate. Repeat procedures are not worthwhile. Gittes' procedure appears to have an earlier failure rate compared to Stamey's operation.

The aim of this study was to prospectively evaluate the potential role of elevated urinary/serum human chorionic gonadotrophin-beta (hCGbeta) in prostate cancer prognosis. 104 patients with newly diagnosed prostate cancers were included; 68 patients had organ-confined, 18 had locally advanced and 18 had metastatic disease. A control group consisted of 115 patients presenting with benign prostatic disease. Serum and urinary total hCGbeta was measured prior to treatment and serum PSA was measured at diagnosis. The patients were treated along conventional lines and progression-free survival was assessed. Four patients had elevated serum and 10 had elevated urinary, total hCGbeta. There were no significant correlations between serum/urinary levels of hCGbeta and tumour stage, Gleason score or PSA. In contrast, serum PSA had significant linear correlations with both clinical tumour stage and Gleason score (p = 0.0001). At a median follow-up of 36 months, 22 (21.2%) patients had died while 17 (16.3%) others had progressed. Kaplan-Meier plots and log-rank test revealed no significant difference in progression-free survival between patients with elevated or normal levels of serum and/or urinary total hCGbeta. Clinical tumour stage, grade and PSA were statistically significant prognostic variables. Immunoassay measurement of serum or urinary hCGbeta has no significant role in the clinical management of prostate cancer.