Seed implant retention score predicts the risk of prolonged urinary retention after prostate brachytherapy.

Purpose: To risk-stratify patients for urinary retention after prostate brachytherapy according to a novel seed implant retention score (SIRS).

Patients And Methods: A total of 835 patients underwent transperineal prostate seed implant from March 1993 to January 2007; 197 patients had (125)I and 638 patients had (103)Pd brachytherapy. Four hundred ninety-four patients had supplemental external-beam radiation.

Third Prize: Comparison of radical nephrectomy, laparoscopic microwave thermotherapy, cryotherapy, and radiofrequency ablation for destruction of experimental VX-2 renal tumors in rabbits.

Background And Purpose: Currently available minimally invasive renal tumor-ablation procedures include cryotherapy, radiofrequency ablation, and microwave thermotherapy. In this study, we investigated the ability of these three approaches to destroy experimental renal tumors in rabbits. The mechanism of potential tumor metastasis was also explored.

Comparison of flexible ureteroscopes: deflection, irrigant flow and optical characteristics.

Purpose: We measured and compared the deflection, irrigation flow rates, distortion, resolution and light transmission of new generation flexible ureteroscopes.

Materials And Methods: Multiple characteristics of 5 flexible ureteroscopes (ACMI DUR-8 Elite, Olympus URF-P3, Storz 11278AU1 [Flex-X], Wolf 7330.072 and Wolf 7325.

What happens to hemostatic agents in contact with urine? An in vitro study.

Background And Purpose: As the indications for topical hemostatic agents increase in urology, the question arises: what happens to these agents when they enter the urinary collecting system? To answer this question, we performed a series of in-vitro experiments mixing three hemostatic agents with normal and sanguineous urine.

Materials And Methods: Four commercially available topical hemostatic products: oxidized regenerated cellulose (Surgicel; Ethicon, Somerville, NJ), fibrin sealant (Tisseel VH Kit; Baxter Health Care Corporation, Irvine, CA), gelatin matrix hemostatic sealant (FloSeal; Baxter Health Care), and polyethylene glycol (CoSeal; Cohesion Technologies, Palo Alto, CA) were studied. Human urine (10 mL) was added to samples of each substance; this was done in triplicate.

Current trends in urologic laparoscopic surgery.

Purpose: We examined the status of laparoscopy in urology and the impact of residency and fellowship training on the performance of laparoscopy as primary surgeon. We also examined whether performing nonsurgical tasks requiring two-handed dexterity had any link to the adoption of laparoscopic techniques by urologists.

Materials And Methods: A total of 8760 laparoscopy questionnaires containing 135 queries were mailed to urologists listed on the American Urological Association practicing urologists mailing list.

Laparoscopic assisted radical cystectomy with ileal neobladder: a comparison with the open approach.

Purpose: To date, there have been only a few reports regarding the feasibility of the laparoscopic approach to radical cystectomy. In none of these cases has the laparoscopic approach been contrasted with a contemporary cohort of open cystectomy and diversion. Recently, we initiated laparoscopic assisted radical cystoprostatectomy and ileal neobladder (LACINB) wherein the cystoprostatectomy and pelvic lymph node dissections are performed laparoscopically and the reconstructive portion is performed via a 15 cm Pfannenstiel incision.

One-knot pyeloplasty.

Laparoscopic pyeloplasty represents one of the more advanced reconstructive procedures for the urologist. While early reports were replete with long operative times, there have been several changes that have added to the efficiency of the procedure. In our practice, we have found three changes to be of greatest value: (1) an upper-midline port placement; (2) use of a continuous suture for the anastomosis with a double-armed, knotted suture; and (3) antegrade stent placement.

Ureteroscopes: flexible, rigid, and semirigid.

Since its introduction, the ureteroscope has undergone significant improvements. Using the currently available rigid, semirigid, and flexible ureteroscopes and working instruments, urologists can diagnose and treat lesions throughout the upper urinary tract. Over the past 25 years, the ureteroscope in combination with shock wave lithotripsy has transformed the diagnosis and treatment of more than 90% of upper urinary tract pathology from an open to an endourologic procedure.

Intraoperative catheter management during laparoscopic excision of a giant bladder diverticulum.

Background: Massive bladder diverticula present a technical challenge to the laparoscopic surgeon. We describe a laparoscopic approach to transperitoneal diverticulectomy, using a specific catheter arrangement to allow excellent control of the various portions of the procedure.

Methods: A 49-year-old male with longstanding frequency was diagnosed with a 1000 cc bladder diverticulum and bladder neck outlet obstruction.

Sealing percutaneous nephrolithotomy tracts with gelatin matrix hemostatic sealant: initial clinical use.

Purpose: Tubeless percutaneous nephrolithotomy (PCNL) has been performed at several centers with good success. However, these cases have been carefully selected with regard to short duration and smaller stone burden to prevent complications associated with the loss of access to the collecting system. We describe the use of gelatin matrix hemostatic sealant (FloSeal Baxter Medical, Fremont, California) as an adjunct to tubeless percutaneous nephrolithotomy to help preclude bleeding complications.

Influence of prostate volume in the detection of prostate cancer.

Objectives: To assess the influence of prostate volume on prostate cancer (CaP) detection in men who underwent repeated sextant transrectal ultrasound biopsy of the prostate.

Methods: Between September 1991 and September 2000, 4376 men underwent sextant transrectal ultrasound-guided biopsy of the prostate. Of the 4376 men, 556 underwent repeat biopsy because of persistent prostate-specific antigen elevation (greater than 4 ng/mL) and/or an abnormal digital rectal examination or suspicious pathologic findings.

The effect of finasteride on the expression of vascular endothelial growth factor and microvessel density: a possible mechanism for decreased prostatic bleeding in treated patients.

Purpose: Several studies have confirmed the benefit of finasteride in limiting hematuria from benign prostatic hyperplasia. Vascular endothelial growth factor (VEGF), a potent stimulator of angiogenesis, and microvessel density have been independently evaluated in the mechanism of decreased bleeding observed in patients treated with finasteride. We evaluated the expression of VEGF and suburethral prostatic microvessel density in patients with benign prostatic hyperplasia treated with finasteride.

Decreased suburethral prostatic microvessel density in finasteride treated prostates: a possible mechanism for reduced bleeding in benign prostatic hyperplasia.

Purpose: We evaluated the influence of finasteride on prostatic microvessel density to elucidate a mechanism of decreased bleeding in finasteride treated patients with hematuria secondary to benign prostatic hyperplasia (BPH).

Materials And Methods: A total of 22 patients with clinical BPH and gross hematuria who underwent prostate reductive surgery between 1998 and 2000 were prospectively evaluated. The prostate from 10 finasteride treated and 12 untreated patients was immunohistochemically stained for CD-34.