No abstract

The aim of this work was to evaluate the clinical feasibility of diffusion-weighted (DW) MRI in detection and staging of urinary bladder tumour and to compare DW MRI with the T(2)-weighted technique. One hundred and six patients with bladder tumour were prospectively included in our study. All patients were evaluated with MR imaging. We started with axial T(2)-weighted high resolution MR of the urinary bladder, then DW MRI. Two radiologists independently interpreted the MR images, and discrepancies were resolved by consensus. The accuracy of DW MRI in staging of bladder tumour was evaluated using the final histopathological findings. In DW imaging (DWI) staging accuracy was 63.6% and 69.6% in differentiating superficial from invasive tumours and organ-confined from non-organ-confined tumours, respectively. On a stage by a stage basis, DWI accuracy was 63.6% (21/33), 75.7% (25/33), 93.7% (30/32) and 87.5% (7/8) for stages T1, T2, T3 and T4, respectively. In the T(2)-weighted technique, the overall staging accuracy was only 39.6% and accuracy for differentiating superficial from invasive tumours and organ-confined from non-organ-confined tumours was 6.1% and 15.1%, respectively. DW is superior to T(2)-weighted MRI in staging of organ-confined tumours (< or =T2) and both techniques are comparable in the evaluation of higher-stage tumours.

To clinically apply the inverse PSA-body mass index (BMI) correlation and enhance PSA sensitivity in obese cases, a new formula is warranted. An innovated BMI-PSA equation is designed. PSA-BMI adjusted formula (named Hekal's equation): measured total PSA (ng ml À1 ) multiplied by age (years) and divided by BMI of the patient. The formula is applied over a randomly chosen 1000 cases of different PSA, BMI, age and trans-rectal ultrasound biopsy results, the yield of new PSA is correlated with pathology and age-specific PSA adjustment values. Among the 988 cases with complete data, obesity (BMI: 30-35 kg m À2 ) in 236 cases (23.8%) and 79 cases (7.9%) have BMI435 kg m À2 . Mean PSA was 5.8 ng ml À1 (s.d.±8.4 ng ml À1 ). Cases stratified based on their age (every 10 years). The new equation was applied. Obesity is detected in 33.5 and 43.6% of fifth and sixth decade of life respectively (P ¼ 0.02), with low measured PSA values (2.1, 3.8 ng ml À1 , respectively). By such PSA measurement biopsy may be omitted, missing 53.3% of malignant cases. In contrast, PSA adjusted were 4 and 9.3 ng ml À1 within the same group of patients. With such values, the decision of a biopsy could not be missed for the targeted groups. Specificity and sensitivity of adjusted PSA values at cutoff point 4 ng ml À1 was 41.7 and 70%, respectively. Based on our results, the new PSA-BMI adjusted formula is reproducible, easy applied formula. With such a formula the higher sensitivity of PSA in obese patients could be achieved. The misleading low PSA in obese cases in the fifth and sixth decade will be corrected.

No abstract

The demonstrated effectiveness, small number of complications at short-term followup, insignificant effect on renal function, blood pressure and relatively small number of recurrences at the long-term followup confirm that shock wave lithotripsy is not only effective but is also safe in the long run.