We investigated the effect of prostatic inflammation on prostate-specific antigen (PSA) and per cent-free PSA levels changing after antibacterial therapy. We evaluated 48 patients whose PSA levels were between 4 and 10 ng/ml, without any suspicious findings on digital rectal examination, with no infection findings in urine analysis. Prostatic inflammation was assessed with prostatic massage. All the patients were given antibiotic therapy for 3 weeks. Patients were re-evaluated 3 weeks after antibacterial therapy with PSA (free/total) and urinalysis. Ten core biopsies were taken with transrectal ultrasound. No differences were found in terms of age, pre-and post-treatment PSA, and PSA varying between patients with and without inflammation in the prostatic massage. In 18 patients, PSA decreased below 4 ng/ml. Prostate cancer was found in 10.8% of the patients with PSA between 4 and 10 ng/ml and none of the patients with PSA values below 4 ng/ml. We suggest an antibiotic therapy for 3 weeks without regarding inflammation findings when PSA is in the gray zone, for biopsy decision.

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to 51). The sensitivity, specificity, positive and negative predictive values of FSE for the 118 right obturator LN regions were 94.7%, 100%, 100% and 99%, respectively. The same values for the 118 left obturator LN regions were 86.7%, 100%, 100% and 98.1%, respectively. At final pathologic examination 28 of 118 (23.7%) patients had LN metastasis at obturator regions. Skipped metastasis was found in 15/90 patients (16.7%). Clinical and pathological stage of the primary tumour were found to be significant parameters for skipped metastasis ( P = 0.008 and P < 0.001, respectively). CONCLUSIONSPerforming FSE of the obturator LNs seems to be a reliable procedure for their evaluation with acceptable negative and positive predictive values. The information obtained with FSE of obturator LNs can be used to determine intraoperatively the extent of LN dissection, especially in patients with significant comorbidity. Our study also showed that if the clinical stage of the primary tumour is < cT2, the possibility of skipped metastasis is zero. KEYWORDS bladder neoplasms, cystectomy, frozen sections, lymphadenectomyWhat's known on the subject? and What does the study add? The anatomic extent of lymphadenectomy to achieve both goals, namely accurate staging and potential curative role, in bladder carcinoma patients is still in debate.We aimed in this study to evaluate the accuracy of frozen section examination (FSE) for detecting lymph node (LN) metastases and whether we can use this information to decide the extent of LN dissection during cystectomy. As a conclusion, we think that in such cases performing FSE only at obturator regions will give the information of possibility of residual positive LNs and the surgeon will then decide whether or not it is worthwhile in that case to proceed with EPLND.Study Type -Diagnostic (exploratory cohort) Level of Evidence 2b OBJECTIVETo evaluate the accuracy of frozen section examination (FSE) for detecting lymph node (LN) metastases and whether we can use this information to decide the extent of LN dissection during cystectomy. PATIENTS AND METHODSFrom August 2005 to August 2009 FSE of obturator LNs was performed in 118 patients with bladder cancer, who were undergoing radical cystectomy with extended LN dissection. Removed tissues from 12 well defined LN regions were sent separately for pathologic evaluation. The FSE results of obturator regions were compared with the final histopathologic results of these node regions. RESULTSThe mean number of removed nodes per patient was 29.4 ± 9.3 (median 28, range 12

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Increased hospitalization and operative time can be related to the large stone sizes and prolonged urine leakage. In our opinion, however, the overall success of laparoscopic ureterolithotomy makes it a feasible and effective procedure, especially for stones that could not be managed easily with ureteroscopic stone therapy.

Introduction: The aim of this study was to determine if antibiotic or anti-inflammatory medications lower serum prostate-specific antigen (PSA) in the presence or absence of inflammation in the prostatic secretions of patients with PSA levels between 2.5 and 10 ng/ml and normal digital rectal examinations (DRE). Materials and Methods: Patients with PSA levels between 2.5 and 10 ng/ml and normal DRE were candidates for the study. One hundred and eight patients with positive expressed prostate secretion (EPS) were randomized into antibiotics, anti-inflammatory and control groups (groups 1, 2 and 3, respectively), and 108 patients with negative EPS were randomized into similar groups (groups 4, 5 and 6, respectively). Repeat PSA levels of all patients were obtained 6 weeks after randomization and 10 core prostate biopsies were performed. Results: Median PSA levels in group 1 before and after treatment were 5.2 (4.3–6.4) and 4.0 ng/ml (3.1–4.9), respectively (p < 0.001). The only significant decrease in PSA was observed in group 1. The percent change in PSA levels in group 1 was significantly greater than both in its control group (group 3; p < 0.001) and the EPS– antibiotics group (group 4; p < 0.001). Conclusions: Antibiotherapy significantly reduces serum PSA only in EPS+ patients, which justifies limiting the use of prebiopsy antibiotics to EPS+ patients with a normal DRE and PSA level between 2.5 and 10 ng/ml, minimizing the major drawbacks of empirical antibiotics usage.

The aim of this study is to determine the early effects of partial outflow obstruction (POO) on the detrusor contractility of diabetic (DM) and non-diabetic rats. A total of 67 adult female Wistar rats with average weight of 214+/-3.1 g were randomized into five groups as control ( n=6), sham operated ( n=6), obstructed ( n=18), DM ( n=19), and DM with obstruction ( n=18). Intraperitoneal injection of 60 mg/kg streptozotocin was performed to achieve DM. Partial bladder neck obstruction was created surgically by ligating the urethra around a 3F feeding tube. Bladder strips were obtained and inspected on days 3, 7, and 14 of both the diabetic period and POO. Mean detrusor weights were measured and the maximal contractile responses to carbachol (Car), adenosine 5'-triphosphate (ATP), substance P (SP) and electrical field stimulation (EFS) of detrusor strips in all groups were studied in vitro. After 14 days of obstruction, no remarkable difference was observed between the maximal contractile responses to Car and SP of strips from obstructed-only (POO) and diabetic-obstructed (DM-POO) rats compared to the control group. The responses to EFS and ATP in the POO rats were significantly lower than the controls ( P<0.01, P<0.01, respectively). In the DM-POO group however, the responses were significantly better than the POO group, reaching almost similar levels with the controls. The contractile responses of DM-POO rats were higher than the POO group but lower than the DM group. Better contractile responses of the rats with DM-POO than POO group can be explained by the early enhancing effects of DM on detrusor contractility. In early DM+POO period, the negative effects of POO on detrusor muscle contractility is masked by diabetes mellitus.

Our data suggests that using either a combination of intrarectal lidocaine gel and periprostatic block or solely unilateral pudendal nerve block for prostate biopsy procedures provides efficient patient comfort by reducing pain both during probe insertion and needle passing through the prostate gland.