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Changes in Weight and Metabolic Syndrome are Associated with Prostate Growth Rate Over a 5 Year Period : Reply
We appreciate your comments and understand your question. The variables were statistically evaluated based on the assumption of normality (Figure 1). There were no interactions between most variables in the multivariable regression model. However, weight, BMI, and WC were found to have multicollinearity. Thus, we selected the weighted variables and removed BMI and WC, because we focused on the correlation between weight status and prostate volume. We agree that SBP and DBP are subject to individual fluctuations over time and can lead to regression dilution bias.
We presented our experience in the treatment of Peyronie disease (PD) with grafting procedure using porcine small intestinal submucosa. In spite of the average curvature of 80°, 82% of the patients had the curvature completely corrected. Dr. Drogo K. Montague addressed 2 main issues related to thesurgical treatment of PD: erectile dysfunction (ED) and penile shortening.
In this series of 28 men with Peyronie disease who had dorsal plaques and dorsal curvature, small intestinal submucosa grafting was done to correct dorsal curvature. Stretched penile length from the pubis to glans tip was measured by the same surgeon pre- and postoperatively. Pre- and postoperative erectile rigidity was subjectively evaluated by the patient and the surgeon as being either sufficient or not sufficient for penetration.
Diuretic renography in neonates with prenatally detected hydronephrosis is integral to identifying obstructive causes requiring surgical intervention to preserve renal function from nonobstructive pelvicalicectasis that resolves spontaneously.1 Sussman et al address the limitations of over reliance on T½ of collecting system emptying after diuretic challenge despite use of the well-tempered renogram (reference 4 in article). In addition to differential renal function and T½ on initial diuretic renography, they examined CUP and C30, 2 parameters measuring the percent of emptying based on the region of interest count.
In infants with SFU (Society for Fetal Urology) grade 3-4 congenital hydronephrosis, 99mTc-mercaptoacetyltriglycine diuretic renography assesses differential function and drainage half-time. We routinely also include the percent of radiotracer drained after 30 minutes of diuresis as well as after 15 minutes with the patient in the upright position. We investigated whether any 1 or more of these parameters on initial diuretic renography predicts persistent or worsening drainage parameters.
Patients with locally inoperable primary tumors or advanced regional or distant metastatic penile cancer continue to represent a therapeutic dilemma.1 Neoadjuvant chemotherapy with subsequent surgical consolidation among responding patients can result in long-term survival in a subset. However, 40% to 50% of such patients do not respond and novel therapeutic strategies are required.2
Therapeutic advances for penile squamous cell carcinoma are still awaited, mainly for advanced stages, due to the small available numbers and the difficulties in performing academic research in the field.1 Ottenhof et al provide the results of a large immunohistochemical analysis of PD-L1 expression in primary tumor samples from patients with penile squamous cell carcinoma. Results revealed that a high proportion of patients expressed PD-L1, mainly those with HPV negative tumors. Also, PD-L1 expression was negatively prognostic for a patient subgroup.
We appreciate the valuable points raised by the comments. We agree that there is a need for uniformity and standardization of urodynamic interpretation, especially when multi-institutional trials are based on urodynamic outcomes. We are currently expanding our pilot study to multi-institutional participation and plan to incorporate our findings into a comprehensive standardized form guiding the interpretation of urodynamic studies.
By performing this unique experiment (having members of the Division of Pediatric Urology at Vanderbilt, all of whom are well versed in reading urodynamic tracings, examine a series of representative studies), these authors have again demonstrated the need for developing uniformity in performing and interpreting urodynamic investigations.1
Urodynamics is arguably the most critical urological test for children with neurogenic bladder. Our assessments of detrusor leak point pressure, of bladder compliance, of the bladder neck and external sphincter, and of detrusor overactivity form the basis of virtually all risk stratification algorithms for children with neurogenic bladder, including the CDC (Centers for Disease Control and Prevention) NSBPR and Newborn Urologic Protocol.1 Therefore, this report by Dudley et al is of paramount importance as it calls into question the reproducibility and objectivity of this test.
Urodynamic studies are crucial to neuropathic bladder management and they often determine surgical intervention. However, current evidence indicates that interpretations show poor agreement across physicians. We sought to determine the interrater reliability of urodynamic interpretation in our practice. We hypothesized that there would be strong correlation among pediatric urologists of similar training in a single academic practice.
We highly appreciate the editorial comments. Undescended testes are one of the most common congenital abnormalities of the genitourinary tract and intra-abdominal testes are a frequent condition treated by pediatric urologist. As we have mentioned in our article, the most appropriate approach for treatment of intra-abdominal testes using single-stage laparoscopic orchiopexy or laparoscopic staged Fowler–Stephens remains the practitioner's choice and continued research is needed to define the best surgical approach.
This retrospective review of a large series of intra-abdominal testes treated by single-stage and staged laparoscopic orchidopexy by multiple surgeons in a single institution offers some valuable insights into the treatment of this regularly encountered condition. The main contributions of their study are that abdominal undescended testes may be safely corrected by either single-stage or staged techniques, although some differences are noted: 4 of 50 atrophies (8%) in the single-stage group and an increased risk of unsatisfactory postoperative positioning (20%) vs 4 or 35 atrophies (11.4%) in the staged group and none with an abnormal postoperative positioning.
Frailty and the role of obliterative versus reconstructive surgery for pelvic organ prolapse; a national study
To determine whether frailty affects the type of pelvic organ prolapse (POP) surgery performed and the odds of postoperative complications.
A strategy of alternately flooding and starving the body of testosterone is producing good results in patients who have metastatic prostate cancer that is resistant to treatment by chemical or...
In a recent study, a simple exercise program carried out at home improved dialysis patients' walking performance and quality of life.
The Lue group makes a cogent argument that collagenase Clostridium histolyticum (CCH) therapy does not yield similar outcomes in all patients, hence the importance of proper patient selection. In our practice, the majority of men with Peyronie disease (PD) receive a complete evaluation, including a penile duplex Doppler ultrasound. Patients who demonstrate severely compromised sexual function on history, the Sexual Health Inventory for Men questionnaire, and penile duplex Doppler ultrasound are directed to alternative approaches, such as the insertion of an inflatable penile prosthesis.
This article reports the results of a retrospective review of 77 Peyronie disease (PD) patients treated with collagenase clostridium histolyticum (CCH) from April 2014 to March 2106. Of these patients, 41 patients completed 4 cycles of treatment. For all-comers, curvature improved from pretreatment 58.2° to posttreatment 41°. The authors concluded that therapeutic benefit may decline after the third cycle of treatment and that patients who had a ≥20% final reduction in curvature has a significantly greater change in curvature following the first injection (−16.2° vs −5.8°).
A new case report about a woman with a UTI who became ill from high water intake raises questions about doctors' advice to 'drink plenty of fluids.'
Magnetic Resonance Imaging Provides Added Value to the Prostate Cancer Prevention Trial Risk Calculator for Patients with Estimated Risk of High Grade Prostate Cancer Less Than or Equal to 10%
To determine the added value of prostate MRI to the Prostate Cancer Prevention Trial risk calculator.