Taking the Procedure to the Patient: Increasing Access to Urological Procedural Care through Outreach.

Introduction: We previously showed that urological outreach clinics significantly increase access to urological clinical care in rural populations. How such clinics affect access to urological procedural care is unknown. In this study we analyzed the use of outreach facilities for outpatient hospital based urological procedural care in a rural state.

Malignant mesothelioma of the tunica vaginalis: a rare case report and description of multimodal treatment.

Malignant mesothelioma is an uncommon neoplasm that develops from serous surfaces, and rarely from the tunica vaginalis. Although atypical in any location, paratesticular presentation is exceedingly infrequent as only 0.3% to 1.

Bladder cancer will grow anywhere: report of a urothelial carcinoma drop metastasis to the vagina and literature review.

Urothelial carcinoma is the 2nd most common cancer of the urinary tract and accounts for the majority of cases of bladder cancer. Metastases are not infrequently encountered, increasing with disease stage and are most commonly seen in the bones and lungs. Many other sites have been described including the omentum, liver, and ovaries.

Microscopic haematuria at time of diagnosis is associated with lower disease stage in patients with newly diagnosed bladder cancer.

Objectives: To determine whether the severity of haematuria (microscopic or gross) at diagnosis influences the disease stage at presentation in patients diagnosed with bladder cancer.

Patients And Methods: We conducted a multi-institutional observational cohort study of patients who were newly diagnosed with bladder cancer between August 1999 and May 2012. We reviewed the degree of haematuria, demographic information, clinical and social history, imaging, and pathology.

Osseous Metaplasia in Mucinous Tubular and Spindle Cell Carcinoma of the Kidney: A Case of Massive, Bilateral Tumors.

Renal cell carcinoma (RCC) is the most common kidney malignancy, with many histologic subtypes. One of the rare forms of RCC is mucinous tubular and spindle cell carcinoma (MTSCC), which is newly described with limited information on clinical picture and outcome. Heterotopic bone formation (osseous metaplasia) is a rare finding within any renal mass.

Pediatric emphysematous cystitis: a report and review of a rare diagnosis in children.

An 11-year-old female with spastic quadriplegia was seen in the emergency room with abdominal pain, vomiting and anorexia. Labs revealed possible pancreatitis and signs of a urinary tract infection. A CT scan was performed to assess her abdominal pain and demonstrated circumferential air within the bladder wall.

Evaluating the safety of intraoperative instillation of intravesical chemotherapy at the time of nephroureterectomy.

Background: Urothelial carcinoma (UC) is a common cancer affecting many patients in the United States. Nephroureterectomy remains the gold standard for the treatment of high grade upper tract disease or low grade tumors that are not amenable to endoscopic management. Recent reports have shown a decrease in UC recurrence in patients who underwent nephroureterectomy and who had Mitomycin C (MMC) instilled into the bladder at the time of catheter removal.

Basal cell carcinoma of the penis: a case report and review of the literature.

Basal cell carcinoma of the penis is an extremely rare entity, accounting for less than 0.03% of all basal cell carcinomas. Fortunately, wide local excision of such lesions is generally curative.

Novel Use of AngioVac System to Prevent Pulmonary Embolism during Radical Nephrectomy with Inferior Vena Cava Thrombectomy.

Venous tumor thrombus occurs in 5-10% of patients with renal cell carcinoma. Surgical excision offers the best chance for survival, but is technically difficult. Risk of pulmonary embolism from venous thrombus or tumor thrombus is high, especially with tumors located higher in the inferior vena cava.

Prostate cancer vaccines in combination with additional treatment modalities.

Immunotherapy has been investigated in both preclinical studies and clinical trials as a new therapy for prostate cancer. Vaccines, including those that utilize dendritic cells, viruses, or DNA, immunize against prostate-specific antigen and prostatic acid phosphatase. The vaccines have long been studied as monotherapy for the cancer, but increasingly more trials have been initiated in combination with other modalities.

Use of blunt right angles to aid in intussusception of a Bricker ileal conduit.

The Bricker ileal conduit has been the most popular urinary diversion technique following a radical cystectomy since the 1950s. The procedure typically provides a high quality of life for patients. However, stomal complications occur in 16%-65% of ileal conduit cases.

Variations in the open market costs for prostate cancer surgery: a survey of US hospitals.

Objective: To examine variation in the open market cost of a radical prostatectomy (RP) procedure in the US hospitals for an uninsured patient, as many proposals for health care reform highlight the importance of individuals actively participating in selecting care. However, reports suggest that obtaining procedure prices remains challenging and highly variable.

Materials And Methods: We used 2011-2012 US News and World Report rankings to identify a cohort of 100 hospitals making an effort to include an equal distribution of both academic and private centers, city size, and geographic region.

Improving access to urologic care for rural populations through outreach clinics.

Objective: To determine the effect of outreach clinics on access to urologic care in a state with a large rural population. This is especially pertinent given the predicted shortage of urologists over the next decade and the trend toward practice in urban area.

Methods: We analyzed provider level data from urologic practices within the state of Iowa using information from 2 publicly available sources: (1) the Office of Statewide (Iowa) Clinical Education Programs, which collects detailed information on visiting consultant urologists (VCU), and (2) the Iowa Physician Information System, which tracks demographic and professional data on all active physicians in Iowa.

An update in the treatment of male urinary incontinence.

Purpose Of Review: Male urinary incontinence affects a significant number of elderly men and the successful treatment has the potential to significantly improve their quality of life.

Recent Findings: Stress urinary incontinence, overflow incontinence and detrusor overactivity are the major categories of urinary incontinence affecting men. Although the surgical standards of care have not changed significantly for urinary incontinence, there have been recent advances with minimally invasive techniques, which show promise.

Transitional Cell Carcinoma within a Portion of Inguinally Herniated Bladder.

Bladder herniation within the inguinal canal is a relatively uncommon finding. We report an even less-common occurrence of transitional cell carcinoma located within a portion of inguinally herniated bladder. Fewer than 20 reports exist in the literature describing this scenario.

Explosive growth of a renal tumor during active surveillance.

The incidence of small renal masses (≤ 4 cm) has increased over the past three decades. Partial nephrectomy remains the standard for treatment of such lesions, but increased attention is being given to patients who may benefit from active surveillance, given the low risk of metastatic spread and traditionally slow growth rates. Patients with significant comorbidities and the elderly are often considered optimal candidates for surveillance.

Partial nephrectomy: novel closure technique using bovine pericardium.

Partial nephrectomy (PN) has gained popularity over the past two decades as an alternative to radical nephrectomy (RN) in patients with small renal masses. Morbidity and mortality from PN have been shown to be lower than from RN, while oncologic outcomes have been shown to be equivalent for tumors < 7 cm. PN has become increasingly popular in academic centers, but the general urologic community continues to lag behind.

Prostate-specific antigen velocity based risk-adapted discontinuation of prostate cancer screening in elderly men.

Objective: • To evaluate weather prostate-specific antigen (PSA) velocity could be used to stratify patients at risk of death from prostate cancer (PCa) and be useful in aiding decision making regarding PSA screening in elderly men, as previous studies have shown that PSA velocity can predict PCa risk.

Patients And Methods: • The cohort included 3,525 patients aged ≥ 75 years with two or more PSA tests before a diagnosis of PCa. Cox proportional hazard model was used to evaluate which variables at time of last PSA measurement were associated with death from PCa.

Baseline PSA as a predictor of prostate cancer-specific mortality over the past 2 decades: Duke University experience.

Background: A diagnosis of prostate cancer is not often predictive of death from prostate cancer because of competing causes of mortality. Identification of the risk of death from prostate cancer and death from all causes using information available at the time of baseline prostate-specific antigen (PSA) measurement appears to be particularly pertinent.

Methods: The Duke Prostate Center database was used to identify men who had their PSA level measured over the past 20 years.

Tumor percent involvement predicts prostate specific antigen recurrence after radical prostatectomy only in men with smaller prostate.

Purpose: We determined the predictive power of tumor percent involvement on prostate specific antigen recurrence in patients when stratified by prostate weight.

Materials And Methods: Data on 3,057 patients who underwent radical prostatectomy between 1988 and 2008 was retrieved from our institutional prostate cancer database. Patients with data on tumor percent involvement, prostate volume and prostate specific antigen recurrence were included in analysis.

Initial prostate specific antigen 1.5 ng/ml or greater in men 50 years old or younger predicts higher prostate cancer risk.

Purpose: Studies show that initial prostate specific antigen higher than the median in young men predicts a subsequent higher risk of prostate cancer. To our knowledge this relationship has not been studied in patients stratified by race.

Materials And Methods: A cohort of 3,530 black and 6,118 white men 50 years or younger with prostate specific antigen 4 ng/ml or less at the first prostate specific antigen screening was retrieved from the prostate center database at our institution.

Prostate-specific antigen-based risk-adapted discontinuation of prostate cancer screening in elderly African American and Caucasian American men.

Objectives: To evaluate the relationship between initial prostate-specific antigen (PSA) and prostate cancer (PCa) risk in elderly African American (AA) and Caucasian American (CA) men.

Methods: A total of 408 AA and 1720 CA men whose initial PSA measurement was performed between 75 and 80 years of age were retrieved from Duke Prostate Center database. Patients were stratified by race and initial PSA value.

Tumor volume, tumor percentage involvement, or prostate volume: which is predictive of prostate-specific antigen recurrence?

Objectives: To compare the effects of tumor volume (TV), tumor percentage involvement (TPI), and prostate volume (PV) on prostate-specific antigen (PSA) recurrence (PSAR) after radical prostatectomy (RP).

Methods: A cohort of 3528 patients receiving RP between 1988 and 2008 was retrieved from the Duke Prostate Center. Patients were stratified by TV (< 3, 3-6, > 6 cm(3)), TPI (< 10%, 10%-20%, > 20%), and PV (< 35, 35-45, > 45 cm(3)) and their effects on PSAR evaluated using Kaplan-Meier analysis.