Purpose: We performed a prospective study to confirm early results implying that intraprostatic tissue pressure is elevated in men with the chronic prostatitis-chronic pelvic pain syndrome. We planned to determine further whether this technique would detect a significant difference in inflammatory and noninflammatory categories IIIA and IIIB.Materials and Methods: A total of 48 patients with the chronic prostatitis-chronic pelvic pain syndrome, including 18 with inflammatory category IIIA and 30 with noninflammatory category IIIB disease, and 12 asymptomatic controls completed a Finnish version of the National Institutes of Health-Chronic Prostatitis Symptom Index. In addition, culture and microscopy of lower urinary tract segmented specimens, serum prostate specific antigen determination, transrectal ultrasound, uroflowmetry and ultrasound post-void residual urine measurement were done. All patients and controls also underwent independent intraprostatic right and left lobe tissue pressure measurement using a standard intracompartmental tissue pressure monitor system. Pressure was measured via an intraprostatic needle placed percutaneously in the perineum at baseline, and 10, 60 and 120 seconds after standard saline injection.Results: All patients with the chronic prostatitis-chronic pelvic pain syndrome had significantly higher pressure at all measurement points compared with controls (p <0.001). Mean intraprostatic tissue pressure was significantly higher (p <0.01) in category IIIA with greater than 10 leukocytes per high power field in prostate specific specimens compared with category IIIB with less than 10.Conclusions: Our study supports the suggestion that patients with the chronic prostatitis chronic pelvic pain syndrome have significantly higher prostate tissue pressure than controls. Findings also validated the previous clinical assumption that there is a rationale for differentiating chronic prostatitis-chronic pelvic pain syndrome cases into inflammatory and noninflammatory categories.

OBJECTIVE:To determine the occurrence of mental distress related to prostatitis in Finnish men. SUBJECTS AND METHODS:A population-based cross-sectional survey was conducted of 2500 men aged 20--59 years living in the two northernmost provinces of Finland (Oulu and Lapland). The final response rate was 75% (1832 men). RESULTS:The fear of undetected prostate cancer was reported by 17% of the men in the population who had had prostatitis, a value significantly higher (P < 0.001) than in healthy men. Fears of having a sexually transmitted disease and suicidal thinking were also slightly more common. The men who had had prostatitis preferred to be alone in a public toilet during voiding (58% vs 44%, P < 0.001). Erectile dysfunction was reported by 43% of the men with symptomatic prostatitis and decreased libido by 24%. Self-assessment of personality, adjusted for age, showed that the men with prostatitis were more often busy and nervous than the healthy controls (P < 0.001), and that they had a more meticulous attitude to life and its problems. Marital difficulties were reported by 17% of the men who had had prostatitis at some point in their lives, and 4% were convinced that their illness had caused their divorce. Socio-economic status and social well-being had no apparent influence on the occurrence of prostatitis. CONCLUSIONS:This survey showed that psychological stress is common in men with prostatitis. Urologists and general practitioners should consider that a consultation with a psychiatrist may be appropriate for selected men with prostatitis.

OBJECTIVE:To study the lifetime occurrence of prostatitis in Finnish men and their exposure to the disease. Subjects and methods A population-based cross-sectional survey was conducted in the two most northerly provinces of Finland (Oulu and Lapland). Altogether, 2500 male residents aged 20-59 years were chosen at random to complete a questionnaire on prostatitis. The data were collected between June 1996 and October 1997. Replies were received from 1832 men, giving a response rate of 75%.RESULTS:The overall lifetime prevalence of prostatitis was 14.2%. The risk of having or having had prostatitis increased with age, being 1.7 times greater in men aged 40-49 years than in those aged 20-39 years, and 3.1 times greater in those aged 50-59 years. The overall incidence was 37.8/10 000 person years. More than a quarter of the 261 men who had or had had prostatitis symptoms (27%) suffered from them at least once a year, while 16% suffered from persistent symptoms; 63% of the men with prostatitis had their worst symptoms during the winter (November-March). Neither education nor profession had much influence on the occurrence of prostatitis, but divorced and single men had a lower risk than married men. Most patients felt they had not received enough information about the disease at their first visit to a general practitioner.CONCLUSIONS:The results of this survey showed that the occurrence of prostatitis symptoms in men living in northern Finland is higher than that reported in other parts of the world. This could be partly caused by the cold climate.

Forty-two patients with chronic nonbacterial prostatitis (CNP) and twelve men without any urological complaints or history underwent intraprostatic tissue pressure measurement with a Stryker intracompartmental pressure monitor device. The pressures were measured under spinal anesthesia in connection with various surgical procedures. Tissue pressure was monitored at 10, 60 and 120 s after an injection of 1 ml saline. Significantly (P < 0.001) higher intraprostatic pressure values were registered at all the three time points in the patients with CNP compared to the controls. Our study shows that patients with CNP have elevated intraprostatic tissue pressures, probably reflecting increased tissue resistance and a poor tissue microcirculation status. It seems that this method can be used as a diagnostic tool to differentiate between various causes of chronic pelvic pain in the male. The aim is to develop further this method so that it is also suitable for outpatient use.

The purpose of this retrospective study was to assess the outcomes of the patients with total erectile impotence who have undergone non-prosthetic surgery in our hospital and to make a decision concerning the continuation of this treatment modality. The study series consisted of 45 operated patients, 21 of whom had undergone venous leakage surgery and 24 revascularization of the penis. The follow-up time was at least 12 months. The outcome of venous surgery after 6 months was initially good in 16 patients (76%) but declined in such a way that 12 months after the operation it was good only in 6/21 patients (29%). Despite this, 11/21 patients were capable of intercourse after a prostaglandin E1 injection 1 year from the operation. Altogether 17/21 patients (81%) benefited from venous surgery after 12 months. The outcome of arterial surgery was good in 11/24 patients (46%) 12 months after the operation. A moderate outcome was obtained in another 8/24 patients (33%), who were capable of intercourse after a prostaglandin E1 injection. Minor complications occurred in 20% of the venous surgery patients; 25% of the patients with arterial surgery had complications and half of these were severe, resulting in glans hypervascularization. Our findings indicate that non-prosthetic surgery continues to have an established position in the treatment of severe impotence when all conservative treatment modalities have been used.

BACKGROUND AND AIMS:The risk of severe infection and complications in connection with transurethral resection of the prostate (TURP) has clearly increased in patients with urinary retention and an indwelling catheter. The aim of this study was to determine whether the antibiotics ciprofloxacin and ceftazidime are equally efficient in preventing infective complications in these patients.MATERIAL AND METHODS:An open randomized prospective study was carried out on 72 patients with urinary retention undergoing TURP, to compare of 500 mg of ciprofloxacin (CF) orally twice daily and 1 g of ceftazidime (CT) intravenously twice daily.RESULTS:The incidence of early complications was 26% in the CF group and 17% in the CT group. All the complications were minor. On removal of the indwelling catheter, a positive urinary culture was detected in 6% of the patients in the CF group and in 3% in the CT group. One month after TURP, a positive urinary culture was detected in 14% of the patients in the CF group and in 18% of the CT group.CONCLUSIONS:It is concluded that both of the antibiotics used in this trial were equally effective in the prevention of early urinary and other infections and also late complications, in patients with urinary retention undergoing TURP.

A randomized open prospective study with antibodies was conducted on 398 cases of TURP to compare the efficacy of either 250 mg of ciprofloxacin twice daily (CF) or 500 mg/160mg of sulfadiazine-trimethroprim twice daily (ST) in the prevention of urinary and other infection complications. The medication was started on the evening preceding the operation and continued up to the day following the removal of an indwelling catheter. The preoperative risk factors were similar in both groups. The groups did not differ in terms of the duration of the operation, the volume of irrigation fluid or the weight of the resected chips. The incidence of immediate complications was 26% in the CF group and 20% in the ST group. All the complications were minor. There were three serious late complications, one intertervertebral discitis and one coxitis in the CF group and one endocarditis in the ST group. The patient with endocarditis died. One the removal of the indwelling catheter on the third postoperative day, bacteriuria was detected in 3% of the patients in the CF group and in 9% in the ST group. The difference was statistically significant (p < 0.05). One month after TURP, bacteriuria was detected in 7% in both study groups. It is concluded that ciprofloxacin may be more effective to preventing immediate urinary tract infections after TURP than a combination of sulfadiazine and trimethoprim. There were three serious late complications. As late as one month after TURP, bacteriuria was still diagnosed in about 7% of all patients, which is post-TURP monitoring of urinary values is important.

A prospective series of 104 patients underwent bladder neck incision (44 unilateral and 60 bilateral) for urinary obstruction caused by a small benign prostate enlargement. The preoperative mean peak flow value improved significantly from 11.4 ml/s to 16.2 ml/s. There were no significant differences in peak flow values between the unilateral and bilateral incision groups. Subjective results seemed to be similar but transurethral resection of the prostate was needed more often after unilateral incision than after bilateral incision. Postoperative complications were recorded only in the bilateral incision group. Altogether 62% of the patients reported changes in erection or ejaculation ability. Bladder neck incision seems to be an effective means of treating urinary obstruction but adverse effects on sexual function are common, which should be kept in mind when offering this treatment to sexually active men. It can be regarded as the treatment of choice for older men with infravesical obstruction caused by a small prostate enlargement.

A prospective study was carried out on the efficacy and safety of clean intermittent catheterization (CIC). The series included 41 adults (15 females, 26 males), the mean follow-up time being 40 months. Most patients were suffering from neurogenic bladder disorders. All of them used a self-lubricating hydrophilic catheter. Thirty-one patients (76%) continued to undergo CIC, but 9 discontinued. Thirty patients (73%) experienced bacteriuria during the procedure. Three males had epididymitis. Contrary to many earlier reports, urinary tract infections seem to increase after CIC, raising the question of whether prophylactic antibiotic therapy should be used more often in these cases. There were no urethral complications suggesting that the self-lubricating hydrophilic catheters may be less traumatic than those used previously.

Seventy-five patients with recurrent bladder carcinoma were randomized after electroresection to receive either epirubicin (E) or epirubicin + verapamil (E + V) instillation of the bladder at regular intervals for 2 years. Samples of the bladder wall, tumour tissue and peripheral blood were taken from 20 patients. The average follow-up period was 21 months. Fifty per cent of the patients in the E group and 37% in the E + V group developed recurrent tumours. Recurrence rates (RR) were 6.3 and 4.7, respectively. Before the instillation therapy the RR was 16.0. There was a highly significant reduction of RR during the instillation therapies; in group E p less than 0.005 and in group E + V p less than 0.001. The difference between the treatment groups was not statistically significant. Verapamil increased epirubicin concentrations in both the bladder wall and the tumour tissue, but did not affect concentrations in the peripheral blood. Side effects were few and did not lead to discontinuation of treatment.

A case of metastatic Leydig cell carcinoma without sex hormone overproduction is reported. The patient had had a prior testicular contusion trauma on the same side after which the testicle had been swollen and firm. The possible aetiological role of extreme trauma is discussed. Radical orchidectomy is recommended for large tumours because of the difficulty in predicting malignant potential, and routine follow-up with retroperitoneal ultrasound scanning for 10 years in all cases.

A case of bladder sarcoidosis in a woman with known systemic involvement of this disease is reported. The lesion improved and ureteral obstruction was relieved after transurethral resection and systemic corticosteroid treatment. Sarcoidosis and malacoplakia are believed to represent distinct disease processes in the bladder.

Six patients (all women, mean age 59.8 years) with emphysematous pyelonephritis, a rare, severe inflammation causing renal parenchymal destruction and affecting diabetics more commonly than non-diabetics, are described. Four of the patients were diabetics. All underwent ultrasound examination (US), and five computed tomography (CT) of the kidneys. CT was the most reliable diagnostic method. Differentiation between gas and calcification was difficult at US in three patients. Conventional tomography was performed in two patients and showed intra-renal gas. All six patients recovered; three patients had nephrectomy, one as an emergency procedure and two as an elective procedure after two weeks of antibiotic treatment. Infection was eradicated in the other three patients by percutaneous drainage, electrolyte correction and antibiotics. It was concluded that while conventional abdominal radiography may permit the diagnosis of emphysematous pyelonephritis by demonstrating intra-renal gas, CT is the most reliable diagnostic examination. Emergency nephrectomy may not be necessary in all cases.

Urodynamic examinations were performed on 19 patients undergoing radical retropubic prostatectomy for localized prostatic carcinoma. Altogether 16 urodynamic parameters were analyzed preoperatively and 6 months afterwards. There was a significant decrease in bladder wall compliance and an increase in intravesical and abdominal pressure at maximum flow rate postoperatively. These findings may reflect a partial bladder decentralization caused by surgery. The amount of residual urine was reduced postoperatively. Two patients (10.5%) were totally incontinent, and in both the postoperative urethral closure pressures were low.

The first case of renal cell carcinoma in a horseshoe kidney associated with Turner syndrome is reported. Therapeutic and diagnostic aspects are discussed; the literature is reviewed.