Urine Exosomes for Non-Invasive Assessment of Gene Expression and Mutations of Prostate Cancer.

Purpose: The analysis of exosome/microvesicle (extracellular vesicles (EVs)) and the RNA packaged within them (exoRNA) has the potential to provide a non-invasive platform to detect and monitor disease related gene expression potentially in lieu of more invasive procedures such as biopsy. However, few studies have tested the diagnostic potential of EV analysis in humans.

Experimental Design: The ability of EV analysis to accurately reflect prostate tissue mRNA expression was examined by comparing urinary EV TMPRSS2:ERG exoRNA from pre-radical prostatectomy (RP) patients versus corresponding RP tissue in 21 patients.

Predictors of biochemical recurrence in pT3b prostate cancer after radical prostatectomy without adjuvant radiotherapy.

Background: Men with pathologic evidence of seminal vesicle invasion (SVI) at radical prostatectomy (RP) have higher rates of biochemical recurrence (BCR) and mortality. Adjuvant radiotherapy (XRT) has been shown to increase freedom from BCR, but its impact on overall survival is controversial and it may represent overtreatment for some. The present study, therefore, sought to identify men with SVI at higher risk for BCR after RP in the absence of adjuvant XRT.

Close surgical margins after radical prostatectomy mimic biochemical recurrence rates of positive margins.

Introduction: The significance of a "close" but negative surgical margin after radical prostatectomy (RP) is controversial. We evaluated the effect of a close surgical margin (CSM) on biochemical recurrence (BCR) compared to a negative margin after RP.

Materials And Methods: Pathologic records of men who underwent RP from 2005-2011 were retrospectively reviewed.

Ureterorenoscopy for upper tract urothelial carcinoma: how often are we missing lesions?

Objective: To determine the ability of ureterorenoscopy (URS) to identify the precise number and location of all lesions as compared with pathologic review of nephroureterectomy specimens, which have not been previously determined. Upper tract urothelial carcinoma (UTUC) comprises 5% of all urothelial malignancies in the United States. With advances in endoscopic equipment, there has been a move toward using flexible ureteroscopes to perform URS as part of the diagnostic evaluation and management.

The da vinci robot system eliminates multispecialty surgical trainees' hand dominance in open and robotic surgical settings.

Background And Objectives: Handedness, or the inherent dominance of one hand's dexterity over the other's, is a factor in open surgery but has an unknown importance in robot-assisted surgery. We sought to examine whether the robotic surgery platform could eliminate the effect of inherent hand preference.

Methods: Residents from the Urology and Obstetrics/Gynecology departments were enrolled.

Robot-assisted nephroureterectomy and bladder cuff excision without patient or robot repositioning: description of modified port placement and technique.

Introduction: Nephroureterectomy (NUx) with full bladder cuff excision is the gold-standard treatment for upper urinary tract urothelial cancer. Although minimally invasive techniques for NUx have demonstrated comparable outcomes to those of the open technique, the robotic technique is limited by the need for intraoperative patient repositioning and robot redocking to manage the distal ureter and bladder cuff. We describe our novel technique of robotic NUx that allows for complete access to the kidney and full bladder cuff excision.

Baseline serum 25-hydroxyvitamin d levels in men undergoing radical prostatectomy: is there an association with adverse pathologic features?

Introduction/background: The purpose of this study was to evaluate the prevalence of vitamin D (VitD) deficiency in men undergoing radical prostatectomy and determine whether an association exists between preoperative VitD levels and adverse pathologic features.

Patients And Methods: Patients scheduled to undergo radical prostatectomy for clinically localized disease from January to August 2012 were prospectively followed and those with available preoperative serum 25-hydroxyvitamin D levels were included. Men with a known diagnosis of VitD deficiency or taking VitD supplementation were excluded.

Pain and analgesic use after robot-assisted radical prostatectomy.

Purpose: While robot-assisted radical prostatectomy (RARP) is associated with shortened convalescence and decreased blood loss over open prostatectomy, little objective data is available regarding postoperative pain/discomfort and use of analgesic medications after RARP. We sought to examine these parameters in a contemporary cohort.

Patients And Methods: From 2011 to 2013, patients undergoing RARP were prospectively enrolled in a study to examine various pain parameters and carefully monitor opiate and other analgesic medication use while the patient recovered in the hospital.

Outcomes with delayed dorsal vein complex ligation during robotic assisted laparoscopic prostatectomy.

Introduction: There are many concerns expressed by urologists performed robotic assisted laparoscopic prostatectomy (RALP) regarding management of the dorsal vein complex (DVC). We sought to examine the influence of delayed DVC ligation versus standard DVC ligation on the apical surgical margin status and other key surgical parameters following RALP.

Materials And Methods: The Columbia University Urologic Oncology Database was retrospectively reviewed to identify patients who underwent RALP between 2008-2011.

Comparison of 3 upper tract anticarcinogenic agent delivery techniques in an ex vivo porcine model.

Objective: To evaluate the degree of urothelial exposure using 3 upper tract delivery techniques in an ex vivo porcine model, to determine the optimal modality to locally deliver topical anticarcinogenic agents in patients with upper tract urothelial carcinoma.

Materials And Methods: An indigo carmine solution was infused into en bloc porcine urinary tracts to test the 3 techniques: antegrade infusion via nephrostomy tube, reflux via indwelling double-pigtail stent, and retrograde administration via a 5F open-ended ureteral catheter. Nine renal units (3 per delivery method) were used.

Characterization of perioperative leukocytosis in patients undergoing robot-assisted radical prostatectomy: effects of Gleason score and race.

Introduction: Our objective was to determine the impact of race and tumor grade on perioperative leukocytosis on patients undergoing robot-assisted radical prostatectomy (RARP).

Methods: A retrospective review of our urologic oncology database for patients undergoing RARP from August 2002 to July 2011 was conducted. A total of 768 patients were identified with complete data.

Comparison of robot-assisted and open retropubic radical prostatectomy for risk of biochemical progression in men with positive surgical margins.

Objective: Robot-assisted radical prostatectomy (RARP) is a minimally invasive alternative to open retropubic radical prostatectomy (RP), and is reported to offer equivalent oncologic outcomes while reducing perioperative morbidity. However, the technique of extirpation can differ based on the usage of thermal energy and coagulation during RARP, which may alter the risk of finding a positive surgical margin (PSM) as cautery may destroy residual cancer cells. We sought to evaluate whether the method of surgery (RP vs RARP) affects the rate of biochemical recurrence (BCR) in patients with PSMs.

A Pilot Study of Laparoscopic Doppler Ultrasound Probe to Map Arterial Vascular Flow within the Neurovascular Bundle during Robot-Assisted Radical Prostatectomy.

Purpose. To report on the feasibility of a new Laparoscopic Doppler ultrasound (LDU) technology to aid in identifying and preserving arterial blood flow within the neurovascular bundle (NVB) during robotic prostatectomy (RARP). Materials and Methods.

Endoscopic management of intraluminal ureteral endometriosis.

Objective: To present the largest experience on the ureteroscopic management of ureteral obstruction secondary to intraluminal endometrial implantation.

Materials And Methods: We retrospectively evaluated patients who underwent ureteroscopic management of intraluminal endometriosis from 1996 to 2012. All patients were diagnosed with ureteroscopic biopsy and underwent at least 1 ureteroscopic ablation with a holmium YAG (Ho:Yag) laser.

Findings of routine apical margin biopsy during robot-assisted radical prostatectomy.

Introduction: Intraoperative biopsy of the apical margin during radical prostatectomy has been recommended as a way to reduce the positive margin rate at this location. However, the enhanced visibility of the apex during robot-assisted radical prostatectomy (RARP) may obviate this need, allowing for the preservation of maximal urethral length. We assessed pathologic findings of routine apical margin biopsy intraoperative frozen section (IFS) during RARP.

Diagnostic radiation exposure during surveillance in patients with pT1a renal cell carcinoma.

Objective: To determine the pattern of postoperative radiographic surveillance in patients with pT1a renal cell carcinoma (RCC) at a tertiary care hospital.

Methods: An institutionally approved urologic oncology database was used to retrospectively identify patients who underwent partial or radical nephrectomy for pT1a RCC from 1990 to 2010 at a tertiary care center. Baseline characteristics were reviewed, and postoperative imaging for the indication of RCC surveillance was recorded.

Modified-PCNL without modified instruments: a description of technique.

Background And Purpose: Mini-PCNL was developed to reduce the morbidity of PCNL by using smaller tract sizes. Most mini-techniques, however, require specialized instruments and use ureteroscopes as surrogates for nephroscopes, resulting in decreased visualization, poor irrigation, and difficult fragment extraction. We describe our modified technique (mPCNL) that allows for the use of standard PCNL equipment through a tract that is smaller than standard PCNL (sPCNL) but larger than previously reported for mini-PCNL.

Audio and visual analysis of urologic laparoscopic and robotic skills: objective criteria for surgical skill evaluation.

Objective: To assess intraoperative cognitive and motor skills using audio- and video-based analysis.

Materials And Methods: The study enrolled 11 surgeons who were categorized into novice (n = 4), intermediate (n = 4), and expert (n = 3) groups. Categorization of skill level was based on years of experience and as determined by the lead expert surgeon.

R.E.N.A.L. nephrometry score accurately predicts complications following laparoscopic renal cryoablation.

Purpose: The R.E.N.

Outcomes of intrarenal Bacillus Calmette-Guérin/interferon-α2B for biopsy-proven upper-tract carcinoma in situ.

Background And Purpose: While nephroureterectomy (NU) remains the gold-standard treatment for upper-tract carcinoma in situ (UT-CIS), it may be unnecessarily aggressive in comparison with the treatment of bladder CIS. Upper-tract administration of bacillus Calmette-Guérin (BCG) has shown promise for UT-CIS, but with limited reports and varied results. Furthermore, all previous reports included patients with positive cytology results without biopsy-proven CIS, or combined BCG with other topical therapies that are used for bladder CIS.

Correlation of laparoscopic experience with differential functional brain activation: a positron emission tomography study with oxygen 15-labeled water.

Hypothesis: Regions of functional brain activation differ between novice and expert laparoscopists.

Design: We compared novice and expert laparoscopists using positron emission tomography (PET) during the peg transfer task of the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) protocol. The first scan (rest) was performed with the subject's eyes closed.

Comparison of biochemical failure definitions for predicting local cancer recurrence following cryoablation of the prostate.

Background: Various definitions of biochemical failure (BF) have been used to predict cancer recurrence following prostate cryoablation. However to date, none of these definitions have been validated for this use. We have reviewed several definitions of BF to determine their accuracy in predicting biopsy-proven local recurrence following prostate cryoablation.

Diagnostic utility and clinical value of postpercutaneous nephrolithotomy nephrostogram.

Background And Purpose: After percutaneous nephrolithotomy (PCNL), the current standard of care is to obtain a nephrostogram before removal of the nephrostomy tube to rule out distal ureteral obstruction. The aim of this study was to determine whether nephrostogram findings predict prolonged urinary drainage and postoperative ureteral stent insertion.

Patients And Methods: Data for all patients who had nephrostomy tubes inserted post-PCNL between January and December 2006 were retrospectively reviewed.

Renal artery pseudoaneurysm following laparoscopic partial nephrectomy.

Objectives: To present our experience with the management of renal artery pseudoaneurysms following laparoscopic partial nephrectomy (LPN).

Methods: Our bi-institutional LPN database of 259 patients from July 2001 to April 2008 was queried for patients diagnosed with a postoperative renal artery pseudoaneurysm. Demographic data, perioperative course, complications, and follow-up studies in identified subjects were analyzed.