Use of extended pattern technique for initial prostate biopsy.

Purpose: An extended prostate biopsy schema has been advocated at initial prostate biopsy to decrease the rate of false-negative cancer cases. However, critics have raised concerns that this may lead to the greater detection of clinically insignificant cancers. We examined the impact of using an extended pattern schema on cancer detection and also on the finding of smaller and clinically insignificant cancer. Materials and Methods: Clinical data, including patient age, race, prebiopsy prostate specific antigen (PSA), digital rectal examination, prostate volume, number of needle cores and biopsy findings were abstracted from the medical records of all patients who underwent prostate biopsy in a 5-year period. Extended pattern prostate biopsy was defined as more than 10 cores. Clinically insignificant cancer was defined as a maximal tumor dimension of 1.0 cm or less, Gleason sum 6 or less and organ confined disease at radical prostatectomy. Adjusted regression models were developed to assess the independent effects Objective: The purpose of our study was to review the MDCT urography appearance of pathologically proven transitional cell carcinomas of the renal collecting system and ureter and to correlate the MDCT urography findings with pathology findings. Materials and Methods: Of 370 MDCT urography examinations performed over an 18-month period, 18 patients were diagnosed with 27 renal collecting system or ureteral urothelial neoplasms at endoscopic biopsy (n = 8) or surgery (n = 19). Initial MDCT reports were reviewed to determine the sensitivity of original reviewers in detecting these neoplasms. Two radiologists also retrospectively reviewed these scans and characterized the CT appearance of the neoplasms on both axial CT and 3D reformatted images. Findings at retrospective review were correlated with pathology results to determine whether any CT features could be used to predict tumor grade. Results: Eighteen of 27 neoplasms were prospectively identified on MDCT urography, and an additional six neoplasms were detected on retrospective review. Three ureteral neoplasms could not be visualized. The 24 retrospectively detected neoplasms had three distinct MDCT appearances: circumferential urothelial wall thickening (n = 14), small masses (> 5 mm in maximal diameter) (n = 5), and large masses (> 5 mm in maximal diameter) (n = 5). All detected lesions could be seen on axial excretory phase images provided wide window settings were reviewed; however, only six were detected on 3D reconstructions. MDCT urography appearance did not correlate with tumor grade. Conclusion: MDCT urography is a promising technique for detecting upper urinary tract neoplasms. The static 3D reconstructions used in this study are insufficient for visualization. Axial image review remains essential for tumor identification. to be a promising and effective single comprehensive examination in the evaluation of patients with hematuria or with risk for the development of urothelial malignancies. During MDCT urography the images are obtained in the unenhanced phase (detection of calculi), nephrographic-phase (detection of renal masses) and excretory-phase (detection of urothelial lesions). The authors nicely presents the imaging findings of 24 neoplasms retrospectively detected in 18 out 370 patients submitted to the “state of the art” MDCT urography. In this investigation 89% of malignant upper tract foci were detectable with this relatively new technique. One of the several important contributions showed by this study was the possibility of detecting small tumors. These small tumors, similarly to larger ones, were both papillary and flat and both high grade and low grade. The authors were able to retrospectively detect small (< 5 mm) tumors. Similarly to larger lesions, these tumors appeared as intraluminal masses and ureteral wall thickening. Most of these small lesions were seen only on the axial images and with wide window settings.Our early experience with MDCT has also been rewarding since we have been able to prospectively detect some cases of small urothelial malignancies, two of these confirmed as carcinoma in situ. The use of virtual endoscopy in both of theses cases was useful to confirm the presence of such small lesions and to differentiate them from ectopic or prominent papillae. Additional information was also offered to the surgeon when endoscopic resection was the modality of treatment. Background: Penile fracture is not a frequent event. It consists of rupture of the tunica albuginea of the corpora cavernosa. Fracture occurs when the penis is erect, as the tunica is very thin and not flexible. Methods: This prospective study was carried out over a period of 1 year and included 12 patients presenting with penile fracture. Results: Diagnosis was made clinically, and there was no need to perform cavernosography in any case. The most common cause of fracture was trauma to the erect penis during intercourse. Mean age of patients was 29.5 (+ /- 8.96) years, and mean time of presentation was 15.5 (+/- 8.04) hours. Subcoronal circumferential degloving incision was done in all cases. Nine patients were operated on, and three patients refused surgery and were treated conservatively. Repair consisted of evacuation of hematoma and repair of the tunical defect with absorbable sutures. The mean operative time was 33.9 (+/- 8.2) minutes. Preoperative and postoperative antibiotics were used, and all operated cases were discharged on the second postoperative day. All operated cases were able to achieve full erection with straight penis except one, in whom mild curvature and pain during erection was observed. Conclusion: Penis fracture is a true urologic emergency.