Surgical Specialist, Urologists
21 years of experience

Accepting new patients
Albert Einstein Medical Center
5401 Old York Rd
Ste 500
Philadelphia, PA 19141
215-456-1177
Locations and availability (12)

Education ?

Medical School Score Rankings
University of Pennsylvania (1989)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Awards  
AM Board of Urology
Associations
American Urological Association
Member
American Urological Association (urologyhealth.org)
Member

Affiliations ?

Dr. Harkaway is affiliated with 12 hospitals.

Hospital Affilations

Score

Rankings

  • Nazareth Hospital
    2601 Holme Ave, Philadelphia, PA 19152
    • Currently 3 of 4 crosses
    Top 50%
  • Montgomery Hospital XXXXX
    900 E Fornance St, Norristown, PA 19401
    • Currently 3 of 4 crosses
    Top 50%
  • Albert Einstein Medical Center
    5501 Old York Rd, Philadelphia, PA 19141
    • Currently 3 of 4 crosses
    Top 50%
  • Jeanes Hospital
    7600 Central Ave, Philadelphia, PA 19111
    • Currently 3 of 4 crosses
    Top 50%
  • Mercy Suburban Hospital
    2701 Dekalb Pike, Norristown, PA 19401
    • Currently 2 of 4 crosses
  • Mercy Fitzgerald Hospital
    1400 Lansdowne Ave, Darby, PA 19023
    • Currently 2 of 4 crosses
  • Hahnemann University Hospital
    230 N Broad St, Philadelphia, PA 19102
    • Currently 2 of 4 crosses
  • Elkins Park Hospital
    60 Township Line Rd, Elkins Park, PA 19027
  • Mossrehab & Albert Einstein Med Ctr
    60 Township Line Rd, Elkins Park, PA 19027
  • Germantown Hospital & Community Health Services
    1 Penn Blvd, Philadelphia, PA 19144
  • Northeastern Hospital of Philadelphia
    2301 E Allegheny Ave, Philadelphia, PA 19134
  • Temple University Hospital - Episcopal Campus
    100 E Lehigh Ave, Philadelphia, PA 19125
  • Publications & Research

    Dr. Harkaway has contributed to 23 publications.
    Title Serum Creatinine Predicts Success in Retrograde Ureteral Stent Placement in Patients with Pelvic Malignancies.
    Date September 2008
    Journal Urology
    Excerpt

    OBJECTIVES: To evaluate serum hemoglobin, baseline serum creatinine, serum creatinine at the diagnosis of obstructive hydronephrosis, and the increase in serum creatinine greater than baseline to predict for success in retrograde ureteral stent placement in patients with pelvic malignancies. METHODS: In a retrospective chart review, we identified 57 patients at our institution with obstructive hydronephrosis secondary to pelvic malignancies in which retrograde ureteral stent placement was attempted from January 2002 to May 2005. The patient charts were reviewed for the baseline serum creatinine, preoperative serum creatinine and hemoglobin, and serum creatinine at presentation of obstructive hydronephrosis. This population was divided into group 1 (n = 31, 54%), in which retrograde stent placement was successful, and group 2 (n = 26, 46%), in which stent placement failed and subsequent percutaneous nephrostomy tube placement was required. The Student t test was used to determine whether a significant difference existed between the two groups for each laboratory parameter. RESULTS: The serum hemoglobin and baseline creatinine were not significantly different between the two groups and could not be used to predict for the success or failure of stent placement (P = 0.10 and P = 0.59, respectively). However, the average serum creatinine at presentation of obstructive hydronephrosis was significantly different between group 1 (2.4 +/- 1.4 ng/dL) and group 2 (5.3 +/- 6.3; P = 0.014), as was an increase in serum creatinine greater than baseline (P = 0.002). CONCLUSIONS: The results of this study have shown that the serum creatinine level at the presentation of obstructive hydronephrosis can be used to predict for success in retrograde ureteral stent placement in patients with pelvic malignancies.

    Title Medical and Minimally Invasive Therapies for the Treatment of Benign Prostatic Hyperplasia.
    Date January 2007
    Journal Prostate Cancer and Prostatic Diseases
    Excerpt

    Over the last decade, management of benign prostatic hyperplasia (BPH) has changed with a substantial decrease in the use of transurethral prostatectomy (TURP) and a simultaneous increase in the use of medical therapy and minimally invasive surgical therapy (MIST). The goal of management of this chronic progressive condition is not only to provide relief of lower urinary tract symptoms (LUTS) but also to reduce the lifetime risk of adverse outcomes. Recent clinical evidence has demonstrated a clear role for medical therapy, particularly with 5-alpha-reductase inhibitors (5ARIs) either alone or in combination with alpha-blockers, to reduce the risk of acute urinary retention and need for surgery and provide symptom relief. Clinical data on MISTs also indicate a more pronounced short-term effect; however, the long-term durability of these therapies remains uncertain. Minimally invasive surgical therapies confer treatment benefits in a single 1-h treatment session under local anesthesia. Recovery times and adverse events are improved compared with TURP, but issues such as hematuria, prolonged catheterization, urinary tract infection and retreatment remain commonly reported issues. Today, urologists are faced with the challenge of identifying the most appropriate treatment option for the long-term management of BPH. The initial choice for any given patient will depend on his presenting circumstances and the influence of treatment risks on these circumstances. Providing patients with informed treatment decisions is a key element of management.

    Title Adjunctive Use of Androgel (testosterone Gel) with Sildenafil to Treat Erectile Dysfunction in Men with Acquired Androgen Deficiency Syndrome After Failure Using Sildenafil Alone.
    Date April 2006
    Journal Urology
    Excerpt

    OBJECTIVES: To evaluate whether combination therapy with testosterone gel (T-gel) and sildenafil citrate is effective in achieving adequate potency in subjects with low-normal serum testosterone levels in whom sildenafil alone has failed. METHODS: From July 2000 to June 2001, we evaluated 90 men (aged 32 to 72 years) in whom 3 months of sildenafil therapy at the maximal recommended dose (100 mg) with at least three attempts at intercourse during the 3-month period had failed. Of these, 24 men had testosterone levels less than 400 ng/dL (range 92 to 365, mean 231.4) and were subsequently started on 1% T-gel monotherapy (AndroGel, 5 g daily). After 4 weeks of T-gel alone (week 4), sildenafil citrate (Viagra, 100 mg) was added to the treatment regimen for an additional 12 weeks (through week 16). Potency was defined as the ability to have at least one episode of satisfactory intercourse during the treatment period. RESULTS: All the men had normalized serum testosterone levels after 4 weeks of T-gel monotherapy (range 424 to 596 ng/dL, mean 525). However, none of the men regained potency. At week 16, almost all (22 of 24, 92%) of the men reported improved potency with combination therapy. Improvement in erection quality was also observed. CONCLUSIONS: The results of this study support the use of T-gel with sildenafil citrate in men with low-normal serum testosterone levels in whom sildenafil alone fails. It also underscores the numbers of men with low to low-normal testosterone levels who would benefit from testosterone screening when evaluated for erectile dysfunction.

    Title Use of Intraurethral Alprostadil in Patients Not Responding to Sildenafil Citrate.
    Date October 2004
    Journal Urology
    Excerpt

    OBJECTIVES: To determine whether intraurethral alprostadil would be an effective alternative for men with erectile dysfunction who did not respond adequately to sildenafil citrate but desired minimally invasive treatment. METHODS: A total of 44 male patients aged 41 to 74 years with erectile dysfunction refractory to treatment with sildenafil citrate were enrolled in this study. Of the 44 patients, 10 had undergone prior radical retropubic prostatectomy. The patients were evaluated for subjective improvement in an office setting and completed the Sexual Health Inventory for Men questionnaire as an objective assessment of improved erectile ability. Success was defined as subjective improvement in erectile function, as well as an improved Sexual Health Inventory for Men score. RESULTS: Of the 44 men, 13 (29.5%) responded successfully to intraurethral alprostadil, with a follow-up ranging from 2 to 15 months. The remaining 31 men had no response (n = 28, 90%), refused escalating doses (n = 2, 7%), or were lost to follow-up (n = 1, 3%). In the subgroup of 10 men with prior radical retropubic prostatectomy, 5 (50%) reported success with intraurethral alprostadil (500 microg in 2 patients and 1000 microg in 3 patients). CONCLUSIONS: Although sildenafil citrate remains the most common initial therapy in men with erectile dysfunction, intraurethral alprostadil may be a reasonable treatment option for sildenafil nonresponders. This may be especially true in men having undergone prior radical retropubic prostatectomy.

    Title Estimated Blood Loss Underestimates Calculated Blood Loss During Radical Retropubic Prostatectomy.
    Date June 2004
    Journal Urologia Internationalis
    Excerpt

    OBJECTIVE: To compare the calculated blood loss for radical retropubic prostatectomy (RRP) with the anesthesiologist's and operating surgeon's estimates of operative blood loss. METHODS: A retrospective review of 52 consecutive patients undergoing RRP between January 1999 and February 2000 was performed. Patient charts were reviewed for preoperative hemoglobin (Hgb(i)), preoperative hematocrit (Hct(i)), body weight (Wt), anesthesiologist's and surgeon's estimated blood loss (EBL(A) and EBL(S)), and postoperative day one morning hemoglobin (Hgb(f)) and hematocrit (Hct(f)). For each patient, the actual blood loss (ABL), i.e., the amount of blood that left the patient's body, was calculated as the average ABL(n) resulting from two computations of the following formula: ABL(n) = (EBV x (H(i) - H(f)) / ((H(i) + H(f))/2) + (500 x T(u)) where: (1) estimated blood volume (EBV) is assumed to be 70 cm(3)/kg; (2) H(i) and H(f) represent Hgb(i )and Hgb(f) for one computation and Hct(i) and Hct(f) for the second computation, and (3) T(u) is the sum of autologous whole blood (AWB), packed red blood cells (PRBC), and cell saver (CS) units transfused. For each patient, ABL was compared with EBL(A) and EBL(S). Descriptive statistics of the pooled data were calculated. RESULTS: The mean (+/- SD) age was 60 +/- 7.1 years. The mean ABL was 2,774 +/- 1,014 cm(3). Patients received an average of 1.96 U CS, 0.14 U PRBC, and 0.42 U AWB. Five patients (9.6%) were exposed to homologous blood. The average ABL(net) (i.e. ABL reduced by the amount of CS returned) was 1,794 +/- 806 cm(3). EBL(A) and EBL(S) were 1,337 +/- 676 and 1,300 +/- 658 cm(3), respectively. CONCLUSION: During radical retropubic prostatectomy, anesthesiologists and urologists both appear to underestimate blood loss as determined by standard calculation.

    Title Under-reporting of Erectile Dysfunction Among Men with Unrelated Urologic Conditions.
    Date January 2004
    Journal International Journal of Impotence Research
    Excerpt

    To evaluate the incidence of erectile dysfunction (ED) in men with unrelated urologic conditions paying special attention to the reasons for patient under-reporting. We asked 500 consecutive men over age 50 visiting their urologist's office for problems unrelated to ED, whether or not they had any difficulty with their potency. Those who gave a positive response were then asked to complete a questionnaire to assess their reasons for under-reporting and whether they had had any previous discussions with their primary-care physicians regarding their sexual function. Out of 500 men, 218 (44%) reported experiencing some degree of ED. Reasons for failure to discuss ED with their urologist included: 161 out of 218 (74%) were embarrassed; 27 out of 218 (12%) felt that ED was a natural part of aging; 20 out of 218 (9%) were unaware that urologists dealt with the problem of ED; and 10 out of 218 (5%) did not consider the problem worthy of attention. Only 48 of the 218 men with ED reported having previous discussions about their problem with their primary-care physicians. Of the 170 patients who did not report having such discussions, 140 (82%) reported that they would have liked their primary-care physician to have initiated a discussion of ED during their routine visits. In conclusion. a significant percentage of older men with some unrelated urologic complaint also suffer from some degree of ED and remain undiagnosed unless specifically questioned about this problem. By far, the most common reason for under-reporting of ED was patient embarrassment. While urologists are able to elicit information regarding erectile function on specific questioning, patients appear comfortable and willing to discuss their potency with primary-care physicians.

    Title Sickle Cell Episode Manifesting As Superficial Thrombophlebitis of the Penis.
    Date April 2003
    Journal The Journal of the American Osteopathic Association
    Excerpt

    In 1955, the first reported case of Mondor's disease (superficial thrombophlebitis) of the penis was published. Since then, there have been scattered reports of penile Mondor's disease in the literature. Most studies suggest sexual trauma or neoplasm as the most frequent etiologic factor. The authors report a case of a sickle cell episode presenting with superficial thrombophlebitis of the penis. The patient was treated with an antiinflammatory agent and reassured that this is a self-limiting process. Resolution of symptoms occurred within 6 weeks.

    Title The Need for Voiding Diaries in the Evaluation of Men with Nocturia.
    Date June 2002
    Journal The Journal of the American Osteopathic Association
    Excerpt

    In a study to assess the need for voiding diaries in the evaluation of men with nocturia, 337 consecutive male patients were asked to estimate their number of voiding episodes per night. Patients were placed into seven separate groups based on the number of estimated number of voiding episodes. These patients used a voiding diary to track their voiding habits for 1 week. The mean number of voiding episodes recorded in the diaries were then compared with the subjects' original estimations. The estimated number of voiding episodes correlated with the mean number of diary-recorded voiding episodes 48% of the time. Correlation was highest for patients reporting few episodes per evening and lowest for those reporting five or six episodes per night. The study findings suggest that voiding diaries are essential in helping to determine the actual number of voiding episodes per night and that the need for a voiding diary becomes more important as the perceived amount of nocturia increases.

    Title Ureteral Segment Replacement Using a Circumferential Small-intestinal Submucosa Xenogenic Graft.
    Date April 2002
    Journal Journal of Investigative Surgery : the Official Journal of the Academy of Surgical Research
    Excerpt

    We wished to determine whether small-intestinal submucosa (SIS) will epithelialize when used as a ureteral replacement material. An 11-mm segment of native ureter was excised from eight New Zealand White rabbits and replaced with an 11-mm porcine SIS graft, which was circumferentially wrapped around a ureteral stent. The SIS ureteral grafts were harvested at 11 days or 35 days postimplantation and examined grossly and by standard light microscopy techniques. Partial epithelialization with the ingrowth of urothelium, smooth muscle cells, and blood vessels was observed in the grafts harvested at 11 days postimplantation. The SIS ureteral grafts examined at 35 days postimplantation showed additional restructuring of the smooth muscle cell layer and more organized epithelialization in comparison to the SIS graft examined at 11 days. After 35 days of regenerative healing, elements of all three layers of the native ureter were observed within the collagen matrix of the SIS graft. No significant complications were observed, but all subjects (8/8) demonstrated mild intra-abdominal adhesions. Mild collecting system dilatations were observed in 4/4 (100%) of the animals harvested at 35 days and in 0/4 (0%) of the animals harvested at 11 days. We have this demonstrated in this preliminary study that SIS xenografts will epithelialize when used as a ureteral replacement material. The repair mechanism of these ureteral grafts occurred through a regenerative healing process rather than by scar formation. With further studies, this material may prove to be a useful treatment option in patients with ureteral injuries.

    Title Improved Continence After Radical Retropubic Prostatectomy Using Two Pubo-urethral Suspension Stitches.
    Date March 2002
    Journal Urologia Internationalis
    Excerpt

    OBJECTIVES: To determine if placement of urethral suspension stitches during radical retropubic prostatectomy improves postoperative urinary continence. METHODS: Between January 1997 and January 1998 we performed radical retropubic prostatectomy on 50 men. The first 25 consecutive men had their surgery without urethral suspension stitches while the next 25 received placement of two anastomotic urethral suspension stitches anchored to the lower portion of the pubic bone. Patients were interviewed six months postoperatively and each underwent valsalva leak-point pressure measurement. Patients were categorized as either completely continent (requiring no pads and having no measurable valsalva leak point), socially continent (zero or one pad per day), or incontinent (two or more pads per day). RESULTS: In the urethral suspension group, 8/25 (32%) patients were completely continent and did not have a measurable valsalva leak-point pressure while 3/25 (12%) without urethral suspension were completely continent. Of the remaining patients in the urethral suspension group, 13/17 (76%) patients were socially continent while 4/17 (24%) were incontinent. The mean valsalva leak-point pressure in the 17 patients with suspension stitches was 89.6 +/- 21.6 cm H2O. In the patients without urethral suspension, there were 22 patients who had some degree of incontinence. Among non-stitch patients, 13/22 (59%) were socially continent while 9/22 (41%) were incontinent. The average valsalva leak-point pressure in these patients was 74.0 +/- 16.7 cm H2O, which was significantly lower than those with the suspension (p = 0.015). CONCLUSIONS: Placement of anastomotic urethral suspension stitches during radical retropubic prostatectomy may increase the likelihood of complete postoperative urinary continence. The urethral suspension stitches also increase valsalva leak-point pressure, which may improve the percentage of patients with socially acceptable incontinence.

    Title Effects of Irrigation Fluid Temperature on Core Body Temperature During Transurethral Resection of the Prostate.
    Date March 2002
    Journal Urology
    Excerpt

    OBJECTIVES: To determine the effect irrigation fluid temperature has on core body temperature changes in patients undergoing transurethral resection of the prostate (TURP). METHODS: Fifty-six male patients (mean age 71.2 +/- 8.2 years) scheduled for TURP were enrolled in the study. Patients were randomized to one of two groups. Group 1 consisted of 27 patients who received room temperature irrigation fluid (70 degrees F) throughout TURP; group 2 consisted of 29 patients whose procedure was performed with warmed irrigation fluid (91.5 degrees F). The irrigation fluid used for both groups was glycine. The baseline temperature, final temperature, total time in the operating room, and amount of irrigation fluid used during the procedure were recorded for each patient. RESULTS: No significant difference in the average time spent in the operating room or in the total irrigation fluid used between the two groups was observed. Of the 27 patients who received room temperature irrigation fluid, 15 (55.6%) had a decrease in body temperature. A decrease in temperature was observed in 21 (72.4%) of the 29 patients who received warm irrigation fluid. Groups 1 and 2 had 12 (44.4%) of 27 and 8 (27.6%) of 29 patients, respectively, who demonstrated an elevation in their core body temperature. CONCLUSIONS: The results of our study suggest that irrigation fluid temperature is not a factor responsible for altering the core body temperature in patients undergoing TURP.

    Title Discontinuation of Alpha-blockade After Initial Treatment with Finasteride and Doxazosin in Men with Lower Urinary Tract Symptoms and Clinical Evidence of Benign Prostatic Hyperplasia.
    Date August 2001
    Journal Urology
    Excerpt

    OBJECTIVES: To determine the effect of discontinuation of alpha-blockade and continuation of finasteride in men with lower urinary tract symptoms and enlarged prostates receiving combination treatment and to determine whether the alpha-blocker dose influences the ability to discontinue it. METHODS: We treated 272 consecutive men with a prostate size greater than 40 g and American Urological Association symptom score greater than 20 with 5 mg finasteride and 2 mg doxazosin daily. Two hundred forty men reported a favorable response to therapy, defined as any reduction in symptom score and toleration of the medications. The dose was maintained at 2 mg doxazosin in 100 men and was titrated to 4 mg doxazosin in 80 patients and to 8 mg doxazosin in an additional 60 patients. We discontinued doxazosin at 3, 6, 9, or 12 months, while continuing finasteride, and then re-evaluated the patients 1 month later to determine whether any worsening of symptoms had resulted. RESULTS: In patients discontinuing doxazosin at 3 months, success (defined as no increase in symptom score and no desire to resume doxazosin) was reported by 20%, 15%, and 13% of those taking 2, 4, and 8 mg, respectively. In patients discontinuing doxazosin at 6 months, success was reported by 48%, 45%, and 40% of those taking 2, 4, and 8 mg, respectively. In patients discontinuing doxazosin at 9 months, success was reported by 84%, 80%, and 73% of those taking 2, 4, and 8 mg, respectively. In patients discontinuing doxazosin at 12 months, success was reported by 84%, 85%, and 87% of those taking 2, 4, and 8 mg, respectively. CONCLUSIONS: Patients with lower urinary tract symptoms and moderately enlarged prostates initially receiving combination therapy using finasteride and an alpha-blocker are likely to experience no significant symptom deterioration after discontinuing the alpha-blocker after 9 to 12 months of combination therapy regardless of the dose of alpha-blocker chosen.

    Title Discontinuation of Alpha-blockade After Initial Treatment with Finasteride and Doxazosin for Bladder Outlet Obstruction.
    Date July 2001
    Journal Urologia Internationalis
    Excerpt

    OBJECTIVES: Patients with symptomatic bladder outlet obstruction and moderately enlarged prostates can receive durable relief from finasteride. However, the delayed onset of action has led many clinicians to prescribe an alpha-blocker in addition to finasteride early in therapy for more rapid symptom relief. Our goal was to determine when to discontinue the alpha-blocker in this group of patients. METHODS: We enrolled 100 consecutive men with an estimated prostate size of >40 g and an AUA symptom score of > or =20, who reported an initially favorable response to combination therapy with 5 mg finasteride and 2 mg doxazosin daily. The average symptom score reduction at 1 month was 3.3. We discontinued the doxazosin at 3, 6, 9, or 12 months, while continuing finasteride, then reevaluated patients 1 month later to determine if the patients reported any worsening of symptoms. RESULTS: Twenty-five patients discontinued doxazosin at 3 months. Five (20%) were successfully discontinued, reporting no change in symptom score. Twenty reported worsening symptoms. Twenty-five patients discontinued doxazosin at 6 months. Twelve (48%) were successfully discontinued, reporting no change in symptom scores. Thirteen (52%) reported worsening symptoms. Twenty-five patients discontinued doxazosin at 9 months. Twenty-one (84%) were successfully discontinued, reporting no change in symptom scores. Four (16%) reported worsening symptoms. Twenty-five patients discontinued doxazosin at 12 months. Twenty-one (84%) were successfully discontinued, reporting no change in symptom scores. Four (16%) reported worsening symptoms. CONCLUSION: Patients with symptomatic bladder outlet obstruction and moderately enlarged prostates who are placed initially on combination therapy using finasteride and an alpha-blocker are likely to tolerate discontinuation of the alpha-blocker after 9 months of combination therapy.

    Title A New Diagnostic Algorithm for the Evaluation of Microscopic Hematuria.
    Date June 2001
    Journal Urology
    Excerpt

    OBJECTIVES: To evaluate a new diagnostic algorithm for microscopic hematuria in which intravenous urography (IVU) is performed as a secondary radiographic study when microhematuria has persisted for 3 months after the initial workup with renal ultrasound (US) and cystoscopy was negative. METHODS: We evaluated 372 consecutive patients who presented with microhematuria and negative urine cultures and cytologic findings at our institution. All patients underwent renal US scanning and cystoscopy as their initial evaluation. All patients underwent re-evaluation 3 months after the initial workup. Patients with persistent microhematuria with no apparent etiology were then evaluated with IVU. RESULTS: The initial evaluation was negative in 212 of 372 patients. Eighty-one of these patients had persistence of their microhematuria at the 3-month follow-up without a definitive diagnosis. Seventy-five of these patients underwent IVU. Abnormalities were found in 11 of the 75 patients. Six patients had renal stones, two had ureteral stones, two had ureteral tumors, and one had a tumor of the renal pelvis. Forty of the 131 patients with resolution of their microhematuria underwent IVU at their request. All those studies were normal. CONCLUSIONS: The combination of cystoscopy and renal US along with urinalysis, urine culture, and cytology is a good initial evaluation in patients with microhematuria. Those patients with persistent microhematuria after 3 months without definite etiology of the bleeding may still benefit from IVU.

    Title Helical Ct Scanning: the Primary Imaging Modality for Acute Flank Pain.
    Date November 2000
    Journal The American Journal of Emergency Medicine
    Excerpt

    We set out to evaluate the accuracy of nonenhanced helical computed tomography (CT) scanning at stone detection in the patient with acute flank pain, and as a means of detecting noncalculus causes of acute flank pain. Between April 1995 and April 1997, 412 consecutive patients with acute flank pain underwent noncontrast-enhanced helical CT. Two hundred eighty-one patients had confirmation of their CT diagnosis by other radiographic studies, urologic intervention, or spontaneous stone passage of calculi. We determined the presence or absence of urinary calculi, as well as the presence of other noncalculus pathology. CT scanning revealed a stone in 92/281 patients (32.7%) and no stone in 189/281 patients (67.3%). Of the 189 patients, 60/189 patients (32%) had another positive finding as a cause for flank pain. Eighty-one of 92 patients with a stone on CT (88%) had confirmation of stone disease by radiologic or surgical intervention. Eleven of 92 patients (12%) did not have confirmation of their diagnosis because of resolution of symptoms or refusal of further intervention. On helical CT scans 129/189 patients demonstrated no abnormalities. Two of 189 (1.5%) thought to be stone free by CT passed a stone. Helical CT had a sensitivity of 97%, a specificity of 92%, a positive predictive value of 88%, and a negative predictive value of 98% at stone detection. Noncontrast-enhanced helical CT is accurate and rapid in detecting calculus disease in patients with acute flank pain. Perhaps more importantly, it provides the added benefit of detecting noncalculus causes of flank pain in greater than 30% of patients.

    Title Pretreatment with Finasteride Decreases Perioperative Bleeding Associated with Transurethral Resection of the Prostate.
    Date May 2000
    Journal Urology
    Excerpt

    OBJECTIVES: The efficacy of finasteride in the treatment of gross hematuria associated with benign prostatic hyperplasia is well established. We evaluated a regimen of pretreatment with finasteride in decreasing perioperative bleeding associated with transurethral resection of the prostate (TURP). METHODS: A prospective analysis compared 25 patients pretreated with finasteride for 2 to 4 months before TURP with 50 patients without pretreatment. Patients in each group were further separated by the amount of prostate tissue resected. Patients were then followed up for perioperative bleeding, defined as a perioperative blood transfusion requirement or a return visit to the emergency room with gross hematuria or clot retention. RESULTS: None of the patients with less than 30 g of prostate tissue resected experienced perioperative bleeding. In patients with 30 g or more resected, several episodes of bleeding occurred. In the patients pretreated with finasteride, 1 (8.3%) of 12 experienced perioperative bleeding; in the control group, 7 (36.8%) of 19 had an episode of bleeding. CONCLUSIONS: In patients with large prostate glands undergoing TURP, pretreatment with finasteride appears useful in reducing perioperative bleeding.

    Title Use of a Prostate Model to Assist in Training for Digital Rectal Examination.
    Date May 2000
    Journal Urology
    Excerpt

    OBJECTIVES: To assess the accuracy of prostate size estimation on digital rectal examination (DRE) before and after training with a three-dimensional prostate model relative to prostate volume by transrectal ultrasound (TRUS). METHODS: A total of 100 subjects underwent DRE by one of four family physicians (FP1, n = 34; FP2, n = 26; FP3, n = 22; and FP4, n = 18). One half were examined before any training on DRE prostate size examination and one half after the physicians were trained. Training involved teaching with a three-dimensional prostate model having posterior surface areas corresponding to the average dimensions of six different prostate volumes. The FPs were instructed to estimate the prostate size on the DRE to the nearest 5 g. A single urologist unaware of the DRE results performed TRUS on all patients to measure the prostate volume. RESULTS: Before training, the DRE size estimates ranged from 10 to 100 g (mean +/- SD 32.8 +/- 21.6), with a TRUS volume of 11 to 122 g (mean +/- SD 38.9 +/- 23.1). The correlation between the DRE and TRUS estimates was 0.25, suggesting low agreement (intraclass correlation coefficient [ICC] 0.35, 95% confidence interval 0.31, 0. 38). After training, 50 different patients had DRE size estimates of 10 to 100 g (mean +/- SD 39.4 +/- 19.7) and TRUS volume of 10 to 119 g (mean +/- SD 41.5 +/- 24.1). The correlation between the techniques was higher in patients examined after training (r = 0. 765), suggesting much better agreement between the techniques (ICC 0. 87; 95% confidence interval 0.86, 0.88). Among the physicians, agreement between DRE and TRUS was higher after training (ICC 0.64 to 0.96) than before training (ICC 0.02 to 0.49). CONCLUSIONS: Although the subjects examined before and after training differed, the agreement between TRUS and DRE prostate size estimates by the FPs appeared to be stronger after training with a three-dimensional prostate model. This model may be a useful tool to assist in training FPs and medical students to measure prostate size on DRE.

    Title Role of Urologic Evaluation in the Adult Spina Bifida Patient.
    Date April 2000
    Journal Urologia Internationalis
    Excerpt

    OBJECTIVE: To evaluate a population of adult spina bifida patients performing clean intermittent catheterization (CIC) and determine the indications for urologic consultation and intervention. METHODS: We evaluated 52 adults (ages 18-37 years) with a history of lumbar myelomeningocele, all of whom performed CIC and were dry between catheterizations. We excluded 12 patients with conditions potentially predisposing to renal insufficiency (staghorn calculus, n = 3; multiple admissions for pyelonephritis, n = 5; history of vesicoureteral reflux, n = 2, and renal scarring on ultrasound, n = 2), leaving 40 patients evaluable. Each patient kept a catheterization diary for 2 weeks from which an average catheterized volume was recorded. RESULTS: In patients with normal ultrasound and normal serum creatinine (<1.5 mg/dl), there were no individuals (0/20) whose average catheterized volume corresponded to a bladder pressure of >40 cm H(2)O on cystometry. However, in the patients with hydronephrosis and/or elevated creatinine, 30% (6/20) had average catheterized volumes corresponding to a bladder pressure of >40 cm H(2)O, and are therefore theoretically at risk for upper tract deterioration. CONCLUSION: Many spina bifida patients receive urologic care only as children, and those without urinary calculi or urinary incontinence are assumed to be urologically stable. However, certain patients have urodynamic parameters which put them at risk for renal deterioration even if they appear to be problem-free. We recommend a yearly renal ultrasound and serum creatinine determination in all adult spina bifida patients with immediate urologic consultation and urodynamics if either is abnormal.

    Title Stuttering Priapism in a Liver Transplant Patient with Toxic Levels of Fk506.
    Date April 2000
    Journal Urology
    Excerpt

    This is the first report of stuttering priapism in a liver transplant patient with toxic levels of the immunosuppressive agent FK506. To date, stuttering priapism has only been reported in patients with sickle cell disease and is not currently listed in the toxicity profile of FK506 or cyclosporine, a drug with a similar mechanism of action. The erections resolved when the FK506 levels normalized. We review the possible mechanisms by which FK506 may have caused these erections.

    Title Testicular Cysts: Management and Literature Review.
    Date December 1999
    Journal The Journal of the American Osteopathic Association
    Excerpt

    Simple testicular cysts are extremely rare; only 20 cases have been reported in the literature. Sites include the tunica albuginea, tunica vaginalis, and testicular epidermis. Conservative enucleation is an effective treatment for these lesions once ultrasound examination establishes that the mass is cystic. Such Enucleation salvages testicular tissue. In the cases discussed, two patients were initially evaluated for vague testicular discomfort and one patient for male infertility. All were subsequently found to have benign testicular cysts. All the cysts were excised, and all patients remain disease-free. Included is a case series report of simple testicular cysts and a review of the literature.

    Title Reassessing the Role of Urodynamics After Cerebrovascular Accident. Males Versus Females.
    Date March 1999
    Journal Urologia Internationalis
    Excerpt

    BACKGROUND AND PURPOSE: To determine whether there is a gender difference in the need for urodynamics in the evaluation of urinary incontinence after cerebrovascular accident (CVA). MATERIALS AND METHODS: We studied 72 consecutive post-CVA patients with new onset urinary incontinence documented by the patients or the persons who looked after them. Patients were evaluated between 4 and 6 weeks after their CVA and all had negative urine cultures and a postvoid residual urine determination. Exclusion criteria included narrow angle glaucoma, postvoid residual urine greater than 100 cm3 and radiographic evidence for a brainstem infarct. This left 30 male (mean age 65) and 30 female (mean age 67) patients evaluable. Patients were empirically started on anticholinergic medications and timed voids for 4 weeks after which cytoscopy and cystometry were performed. RESULTS: 28/30 females (93%) reported subjective improvement in their continence with conservative measures. 1 (3%) was found to have a urethral diverticulum, and 1 (3%) had uninhibited detrusor contractions that did not improve with medications. In the male group, 20/30 (67%) reported subjective improvement, 5 (17%) developed elevated postvoid residual urine volumes, 3 (10%) were diagnosed with urethral strictures, 1 (3%) had a bladder neck contracture, and 1 (3%) had transitional cell carcinoma in situ in the bladder. CONCLUSION: In the patient with new onset urinary incontinence in the initial period after CVA, an empiric trial of anticholinergic medications and timed voiding may be warranted in a select population of female patients without urodynamic testing or cystoscopy. This conservative approach may not be appropriate in males because of their increased likelihood of having secondary urologic conditions.

    Title Rare Presentation of Acute Urinary Retention Secondary to Herpes Zoster.
    Date November 1998
    Journal The Journal of the American Osteopathic Association
    Excerpt

    There are many causes of acute urinary retention. Reported here is a case of one of the more rare causes: herpes zoster. Fewer than 70 cases have been reported in the literature since 1890. In the present clinical environment where many patients are immunocompromised, reports of herpes zoster and its sequelae are no longer thought of as anecdotal. The virus may interrupt the detrusor reflex due to involvement of the sacral dorsal root ganglia. Urinary retention with sensory loss of both bladder and rectum as well as flaccid paralysis of the detrusor can develop in patients with herpes zoster. Fortunately, the outcome of this process is benign and full recovery of the detrusor is likely.

    Title Prostatic Adenocarcinoma Diagnosed by Prostate-specific Antigen Analysis of Pleural Fluid.
    Date September 1998
    Journal Urologia Internationalis
    Excerpt

    Adenocarcinoma of the prostate may result in a malignant pleural effusion. However, most of these cases involve patients with either a known primary prostate cancer or radiographic evidence of pulmonary metastases. Occasionally, the initial diagnosis of prostate cancer is made because of prostate-specific antigen (PSA) staining cells in the pleural fluid. We report a case of adenocarcinoma of the prostate that was suspected only because of an elevated PSA in the pleural fluid in a patient who lacked malignant cytology, a history of prostate cancer, and radiographic evidence of pulmonary disease.

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