Urology News Feeds
In this series the rate of fistula at the proximal urethral anastomosis (the connection of the native urethra to the urethroplasty portion of the urethra, which is made of tubularized paravaginal flaps) more than doubled from 21% to 48% when simultaneous vaginectomy was not performed. The reasons for this are clear. When the vagina is removed, several more layers can be added to this otherwise delicate urethral suture line. 1) The bulbospongiosus muscle, which in the natal female is splayed out rather than encircling the urethra as in the natal male, can be freed and used to cover the midline urethral suture lines.
The PICTURE study (references 13 and 14 in article) and the companion PROMIS study (reference 1 in article), in which men being evaluated for prostate cancer underwent magnetic resonance imaging followed by a comprehensive mapping biopsy, are monumental contributions. The biopsy procedure involved transperineal template sampling of the prostate at 5 mm intervals and often more than 60 cores of tissue were obtained at 1 sitting. The work helped establish the value of MRI in men suspected of having prostate cancer.
In this study a cost-effective analysis was done comparing the performance of TRUSB in all men with elevated PSA and the use of various biomarkers or magnetic resonance imaging first and only performing biopsy if the biomarker was positive. The study modeled biopsy outcomes and likely management strategies. All costs, utilities and other inputs that went into the model were ascertained from the literature.
Patients in the study group had biopsy proved, high grade UTUC as well as a visible lesion on axial imaging and underwent neoadjuvant chemotherapy followed by RNU. By comparison, patients who had biopsy proved, high grade UTUC but no visible lesion on axial imaging underwent RNU alone. Neoadjuvant chemotherapy was not offered to patients with CIS on ureteroscopic biopsy only. Patients in our study group likely had increased rates of CIS on final surgical pathology because CIS is conventionally unresponsive to chemotherapy, and as a result CIS was the only residual disease in patients who responded effectively to neoadjuvant chemotherapy.
Re: Comparison of Pathological Stage in Patients Treated with and without Neoadjuvant Chemotherapy for High Risk Upper Tract Urothelial Carcinoma
Liao et al report outcomes of patients with high risk upper tract urothelial carcinoma (UTUC) treated with or without neoadjuvant chemotherapy. The survival rate of patients with high risk UTUC is poor despite the fact that radical nephroureterectomy (RNU) has been the standard treatment for this condition. The authors suggest that patients treated with neoadjuvant chemotherapy before RNU had a reduction in pathological tumor stage and a decreased prevalence of pT2 or higher disease. Interestingly we noted that the prevalence of Tis was higher in patients who had undergone neoadjuvant chemotherapy than those who had not.
How Would MRI-Targeted Prostate Biopsy Alter Radiation Therapy Approaches in Treating Prostate Cancer?
To determine if MRI/ultrasound fusion-targeted prostate biopsy (TB) would lead to increased recommendations of aggressive radiotherapy treatments for higher risk prostate cancer compared to systematic biopsy (SB) results.
A Population Based Cohort Study of the Impact of Infectious Complications Requiring Hospitalization after Prostate Biopsy on Radical Prostatectomy Surgical Outcomes
To compare radical prostatectomy outcomes in men with and without exposure to a major infectious event within 30-days of a prior TRUS-biopsy.
A novel scoring system for prediction of prostate cancer based on shear wave elastography and clinical parameters
To develop a novel scoring system for the prediction of prostate cancer (PCa).
Effect of Kallikrein-related Peptidase KLK1 on Ameliorating Spermatogenesis Regeneration in Busulfan-induced Azoospermic Mice and Promoting Mouse Spermatogonial Stem Cell Proliferation In vitro
To investigate the effect of kallikrein-related peptidase KLK1 on azoospermic mice induced by busulfan and mouse spermatogonial stem cell.
Ileocalicostomy Ureteral Substitution for Complex Ureteropelvic Junction Stricture: Technique and Initial Experience
To present our novel surgical technique, ileocalicostomy ureteral substitution, for the management of long upper ureteral strictures in patients without a dilated extra-renal pelvis.
Preliminary kidney parenchymal ligation using Endoloop® ligatures—A simple method to achieve a trifecta in laparoscopic partial nephrectomy without hilar clamping for polar complex tumors
To describe a novel and simple technique of preliminary kidney parenchymal ligation using Endoloop® ligatures during laparoscopic partial nephrectomy (PN) without hilar clamping for polar complex tumor cases.
An asymptomatic 64 year-old male with an elevated PSA of 28.0 ng/dL underwent transrectal ultrasound-guided prostate biopsy and was diagnosed with Gleason 8 (4+4) ductal adenocarcinoma in 8/12 cores sampled. Bone scan, chest x-ray and abdominal CT scan were all radiographically negative for metastatic disease. He underwent curative intensity-modulated radiation therapy (IMRT) with 79.2 Gy in 44 fractions as well as adjuvant androgen deprivation (ADT) incorporating leuprolide, per AUA and NCCN guidelines.
Clinical evaluation of an individualized risk prediction tool for men on active surveillance for prostate cancer
To determine whether providing individualized predictions of health outcomes to men on active surveillance (AS) alleviates cancer-related anxiety and improves risk understanding.
Acceptability of Mobile Health Technology for Promoting Fluid Consumption in Patients with Nephrolithiasis
To evaluate kidney stone patients’ interest in lifestyle behavior modification and a variety of mobile health (mHealth) technologies to improve adherence to fluid consumption recommendations for the prevention of nephrolithiasis. Of particular interest was the acceptability of various intervention components for the design of a stone-specific mHealth technology.
Trans-perineal approach for Intracorporeal Ileal Conduit Urinary Diversion using a Purpose-Built Single-Port Robotic System: step-by-step
To describe the step-by-step technique for single-port trans-perineal intracorporeal ileal conduit urinary diversion using a purpose-built robotic platform.
In this study Kowalik et al found that 50% of women with OAB symptoms reported painful bladder filling and/or painful urgency. These are classic symptoms of IC/BPS (reference 8 in article). Yet a subset of patients with OAB reported bladder pain and comorbid pain conditions similar to IC/BPS.
Stratification of patients with interstitial cystitis/bladder pain syndrome according to the anatomical bladder capacity.
To compare the data of score symptoms (ICPI, ICSI, PUF and SF-36), voiding diaries, urodynamic studies and cystoscopy under general anaesthesia according to the anatomical bladder capacity for patients with IC/BPS.
Better characterize granular cell tumor of the bladder, with only 20 cases reported to date and unclear management guidelines.
Care Seeking Patterns for Women Requiring a Repeat Pelvic Organ Prolapse Surgery due to Native Tissue Repair Failure Compared to a Mesh Complication
To explore patient migration patterns in patients requiring repeat surgery after Pelvic Organ Prolapse repair as there is a limited understanding of care seeking patterns for repeat surgery after Pelvic Organ Prolapse (POP) repair. We hypothesized that undergoing repeat surgery for a prolapse mesh complication would be associated with an increased incidence of migration to a new facility for care compared to those undergoing repeat surgery for recurrent POP.
A 62-year-old male with a past medical history of cigarette smoking and laparoscopic repair of bilateral inguinal hernias using total extraperitoneal (TEP) mesh presented with persistent dysuria and perineal pain. Urine culture was negative, and he was treated with an extended course of antibiotics for a working diagnosis of prostatitis. His urinary symptoms improved but he returned with gross hematuria a few months later. CT Urogram was concerning for a bladder tumor, with soft tissue thickening from the dome of the bladder extending to the abdominal wall and left inguinal region.