Urology News Feeds

Pathologic Specimens at Time of Pyeloplasty: Frequency and Practice Patterns

Urology (Gold Journal) In Press - Wed, 09/05/2018 - 00:00
To assess national and regional practice patterns and rates of pathologic specimen identification sent at time of pyeloplasty, as well as project associated costs, we used a national administrative database. The rate at which the excised UPJ is sent for pathologic identification is variable, arguably without a clear clinical purpose.
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Detection and Treatment of Primary Prostatic Melanoma

Urology (Gold Journal) In Press - Wed, 09/05/2018 - 00:00
Primary melanoma of the genitourinary (GU) tract is a very rare disease, representing less than 1% of all melanomas in men 1. The majority develop from the penis and distal urethra, with fewer cases of primary melanoma originating more proximally along the GU tract. Of the described cases of prostatic melanoma, most are of prostatic urothelial origin or secondary to metastatic disease 2. To our knowledge, only six cases of primary melanomas have been reported in the English literature to have unequivocally originated from the prostatic parenchyma (Table 1) (3-8).
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Understanding the popcorn effect during holmium laser lithotripsy for dusting

Urology (Gold Journal) In Press - Wed, 09/05/2018 - 00:00
To assess low and high power settings for the popcorn technique, and relationship of laser fiber-to-stone distance and calyceal size on submillimeter fragmentation. Our in-vitro findings may help guide strategies to improve a dusting technique for ureteroscopy.
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Single Session Bilateral Versus Staged Bilateral Ureteroscopy for Nephrolithiasis: An Assessment of Safety and Efficacy

Urology (Gold Journal) In Press - Wed, 09/05/2018 - 00:00
To compare outcomes of patients undergoing SSBU to those undergoing planned staged URS for bilateral nephrolithiasis. While single session bilateral ureteroscopy (URS) (SSBU) has the advantage of one anesthetic procedure, some may pursue a staged approach due to the potential higher risk of complications and patient discomfort with two ureteral stents.
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Anaphylactoid Reactions after Instillation of Contrast Material into the Urinary Tract: A Survey of Contemporary Practice Patterns and Review of the Literature

Urology (Gold Journal) In Press - Wed, 09/05/2018 - 00:00
To assess drug reactions (ADRs) encountered by practicing urologists for contrast instilled into the urinary collecting system, and to describe current practice patterns regarding contrast administration into the urinary tract for patients with known contrast allergies.
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Urologic conditions lead to depression, sleep issues in men

MedicalNewsToday - Tue, 09/04/2018 - 16:00
Physicians need to be aware that men with urologic conditions often have depression and sleep problems and should refer them appropriately, says a study.
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Editorial Comment

In partial nephrectomy for a cystic mass the widely recognized challenge resides in the fact that rupture of the cystic wall might translate into “spillage” of cancerous cells. This is concerning, especially when working in a closed environment (the pneumoperitoneum). The authors performed this intriguing study on those partial nephrectomies in which a cystic renal mass was inadvertently “ruptured.” They reviewed 268 cases done in open or robotic fashion at a total of 8 European institutions and recorded an 18% rupture/effraction/spillage rate, which is nonnegligible.
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Editorial Comment

The authors report 50 intraoperative CRs in this multi-institutional experience with 268 partial nephrectomies for cystic renal masses. In the patients with CR final pathology revealed malignancy in 38 (77.5%) with Fuhrman grade 2 tumors in 69% and grade 3 or greater tumors in 12%. Although it is disconcerting for the surgeon when CR occurs, it is encouraging that there was no local or systemic recurrence at a median followup of 40 months in the CR group while there was a 2.5% local recurrence rate in the nonCR group.
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Editorial Comment

Proper information and communication are essential in the process of individualized treatment decision making in men with localized prostate cancer.1,2 The randomized ProtecT trial (Prostate Testing for Cancer and Treatment, ClinicalTrials.gov NCT02044172) did not show any difference in generic anxiety scores among surgery, radiation or monitoring. Using compacted measures the current study confirms favorable long-term anxiety levels in men who are treated expectantly.
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Outcomes and Quality of Life Among Men After Anal Sphincter-Sparing Transperineal Rectourethral Fistula Repair

Urology (Gold Journal) In Press - Tue, 09/04/2018 - 00:00
To describe long-term quality of life (QOL) outcomes after rectourethral fistula (RUF) repair. RUF is a debilitating diagnosis and complex surgical dilemma with limited data regarding QOL after repair.
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Editorial Comment

Sonpavde et al report the results of a study evaluating the optimal number of cycles of first line, platinum based chemotherapy in patients with advanced urothelial carcinoma. While trials have been done to investigate the most effective platinum based regimen, there is limited guidance regarding the optimal number of cycles of chemotherapy.1 Based on the results of these trials most patients in clinical practice are treated with the goal of completing 6 or more cycles, a number that was arbitrarily chosen in these trials.
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Which Patients with Negative Magnetic Resonance Imaging Can Safely Avoid Biopsy for Prostate Cancer?

To determine if there is a sub-set of men who can avoid prostate biopsy (PBx), based on multi-parametric MRI (mpMRI) and clinical characteristics.
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The Impact of Positron Emission Tomography with 18F-Fluciclovine on the Management of Patients with Biochemical Recurrence of Prostate Cancer: Results from the LOCATE Trial

The prospective, multicenter LOCATE trial assessed the impact of positron emission tomography/computed tomography (PET/CT) with 18F-fluciclovine on management plans for patients with biochemical recurrence (BCR) of prostate cancer after curative-intent primary therapy.
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Role of Stereotactic body radiation therapy in the management of oligometastatic renal cell carcinoma

Kidney cancer has been increasing by 1.7% annually. Renal cell carcinoma (RCC) is the most common kidney cancer, and can metastasize. Our aim is to analyze patients treated with Stereotactic Body Radiation Therapy (SBRT) on metastases from RCC.
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Coffee, Caffeine Metabolism Genotype, and Disease Progression in Localized Prostate Cancer Patients Managed with Active Surveillance

Active surveillance (AS) is increasingly used as a management strategy for localized prostate cancer. Coffee intake has been associated with lower prostate cancer incidence; and we assessed whether coffee was associated with disease progression in men on AS.
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Genomic Prostate Score, PI-RADSv2, and Progression in Men with Prostate Cancer on Active Surveillance

OncotypeDx Genomic Prostate Score (GPS) is a 17-gene RNA expression assay intended to help guide treatment decisions for men diagnosed with prostate cancer. The Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) was developed to standardize the risk stratification of lesions identified on multiparametric prostate MRI. We sought to determine whether these tests are associated with increased risk of biopsy upgrade in men on active surveillance (AS).
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Clinical and Radiographic Predictors of Great Vessel Resection or Reconstruction During Retroperitoneal Lymph Node Dissection for Testicular Cancer

Urology (Gold Journal) In Press - Sat, 09/01/2018 - 00:00
To evaluate whether specific clinical or radiographic factors predict inferior vena cava (IVC) or abdominal aortic (AA) resection or reconstruction (RoR) at the time of post-chemotherapy retroperitoneal lymph node dissection (RPLND) for germ cell tumors of the testicle.
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Reply by Authors

We are familiar with the anatomical dimensions of the prostate since the senior author was the first to describe them in The Journal of Urology in 1993 (reference 13 in article). We find that real-time intraoperative 3-dimensional guided MRI pelvic floor dissection is more valuable than static preoperative studies and better facilitates safe pelvic dissection, whichever type of repair is chosen at initial closure.1 Finally, because ours is a referral center and we have seen more than 25 young patients with loss of the glans, corpora or both with penile disassembly and radical soft tissue mobilization, we avoid these 2 procedures.
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Editorial Comment

This study offers unique observations on the anatomical dimensions of the prostate and the prostatic, periprostatic, pudendal and penile vasculature using MRI before surgical reconstruction in males with bladder exstrophy compared to normal controls. Awareness of the vascular anatomy in this region is intuitively paramount as any damage to these structures during surgery can cause significant morbidity, eg penile loss during radical soft tissue mobilization.1 Unfortunately the authors did not attempt to correlate the findings on preoperative MRI with the intraoperative findings, treatment choices, modifications of the anatomy postoperatively or outcome of the repair.
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Reply by Authors

The comment addresses the importance of having patients understand the implications of the choice of whether to leave the vagina intact. In this light we emphasize the value of shared decision making in this field.
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