The response rate to the questionnaire was 78% (344 men). Patients with prostates of >75 g were older, with a median (range) age of 65 (51-74) years, than the other group, at 61 (40-76) years ( P = 0.01), and had higher initial prostate-specific antigen (PSA) levels, at 9.6 (3.4-37.8) and 7.6 (0.1-30.0) ng/mL, respectively ( P = 0.001). Tumours within larger prostates were of a lower stage ( P = 0.035), lower Gleason grade (median 6 and 7, P = 0.015), of smaller volume (median 1.0, 0.1-12.4; and 1.5, 0.1-21.1 mL; P = 0.04) and more often 'clinically insignificant' (23% and 6%, P = 0.001). There was no difference in the number or distribution of positive surgical margins. For a limited median follow-up of 20-25 months, patients with prostates of >75 g were less likely to have biochemical recurrence (5% vs 24%, P < 0.001). Potency and continence rates were similar between the groups. CONCLUSIONSProstate size at RRP does not affect the risk of impotence or incontinence afterward. A prostate of >75 g is associated with a lower likelihood of PSA-relapse, potentially as a result of lead-time bias. While an enlarged prostate may contraindicate other potentially curative cancer treatments, the outcomes of RRP appear to be unaffected. KEYWORDSprostatic neoplasm, volume, prostatectomy, incontinence, erectile dysfunction OBJECTIVESTo determine the effect of a large prostate at radical retropubic prostatectomy (RRP) on the pathological outcome, biochemical recurrence rates, potency and continence. PATIENTS AND METHODSFrom a database of 440 patients treated with RRP, retrospective information was obtained on prostate weights, patient and tumour characteristics, and follow-up. Potency and continence after RRP was obtained using a self-reported validated questionnaire. Patients with prostates of >75 or ≤ 75 g were compared. RESULTSThe median (range) prostate size was 87 (76-182) and 42 (4.1-75) g in the two groups.
Acute retention of urine (AUR) is a common urological emergency characterised by a sudden inability to pass urine associated with lower abdominal pain. In recent years, the natural history and incidence of AUR has become better understood, however, further research into methods to prevent it and evaluation of the impact an episode of AUR has on the patient is required. This review provides an overview of the current management of AUR in men and the impact of the condition on patients' quality of life.
SUMMARY A type of electromyographic activity, formerly referred to as "pseudomyotonia", can be recorded from the striated muscle of the urethral sphincter using a concentric needle electrode. There are two components to this activity, complex repetitive discharges and decelerating bursts. The latter usually dominate recordings and sound very like myotonic discharges. Analysis of these discharges indicates that they are a form of "bizarre repetitive discharge", and as such, result from ephaptic spread of excitation between muscle fibres rather than from excitation arising in the terminal branches of the motor axon. Profuse activity of this type has been found in 15 women with symptoms of urethral dysfunction, including 11 with urinary retention. It is suggested that this activity is associated with a failure of urethral sphincter relaxation.The striking EMG activity that may be recorded from the urethral sphincter with a needle electrode, was first reported as "pseudomyotonia" by DiBenedetto and Yalla in 1979.' Other reports of this activity in the urological literature have subsequently adopted the same terminology,24 with the exception-of Dyro et al,5 who used the term "complex repetitive discharges". Because such confusion surrounds the term "pseudomyotonia", we have avoided it and in a recent publication referred to the activity as " complex repetitive discharges" plus "decelerating burst" discharges.6 Although the term "complex repetitive discharges" introduced by Dyro et al' is very appropriate, it does not encompass the dominant component of such recordings, the bursts of activity which have a decelerating rate and therefore sound so like myotonic discharges. We discuss later the electromyographic terminology used to describe various abnormal discharges recorded from muscle.The significance of decelerating burst and complex repetitive discharge activity in the urethral sphincter has been obscure. It has been reported in adults and children with a wide range of urological
Black men in England have three times the age-adjusted incidence of diagnosed prostate cancer as compared with their White counterparts. This population-based retrospective cohort study is the first UK-based investigation of whether access to diagnostic services underlies the association between race and prostate cancer. Prostate cancer was ascertained using multiple sources including hospital records. Race and factors that may influence prostate cancer diagnosis were assessed by questionnaire and hospital records review. We found that Black men were diagnosed an average of 5.1 years younger as compared with White men (Po0.001). Men of both races were comparable in their knowledge of prostate cancer, in the delays reported before presentation, and in their experience of co-morbidity and symptoms. Black men were more likely to be referred for diagnostic investigation by a hospital department (P ¼ 0.013), although general practitioners referred the large majority of men. Prostate-specific antigen levels were comparable at diagnosis, although Black men had higher levels when compared with same-age White men (Po0.001). In conclusion, we found no evidence of Black men having poorer access to diagnostic services. Differences in the run-up to diagnosis are modest and seem insufficient to explain the higher rate of prostate cancer diagnosis in Black men. Radical treatment can cure localised prostate cancer, but can lead to serious side effects, and many untreated men do not develop advanced disease (Albertsen et al, 2005). Risk factors and prognostic factors are needed to identify those men with an increased chance of developing cancer and of seeing that cancer progress, as these men have a more favourable balance of risks and benefits when undergoing screening tests and radical treatment. Black race is one of very few factors supported by convincing evidence (Gronberg, 2003). Surveillance, Epidemiology, and End Results (SEER) data from the United States indicate that Black men are 2.4 times more likely to die of prostate cancer than White men of the same age (US Cancer Statistics Working Group, 2005). In England, where prostate-specific antigen (PSA)-based screening is uncommon, the PRostate Cancer in Ethnic SubgroupS (PROCESS) study has demonstrated Black men to have 3.1 times the incidence of prostate cancer as compared with their same-age White counterparts . Black men also have a poorer prognosis than similar age White men. A meta-analysis of US data found the disease-specific case-fatality rate to be 29% higher . The higher rate of prostate cancer in Black men may arise from a genuinely higher incidence, or alternatively there may be an equal incidence of prostate cancer but a greater likelihood of diagnosis among Black men. US studies suggest that Black men have worse access to health care generally (Institute of Medicine, 2001), and may have poorer access to PSA testing in particular (Freedland and Isaacs, 2005), although a recent study has found Black men aged 40 -49 years to be subject to a higher rate of test...
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