Frozen section evaluation of margins in radical prostatectomy specimens: a contemporary study and literature review.

The utility of routine frozen section (FS) analysis for margin evaluation during radical prostatectomy (RP) remains controversial. A retrospective search was conducted to identify RPs evaluated by FS over a 5-year period. The potential of FS to discriminate between benign and malignant tissue and to predict final margins was evaluated.

Evaluation of novel formula of PSA, age, prostate volume, and race in predicting positive prostate biopsy findings.

Objective: To develop a formula that incorporates age, prostate volume, race, and prostate-specific antigen (PSA) level into a single score for prostate cancer detection.

Materials And Methods: We developed a PSA-age volume (AV) score by multiplying the patient age by the prostate volume and dividing it by the PSA level. The PSA-AV was developed using 1000 prostate biopsy specimens and was validated on 318 internal and 4406 external biopsy specimens.

Robotic versus open radical cystectomy: identification of patients who benefit from the robotic approach.

Purpose: To identify patients who would benefit from robot-assisted radical cystectomy (RARC), we report perioperative outcomes and complications.

Patients And Methods: We compared patients who underwent RARC to patients who underwent open cystectomy (OC) in our institution. Data included demographics, operative variables, and recovery.

Outcome of hand assisted laparoscopic bilateral native nephrectomy in transplant recipients.

Purpose: We explored the safety and reproducibility of hand assisted laparoscopic bilateral native nephrectomy. We also present our improvements to the surgical technique.

Materials And Methods: We retrospectively reviewed the charts of 36 patients who underwent hand assisted laparoscopic bilateral nephrectomy at our institution between 2003 and 2010.

A simple method for estimating the optimum number of prostate biopsy cores needed to maintain high cancer detection rates while minimizing unnecessary biopsy sampling.

Objective: The objective was to provide urologists with a simple basis for optimizing the number of prostate biopsy cores that should be taken.

Methods: The records of 1024 patients who had undergone transrectal ultrasound-guided biopsies were reviewed. The prostate volume was divided by the number of biopsies to obtain the volume/biopsy ratio (VBR).

Practical use of investigations in patients with hematuria.

Objective: The majority of patients with microscopic hematuria undergo a complete evaluation resulting in negative findings. The outcome of patients with hematuria was analyzed in an effort to optimize the use of investigations.

Patients And Methods: The records for 404 patients who presented with hematuria were reviewed.

Novel technique for hand assisted laparoscopic right donor nephrectomy.

Purpose: Most surgeons divide the renal vein with a laparoscopic stapler during laparoscopic donor nephrectomy. The right renal vein is usually shorter than the left one and using the stapler on the right side can result in a higher incidence of vascular complications for right kidney recipients. We present our experience with a new technique for hand assisted laparoscopic right donor nephrectomy.

Anesthesia for laparoscopic donor nephrectomy: is nitrous oxide contraindicated?

Purpose: We performed this study to test the hypothesis that nitrous oxide produces clinically significant bowel distention during laparoscopic abdominal surgery.

Materials And Methods: Laparoscopic kidney donors were randomized into 2 groups. Group 1 received N2O and oxygen inhalation through anesthesia, and group 2 received a mixture of air and oxygen.

Computerized tomographic angiography for renal donor evaluation leads to a higher exclusion rate.

Purpose: We compared the exclusion rate for potential living renal donors evaluated with computerized tomography angiography and radionuclide renal scintigraphy (renal scan) vs excretory urogram, renal scan and renal arteriography.

Materials And Methods: From March 2004 through February 2006, 603 consecutive patients were evaluated as potential living renal donors. From March 2004 through February 2005, 270 consecutive patients underwent evaluation with excretory urogram, renal scan and renal angiography (group 1).

EUS-guided FNA for the diagnosis of recurrent bladder cancer through the ileal conduit: a novel approach.

Background: Diagnosing local recurrence of tumor after cystectomy and ileal conduit construction for urinary bladder cancer remains a diagnostic challenge. Also, distinction of benign stricture from recurrent tumor at the site of ureteral anastomosis in the ileal conduit is difficult.

Objective: A new method is described for performing EUS-guided FNA through the ileal conduit in patients suspected of having local tumor recurrence after complete cystectomy for bladder cancer.

Laparoscopic right nephrectomy using a novel technique to excise an inferior vena-caval cuff in a porcine model.

Background And Purpose: Laparoscopic right nephrectomy has been performed using laparoscopic staplers to clamp and divide the renal vessels. In patients who have a tumor thrombus in the renal vein and in rightkidney donors, it is necessary to excise a cuff of the inferior vena cava (IVC) with the renal vein. We present a new technique for excising a cuff of the IVC and suturing it intracorporally using a new vascular clamp designed in our institution.

Retrograde stenting for obstruction of the renal transplant ureter.

Objectives: To present our experience with retrograde stent placement and stent exchange for transplant ureteral obstruction.

Methods: A review of our renal transplant database was performed to identify all renal transplant patients who underwent attempted retrograde ureteral stenting for allograft ureteral obstruction or attempted allograft ureteral stent exchange between May 1992 and April 2004. A retrospective review was performed.

Bladder cancer. Clinical practice guidelines in oncology.

Urothelial tumors represent a spectrum of diseases with a range of prognosis. After a diagnosis is established at any point within the urothelial tract, the patient remains at risk for developing a new lesion at a different or the same location and at a similar or more advanced stage. Continued monitoring for recurrence is an essential part of management, because most recurrences are superficial and can be managed endoscopically.

Donor nephrectomy: A comparison of techniques and results of open, hand assisted and full laparoscopic nephrectomy.

Purpose: Laparoscopic donor nephrectomy (LAP) has been gaining more popularity among kidney donors and transplant surgeons. There have been some concerns about the function of kidney grafts harvested by laparoscopic procedures. We report our results of LAP.

Surgical management of renal tumors.

Renal cell carcinoma is a relatively rare tumor, accounting for approximately 3% of malignancies in adults, but is the most common tumor of the kidney and the third most common tumor seen by urologists. Renal cell carcinoma is refractory to most traditional oncologic treatments, including chemotherapy, radiation therapy, and hormonal therapy. Because of recent advances in sophisticated radiologic studies, the surgeon can now make an accurate preoperative assessment of the nature and extent of kidney tumors.

Camptothecin analogues and vinblastine in the treatment of renal cell carcinoma: an in vivo study using a human orthotopic renal cancer xenograft.

To perform a series of in vivo cytotoxicity studies using a variety of doses of the comptothecin analogues 9-Aminocamptothecin (9-AC) and Irinotecan (CPT-11) with a human RCC xenograft tumor line (DU11983m). Using the subrenal capsule assay (80 nude mice) (NM-SRCA), 9-AC was evaluated at both low and high dosage levels (0.75 mg/kg and 1.

Follow-up functional radiographic studies are not mandatory for all patients after ureteroscopy.

Objectives: To evaluate the usefulness of follow-up radiographic studies after ureteroscopy by retrospective chart review.

Methods: We reviewed the charts of 118 patients who underwent 134 ureteroscopic procedures from January 1998 to November 1999.

Results: Follow-up was obtained at our institution for 87 patients.

Genetic adaptive neural network to predict biochemical failure after radical prostatectomy: a multi-institutional study.

Background And Purpose: Despite many new procedures, radical prostatectomy remains one of the commonest methods of treating clinically localized prostate cancer. Both from the physician's and the patient's point of view, it is important to have objective estimation of the likelihood of recurrence, which forms the foundation for treatment selection for an individual patient. Currently, it is difficult to predict the probability of biochemical recurrence (rising serum prostate specific antigen [PSA] concentration) in an individual patient, and approximately 30% of the patients do experience recurrence.

Radical prostatectomy in a community practice.

Purpose: We report the experience of a community based urologist with anatomical retropubic radical prostatectomy. We compared outcome data with that reported experience at several well-known academic institutions.

Materials And Methods: Between May 1986 and December 2000, 382 consecutive patients underwent anatomical radical retropubic prostatectomy performed by a single community based urologist.

Long-term efficacy of sildenafil and tachyphylaxis effect.

Purpose: We observed that patients who initially responded to sildenafil frequently became resistant to it with time. We evaluated the long-term efficacy of sildenafil.

Materials And Methods: A telephone survey was conducted of patients during the first year of sildenafil usage, and another one was completed 2 years later of the same group.

Update on extracorporeal magnetic innervation (EXMI) therapy for stress urinary incontinence.

Pulsed magnetic technology has been developed for pelvic floor muscle strengthening for the treatment of urinary incontinence. This report includes an update of the prospective multicenter study of extracorporeal magnetic innervation (ExMI) therapy for stress incontinence and a discussion of the possible mechanisms of action. Issues of patient selection for ExMI therapy will also be discussed.

Poor prognosis associated with thrombocytosis in patients with renal cell carcinoma.

Objectives: To better define the relationship between platelet count and survival using a retrospective analysis in patients with thrombocytosis and metastatic renal cell carcinoma (RCC), some of whom had a shorter life expectancy than those with a normal platelet count.

Patients And Methods: The records were reviewed of patients with stage IV RCC who had undergone a variety of adjuvant therapies after nephrectomy between 1972 and 1992. Entry criteria included a tissue diagnosis of RCC, at least one platelet count and a complete follow-up until the time of death.