Natural orifice transluminal endoscopic surgery (NOTES): current experience and urologic applications.

Natural orifice transluminal endoscopic surgery (NOTES) has attracted considerable recent attention for its potential to allow traditional abdominal procedures to be performed without a transabdominal incision. With considerable experience in the development and application of minimally invasive techniques, urologists have played a significant role in early experimental NOTES efforts and have contributed to early investigations in human subjects accordingly. However, adoption of these techniques has been limited due to cumbersome endoscopic equipment and concerns regarding peritonitis from failed viscerotomy closure.

Outcomes of percutaneous nephrolithotomy stratified by body mass index.

Background: Obesity places surgical patients at a greater risk of complications. The effects of obesity on outcomes and complications from percutaneous nephrolithotomy (PCNL) are not well defined.

Objective: The objective of this study was to stratify outcome and morbidity of PCNL with respect to body mass index (BMI) in a large contemporary series.

Increased nerve growth factor in neurogenic overactive bladder and interstitial cystitis patients.

Objectives: Studies have suggested that pathology of the lower urinary tract can be detected by following changes in urinary proteins. We evaluated urine nerve growth factor (NGF) levels from patients with a variety of urologic conditions to examine NGF's role as a future biomarker.

Materials And Methods: Urine samples were obtained from 72 patients with normal non-diseased urinary tracts (n = 13), neurogenic overactive bladder (NOAB) (n = 13), idiopathic overactive bladder (OAB) (n = 17), interstitial cystitis/painful bladder syndrome (IC/PBS) (n = 8), prostate cancer (n = 7), history of prostate cancer status post robot-assisted laparoscopic prostatectomy (RALP) (n = 6), active bladder cancer (n = 4), and nephrolithiasis (n = 4).

Investigational therapies for non-muscle invasive bladder cancer.

Importance Of The Field: Bacillus Calmette-Guérin (BCG) is currently the most effective adjuvant intravesical agent at preventing disease recurrence and the only therapy shown to inhibit disease progression in non-muscle invasive bladder cancer (NMIBC). However, recurrence rates as high as 30% and significant local/systemic toxicity have resulted in an increased interest in the use of alternative intravesical agents.

Areas Covered In The Review: Our aim is to discuss recent clinical trial evidence utilizing novel intravesical agents for treatment of NMIBC.

Emerging intravesical therapies for management of nonmuscle invasive bladder cancer.

Transitional cell carcinoma (TCC) is the second most common urologic malignancy, and 70% of patients present with superficial or nonmuscle invasive bladder cancer (NMIBC). Intravesical bacillus Calmette-Guerin (BCG) is the most effective agent for preventing disease recurrence, and the only therapy able to inhibit disease progression. However, recurrence rates as high as 30% and significant local and systemic toxicity have led to increased interest in alternative intravesical therapies.

Factors affecting blood loss during percutaneous nephrolithotomy using balloon dilation in a large contemporary series.

Objective: Renal hemorrhage is a common and worrisome complication of percutaneous nephrolithotomy (PNL). We review factors affecting blood loss and transfusion requirements in a large contemporary series of patients undergoing PNL utilizing balloon dilation.

Methods: We retrospectively reviewed all patients undergoing PNL at one institution from July 2000 to January 2008.

Eligibility for active surveillance and pathological outcomes for men undergoing radical prostatectomy in a large, community based cohort.

Purpose: We analyzed competing active surveillance criteria in men who underwent radical prostatectomy in relation to outcome data in a large, community based cohort.

Materials And Methods: We identified all men from the CaPSURE database who underwent radical prostatectomy from 1999 to 2007 and met inclusion criteria for the stringent prospective University of California-San Francisco and Johns Hopkins active surveillance protocols. Rates of pathological upgrading, up staging and biochemical recurrence were compared.

The evolution of the endourologic management of pediatric stone disease.

In the 1980s, the advent of shock wave lithotripsy (SWL) revolutionized pediatric stone management and is currently the procedure of choice in treating most upper tract calculi < 1.5 cm in children. However, with miniaturization of instruments and refinement of surgical technique the management of pediatric stone disease has undergone a dramatic evolution over the past twenty years.

Estimating postoperative mortality and morbidity risk of radical cystectomy with continent diversion using predictor equations.

Purpose: The POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) and Portsmouth POSSUM predictor equations are scoring systems validated in the general surgery literature that estimate postoperative morbidity and mortality risk. We tested the validity of POSSUM and Portsmouth POSSUM in patients undergoing radical cystectomy with continent diversion.

Materials And Methods: We retrospectively reviewed physiological parameters, operative parameters, and 30-day morbidity and mortality in 102 patients who underwent radical cystectomy with continent orthotopic diversion, as done by a single surgeon.

Management of benign ureteral strictures in the endoscopic era.

Background And Purpose: During the past decade, endoscopic management has emerged as the first-line treatment of benign ureteral strictures. We reviewed our experience with the management of benign ureteral strictures to determine the success rate of endoscopic surgery in a contemporary series and assessed the viability of surgical reimplantation in the modern era.

Patients And Methods: We identified 75 patients with a diagnosis of ureteral stricture between 2000 and 2005 via electronic medical records search and excluded those with completely obliterated, external compressive, malignant, or ureteroenteric strictures, ureteropelvic junction obstruction, and those with follow-up less than 2 months.

Robotic-assisted laparoscopic extravesical ureteroneocystostomy for management of adult ureteral duplication with upper pole prostatic urethral insertion.

A 55-year-old male presented with progressive lower urinary tract symptoms and renal colic. The workup revealed a complete left ureteral duplication with a hydronephrotic upper pole moiety inserting into the prostatic urethra. Using a 5-port transperitoneal robotic-assisted laparoscopic technique, an extravesical upper pole ureteroneocystostomy was performed.

Percutaneous nephrolithotomy in children.

Purpose: To review the history of percutaneous nephrolithotomy (PCNL) in children, describe technical considerations, including advancements in equipment, and discuss future directions.

Materials And Methods: A comprehensive literature review was performed using MEDLINE/PubMed to evaluate the use of PCNL in the pediatric population, including historical background, indications, operative techniques, and outcomes.

Results: PCNL was first applied to the pediatric population in the 1980s using adult-size instruments.

The application of endoscopic techniques in the management of upper tract recurrence after cystectomy and urinary diversion.

Although nephroureterectomy remains the gold-standard therapy for upper tract recurrence of transitional cell carcinoma after cystectomy and urinary diversion, conservative endoscopic techniques are increasingly being utilized for surveillance and management of recurrent low-grade upper tract lesions. A retrograde or antegrade approach is technically feasible and can be an effective alternative in patients with significant medical comorbidities, chronic renal insufficiency, bilateral disease, or solitary renal units. Recent series have expanded the utility of these procedures to include solitary, low-grade, and completely resectable tumors in patients with normal contralateral kidneys who are willing to accept lifelong surveillance for recurrence.

Strategies to enhance the efficacy of intravescical therapy for non-muscle invasive bladder cancer.

Transitional cell carcinoma (TCC) is the second most common urologic malignancy, and 70% of patients present with superficial, or non-muscle invasive disease (NMIBC). Bacillus Calmette-Guerin (BCG), currently the most effective intravesical agent at preventing disease recurrence, is the only therapy shown to inhibit disease progression. Unfortunately, approximately 20% of patients discontinue BCG due to local and systemic toxicity and more than 30% show evidence of recurrence; this has led to increased interest in alternate chemotherapeutic agents.

The impact of obesity on overall and cancer specific survival in men with prostate cancer.

Purpose: We examined the impact of obesity on disease specific and overall survival in patients with prostate cancer.

Materials And Methods: We identified 7,274 men from the Cancer of the Prostate Strategic Urological Research Endeavor database with clinically localized prostate cancer, known body mass index and clinicopathological disease characteristics. Patients were classified by body mass index as normal (less than 25 kg/m(2)), overweight (25 to 29.

Clinical implications of hypoxia inducible factor in renal cell carcinoma.

Management of renal cell carcinoma (RCC) has made considerable strides in the past decade, due in large part to identification of the von Hippel Lindau (VHL) tumor suppressor as a negative regulator of hypoxia inducible factor alpha (HIF-alpha) protein expression. Stabilization of HIF-alpha appears to be critical for renal tumorigenesis, and is observed even in VHL-independent RCC. Thus, an understanding of the pathways that regulate expression and activation of the different HIF-alpha isoforms is key to delineating the mechanism of renal transformation and for the development of novel therapeutics.

Robot-assisted laparoscopic prostatectomy: the first 100 patients-improving patient safety and outcomes.

Background And Purpose: Patient safety and outcomes are paramount when using new technology. We report our initial experience of 100 patients with robot-assisted laparoscopic prostatectomy (RALP) with a focus on patient safety and outcomes.

Materials And Methods: Data were prospectively collected from the first 100 consecutive patients who underwent RALP for localized prostate cancer from October 2004 to August 2007.

Differential expression of functional cannabinoid receptors in human bladder detrusor and urothelium.

Purpose: Although cannabinoid receptor expression has been demonstrated in human brain and other peripheral neuronal tissues, definitive expression of these receptors in the human bladder has not been reported. Consequently we investigated the expression of functional cannabinoid 1 and 2 receptors in human bladder detrusor and urothelium.

Materials And Methods: Human bladders were micro-dissected for detrusor (6) and urothelium (8), and analyzed for cannabinoid 1 and 2 mRNA expression using real-time quantitative polymerase chain reaction, and for protein expression using immunohistochemistry and Western blot.

Endourologic management of upper tract transitional cell carcinoma following cystectomy and urinary diversion.

Traditionally, nephroureterectomy is the gold standard therapy for upper tract recurrence of transitional cell carcinoma (TCC) following cystectomy and urinary diversion. With advances in endoscopic equipment and improvements in technique, conservative endourologic management via a retrograde or antegrade approach is technically feasible with acceptable outcomes in patients with bilateral disease, solitary renal units, chronic renal insufficiency, or significant medical comorbidities. Contemporary studies have expanded the utility of these techniques to include low-grade, low-volume disease in patients with a normal contralateral kidney.

Inguinal canal recurrence of colorectal adenocarcinoma following cytoreductive surgery and intraperitoneal hyperthermic chemotherapy.

Peritoneal carcinomatosis, the second most common cause of death among patients with colorectal carcinoma, may be managed with cytoreductive surgery and adjuvant intraoperative peritoneal hyperthermic chemotherapy (IHPC). We present the case of a 35-year-old male with locally recurrent colorectal adenocarcinoma in the inguinal canal and testis following intraperitoneal debulking and IPHC. When communicating with the peritoneal cavity, the inguinal canal may act as an anatomic sanctuary site and allow peritoneal carcinomatosis to escape the effects of intraperitoneal chemotherapy.

Endourological management of pediatric stone disease: present status.

Purpose: The incidence of nephrolithiasis in the pediatric population has been steadily increasing. The miniaturization of endoscopic instruments and improvement in imaging modalities have facilitated safe and effective endourological treatment in this patient population. We reviewed the current status of pediatric stone disease management.

Stem cell therapy for urethral sphincter regeneration.

In anatomical and functional studies of the human and animal urethra, the middle urethral contained rhabdosphincter is critical for maintaining continence. Transplanted stem cells may have the ability to undergo self renewal and multipotent differentiation, leading to sphincter regeneration. In addition, such cells may release, or be engineered to release, neurotrophins with subsequent paracrine recruitment of endogenous host cells to concomitantly promote a regenerative response of nerve-integrated muscle.