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Old Tools, Old Problems, New Solution: the Use of a Modified Cecil-Culp Concept in the Trauma Setting

21 hours 26 min ago
A 12-year-old boy sustained a close-range shotgun wound with buckshot to the penis and lower abdomen. The proximal two-thirds of the corpora cavernosa were obliterated, and the distal third was thrombosed. All dorsal penile skin was lost. The urethra remained intact. The patient underwent multiple debridements, allowing the wound to declare its borders. Employing the tissue transfer concept used by Cecil and Culp in hypospadias repairs, the penis was marsupialized onto the suprapubic area where it remained for 8 months.
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Physicians' Perceptions of Factors Influencing the Treatment Decision-Making Process for Men with Low-Risk Prostate Cancer

21 hours 26 min ago
To assess physicians' attitudes regarding multiple factors that may influence recommendations for AS vs. AT given the central role physicians play in the treatment-decision making process.
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Use of a 17-gene prognostic assay in contemporary urologic practice: results of an interim analysis in an observational cohort

21 hours 26 min ago
To study the impact of genomic testing in shared decision making for men with clinically low risk prostate cancer (PCa).
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Expanding Immunotherapy Options for Bladder Cancer

21 hours 26 min ago
KEYNOTE-045 was a phase 3 multicenter open-label randomized trial of the PD-1 inhibitor pembrolizumab versus second line chemotherapy in patients with advanced urothelial cancer. It included patients previously treated for advanced disease with a platinum-containing regimen as well as those who recurred within 12 months of receiving perioperative chemotherapy for muscle-invasive disease. To be eligible, patients had to have a good ECOG performance status (PS score of 0 or 1). Patients with an ECOG PS score of 2 were allowed only if they had none of the other three Bellmunt risk factors (hemoglobin under 10 g/dL, liver metastasis or last chemotherapy within the past 3 months) [1].
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Ointment Fistulography: Introducing a Novel Technique for Single or Multiple Urethrocutaneous Fistula Diagnosis after Hypospadias Surgery

21 hours 26 min ago
Hypospadias is a common congenital malformation of the male genital tract. The most frequent complication after hypospadias repair is urethrocutaneous fistula (1). Its incidence has been reported up to 35% worldwide (2). The diagnosis of these fistulas is sometime challenging particularly with tiny and multiple fistulas. Usually parents complain of urinary spraying, sprinkling or passing a single stream of urine from the undersurface of the penis after the surgery. Urethrocutaneous fistulas are not always visible on physical examination.
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Letter to the Editor

Mon, 04/24/2017 - 00:00
We read with great interest the recent manuscripts by Pak et al.1 and Borza et al.2, each who investigated open vs robotic cystectomy regarding outcomes and 30-day readmissions, respectively. We applaud the authors for their analyses comparing these two techniques of radical cystectomy. We believe that they are an important contribution, as the benefit of incorporating robotic surgery for radical cystectomy remains unclear. To date, there are no published large, multi-center randomized controlled comparative studies trials on this topic.
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Minimally Invasive Inguinal Lymphadenectomy in the Management of Penile Carcinoma

Mon, 04/24/2017 - 00:00
To report and analyze the outcomes of endoscopic inguinal lymph node dissection (E-ILND), inclusive of video endoscopic ILND (VEIL) and robotic-assisted ILND (RAIL) approaches, in the largest reported series to date.
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Reply

Mon, 04/24/2017 - 00:00
We appreciate the editorial comments. There has been substantial heterogeneity among published studies that explore the capabilities of detecting prostate cancer with multiparametric magnetic resonance imaging (mpMRI).1-3 Not surprisingly, differences in patient population, magnetic field strength, techniques, reference standard, methodology, reader experience, and interpretation criteria have resulted in a broad range of negative predictive values from 63% to 98%.1,2
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Editorial Comment

Mon, 04/24/2017 - 00:00
Multiple studies have demonstrated that multiparametric magnetic resonance imaging (mpMRI) can significantly improve the detection of prostate cancers belonging to Grade Groups ≥2 when compared with systematic transrectal ultrasound-guided biopsies.1 The ability of mpMRI to predict a negative systematic biopsy result has also been demonstrated, although to a lesser extent; this is considered one of the main potential benefits of mpMRI, as it could help reduce the number of unnecessary biopsies, cases of overtreatment, and any associated side effects.
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Editorial Comment

Fri, 04/21/2017 - 00:00
In this article, Dr. Morey and his group report their outcomes with urethral ligation with suprapubic tube drainage, as an alternative to formal urinary diversion or persistent severe urinary incontinence, in older debilitated men with “end-stage” urethra following artificial urinary sphincter (AUS) placement. The authors subjectively describe end-stage urethra as a compromised, nonviable bulbar urethra that is not amenable to AUS replacement following AUS cuff erosion in a patient with a history of either open urethroplasty or AUS cuff erosion.
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Atypical Small Acinar Proliferation and High Grade Prostatic Intraepithelial Neoplasia in the Era of Multi-Parametric MRI: a Contemporary Review

Fri, 04/21/2017 - 00:00
Multiparametric Magnetic Resonance Imaging (mpMRI) has added to the armamentarium for the diagnosis and surveillance for organ confined prostate cancer. Atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) are premalignant prostatic lesions. The management of such lesions remains contentious, and the addition of mpMRI introduces further uncertainty given its ability to pick up indolent lesions and its use in targeted biopsy. We aimed to perform a comprehensive review of current evidence regarding ASAP, HGPIN and mpMRI to ascertain a consensus for a current management algorithm.
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Near-Infrared Intraoperative Molecular Imaging Can Identify Metastatic Lymph Nodes in Prostate Cancer

Fri, 04/21/2017 - 00:00
To propose a novel method to perform indocyanine green (ICG) based near-infrared (NIR) fluorescence imaging during pelvic lymph node dissection (PLND) for prostate cancer patients with lymph node metastasis (LNM).
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Diagnostic Accuracy of Cu-PSMA PET/CT for Primary Lymph Node Staging of Intermediate to High Risk Prostate Cancer: Our Preliminary Experience

Fri, 04/21/2017 - 00:00
To assess the diagnostic accuracy of 64Copper Prostate-Specific Membrane Antigen (64Cu PSMA) positron emission tomography/computed tomography (PET/CT) in the primary lymph node (LN) staging of a selected cohort of intermediate-high risk Prostate Cancer (PCa) patients.
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The Impact of Multiple Prostate Biopsies on Risk for Major Complications Following Radical Prostatectomy: a Population-Based Cohort Study

Fri, 04/21/2017 - 00:00
To evaluate the impact of multiple transrectal ultrasound-guided prostate biopsies (TRUS-Bx) before radical prostatectomy (RP) on surgical outcomes.
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Laser Endopyelotomy in the Management of Pelvi-Ureteric Junction Obstruction in Adults: a Systematic Review of the Literature

Fri, 04/21/2017 - 00:00
Laser endopyelotomy (LEP) is considered as an option to treatment of pelvi-ureteric junction obstruction (PUJO) in adults. A comprehensive systematic search of the published literature was performed to assess the success rate and peri-operative complications of LEP in the treatment of primary and secondary PUJO and identify the factors that may impact of the success of LEP. The evidence available has significant limitations with heterogeneous study design and definitions of outcomes. The average overall success rate of the pooled data was 75% with a mean follow-up of 29 months.
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Bladder Recurrence of Clear Cell Sarcoma of the Kidney 7 Years after Initial Presentation

Fri, 04/21/2017 - 00:00
Clear cell sarcoma of the kidney (CCSK) is the second most common pediatric renal malignancy after Wilms tumor. CCSK has the potential to metastasize to distant sites and was historically known as the bone metastasizing renal tumor. We report an exceedingly rare case of a bladder recurrence of CCSK. Our patient presented with gross hematuria 7 years after initial complete response. He was found to have a large sessile bladder tumor and underwent a partial cystectomy with right pelvic lymph node dissection.
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The Expanding Role of Advanced Practice Providers in Urologic Procedural Care

Thu, 04/20/2017 - 00:00
To understand the role of Advanced Practice Providers (APPs) in urologic procedural care, and its change over time. As the population ages and the urologic workforce struggles to meet patient access demands, the role of APPs in the provision of all aspects of urologic care is increasing. However, little is currently known about their role in procedural care.
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Clinical Efficacy of 1-Year Intensive Systematic Dietary Manipulation as Complementary and Alternative Medicine Therapies on Female Interstitial Cystitis/Bladder Pain Syndrome Patients

Thu, 04/20/2017 - 00:00
To evaluate the clinical efficacy of intensive systematic dietary manipulation (ISDM) for female patients with interstitial cystitis (IC)/bladder pain syndrome (BPS) in stable condition who were followed in our hospital.
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Could Reduced Fluid Intake Cause the Placebo Effect Seen in Overactive Bladder Clinical Trials? Analysis of a Large Solifenacin Integrated Database

Thu, 04/20/2017 - 00:00
OBJECTIVETo assess the hypothesis that patients receiving placebo in overactive bladder (OAB) trials who experience less benefit from ‘treatment’ continue with behavioral modifications such as fluid restriction, whereas those on active treatment adopt more normal drinking patterns. This may manifest itself as a reduction in micturition frequency (MF).MATERIALS AND METHODSWe interrogated a large integrated database containing pooled patient data from 4 randomized, placebo-controlled phase III OAB solifenacin studies.
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Cytoreductive Prostatectomy for Metastatic Prostate Cancer: First Lessons Learned From the Multicentric Prospective LoMP Trial

Thu, 04/20/2017 - 00:00
To prospectively evaluate patients with newly diagnosed metastatic prostate cancer (mPCa) in the context of the LoMP trial (which investigates the role of cytoreductive radical prostatectomy [cRP] in addition to standard of care [SoC]). To provide a preliminary analysis of patient's characteristics, safety of cRP and early local symptoms.
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