Hyperbaric oxygen therapy for hemorrhagic radiation cystitis.

Background: Hemorrhagic radiation cystitis (HRC) is a significant clinical problem that occurs after pelvic radiation therapy and is often refractory.

Objectives: To evaluate the efficacy and safety of hyperbaric oxygen therapy (HBO) for HRC.

Methods: Daily 90 minute sessions of HBO at 2 ATM 100% oxygen were given to 32 HRC patients with ASTRO grades 3-4 hematuria.

[Part-time residency training in Israel].

Full-time work has long been perceived as a cornerstone of medical residency, the consensus being that a resident must apply the bulk of his time and attention to his professional training. Demographic and cultural changes that have taken place over the last several years, specifically the rise in the number of female doctors and the importance of leisure time to the younger generation, have intensified the need to find new and innovative ways to deal with the plight of the resident population. One idea, already in effect in many Western countries, is the institution of part-time residency programs.

Comparison of lower urinary tract symptoms between women with detrusor overactivity and impaired contractility, and detrusor overactivity and preserved contractility.

Purpose: We compared symptoms in women with detrusor overactivity with impaired contractility and women with detrusor overactivity who had preserved contractility.

Materials And Methods: The study included 359 consecutive women with detrusor overactivity who underwent multichannel urodynamics at our department between 2009 and 2011. The women were divided into 2 groups, including 151 (42%) with detrusor overactivity and impaired contractility, and 208 (58%) with detrusor overactivity and preserved contractility.

Predictors of response to intravesical dimethyl-sulfoxide cocktail in patients with interstitial cystitis.

Objective: To identify predictors of treatment failure of dimethyl sulfoxide (DMSO) "cocktail" for patients with interstitial cystitis (IC).

Methods: Fifty-one IC patients received weekly intravesical instillations of "cocktail" composed of 50% DMSO (50 mL), 100 mg of hydrocortisone (5 mL), 10,000 U of heparin sulfate (10 mL), and 0.5% bupivacaine (10 mL) for 12 weeks.

Decreased amplitude of detrusor overactivity by repetitive swallowing.

Purpose: We determined whether swallowing has an effect on the degree of urinary urgency and on the amplitude of detrusor contraction during filling cystometry in patients with detrusor overactivity.

Materials And Methods: Included in study were 20 consecutive patients with detrusor overactivity. During urodynamics the mean peak pressure of each contraction was documented and compared.

[Interstitial cystitis/painful bladder syndrome: a comprehensive review of the current literature].

Interstitial cystitis/painful bladder syndrome (IC/PBS) presents as a pelvic pain condition associated with urinary urgency and frequency. These symptoms significantly impair the patient's quality of life. The prevalence of IC/PBS is 0.

[Pelvic floor medicine--innovative versus conservative approach].

Unlabelled: Female pelvic floor medicine treats a variety of conditions including urinary and anal incontinence, pelvic floor prolapse, overactive bladder, periurethral lesions and chronic pelvic pain. A third of the women are expected to experience one of these conditions, and one out of 9 women will have a pelvic floor surgery. Pelvic floor dysfunction impairs patients' quality of life and results in social embarrassment and psychological distress.

[Is the rate of medical publication from Israel similar to other countries? A comparative study of three medical specialties].

Unlabelled: Academic careers of individual doctors are commonly evaluated by examining the number and quality of authored publications. Similarly, the extent and quality of medical research may be assessed nationwide by measuring the number of publications originating from the country of interest over time. This in turn, may indicate on the quality of medicine practiced.

Evolution from active surveillance to focal therapy in the management of prostate cancer.

Organ-preserving therapies are widely accepted in many facets of medicine and, more recently, in oncology. For example, partial nephrectomy is now accepted as a preferred alternative over radical nephrectomy for small (up to 4 cm or T1) tumors. Focal therapy (FT) is another organ-preserving strategy applying energy (cryotherapy, laser ablation and/or high-intensity focused ultrasound) to destroy tumors while leaving the majority of the organ, surrounding tissue and structures unscathed and functional.

The predominance of benign histology in small testicular masses.

Objectives: To evaluate the concordance between testicular tumor size and benign histology in order to identify a cut-off size, below which the rate of benign lesions would be highest.

Methods And Materials: During the years 1995-2008, we performed 131 consecutive testicular operations for testicular tumors. Ten of these were testicular preserving surgery, whereas the other 121 patients had radical orchiectomy.

Sterility of reusable transrectal ultrasound transducer assemblies for prostate biopsy reprocessed according to food and drug administration guidelines--bacteriologic outcomes in a clinical setup.

Objectives: To test the effectiveness of the sterilization process of the transducer while applying the Food and Drug Administration recommendations on a routine basis in a high-volume clinical setup. In June 2006, the Food and Drug Administration issued a Public Health notification about reprocessing of the reusable ultrasound transducer assemblies used for transrectal biopsy of the prostate.

Methods: Transrectal ultrasound assembly components were systematically swabbed and cultured.

Use of adult criteria for slice imaging may limit unnecessary radiation exposure in children presenting with hematuria and blunt abdominal trauma.

Objective: To examine whether it would be safe to use adult criteria for imaging in pediatric blunt renal trauma and hematuria.

Material And Methods: From 1999 to 2007, 46 consecutive children were admitted for renal trauma and hematuria. All had abdominal computed tomography (CT) scan.

Current status of en bloc stapling of the renal hilum during laparoscopic nephrectomy.

Introduction: Increasing literature has been published lately addressing the safety and efficacy of en bloc stapling of the renal hilum during laparoscopic nephrectomy and nephroureterectomy. The aim of this review was to analyze the available literature on en bloc stapling of the renal hilum and to complement it with technical issues that are required, according to our vast experience in en bloc and separate stapling, to safely control the hilum with this technique.

Materials And Methods: A PubMed search using the terms "en bloc," "nephrectomy," and "laparoscopy" was conducted.

Sex, age, and surgeon decision on nephron-sparing surgery are independent predictors of renal masses with benign histologic findings--a multicenter survey.

Objectives: To define the preoperative independent predictors indicating that renal mass has benign histologic features.

Methods: A total of 1664 patients with Stage T1-T2N0M0 with a unilateral renal mass underwent nephrectomy. The endpoint at multivariate analysis was benign versus malignant histologic features.

Increasing medical staff safety by using a closed system for intravesical instillation of mitomycin C.

Objectives: Intravesical treatment with mitomycin C (MMC) after trans-urethral resection of bladder tumor is indicated by the guidelines of the European Association of Urology and the American Urology Association. MMC solution is highly irritative to skin and mucous membranes and may be of potential harm to staff handling it. We describe a closed-system device that we have developed for MMC intravesical instillation immediately after transurethral resection of bladder tumor (TURBT) for bladder cancer.

Renal oncocytoma--are there sufficient grounds to consider surveillance following prenephrectomy histologic diagnosis.

Introduction: Oncocytoma is a benign neoplasm of the kidney and comprises about 12% of all renal masses. A definitive preoperative diagnosis of oncocytoma is currently technically not feasible and its practical implication is controversial.

Objectives: To analyze the current status of preoperative diagnostic tools for oncocytoma, study the different occurrences of oncocytoma-renal cell carcinoma (RCC) coexistence, including the phenomenon of true hybrid tumors, and investigate the rare reports on the natural history of unresected oncocytoma.

[Palliative surgery for locally advanced prostate cancer].

Local progression of prostate cancer occurs when the tumor grows beyond the prostatic capsule and invades adjacent structures such as the urinary bladder, rectum, pelvic side-wall and ureters. This is an important clinical event that can in itself cause significant morbidity, impaired quality of life and even mortality. Patients with this condition may experience urinary symptoms due to bladder outlet obstruction by the tumor mass, ureteral obstruction and renal failure, hematuria due to invasion of the tumor into the bladder, and pelvic pain, constipation or tenesmus, as a result of rectal involvement.

Positive surgical margins with renal cell carcinoma have a limited influence on long-term oncological outcomes of nephron sparing surgery.

Objectives: To define the rate of positive surgical margins (PSMs) and analyze the outcome of patients with PSMs. The outcome and proper management of patients with positive PSMs during nephron sparing surgery (NSS) are questionable. In this study we define the clinical outcomes of PSMs at NSS and suggest management.

Association between tamsulosin and intraoperative "floppy-iris" syndrome.

Intraoperative "floppy-iris" syndrome is a novel entity that was initially described in 2005 by Chang and Campbell who encountered it during cataract surgery. The manifestations include a triad of the following intraoperative findings: (a) flaccid iris stroma leading to fluttering and bellowing of the iris, (b) prolapse of the iris through the surgical incisions, and (c) progressive pupil constriction. IFIS has been associated with increased surgical difficulty and, as a result, with increased morbidity including retinal detachment and loss of vision.

Saturation prostate biopsy in high risk patients after multiple previous negative biopsies.

Objectives: To evaluate the diagnostic value of saturation prostate biopsy in patients with prostate-specific antigen (PSA) greater than 10 ng/mL, PSA velocity greater than 0.75 ng/mL/year, free PSA ratio less than 0.2, and at least 3 sets of negative biopsy specimens.

Intracavernosal saline infusion decreases intraoperative blood loss during radical retropubic prostatectomy.

Objective: Radical retropubic prostatectomy (RRP) is associated with intraoperative blood loss. We studied whether regional hemodilution using intracavernosal saline infusion has an impact on blood loss during RRP.

Methods: This is a prospective, randomized controlled study.

Neoadjuvant chemohormonal therapy in poor-prognosis localized prostate cancer.

Objectives: To conduct a trial of neoadjuvant chemohormonal therapy and radical prostatectomy for patients with poor-prognosis localized prostate cancer (prostate-specific antigen [PSA] value 20 ng/mL or greater, Gleason score 8 or higher, and clinical stage T2c or greater), who are at high risk for local and systemic relapse.

Methods: Complete androgen blockage and four cycles of docetaxel (70 mg/m2) on day 2 and estramustine (280 mg three times daily) on days 1 to 5 every 21 days were given to 22 patients before radical prostatectomy and nerve preservation.

Results: Patient characteristics, as median (range), were as follows: age 61 (49 to 70) years, PSA value 21.

Ultrashort intracorporeally maneuverable cryoprobes for laparoscopic renal cryoablation in the porcine model.

Aim: To determine the feasibility and efficacy of laparoscopic renal cryosurgery using a novel ultrathin ultrashort intracorporeal cryoprobe in a porcine model.

Material And Methods: Novel cryoprobes 4 cm in length and 1.5 mm in diameter were manipulated intracorporeally after insertion via a designated 15 mm laparoscopic port.

The prevalence of malignancy in satellite renal lesions and its surgical implication during nephron sparing surgery.

Purpose: We examined the prevalence of malignancy in a synchronous ipsilateral renal lesion identified during partial nephrectomy and evaluated its clinical significance.

Materials And Methods: We retrospectively reviewed the records of 112 patients (114 renal units) who underwent nephron sparing surgery for a clinically localized sporadic renal mass between May 1995 and September 2005.

Results: In 37 patients (32%) an additional lesion was diagnosed and excised intraoperatively, while in 67% these lesions were known before the operation and believed to be simple cysts.

Does prostate biopsy Gleason score accurately express the biologic features of prostate cancer?

Purpose: To correlate Gleason grading in prostate biopsies with the final Gleason score in radical prostatectomy specimens, and to investigate predictors for concordance and preoperative undergrading.

Materials And Methods: The charts of 303 patients who underwent radical retropubic prostatectomy between 1992 and 2002 were retrospectively reviewed. Prostate biopsy and surgical specimen Gleason scores and correlative clinical data were recorded, and a multivariate analysis model was applied.