Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia.

Purpose: Holmium laser prostate enucleation is a contemporary treatment for benign prostatic hyperplasia. We report our experience with more than 1,000 procedures.

Materials And Methods: From June 1998 to March 2009 we performed 1,065 holmium laser prostate enucleations.

A novel drug eluting ureteral stent: a prospective, randomized, multicenter clinical trial to evaluate the safety and effectiveness of a ketorolac loaded ureteral stent.

Purpose: We evaluated the short-term safety and efficacy of a ketorolac loaded ureteral stent compared to a standard stent (control).

Materials And Methods: In this prospective, multicenter, double-blind study patients were randomized 1:1 to ketorolac loaded or control stents after ureteroscopy. The primary end point was an intervention for pain defined as unscheduled physician contact, change in pain medication or early stent removal.

Risk factors for CKD in persons with kidney stones: a case-control study in Olmsted County, Minnesota.

Background: Kidney stones are associated with increased risk of chronic kidney disease (CKD); however, risk factors in the general community are poorly defined.

Study Design: A nested case-control study was performed in residents of Olmsted County, MN, who presented with a kidney stone at the Mayo Clinic in 1980-1994 to contrast patients with kidney stones who developed CKD with a group that did not.

Setting & Participants: Participants were selected from the Rochester Epidemiology Project, an electronic linkage system among health care providers in Olmsted County, MN.

Holmium laser enucleation of the prostate for prostates larger than 175 grams.

Background And Purpose: Open simple prostatectomy has been considered the treatment of choice for symptomatic benign prostatic hyperplasia (BPH) of large prostates because traditional endoscopic techniques have not proven either effective or feasible. We present our experience with holmium laser enucleation of the prostate (HoLEP) for glands >175 cc.

Methods: An Institutional Review Board approved prospective database has been maintained since January 1999 for all HoLEP procedures.

Surgical treatment of renal cell carcinoma in the immunocompromised transplant patient.

Objectives: To determine whether iatrogenic immunosuppression used after transplantation infers a poor prognosis of renal cell carcinoma (RCC) as natural negative immune regulators have been associated with decreased cancer-specific survival from RCC.

Methods: All patients with a solid organ transplant who underwent radical nephrectomy or nephron-sparing surgery for nonhereditary sporadic RCC from 1970 to 2003 were identified and retrospectively reviewed.

Results: We identified 17 patients with surgically treated rcc who also underwent a solid organ transplant: 11 with transplant before RCC and 6 with transplant after RCC.

Percutaneous management of caliceal diverticuli.

Background And Purpose: Caliceal diverticula are rare congenital abnormalities that can become symptomatic if associated with a calculus or infection. We review percutaneous management of caliceal diverticula.

Methods: Pathogenesis, clinical evaluation, management options, and recommended follow-up for symptomatic caliceal diverticula are reviewed.

Fibroepithelial polyps of the ureter: a single-institutional experience.

Objective: Ureteral fibroepithelial polyps (UFP) are rare lesions that may mimic ureteral malignancy, and management is not well defined. We report our experience with the management of UFP.

Materials And Methods: Between 1945 and 2008, review of our clinical database identified 27 patients who were found to have UFP.

Intra-tubular deposits, urine and stone composition are divergent in patients with ileostomy.

Patients with ileostomy typically have recurrent renal stones and produce scanty, acidic, sodium-poor urine because of abnormally large enteric losses of water and sodium bicarbonate. Here we used a combination of intra-operative digital photography and biopsy of the renal papilla and cortex to measure changes associated with stone formation in seven patients with ileostomy. Papillary deformity was present in four patients and was associated with decreased estimated glomerular filtration rates.

Endoscopic management of keratinizing desquamative squamous metaplasia of the upper tract: a case report and review of the literature.

Keratinizing desquamative squamous metaplasia (KDSM), also known as leukoplakia or cholesteatoma, of the genitourinary tract is a rare condition that is difficult to differentiate from a malignant process without surgical intervention. We present a case of KDSM of the upper urinary tract that was managed via percutaneous endoscopic approach. Although KDSM is a benign lesion, there are rare reports of it occurring concurrently with squamous-cell carcinoma; however, no direct causal relationship has been identified.

Conservative management of upper tract transitional cell carcinoma.

Aim: Our aim was to review the current literature describing the endoscopic management of upper tract transitional cell carcinoma (TCC).

Materials And Methods: Review of published, peer-reviewed articles relating the primary ureteroscopic or percutaneous management of upper tract TCC was performed using the MEDLINE database.

Results: Historically, the gold-standard management for upper tract TCC consists of nephroureterectomy with excision of a bladder cuff.

Development of a standardized curriculum for teaching cystoscopic skills using a computer-based endourologic simulator.

Introduction: Educational opportunities with simulation are now available to teach endoscopic skills outside the clinical setting. The goal of this study is to assess the learning curve and subjective impressions of cystoscopic tasks performed by untrained subjects on a computer-based simulator using a standardized curriculum.

Methods: We evaluated ten novice subjects on a computer-based cystoscopic simulator (URO Mentor, Simbionix, Lod, Israel) during a standardized cystoscopy skills course developed for the study.

Assessing the impact of ureteral stent design on patient comfort.

Purpose: We assessed the near term comfort of newly designed ureteral study stents or marketed control stents, including Polaris and Percuflex stents. Study stents had distal 6Fr pigtail ends with 3Fr or less loops. Decreased material in situ was hypothesized to enhance comfort.

Natural orifice translumenal endoscopic surgical radical prostatectomy: proof of concept.

Background And Purpose: Innovations in minimally invasive surgery have led to the proposal of incision-free natural orifice translumenal endoscopic surgery (NOTES). The purpose of this manuscript is to describe the initial technique of natural orifice translumenal endoscopic surgical radical prostatectomy (NOTES-RP).

Materials And Methods: NOTES-RP was performed on four male cadavers in a surgical simulation laboratory setting.

Percutaneous nephrolithotomy success in the transplant kidney.

Purpose: Treatment for symptomatic calculi in the transplanted kidney can be problematic. Percutaneous nephrolithotomy has routinely been used but concerns exist about potential injury to adjacent organs using a percutaneous access technique. We report our experience with percutaneous nephrolithotomy in the transplant kidney.

Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot-assisted techniques.

Objective: To assess the perioperative complications and early oncological results in a comparative study matching open radical retropubic (RRP) and robot-assisted radical prostatectomy (RARP) groups.

Patients And Methods: From August 2002 to December 2005 we identified 294 patients undergoing RARP for clinically localized prostate cancer. A comparison RRP group of 588 patients from the same period was matched 2:1 for surgical year, age, preoperative prostate-specific antigen level, clinical stage and biopsy Gleason grade.

Radiofrequency ablation of renal tumors in the solitary kidney.

Objectives: Radiofrequency ablation (RFA) is a minimally invasive therapy aimed at maximal preservation of renal function in the nonsurgical renal mass patient. We evaluate our experience with RFA of renal tumors in the solitary kidney.

Patients And Methods: A retrospective review of all patients with a solitary kidney treated with RFA for renal mass was performed.

Elective endoscopic management of transitional cell carcinoma first diagnosed in the upper urinary tract.

Objective: To report our experience using ureteroscopic or percutaneous management of upper urinary tract (UUT) transitional cell carcinoma (TCC) in patients with no history of bladder TCC.

Patients And Methods: Between 1983 and 2004 we identified 22 patients who underwent endoscopic management of TCC first diagnosed in the UUT and in the setting of a normal contralateral kidney. We performed a retrospective chart review and conducted outcome analyses.

Long-term outcome of multiple ipsilateral renal tumours found at the time of planned nephron-sparing surgery.

Objective: To evaluate patients with multiple ipsilateral renal tumours and to determine outcomes of nephron-sparing surgery (NSS) and radical nephrectomy (RN), as the treatment of unrecognized sporadic multifocal tumours at NSS presents a surgical dilemma.

Patients And Methods: In all, 104 patients had surgery between 1970 and 2003 for sporadic multiple ipsilateral renal tumours, at least one of which was renal cell carcinoma (RCC); 114 were treated with RN and 26 with NSS. Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method.

Long-term outcomes of percutaneous nephrolithotomy compared to shock wave lithotripsy and conservative management.

Purpose: Percutaneous nephrolithotomy is successful at achieving stone-free status but long-term safety data are lacking. We report our long-term experience with percutaneous nephrolithotomy and compare these results with other treatment modalities.

Materials And Methods: We identified 87 patients treated with percutaneous nephrolithotomy from 1983 to 1984 who continue to receive care at our institution.

Endoscopic management of upper tract transitional cell carcinoma in patients with normal contralateral kidneys.

Objectives: We report our experience using ureteroscopic or percutaneous management of upper tract transitional cell carcinoma (TCC) in elective situations.

Methods: Between 1983 and 2004 we identified 83 patients who underwent endoscopic management of upper tract TCC in the setting of a normal contralateral kidney. We performed a retrospective chart review and conducted outcome analyses.

Analysis of a computer based simulator as an educational tool for cystoscopy: subjective and objective results.

Purpose: Resident education in cystoscopy has traditionally relied on clinical instruction. However, simulators are now available outside the clinical setting. We evaluated a simulator for flexible and rigid cystoscopy.

Potential underdetection of pT(3a) renal-cell carcinoma with laparoscopic morcellation.

Background And Purpose: After tumor morcellation, staging relies on clinical imaging. Our goal was to determine the size distribution of stage pT(3a) renal-cell carcinomas (RCCs) and whether evidence of extrarenal invasion is present on preoperative imaging.

Patients And Methods: We selected patients with organ-confined RCC treated surgically from 1975 to 2002 and subsequently found to have stage pT(3a) disease.

Preventing pain during office biopsy of the prostate: a single center, prospective, double-blind, 3-arm, parallel group, randomized clinical trial.

Background: A prospective, double-blind, 3-arm, parallel group, randomized clinical trial was performed to compare 3 anesthetic techniques for preventing pain during prostate biopsy.

Methods: A total of 243 men undergoing a 12-core prostate biopsy were randomized to 1 of 3 anesthetic methods: 1) seminal vesical-prostatic base blockade, 2) intraprostatic blockade, and 3) apical-rectal blockade. Pain was estimated with the 10-point visual analog scale.

B7-H3 ligand expression by prostate cancer: a novel marker of prognosis and potential target for therapy.

B7 coregulatory ligands can be aberrantly expressed in human disease. In the context of cancer, these ligands may act as antigen-specific inhibitors of T-cell-mediated antitumoral immunity. We recently reported that B7-H1 expression by carcinomas of the kidney and bladder portends aggressive disease and diminished survival.