A qualitative approach to understanding the drivers of unequal receipt of definitive therapy for Black men with prostate cancer in Massachusetts.

Background: Despite mandated insurance coverage since 2006 and robust health infrastructure in urban settings with high concentrations of minority patients, race-based disparities in prostate cancer (PCa) treatment persist in Massachusetts. In this qualitative study, the authors sought to identify factors driving inequities in PCa treatment in Massachusetts.

Methods: Four hospitals offering PCa treatment in Massachusetts were selected using a case-mix approach.

Novel forms of prostate cancer chemoresistance to successful androgen deprivation therapy demand new approaches: Rationale for targeting BET proteins.

In patients with prostate cancer, the duration of remission after treatment with androgen deprivation therapies (ADTs) varies dramatically. Clinical experience has demonstrated difficulties in predicting individual risk for progression due to chemoresistance. Drug combinations that inhibit androgen biosynthesis (e.

Opioid Prescribing Practices of U.S. Urology Trainees after Urological Surgery.

Introduction: We surveyed U.S. urology trainees to determine current prescribing practices after common endourological procedures.

The impact of racial residential segregation on prostate cancer diagnosis and treatment.

Objectives: To examine the effects of racial residential segregation and structural racism on the diagnosis, treatment, and outcomes of patients with prostate cancer.

Patients And Methods: This retrospective cohort study examined men diagnosed with prostate cancer between 2005 and 2015. We collected data from Black and White men, aged ≥30 years, living within the 100 most populous counties participating in the Surveillance, Epidemiology, and End Results programme, a nationally representative dataset.

Testicular torsion: epidemiological risk factors for orchiectomy in pediatric and adult patients.

Testicular torsion is a known cause of morbidity in pediatric patients, but the burden in the adult population is poorly understood. We sought to determine the incidence of testicular torsion and risk factors for orchiectomy in a population encompassing all ages. A cohort analysis of 1625 males undergoing surgery for torsion was performed using the 2011 and 2012 Healthcare Cost and Utilization Project Nationwide Emergency Departments Sample.

Concurrent urinary and bowel diversion: Surgical modification with sigmoid colon that avoids a bowel anastomosis.

Objective: Cystectomy with urinary diversion is the gold standard for muscle invasive bladder cancer. It also may be performed as part of pelvic exenteration for non-urologic malignancy, neurogenic bladder dysfunction, and chronic conditions that result in a non-functional bladder (e.g.

Nephrostomy tube placement prior to percutaneous nephrolithotomy does not impact outcomes.

Introduction: This study aims to compare outcomes of percutaneous nephrolithotomy (PCNL) performed with a nephrostomy tube placed prior to surgery versus access at the time of surgery.

Materials And Methods: Between March 2005 and August 2014, 233 PCNLs were performed. One hundred and nine of those cases underwent placement of nephrostomy tubes at least 1 day prior to surgery (Group A), and the remaining 124 cases were performed in which access was obtained at the time of PCNL (Group B).

Single-Incision Thoracoabdominal Approach With Normothermic Cardiopulmonary Bypass for the Management of Urologic Tumors Invading the Inferior Vena Cava.

Urologic tumors invading the inferior vena cava can be a difficult management problem. They are traditionally dealt with utilizing hypothermic circulatory arrest through central cannulation for cardiopulmonary bypass performed through a median sternotomy in addition to the large abdominal incision for the kidney tumor. We describe a single incision approach utilizing normothermic cardiopulmonary bypass to address this technical challenge.

Oncological and functional outcomes after robot-assisted radical cystectomy: critical review of current status.

Although open radical cystectomy (ORC) remains the gold-standard management of muscle-invasive bladder cancer, the number of centers performing robotic-assisted radical cystectomy (RARC) has recently increased, prompting greater oncological outcome concerns. Although limited in patient number and follow-up, short-term RARC data from centers of excellence appear to show the approach to be safe and effective, with improved perioperative and functional outcomes, while maintaining comparable oncologic efficiency. Nevertheless, despite the surge of centers adopting RARC, the long-term effectiveness of minimally-invasive techniques has yet to be proven.

Effect of body mass index on perioperative outcomes for laparoscopic partial nephrectomy.

Background And Purpose: Obesity is becoming an increasing problem and is associated with increased incidence of renal-cell carcinoma. We sought to assess the impact of obesity on outcomes of laparoscopic partial nephrectomy for renal masses.

Patients And Methods: We retrospectively reviewed the pathologic and clinical outcomes from January 2004 through August 2010 of consecutive partial nephrectomies that were performed at a single institution.

Gleason 6 prostate cancer in one or two biopsy cores can harbor more aggressive disease.

Background And Purpose: Patients with Gleason (GL) 6 prostate cancer in one or two biopsy cores can be upgraded and/or upstaged at the time of surgery, which may adversely impact long-term outcome. A novel model for prediction of adverse pathologic outcomes was developed using preoperative characteristics.

Patients And Methods: Between 2003 and 2007, 1159 patients underwent robot-assisted radical prostatectomy (RARP) at our institution.

Laparoscopic radical versus laparoscopic partial nephrectomy for clinical T1bN0M0 renal tumors: comparison of perioperative, pathological, and functional outcomes.

Aim: To compare outcomes in patients treated with laparoscopic partial nephrectomy (LPN) and laparoscopic radical nephrectomy (LRN) for clinical T1bN0M0 renal masses.

Materials And Methods: Between 2002 and 2008, 33 and 52 consecutive patients who underwent LPN and LRN, respectively, for clinical stage T1bN0M0 tumors were retrospectively identified from a prospectively maintained database of 450 patients undergoing laparoscopic renal surgery. Perioperative, pathological, and postoperative outcomes were compared.

Application of ice cold irrigation during vascular pedicle control of robot-assisted radical prostatectomy: EnSeal instrument cooling to reduce collateral thermal tissue damage.

Background And Purpose: Energy-based hemostasis of the prostatic vascular pedicles (PVP) during robot-assisted radical prostatectomy (RARP) may cause collateral thermal injury to adjacent neural tissue and has been shown to negatively impact sexual function recovery. The unique engineering design of the EnSeal(®) (Ethicon, Cincinnati, OH) has been demonstrated to limit collateral thermal tissue damage to <1.0 mm.

Laparoscopic nephron-sparing surgery in the management of angiomyolipoma: a single center experience.

Background And Purpose: Angioembolization is often the first-line treatment for patients with renal angiomyolipoma (AML). Regrowth and repeated hemorrhage after embolization, however, remain a concern. Laparoscopic partial nephrectomy (LPN) is the definitive, minimally invasive treatment alternative.

Radical cystectomy in patients previously treated for localized prostate cancer.

Objectives: To present outcomes of a contemporary series of patients undergoing radical cystectomy (RC) for bladder cancer after previous treatment for localized cancer of the prostate (CaP).

Methods: A retrospective review of more than 1000 RCs performed for bladder cancer between 1995 and 2008 identified 49 patients previously treated for localized CaP. Patients were stratified according to the type of primary therapy received for CaP: any form of primary or adjuvant radiotherapy (brachytherapy or external beam radiotherapy) versus radical prostatectomy (RP) monotherapy.

Localized T1a renal lesions in the elderly: outcomes of laparoscopic renal surgery.

Objective: The objective of this study was to compare the outcomes of patients >or=70 years of age undergoing laparoscopic partial nephrectomy (LPN), laparoscopic radical nephrectomy (LRN), and laparoscopic ablative techniques (LAT) for small renal masses.

Methods: From a prospectively maintained database we identified 19 (LRN), 28 (LPN), and 19 (LAT) patients aged >or=70 who underwent surgery for cT1aN0M0 lesions. Perioperative, surgical, and functional outcomes were compared.

External beam radiation therapy after transurethral resection of the prostate: a report on acute and late genitourinary toxicity.

Purpose: To describe genitourinary (GU) toxicity in men with a history of transurethral resection of the prostate (TURP) treated with external beam radiation therapy (EBRT) for prostate cancer.

Methods And Materials: Seventy-one men with a history of TURP were treated with EBRT for prostate cancer. The median time from TURP to EBRT was 15 months.

Laparoscopic partial nephrectomy: a single-center evolving experience.

Objectives: To review our laparoscopic partial nephrectomy (LPN) experience, examine the evolution of technique, and compare the outcomes between the early and recent experience. The indications and surgical technique of LPN continuously evolve.

Methods: Data for 184 patients who underwent LPN for a tumor between October 2002 and August 2008 was retrieved from a prospective database.

Orthotopic neobladder versus Indiana pouch in women: a comparison of health related quality of life outcomes.

Purpose: Little is known about the health related quality of life of women who have undergone continent urinary diversion. We compared health related quality of life outcomes for women who underwent radical cystectomy with an orthotopic neobladder or Indiana pouch.

Materials And Methods: From 1995 to June 2008 a single surgeon (GDS) performed radical cystectomy with an orthotopic neobladder in 47 women and radical cystectomy with an Indiana pouch in 45.

Laparoscopic partial nephrectomy for technically challenging tumours.

Study Type: Therapy (case series) Level of Evidence 4.

Objective: To investigate the outcomes of laparoscopic partial nephrectomy (LPN) for endophytic tumours and those located near the hilum or the posterior upper-pole, as these pose a technical challenge.

Patients And Methods: Technically challenging tumours were defined as endophytic, hilar, or at the posterior upper-pole (group 1), and were compared to tumours in other locations (group 2).

Analysis of continence rates following robot-assisted radical prostatectomy: strict leak-free and pad-free continence.

Objectives: To propose a strict and specific definition of continence (leak-free and pad-free [LFPF]) and apply it to robot-assisted radical prostatectomy (RARP) outcomes on the basis of University of California-Los Angeles-Prostate Cancer Index (UCLA-PCI), as postprostatectomy incontinence is not well defined.

Methods: A single-institution RARP database was reviewed concerning continence variables prospectively recorded by the UCLA-PCI. Specific responses to urinary function and continence items were reviewed at baseline and 1, 3, 6, 12, and 24 months after surgery.