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How useful is the cremasteric reflex in diagnosing testicular torsion?
Vol. 199, No. 3S, September 2004
Uurological/Reproductive Surgery
RESULTS: 22 of 24 (92%) patients had inhibitory effect on their PSA after 3 mos of treatment:8/24 had decline and 3/24 had stabilization of their PSA. Of the remaining 13, 11 had slowing of PSADT-mean increase (i.e. slowing) of PSADT was 4.5-fold from pre-treatment. Only 2 patients had no initial change in PSADT at 3 mos., yet both eventually showed increase of PSADT (2.2-fold, 4.0fold) by 12 mos. There was a significant shift of patients with rapid towards slower/stable PSADT at all time points (p ⫽ 0.008; see table). Comparison of PSA rise before vs. after celecoxib treatment showed significant flattening of slope of logPSA vs. time from pretreatment (1.48) vs. 3 mos. (0.09), 6 mos. (0.35) and 12 mos. (0.46) (p ⬍ 0.05), There was no significant change in testosterone levels.
Pre 3m 6m 12 m
High
Moderate
Slow
Stable/decline
11/24 1/24 1/24 1/24
6/24 1/24 4/24 3/24
7/24 11/24 11/24 18/24
0/24 11/24 8/24 2/24
CONCLUSIONS: COX-2 inhibitors may decrease PSA levels in patients with biochemical progression after XRT or RP. These results suggest that COX-2 inhibitors may help delay disease progression in these patients.
Risk of bladder cancer following external beam radiation for prostate cancer Kristin L Chrouser MD, Bradley Leibovich MD, Horst Zincke MD, PhD, Michael Blute MD Mayo Clinic Rochester, MN INTRODUCTION: Increased rates of secondary malignancies of the bladder have been reported after external beam radiation therapy (EBRT) for gynecologic malignancies with relative risks varying from 3-57. This study will determine if there is increased risk of subsequent bladder cancer for men treated with EBRT for prostate cancer from 1970-1999. METHODS: We retrospectively reviewed the Mayo Clinic Cancer Registry for patients who received EBRT for prostate cancer, and isolated a cohort of patients with 10,000 man-years of follow-up after radiation. Medical histories of patients who developed subsequent bladder cancer were reviewed. Comparative cancer incidence rates were obtained from the SEER database (2000). RESULTS: Of 3700 patients treated with EBRT for prostate cancer from 1970-1999, 806 patients (with 10,002 follow-up years) were randomly selected. 26 developed a subsequent bladder cancer. 20 sporadic cases of TCC were expected in a similarly aged population without radiation (from SEER data). Our data demonstrates the relative risk of developing a subsequent bladder cancer is 1.3 (CI 0.85-1.91) which is elevated but not statistically significant. CONCLUSIONS: This retrospective review shows the risk of bladder cancer in men who received radiation for prostate cancer is slightly higher than expected in a non-irradiated population. It is,
S101
however, lower than the risk reported in the gynecologic literature. Both radiation cystitis and bladder tumors can present with hematuria and irritative voiding. Urologists should be vigilant in evaluation of this subset of patients at increased risk for vesical neoplasms.
How useful is the cremasteric reflex in diagnosing testicular torsion? Elliot M Paul MD, Carolina Alvayay MD, Lane S Palmer MD, FACS Schneider Children’s Hospital/Long Island Jewish Medical Center New Hyde Park, NY INTRODUCTION: Many factors are used in evaluating boys with possible testicular torsion, including the cremasteric reflex (CR). However, there is a paucity of literature scrutinizing the reliability of CR. We sought to confirm the clinical utility of the CR in assessing boys of different ages with the acute scrotum and to determine if CR alone was diagnostic of testicular torsion. METHODS: 358 boys presenting with acute scrotal pain and/or swelling between 1/1999-10/2002 (ages: 0-18 years) were evaluated. Chart review assessed the presence or absence of CR. Results were compared with final diagnoses as established from operative findings, office charts, and/or telephone contact. Boys were stratified by age and statistical analyses were performed. RESULTS: 211 charts were available for complete analysis. The presence of CR on the symptomatic side correlated with the absence of testicular torsion in 167 cases. The absence of CR correlated with surgically confirmed testicular torsion in 15 cases. There were 27 cases of absent CR in non-torsed testes and two cases of present CR in surgically confirmed torsion. CR carried 88.2% sensitivity, 86.2% specificity, 35.7% PPV, 98.9% NPV, and 86.3% accuracy. In children under 11 years, the sensitivity was 75%, specificity 83.9%, accuracy 83.3%, while boys ⱖ11 years had a sensitivity of 100%, specificity 89%, and accuracy of 90.1%. CONCLUSIONS: In this large series, absent CR was found to be suboptimal in diagnosing testicular torsion, particularly in children under 11 years old. Although not infallible, the presence of CR excluded the diagnosis of torsion in nearly all children, irrespective of age.
Parthenogenesis: A novel source of stem cells for reconstruction Chester Koh MD, Robert Lanza PhD, Shay Soker PhD, James Yoo MD, PhD, Anthony Atala MD, FACS Wake Forest University School of Medicine Winston Salem, NC INTRODUCTION: Parthenogenesis, the ability to create cloned 100 cell embryos from the maternal egg alone, without the use of sperm, has been identified as a potential source for stem cells. The ability to have embryonic stem cells, without sacrificing conception human embryos, would be valuable, especially for conditions where muscle, vascular and bony abnormalities may be present. We investigated whether multipotent stem cells could be isolated from parthenogenesis-derived cells for potential surgical applications.
Uurological/Reproductive Surgery
RESULTS: 22 of 24 (92%) patients had inhibitory effect on their PSA after 3 mos of treatment:8/24 had decline and 3/24 had stabilization of their PSA. Of the remaining 13, 11 had slowing of PSADT-mean increase (i.e. slowing) of PSADT was 4.5-fold from pre-treatment. Only 2 patients had no initial change in PSADT at 3 mos., yet both eventually showed increase of PSADT (2.2-fold, 4.0fold) by 12 mos. There was a significant shift of patients with rapid towards slower/stable PSADT at all time points (p ⫽ 0.008; see table). Comparison of PSA rise before vs. after celecoxib treatment showed significant flattening of slope of logPSA vs. time from pretreatment (1.48) vs. 3 mos. (0.09), 6 mos. (0.35) and 12 mos. (0.46) (p ⬍ 0.05), There was no significant change in testosterone levels.
Pre 3m 6m 12 m
High
Moderate
Slow
Stable/decline
11/24 1/24 1/24 1/24
6/24 1/24 4/24 3/24
7/24 11/24 11/24 18/24
0/24 11/24 8/24 2/24
CONCLUSIONS: COX-2 inhibitors may decrease PSA levels in patients with biochemical progression after XRT or RP. These results suggest that COX-2 inhibitors may help delay disease progression in these patients.
Risk of bladder cancer following external beam radiation for prostate cancer Kristin L Chrouser MD, Bradley Leibovich MD, Horst Zincke MD, PhD, Michael Blute MD Mayo Clinic Rochester, MN INTRODUCTION: Increased rates of secondary malignancies of the bladder have been reported after external beam radiation therapy (EBRT) for gynecologic malignancies with relative risks varying from 3-57. This study will determine if there is increased risk of subsequent bladder cancer for men treated with EBRT for prostate cancer from 1970-1999. METHODS: We retrospectively reviewed the Mayo Clinic Cancer Registry for patients who received EBRT for prostate cancer, and isolated a cohort of patients with 10,000 man-years of follow-up after radiation. Medical histories of patients who developed subsequent bladder cancer were reviewed. Comparative cancer incidence rates were obtained from the SEER database (2000). RESULTS: Of 3700 patients treated with EBRT for prostate cancer from 1970-1999, 806 patients (with 10,002 follow-up years) were randomly selected. 26 developed a subsequent bladder cancer. 20 sporadic cases of TCC were expected in a similarly aged population without radiation (from SEER data). Our data demonstrates the relative risk of developing a subsequent bladder cancer is 1.3 (CI 0.85-1.91) which is elevated but not statistically significant. CONCLUSIONS: This retrospective review shows the risk of bladder cancer in men who received radiation for prostate cancer is slightly higher than expected in a non-irradiated population. It is,
S101
however, lower than the risk reported in the gynecologic literature. Both radiation cystitis and bladder tumors can present with hematuria and irritative voiding. Urologists should be vigilant in evaluation of this subset of patients at increased risk for vesical neoplasms.
How useful is the cremasteric reflex in diagnosing testicular torsion? Elliot M Paul MD, Carolina Alvayay MD, Lane S Palmer MD, FACS Schneider Children’s Hospital/Long Island Jewish Medical Center New Hyde Park, NY INTRODUCTION: Many factors are used in evaluating boys with possible testicular torsion, including the cremasteric reflex (CR). However, there is a paucity of literature scrutinizing the reliability of CR. We sought to confirm the clinical utility of the CR in assessing boys of different ages with the acute scrotum and to determine if CR alone was diagnostic of testicular torsion. METHODS: 358 boys presenting with acute scrotal pain and/or swelling between 1/1999-10/2002 (ages: 0-18 years) were evaluated. Chart review assessed the presence or absence of CR. Results were compared with final diagnoses as established from operative findings, office charts, and/or telephone contact. Boys were stratified by age and statistical analyses were performed. RESULTS: 211 charts were available for complete analysis. The presence of CR on the symptomatic side correlated with the absence of testicular torsion in 167 cases. The absence of CR correlated with surgically confirmed testicular torsion in 15 cases. There were 27 cases of absent CR in non-torsed testes and two cases of present CR in surgically confirmed torsion. CR carried 88.2% sensitivity, 86.2% specificity, 35.7% PPV, 98.9% NPV, and 86.3% accuracy. In children under 11 years, the sensitivity was 75%, specificity 83.9%, accuracy 83.3%, while boys ⱖ11 years had a sensitivity of 100%, specificity 89%, and accuracy of 90.1%. CONCLUSIONS: In this large series, absent CR was found to be suboptimal in diagnosing testicular torsion, particularly in children under 11 years old. Although not infallible, the presence of CR excluded the diagnosis of torsion in nearly all children, irrespective of age.
Parthenogenesis: A novel source of stem cells for reconstruction Chester Koh MD, Robert Lanza PhD, Shay Soker PhD, James Yoo MD, PhD, Anthony Atala MD, FACS Wake Forest University School of Medicine Winston Salem, NC INTRODUCTION: Parthenogenesis, the ability to create cloned 100 cell embryos from the maternal egg alone, without the use of sperm, has been identified as a potential source for stem cells. The ability to have embryonic stem cells, without sacrificing conception human embryos, would be valuable, especially for conditions where muscle, vascular and bony abnormalities may be present. We investigated whether multipotent stem cells could be isolated from parthenogenesis-derived cells for potential surgical applications.