Clinical judgment versus biomarker prostate cancer gene 3: which is best when determining the need for repeat prostate biopsy?

Objective: To assess the value of best clinical judgment (BCJ) and the prostate cancer gene 3 (PCA3) assay in guiding the decision to perform a repeat prostate biopsy (PBx) after a previous negative PBx.

Materials And Methods: Using the RAND/UCLA Appropriateness Method, 12 European urologists established recommendations (BCJ) for the appropriateness of PBx according to the prostate-specific antigen level, digital rectal examination findings, number of previous negative PBxs, prostate volume, and life expectancy, with and without consideration of the PCA3 scores. These recommendations were applied to 1024 subjects receiving placebo in the Reduction by Dutasteride of Prostate Cancer Events trial, including men with a previous negative PBx, a baseline prostate-specific antigen level of 2.

Intraoperative colonoscopy does not worsen the outcomes of laparoscopic colorectal surgery: a case-matched study.

Background: Intraoperative colonoscopy is sometimes needed as an adjunct to colorectal surgery. When it is performed with laparoscopic surgery, there is the potential for prolonged bowel distension, obstructed surgical exposure, and increased morbidity. This study aimed to evaluate the overall safety and outcomes of laparoscopic colorectal procedures in which intraoperative colonoscopy was performed.

Preoperative pelvic radiation increases the risk for ileal pouch failure in patients with colitis-associated colorectal cancer.

Background And Aims: To evaluate the impact of preoperative radiation on pouch outcomes in patients with colitis-associated cancer (CAC).

Methods: CAC patients who underwent restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) from 1984 to 2009 were identified from our registry. The impact of preoperative pelvic radiation for CAC or other pelvic cancer on pouch related outcomes was evaluated.

Gender differences in benign renal masses.

Purpose: To examine gender-specific differences in benign renal tumors.

Methods: This retrospective study included 135 adult Caucasian patients with 143 benign renal tumors, which were treated surgically at a single institution. Demographics, comorbidity, histology, renal function, and management were compared by gender.

Consequences of anastomotic leak after restorative proctectomy for cancer: effect on long-term function and quality of life.

Background: Long-term consequences of anastomotic leak after restorative proctectomy for rectal cancer, in terms of bowel function and quality of life, have been poorly delineated.

Objective: The purpose of this study is to evaluate the impact of anastomotic leak, when intestinal continuity can still be maintained, on bowel function and quality of life in patients undergoing rectal cancer resection with low colorectal or coloanal anastomoses.

Design: From 1980 to 2010, 864 patients undergoing restorative resection for rectal cancers were identified from a prospective cancer database.

Manometric evaluation of evacuatory difficulty (dyschezia) in ileal pouch patients.

Background: Dyschezia occurs in patients with ileal pouch-anal anastomosis. There are limited data on the mechanisms of this condition. We hypothesized that paradoxical contractions may contribute to dyschezia in those patients with mechanical or inflammatory pouch conditions.

Backwash ileitis and the risk of colon neoplasia in ulcerative colitis patients undergoing restorative proctocolectomy.

Background: The significance of backwash ileitis (BWI) relating to the risk of colon neoplasia in ulcerative colitis (UC) patients is controversial.

Aim: We investigated the association between BWI and the presence of colon neoplasia in the colectomy specimen.

Methods: From 4,198 UC patients in a prospectively maintained pouch database from 1983 to 2011, patients with extensive colitis and BWI (n = 178) in proctocolectomy were compared with 537 controls [extensive colitis (n = 385) and left-sided colitis (n = 152)] without ileal inflammation.

Clinical course of cuffitis in ulcerative colitis patients with restorative proctocolectomy and ileal pouch-anal anastomoses.

Background: Cuffitis, considered a form of reminiscent ulcerative colitis (UC), is one of the common complications of ileal pouch-anal anastomosis (IPAA) and its disease course has not been systematically characterized. The aim was to examine the disease course of cuffitis in a large historical cohort.

Methods: All patients with cuffitis diagnosed based on a combined evaluation of symptom and pouch endoscopy at the initial visit to our Pouchitis Clinic were included.

Accidental puncture or laceration in colorectal surgery: a quality indicator or a complexity measure?

Background: Accidental puncture or laceration during a surgical procedure is a patient safety indicator that is publicly reported and will factor into the Centers for Medicare and Medicaid's pay-for-performance plan. Accidental puncture or laceration includes serosal tear, enterotomy, and injury to the ureter, bladder, spleen, or blood vessels.

Objective: This study aimed to identify risk factors and assess surgical outcomes related to accidental puncture or laceration.

Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients.

Background: Ileal pouch anal anastomosis (IPAA) is the treatment of choice for chronic, medically refractory mucosal ulcerative colitis, indeterminate colitis, familial adenomatous polyposis (FAP), and a select group of patients with Crohn's disease.

Aim: : We report outcomes, complications, and quality of life (QOL) in a cohort of 3707 patients treated at our institution from January 1984 to March 2010.

Methods: Data were collected from a prospectively maintained database and chart review of 3707 consecutive primary IPAA cases.

Single-port laparoscopic colectomy.

Single-port laparoscopy (SPL) for colorectal surgery was first described for a right hemicolectomy in 2008. Since then, technology and experience have advanced, and SPL is now reported for a variety of colorectal procedures. Multiple case series and reports have demonstrated the adequate safety of SPL, but there are few reports of a measurable benefit of the technique.

Key factors associated with postoperative complications in patients undergoing colorectal surgery.

Background: Surgical outcomes are determined by complex interactions among a variety of factors including patient characteristics, diagnosis, and type of procedure.

Objective: The aim of this study was to prioritize the effect and relative importance of the surgeon (in terms of identity of a surgeon and surgeon volume), patient characteristics, and the intraoperative details on complications of colorectal surgery including readmission, reoperation, sepsis, anastomotic leak, small-bowel obstruction, surgical site infection, abscess, need for transfusion, and portal and deep vein thrombosis.

Design: This study uses a novel classification methodology to measure the influence of various risk factors on postoperative complications in a large outcomes database.

Prediction of cancer specific survival after radical nephroureterectomy for upper tract urothelial carcinoma: development of an optimized postoperative nomogram using decision curve analysis.

Purpose: We conceived and proposed a unique and optimized nomogram to predict cancer specific survival after radical nephroureterectomy in patients with upper tract urothelial carcinoma by merging the 2 largest multicenter data sets reported in this population.

Materials And Methods: The international and the French national collaborative groups on upper tract urothelial carcinoma pooled data on 3,387 patients treated with radical nephroureterectomy for whom full data for nomogram development were available. The merged study population was randomly split into the development cohort (2,371) and the external validation cohort (1,016).

Results and outcomes after endoscopic treatment of upper urinary tract carcinoma: the Austrian experience.

Introduction: Through evolution in technology, endoscopic treatment has gained popularity for the treatment of upper tract urothelial carcinoma (ENDO-UTUC).

Methods: A total of 20 patients with ENDO-UTUC were compared to 178 treated by radical nephroureterectomy (RNU) for a pTa-1 UTUC, and a systematic review was performed.

Results: Mean age for ENDO-UTUC was 71.

Risk factors for peristomal pyoderma gangrenosum complicating inflammatory bowel disease.

Background And Aims: Risk factors for peristomal pyoderma gangrenosum (PPG) are not well defined. The aim of this study was to evaluate risk factors associated with development of PPG.

Methods: Both PPG patients and controls were obtained by searching a database of the Cleveland Clinic using the ICD-9 code from March 2005 to May 2011.

Ethnicity and the risk of development of Crohn's disease of the ileal pouch.

Background: A system-wide, multi-ethnicity study on Crohn's disease (CD) of the pouch, including Indian American (IA) patients has not been conducted.

Aim: To compare the frequency of subsequent development of CD of the pouch for African-American (AA), Hispanic-American (HA), IA and Caucasian patients with ulcerative (UC) undergoing ileal-pouch anal anastomosis (IPAA).

Methods: In this historical cohort study from our Pouch Registry, patients with restorative proctocolectomy and IPAA for IBD with identifiable, self-declared racial background (i.

[Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations].

Context: The incidence of postoperative complications is still the most frequently used surrogate marker of quality in surgery, but no standard guidelines or criteria exist for reporting surgical complications in the area of urology.

Objective: To review the available reporting systems used for urologic surgical complications, to establish a possible change in attitude towards reporting of complications using standardised systems, to assess systematically the Clavien-Dindo system when used for the reporting of complications related to urologic surgical procedures, to identify shortcomings in reporting complications, and to propose recommendations for the development and implementation of future reporting systems that are focused on patient-centred outcomes.

Evidence Acquisition: Standardised systems for reporting and classification of surgical complications were identified through a systematic review of the literature.

Intraoperative radiation therapy with the photon radiosurgery system in locally advanced and recurrent rectal cancer: retrospective review of the Cleveland clinic experience.

Background: Patients with locally advanced or recurrent rectal cancer often require multimodality treatment. Intraoperative radiation therapy (IORT) is a focal approach which aims to improve local control.

Methods: We retrospectively reviewed 42 patients treated with IORT following definitive resection of a locally advanced or recurrent rectal cancer from 2000-2009.

Risk of cancer-specific mortality following recurrence after radical nephroureterectomy.

Purpose: To describe the natural history and identify predictors of cancer-specific survival in patients who experience disease recurrence after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).

Methods: Of 2,494 UTUC patients treated with RNU without neoadjuvant chemotherapy, 597 patients experienced disease recurrence. A total of 148 patients (25 %) received adjuvant chemotherapy before disease recurrence.

Dysplasia associated with Crohn's colitis: segmental colectomy or more extended resection?

Background And Objective: There is limited data on the appropriate management of dysplasia in Crohn's colitis. An evidence-based surgical strategy is provided.

Methods: Patients with a pathologic diagnosis of dysplasia in Crohn's colitis from 1987 to 2009 were identified.

Reduced port versus conventional laparoscopic total proctocolectomy and ileal J pouch-anal anastomosis.

Background: The feasibility and safety of single-incision laparoscopic total proctocolectomy (TPC) and ileal pouch anal anastomosis (IPAA) were first reported in 2010. To improve accuracy and efficiency while maintaining the cosmetic advantages of single-incision laparoscopic surgery, we have since modified the technique to include the use of a 5-mm instrument placed through the eventual drain site. The aim of this study is to compare reduced port laparoscopic (RPL) IPAA with conventional laparoscopic IPAA with respect to short-term outcomes to assess safety.

[Upper tract urothelial carcinoma. An update on clinical and pathological prognostic factors].

Upper urinary tract urothelial carcinoma (UTUC) is an uncommon but potentially lethal disease. Accurate risk stratification remains a challenge owing to the difficulty of clinical staging. Identification of risk factors may lead to individualized treatment and patient counselling and holds the potential to improve outcome.

Impact of histological variants on clinical outcomes of patients with upper urinary tract urothelial carcinoma.

Purpose: We investigated the clinical and prognostic impact of variant histologies on upper tract urothelial carcinoma outcomes after radical nephroureterectomy.

Materials And Methods: Data on 1,648 patients with upper tract urothelial carcinoma treated with radical nephroureterectomy without preoperative chemotherapy or radiotherapy were reviewed for histological differentiation and variants. We analyzed differences between pure upper tract urothelial carcinoma and upper tract urothelial carcinoma with variant histology, and differences in the histological variants using different stratifications.