Unilateral segmental dysplasia of the vas deferens.

A healthy 35-year-old male presented for vasectomy after fathering two children. Due to difficulty palpating the left vas, the patient was taken to the operating room for scrotal exploration and vasectomy. The left vas was absent; however, a 1.

Association between cannabis use and the risk of bladder cancer: results from the California Men's Health Study.

Objective: To investigate the association of cannabis use and tobacco smoking on the incidence of bladder cancer within the California Men's Health Study cohort.

Methods: We evaluated the records of 84,170 participants in a multiethnic cohort of men aged 45-69 years. Information on demographic and lifestyle factors including smoking history and cannabis use was collected using mailed questionnaires between 2002 and 2003.

Presurgical sunitinib reduces tumor size and may facilitate partial nephrectomy in patients with renal cell carcinoma.

Objective: To determine whether presurgical sunitinib reduces primary renal cell carcinoma (RCC) size and facilitates partial nephrectomy (PN).

Methods: Data from potential candidates for PN treated with sunitinib with primary RCC in situ were reviewed retrospectively. Primary outcome was reduction in tumor bidirectional area.

A natural language processing program effectively extracts key pathologic findings from radical prostatectomy reports.

Introduction And Objective: Natural language processing (NLP) software programs have been widely developed to transform complex free text into simplified organized data. Potential applications in the field of medicine include automated report summaries, physician alerts, patient repositories, electronic medical record (EMR) billing, and quality metric reports. Despite these prospects and the recent widespread adoption of EMR, NLP has been relatively underutilized.

Impact of surgical case order on perioperative outcomes for robotic-assisted radical prostatectomy.

Objectives: Since its introduction, there have been many refinements in the technique and implementation of robotic-assisted radical prostatectomy (RARP). However, it is unclear whether operative outcomes are influenced by surgical case order. We evaluated the effect of case order on perioperative outcomes for RARP within a large health maintenance organization.

Accuracy and implications of percutaneous renal biopsy in the management of renal masses.

Introduction: Percutaneous renal biopsy in patients with renal masses is increasing. We investigated the accuracy of percutaneous renal mass biopsy results in patients undergoing evaluation of solid renal masses.

Methods: A retrospective review was performed of patients in the Kaiser Permanente Southern California Region who underwent computed tomography or ultrasound-guided percutaneous renal biopsy of a solid renal mass between January 2005 and December 2009.

Impact of trainee involvement with robotic-assisted radical prostatectomy.

Robotic-assisted surgery has been rapidly adopted within urology practice. As a result, academic centers are challenged with the burden of how to effectively train residents and fellows to perform robotic-assisted surgery without compromising outcomes. We evaluated the perioperative outcomes of trainee involvement with robotic-assisted radical prostatectomy (RARP) within our healthcare organization.

Extracting data from electronic medical records: validation of a natural language processing program to assess prostate biopsy results.

Objective: The extraction of specific data from electronic medical records (EMR) remains tedious and is often performed manually. Natural language processing (NLP) programs have been developed to identify and extract information within clinical narrative text. We performed a study to assess the validity of an NLP program to accurately identify patients with prostate cancer and to retrieve pertinent pathologic information from their EMR.

Endoscopic removal of a proximal urethral stent using a holmium laser: Case report and literature review.

Urethral stents were initially developed for the management of urethral strictures and obstructive voiding disorders in select patients. Urethral stent complications are common and may require stent explantation, which is often quite challenging. We present our experience with endoscopic removal of an encrusted UroLume proximal urethral stent in a 72-year-old male using a holmium laser.

Consolidative surgery after targeted therapy for renal cell carcinoma.

Renal cell carcinoma is the most lethal of the common genitourinary neoplasms, with 30% to 40% of patients eventually dying from disease progression. Although the recent development of targeted therapies against kidney cancer has yielded substantially improved tumor response rates and progression-free survival, these agents are still not curative. The integration of systemic therapies with surgery still represents the best management for select patients with advanced disease.

Small renal masses: toward more rational treatment.

Managing small renal masses poses a common and controversial problem. Although radical nephrectomy is still the most common treatment, partial nephrectomy is the new gold standard, and thermal ablation or active surveillance are reasonable for some patients. Renal mass biopsy with molecular profiling will likely allow for more rational treatment in the near future.

Inadequacy of biopsy for diagnosis of upper tract urothelial carcinoma: implications for conservative management.

Objective: To report changes in grade and stage between initial diagnostic and repeat biopsies or resection for urothelial carcinoma (UTUC) and investigate the consequences for endoscopic management. Ureteroscopic management of upper tract UTUC is an alternative to nephroureterectomy, which is less invasive and preserves renal function. However, concerns about potential understaging, inaccurate grading, incomplete resection, lack of effective tertiary chemoprevention, and need for ureteroscopic surveillance limits it appeal.

Acute kidney injury: novel biomarkers and potential utility for patient care in urology.

Urologists are integrally involved in the management of acute kidney injury (AKI), which is common after renal surgery or secondary to postrenal (obstructive) etiologies. The measurement of serum creatinine is a suboptimal indicator of AKI because it lags behind acute changes in renal function. Recent advances indicate that serum/urine biomarkers will prove useful for early detection of AKI, analogous to the use of cardiac enzymes for acute myocardial infarction.

Urologic emergencies in pregnancy.

The management of urological emergencies during pregnancy presents unique clinical challenges for the treating physician. Clinical signs and symptoms are often subtle while diagnostic and therapeutic options are limited in treating patients to avoid fetal morbidity. A high index of suspicion with early diagnosis and treatment are essential for the management of genitourologic emergencies in pregnant women.

Optimizing orthotopic bladder tumor implantation in a syngeneic mouse model.

Purpose: We established a reliable technique for orthotopically implanting bladder tumor cells in a syngeneic mouse model.

Materials And Methods: MBT-2 murine bladder cancer cells were transurethrally implanted in the bladder of syngeneic C3H/He mice (Jackson Laboratory, Bar Harbor, Maine). Different chemical pretreatments were used before tumor implantation, including phosphate buffered saline (control), HCl, trypsin and poly-L-lysine.

Prospective evaluation of prostate cancer risk in candidates for inguinal hernia repair.

Background: Preperitoneal placement of mesh during herniorraphy has been shown to complicate future extirpative prostate surgery. We investigated the value of a prostate cancer screening program in patients considering laparoscopic inguinal herniorrhaphy to identify men at risk of prostate cancer.

Study Design: A prospective cohort study was conducted in men 30 years of age or older presenting with inguinal hernia.

Laparoscopic partial nephrectomy in octogenarians.

Objectives: To assess the safety and technical feasibility of laparoscopic partial nephrectomy in patients aged >or=80 years at our institution to determine whether this treatment modality may be justifiable in select octogenarians. As the US population ages, an increasing number of elderly patients with renal masses are considered for partial nephrectomy. We present our experience with laparoscopic partial nephrectomy in octogenarians to determine the safety and technical feasibility of this procedure in an elderly population.

Splenic injury during percutaneous nephrolithotomy.

Background: Injury to the spleen is a recognized complication during percutaneous renal access due to the close anatomical relationship of the spleen and the left kidney. However, transsplenic renal access is a rare complication of percutaneous nephrolithotomy and can also result in considerable morbidity, often requiring emergent splenectomy.

Methods: We present our experience with splenic injury during percutaneous nephrolithotomy managed conservatively with the use of a collagen-thrombin hemostatic sealant (D-Stat; Vascular Solutions, Inc.

Surgical resection of renal cell carcinoma after targeted therapy.

Purpose: The development of targeted agents for renal cell carcinoma has renewed interest in consolidative surgery due to the robust clinical responses seen with these agents. The integration of targeted therapy and surgery requires careful consideration due to the potential for increased perioperative morbidity.

Materials And Methods: We retrospectively identified patients with renal cell carcinoma treated with sunitinib, sorafenib or bevacizumab plus interleukin-2 before tumor resection.

Gonadal vein tumor thrombus in metastatic renal cell carcinoma.

Although renal vein invasion and/or inferior vena cava extension occurs in 4%-10% of patients with renal cell carcinoma, involvement of the gonadal vein is uncommon. We present a case of a patient with unresectable metastatic renal cell carcinoma invading the gonadal vein, who was initially treated with targeted molecular therapy.

Integration of surgery and systemic therapy in the management of metastatic renal cancer.

Integration of surgery and systemic therapies represents the best management option for most patients with metastatic renal cell carcinoma. Cytoreductive nephrectomy, metastasectomy, and consolidative surgery can all play a vital role in this challenging patient population. Relevant issues in this era relate to the timing of surgery, the role of cytoreduction as systemic therapies become more effective, management of the residual mass, and surgical safety after targeted therapy.

Response of the primary tumor to neoadjuvant sunitinib in patients with advanced renal cell carcinoma.

Purpose: We assessed the activity of neoadjuvant sunitinib on primary renal tumors in patients with advanced renal cell carcinoma as well as the feasibility and safety of subsequent surgical resection.

Methods: A total of 19 patients with advanced renal cell carcinoma deemed unsuitable for initial nephrectomy due to locally advanced disease or extensive metastatic burden were treated with 50 mg sunitinib daily for 4 weeks on followed by 2 weeks off. Tumor response was assessed by Response Evaluation Criteria in Solid Tumors every 2 cycles and the rate of conversion to resectable status was estimated.

Urethral diverticula in 90 female patients: a study with emphasis on neoplastic alterations.

Purpose: Urethral diverticula are uncommon and occur predominantly in women. We examined a large series of female urethral diverticula to determine associated neoplastic alterations and subsequent clinical outcomes.

Materials And Methods: All pathological evaluations of female urethral diverticulectomies performed at our institution between 1981 and 2007 were retrospectively reviewed and the clinicopathological features were correlated.

Clinicopathologic features and utility of immunohistochemical markers in signet-ring cell adenocarcinoma of the bladder.

Signet-ring adenocarcinoma is an aggressive form of primary bladder adenocarcinoma that has been associated with poor outcomes. The utility of immunohistochemical markers in tumors with signet-ring morphology may vary from more typical adenocarcinomas arising at the same location, although this has not been examined in bladder adenocarcinoma. We examined a series of bladder adenocarcinomas to determine the impact of signet-ring cell features on clinical outcomes and immunohistochemical findings.