Novel application of da Vinci robotic system in patients of Zinners syndrome--case report and review of literature.

Seminal vesicle cysts combined with ipsilateral renal agenesis, ectopic ureter and giant right ampullary cyst of vas deferens represent a rare urological anomaly, Zinners syndrome. In symptomatic patients' seminal vesiculectomy along with enbloc excision of the ipsilateral ampullary cyst, ectopic ureter and dysplastic, renal tissue is the preferred treatment option. We report robotic assisted removal of a large seminal vesicle cyst with ipsilateral renal agenesis, ectopic ureter and a giant right ampullary cyst of vas deferens in a 34-year-old male.

Alpha-methylacyl-CoA racemase: a multi-institutional study of a new prostate cancer marker.

Aim: To test whether alpha-methylacyl-CoA racemase (AMACR) is a sensitive and specific marker of prostate cancer.

Methods And Results: The expression levels of AMACR mRNA were measured by real-time polymerase chain reaction. A total of 807 prostatic specimens were further examined by immunohistochemistry specific for AMACR.

A novel diagnostic test for prostate cancer emerges from the determination of alpha-methylacyl-coenzyme a racemase in prostatic secretions.

Purpose: With the recent discovery that alpha-methlyacly-coenzyme A racemase (AMACR) is over expressed in a majority of prostate cancer (CaP) specimens we developed a novel polymerase chain reaction (PCR) based approach that would predict the presence of CaP from prostatic secretions.

Materials And Methods: A total of 21 patients were enlisted in this study, including 10 with CaP, 2 with high grade PIN and 9 cancer-free individuals (7 healthy men and 2 with benign hyperplasia). Total cellular RNA was extracted from prostatic secretions obtained from post-massage urine specimens.

Monitoring the serological proteome: the latest modality in prostate cancer detection.

Purpose: Various strategies have recently emerged to improve the diagnostic prediction of prostate cancer (CaP). One such strategy includes the mass profiling of serum protein fractions selectively adsorbed onto chemically modified probes. In the current study we further validated this approach, while offering a more versatile, less expensive and yet equally predictive alternative to existing technologies.

Detection of alpha-methylacyl-coenzyme A racemase in postradiation prostatic adenocarcinoma.

Objectives: To assess the utility of alpha-methylacyl-coenzyme A racemase (AMACR), also known as P504S, immunohistochemistry in the detection of postradiation prostatic adenocarcinoma in surgical specimens. Pathologic diagnosis of postradiation prostate cancer is difficult because of the radiation-induced cytologic changes in benign and malignant epithelial cells. AMACR/P504S is a recently identified molecular marker for prostatic adenocarcinoma.

Laparoscopic radical prostatectomy: initial 70 cases at a U.S. university medical center.

Objectives: To report our experience with the first 70 cases of laparoscopic radical prostatectomy. Radical retropubic prostatectomy is an accepted therapy for the management of locally confined prostate cancer. Recently, laparoscopic prostatectomy has been introduced as a minimally invasive alternative to open radical prostatectomy.

Can diet in conjunction with stress reduction affect the rate of increase in prostate specific antigen after biochemical recurrence of prostate cancer?

Purpose: Epidemiological and laboratory evidence indicates that a Western diet is associated with an increased incidence of prostate cancer. Specific components of the diet, such as high saturated fat, low fiber and high meat content, may have greatest clinical significance in the later stages of tumor promotion and progression. However, departure from the conventional diet is difficult to initiate and maintain.

Hand-assisted laparoscopic donor nephrectomy minimizes warm ischemia.

Objectives: Traditional open donor nephrectomy is associated with good donor outcomes and excellent allograft function. Laparoscopic donor nephrectomy may accomplish these same goals with less morbidity. We report our initial experience with hand-assisted laparoscopic living donor nephrectomy using a commercially available hand-assist device.

Agonist induced conformation alteration of neurotensin receptor and the mechanism behind Na+ inhibition of 125I-NT binding.

In the absence of Na+, 125I-Neurotensin (125I-NT) binding to the Neurotensin receptor (NTR) produces a stable noncovalent 125I-NT-NTR complex whose dissociation rate is extremely low even after the addition of 1 microM NT, 100 microM SR48692 (antagonist), 100 microM GPPNHP or 100 mM NaCl. Lowering the medium pH to 4.5 enhances the process (approximately 70% in 10 minutes).

A clinically "silent" pheochromocytoma with spontaneous hemorrhage.

We report a case of an abdominal mass that had hemorrhaged spontaneously into the retroperitoneal space and presented as an acute abdominal catastrophe. The pathological diagnosis was pheochromocytoma, although the patient had no suggestive symptoms preoperatively. The management of this silent pheochromocytoma and its atypical presentation are discussed.

Signet-ring cell carcinoma of bladder. Evaluation of three cases with review of literature.

Three cases of adenocarcinoma involving the bladder and consisting mainly of signet-ring-shaped cells are presented. Each case represents a different form that the lesion may take, and these forms are compared. This unusual neoplasm has a worse prognosis than transitional cell carcinoma of the bladder, possibly because of factors that lead to delays in management.

Acute adrenal insufficiency as a complication of urological surgery.

Acute adrenal insufficiency postoperatively is an uncommon problem and, if unrecognized, it may cause serious morbidity and can be fatal. It can occur as the result of acute bilateral adrenal hemorrhage associated with anticoagulation, inadvertent injury to or removal of a solitary adrenal gland, or postoperative stress in an individual with incipient adrenal insufficiency. Its manifestations, such as fever, tachycardia, hypotension, lethargy, abdominal pain and gastrointestinal dysfunction, mimic the other more common postoperative complications and compound the difficulty in establishing the correct diagnosis.

Plasma concentrations of lidocaine resulting from instillation of lidocaine jelly into genitourinary tract prior to cystoscopy.

Plasma concentrations of lidocaine were measured over a period of three hours following the instillation of lidocaine jelly (Xylocaine 2% Jelly) into the genitourinary tract of 30 patients (15 male, 15 female) scheduled for cystoscopy. The mean quantity of jelly instilled was 21.4 Gm (11-27.

Renal brush biopsy: survey of indications, techniques and results.

Urine cytology is inaccurate in the diagnosis of low grade tumors of the ureter and pelvis. In 1973 the retrograde brush biopsy technique was introduced in an effort to improve diagnostic capabilities. We herein review our experience with retrograde brushing of upper urinary tract radiolucent filling defects in 21 patients during a 6-year period.

Urodynamic localization of isolated bladder neck obstruction in men: studies with micturitional vesicourethral static pressure profile.

Micturitional vesicourethral static pressure profile, a method of recording the static (lateral) component of voiding pressure in the successive urethral segments contiguous with the bladder, has allowed us to establish directly the site and degree of bladder outlet obstruction in 16 men. The diagnosis of isolated bladder neck obstruction was confirmed with greater confidence by using this technique with a 10F trilumen catheter in conjunction with uroflowmetry and radiologic studies. Repeat studies with a 5F single lumen catheter have suggested that the obstructions recognized with the 10F catheter ware not entirely artifactual.

Urodynamic evaluation of prostatic enlargements with micturitional vesicourethral static pressure profiles.

We studied 58 men with prostatism, who were between 58 and 75 years old, with micturitional vesicourethral static pressure profiles. The study consisted of recording static (lateral) pressures of successive segments of the posterior urethra during voiding, with synchronous monitoring of the vesical pressure activity. An abnormal pressure decrease across the supramontane urethra was considered to be a functional compromise to the prostatic urethra.

Isolated bladder neck obstruction of undetermined etiology (primary) in adult male: recognition and management.

Varying degrees of isolated bladder neck obstruction of undetermined etiology were identified with micturitional vesicourethral static pressure profiles. Our experience with the urodynamic studies in 15 patients suggests that isolated bladder neck obstruction is a real entity in young adult males. Our experience also suggests that pharmacologic success with alpha-adrenergic blockade of the dosage tolerated by the patients is inconsistent.

Radiocolloid scintigraphic mapping of the lymphatic drainage of the prostate.

Radionuclide lymphoscintigraphy with the new microcolloid 99mtechnetium antimony sulfide is a diagnostic technique with potential application in patients with urologic malignancy. Scintigraphic images were obtained after simple interstitial injection into the prostate of 9 normal dogs and 2 patients with prostatic cancer and into the testis in 2 dogs. The images show the physiologic lymphatic drainage of the organs injected.

Immunologic indicators of prognosis in bladder cancer: the importance of cell surface antigens.

The loss of isoantigens on the surface of cells has been correlated with invasion in 89 patients with bladder cancer: 73 underwent cystectomy and 16 had stage A tumor and were followed. Tumors from these 89 patients were re-examined for the presence or absence of A, B and O (erythrocytic) isoantigens on the surface of neoplastic cells by the red cell adherence test. In 97% of the cystectomy patients with transitional carcinoma lacking superficial cellular antigens (red cell negative tumors) there was documented evidence of invasion and 71% of the patients with stage A, red cell negative tumors eventually had invasion.