The Role of Multiparametric MRI and MRI-targeted Biopsy in Detecting Clinically Significant Prostate Cancer in the Community Setting: A Retrospective Study.

Multiparametric MRI and the Prostate Imaging-Reporting and Data System (PI-RADS) have emerged as tools to reveal suspicious prostate lesions and MRI-targeted biopsy has shown potential to avoid repeat prostate biopsies and miss fewer significant cancers. This retrospective study sought to assess the differences in diagnostic yield and sampling efficiency between MRI-targeted and standard biopsies in a community urology practice. We concluded that MRI-targeted biopsy was more efficient than a standard biopsy, although neither technique achieved a superior diagnostic yield of clinically significant cancer in our community setting.

Lower extremity neuropathies after robot-assisted laparoscopic prostatectomy on a split-leg table.

Background And Purpose: Lower extremity neuropathies from prolonged lithotomy positioning have been well documented. When we initiated our robot-assisted laparoscopic prostatectomy (RALP) program in December 2002, we chose to use the split-leg table that allows patient support in a more anatomic position, hypothesizing that this would reduce risk of neurologic compression injuries. We report our incidence of lower extremity neuropathies associated with RALP using split-leg positioning and review patient and surgical variables associated with this complication.

Utility of the RENAL nephrometry scoring system in the real world: predicting surgeon operative preference and complication risk.

Objective: • To evaluate the utility of the RENAL scoring system in predicting operative approach and risk of complications. The RENAL nephrometry scoring system is designed to allow comparison of renal masses based on the radiological features of (R)adius, (E)xophytic/endophytic, (N)earness to collecting system, (A)nterior/posterior and (L)ocation relative to polar lines.

Methods: • A retrospective review of all patients at a single institution undergoing radical nephrectomy (RN) or partial nephrectomy (PN) for a renal mass between July 2007 and May 2010 was carried out.

Combined renal sinus fat and perinephric fat renal cell carcinoma invasion has a worse prognosis than either alone.

Purpose: Recently groups reached differing conclusions when examining the prognostic significance of renal cell carcinoma perinephric and sinus fat invasion. We evaluated the impact of these pathological features on renal cell carcinoma survival and recurrence.

Materials And Methods: We identified the pathological and clinical records of 110 patients treated surgically for renal cell carcinoma with extrarenal extension at our institution between 1997 and 2007.

Gleason score and laterality concordance between prostate biopsy and prostatectomy specimens.

Objectives: Prostate biopsy involvement and Gleason score guide treatment decisions in prostate cancer. We evaluated concordance in Gleason score and laterality between biopsy and radical retropubic prostatectomy (RRP) specimens and factors that influenced this relationship.

Materials And Methods: We reviewed 538 prostate cancer diagnoses at a Veterans Affairs medical center (2000-2005) to identify men with prostate biopsy and RRP specimens.

Surgically discovered xanthogranulomatous pyelonephritis invading inferior vena cava with coexisting renal cell carcinoma.

Xanthogranulomatous pyelonephritis (XGP) is a chronic inflammatory process that results in replacement of renal and/or perirenal tissue with a diffuse infiltrate of inflammatory cells referred to as xanthoma cells. We present a case of a 49-year-old man with an incidentally discovered renal mass with inferior vena cava (IVC) thrombus, who was found intraoperatively to have a significant inflammatory process involving the posterior wall of his IVC and right renal vein consistent with XGP surrounding a focus of clear cell renal cell carcinoma in the midportion of his right kidney.

Chyluria after partial nephrectomy: case report and review of the literature.

We report a case of 61-year-old male who presented with chyluria after partial nephrectomy. During workup for appendicitis, an incidental exophytic renal mass was revealed on CT scan. The patient ultimately underwent uncomplicated open partial nephrectomy.

Review of topical treatment of upper tract urothelial carcinoma.

A select group of patients with upper tract urothelial carcinoma may be appropriate candidates for minimally invasive management. Organ-preserving endoscopic procedures may be appropriate for patients with an inability to tolerate major surgery, solitary kidney, bilateral disease, poor renal function, small tumor burden, low-grade disease, or carcinoma in situ. We review the published literature on the use of topical treatment for upper tract urothelial carcinoma and provide our approach to treatment in the office setting.

The significance of lymphovascular invasion in transurethral resection of bladder tumour and cystectomy specimens on the survival of patients with urothelial bladder cancer.

Objective: To test the hypothesis that patients with bladder cancer who had evidence of lymphovascular invasion (LVI) in their transurethral resection of bladder tumour (TURBT) and radical cystectomy (RC) specimens would have a worse prognosis and higher likelihood of clinical understaging, and to assess the effect of LVI discovered at RC on subsequent disease-related mortality, as the prognostic significance of LVI in TURBT or RC specimens of patients treated for urothelial carcinoma of the bladder is not completely established.

Patients And Methods: We retrospectively reviewed the records of 163 patients with urothelial carcinoma of the bladder seen at our institution, and who had TURBT (69) or RC (94) between 1995 and 2005. We compared patients with LVI on TURBT and/or RC specimens to a group of controls who did not have LVI on TURBT (34) or RC (32).

The volume/outcome relationship in urologic cancer surgery.

There is growing evidence in the literature of the association between higher hospital and surgeon volume and better outcomes from high-risk surgical procedures. A Medline search of the literature from 1966 to 2004 was performed using the keywords "outcome," "urology," "neoplasms," "volume," "hospital volume," "surgeon volume," "prostatectomy," "cystectomy," "nephrectomy," "prostate cancer," "bladder cancer," "kidney cancer," and "testis cancer." The relevant articles were reviewed and discussed in reference to each urologic cancer.

Prevalence of delayed clinician response to elevated prostate-specific antigen values.

Objective: To assess the frequency of delayed response to an abnormal prostate-specific antigen (PSA) value.

Patients And Methods: Retrospective review of prostate cancer cases diagnosed between January 1, 2000, and December 31, 2005, in a rural Department of Veterans Affairs health care system serving 44,000 veterans across 2 states. Clinician response was defined as a reference to the elevated PSA result in clinical notes, orders for further evaluation, treatment of presumed prostatitis, or a urology visit or referral.

Impact of previous bacille Calmette-Guérin failure pattern on subsequent response to bacille Calmette-Guérin plus interferon intravesical therapy.

Objectives: To evaluate the effect of the bacille Calmette-Guérin (BCG) failure pattern in patients with non-muscle-invasive bladder cancer on the subsequent response to intravesical immunotherapy.

Methods: Data from the national Phase II multicenter trial for BCG plus interferon-alpha intravesical therapy for non-muscle-invasive bladder cancer were analyzed. The cancer-free rates for BCG-naive (BCG-N) and BCG-failure (BCG-F) patients with different failure patterns were compared using Kaplan-Meier analysis.

Analysis of complications following partial and total nephrectomy for renal cancer in a population based sample.

Purpose: We determined the frequency and predictors of complications of partial and total nephrectomy in a population based sample.

Materials And Methods: There were 3,019 partial and 18,575 total nephrectomies identified from the Nationwide Inpatient Sample data set of the Healthcare Cost and Utilization Project (2000 to 2003). The prevalence of International Classification of Diseases, 9th Revision coded complications following nephrectomy was determined.

Complete response of bony metastatic bladder urothelial cancer to neoadjuvant chemotherapy and cystectomy.

We report on a 38-year-old male diagnosed with biopsy-proven bladder urothelial carcinoma metastatic to the bone, who had a complete response to neoadjuvant chemotherapy consisting of carboplatin and gemcitabine. The final pathology of his radical cystoprostatectomy revealed no residual cancer. The patient continues to be without evidence of disease 2 years postoperatively.

Maximizing clinical information obtained by CT.

CT scanning is an integral part of the urologist's practice today. It is the most commonly used imaging modality and the one with which urologists are most familiar. CT urography, CT angiography, and 3D reconstruction enable the urologist to perform comprehensive evaluations of patients who have different urologic diseases, using a single imaging modality.

Final results from a national multicenter phase II trial of combination bacillus Calmette-Guérin plus interferon alpha-2B for reducing recurrence of superficial bladder cancer.

Background: Both bacillus Calmette-Guérin (BCG) and interferon-alpha (IFN-alpha) express activity against superficial bladder cancer. The results of a national multicenter phase II trial of a combination of these 2 agents used in a wide range of patients are reported.

Materials And Methods: Patients previously having BCG failure received IFN-alpha (50 million units) plus reduced dose BCG, while patients naïve to BCG received the same IFN-alpha dose with standard dose BCG.

The impact of age on the response of patients with superficial bladder cancer to intravesical immunotherapy.

Purpose: We determined the influence of age on response to intravesical immunotherapy in patients with superficial bladder cancer.

Materials And Methods: Data from a national phase II multicenter trial for BCG plus IFN-alpha intravesical therapy for superficial bladder cancer were analyzed. Recurrence-free survival 2 years after the initiation of therapy was examined in patients by incremental age decade.

Minimally invasive management of upper tract urothelial carcinoma.

Recently published studies that evaluated minimally invasive treatments for upper tract urothelial cancer (UTUC) were reviewed, including adjuvant topical therapy. Ureteroscopic management remains the initial diagnostic and possibly therapeutic procedure of choice. Percutaneous management is used to treat bulky tumors or tumors that cannot be accessed ureteroscopically.

The impact of provider volume on outcomes from urological cancer therapy.

Purpose: Growing evidence suggests an association between higher hospital and surgeon volumes, and better outcomes after high risk surgical procedures. We reviewed the literature on volume and outcomes, specifically in urological cancer therapy.

Materials And Methods: We searched the literature from 1966 to 2004 using MEDLINE with the keywords outcomes, urology, neoplasms, volume, hospital volume, surgeon volume, prostatectomy, cystectomy, nephrectomy, prostate cancer, bladder cancer, kidney cancer and testis cancer.

Second-line intravesical therapy versus cystectomy for bacille Calmette-Guérin (BCG) failures.

Purpose Of Review: To give an update on the new modalities in treating patients with superficial bladder cancer who have failed bacille Calmette-Guérin.

Recent Findings: The addition of interferon to bacille Calmette-Guérin has proven to be an effective combination therapy for bacille Calmette-Guérin failures. Electromotive intravesical mitomycin C as well as local microwave hyperthermia have been shown to improve drug delivery and increase response rates.

Fluorescence cystoscopy and bladder surveillance.

Purpose Of Review: Update on new developments in the field of fluorescence cystoscopy.

Recent Findings: New agents are being studied to improve the accuracy of fluorescence cystoscopy. Hexyl-5-aminolevulinic acid is an ester form of 5-aminolevulinic acid with improved uptake by tumor cells.

Contemporary management of superficial bladder cancer in the United States: a pattern of care analysis.

Objectives: To assess the practice preferences among urologists treating superficial bladder cancer in the United States.

Methods: We surveyed 226 urologists using a specially designed survey instrument. The type of practice, number of urologists in group practice, annual volume of patients with bladder cancer, and those treated with intravesical therapy were assessed.