Asian Race and Risk of Prostate Cancer: Results from the REDUCE Study.

Background: Global prostate cancer incidence rates are lower in Asian men than Caucasian men. Whether this is the result of less screening in Asian men remains to be determined. We examined whether Asian race was associated with prostate cancer diagnosis in the Reduction by Dutasteride of Cancer Events (REDUCE) study.

Comparison of valve-less and standard insufflation on pneumoperitoneum-related complications in robotic partial nephrectomy: a prospective randomized trial.

To prospectively compare standard and valve-less insufflation systems on pneumoperitoneum-related complications in robotic-assisted laparoscopic partial nephrectomy. A prospective randomized controlled trial was conducted during a 1.5-year period to compare insufflation-related complications in partial nephrectomy surgery by a single surgeon.

Randomised comparison of techniques for control of the dorsal venous complex during robot-assisted laparoscopic radical prostatectomy.

Objective: To prospectively compare the effects of endoscopic stapling, division and suture ligation, and suture ligation with suspension of the dorsal venous complex (DVC) on continence during robot-assisted laparoscopic radical prostatectomy (RARP).

Patients And Methods: In all, 300 consecutive patients undergoing RARP by a single surgeon were randomised to three groups: endoscopic stapling, cut and suture ligation, and suture ligation with suspension. The only difference between the groups was the technique to control the DVC.

A Single-Surgeon Retrospective and Preliminary Evaluation of the Safety and Effectiveness of the Penuma Silicone Sleeve Implant for Elective Cosmetic Correction of the Flaccid Penis.

Background: Silicone blocks and sleeves are simple devices used in cosmetic surgery. They are generally viewed as safe and effective; however, there is little information on their use in the penis.

Aim: This study evaluates a large single-surgeon series using a novel silicone sleeve penile implant (Penuma) to cosmetically correct the flaccid penis.

PSA predicts development of incident lower urinary tract symptoms: results from the REDUCE study.

Background: The relationship between baseline prostate-specific antigen (PSA) and development of lower urinary tract symptoms (LUTS) in asymptomatic and mildly symptomatic men is unclear. We sought to determine if PSA predicts incident LUTS in these men.

Methods: A post-hoc analysis of the 4-year REDUCE study was performed to assess for incident LUTS in 1534 men with mild to no LUTS at baseline.

Serum cholesterol and risk of lower urinary tract symptoms progression: Results from the Reduction by Dutasteride of Prostate Cancer Events study.

Objective: To determine if cholesterol is a risk factor for the development of lower urinary tract symptoms in asymptomatic men.

Methods: A post-hoc analysis of the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study was carried out in 2323 men with baseline International Prostate Symptom Score <8 and not taking benign prostatic hyperplasia or cholesterol medications. Cox proportion models were used to test the association between cholesterol, high-density lipoprotein, low-density lipoprotein and the cholesterol : high-density lipoprotein ratio with incident lower urinary tract symptoms, defined as first report of medical treatment, surgery or two reports of an International Prostate Symptom Score >14.

Prospective Pilot Trial to Evaluate a High Resolution Diffusion-Weighted MRI in Prostate Cancer Patients.

Objectives: High-resolution prostate imaging may allow for detection of subtle changes in tumor size, decrease the reliance on biopsies, and help define tumor boundaries during ablation. This pilot clinical trial evaluates a novel high-resolution prostate MRI for detection of small, biopsy-proven prostate tumors.

Methods: Our team developed a software that can be loaded on any modern MRI to generate high resolution diffusion-weighted imaging sequences (HR-DWI), which were compared to standard diffusion-weighted imaging sequence (S-DWI) in a prospective pilot trial in active surveillance patients.

Female Sexual Dysfunction: Is It a Treatable Disease?

Female sexual dysfunction affects approximately 40% of women (Sexual problems and distress in United States women: prevalence and correlates; Shifren et al., Obstet Gynecol, 112(5): 970-978, 2008). Due to its multi-factorial etiology, a wide variety of treatments are available that address specific symptoms, but no treatment exists that treats the overall disorder.

Appendicovesical Fistula Following Transurethral Resection of Bladder Tumor With Mitomycin C.

Appendicovesical fistula is a rare entity, with only 116 cases reported to date. It is an uncommon form of enterovesical fistula and often associated with a history of appendicitis. It can present as pneumaturia, fecaluria, and recurrent urinary tract infections, not unlike symptoms of enterovesical fistulas.

Sacral Osteomyelitis After Robotic Sacrocolpopexy.

Background: Robotic-assisted abdominal sacrocolpopexy (RASC) is an effective procedure for the surgical treatment of vaginal vault prolapse associated with a rare, but serious, risk of sacral osteomyelitis.

Case: We report a case of Bacteroides fragilis sacral osteomyelitis after RASC that presented only as back pain. Treatment included intravenous antibiotics and abdominal exploration with removal of sacral mesh.

Metformin use and risk of prostate cancer: results from the REDUCE study.

The role of metformin in prostate cancer chemoprevention remains unclear. REDUCE, which followed biopsy-negative men with protocol-dictated PSA-independent biopsies at 2- and 4-years, provides an opportunity to evaluate the link between metformin use and prostate cancer diagnosis with minimal confounding from screening biases. In diabetic men from REDUCE, we tested the association between metformin use, use of other antidiabetic medications, versus no antidiabetic medication use, and prostate cancer diagnosis as well as prostate cancer grade (low-grade Gleason 4-6 and high-grade Gleason 7-10) using logistic regression.

Preoperative Testing for Urethral Sling Surgery for Stress Urinary Incontinence: Overuse, Underuse and Cost Implications.

Purpose: We identify areas of overuse and underuse in the preoperative evaluation of patients undergoing mid urethral sling surgery. We also estimate the effect of overuse of preoperative testing on health care costs.

Materials And Methods: We conducted a retrospective review of women who underwent sling surgery with or without concomitant prolapse repair between 2012 and 2013.

Multiparametric MRI Improves Accuracy of Clinical Nomograms for Predicting Extracapsular Extension of Prostate Cancer.

Objective: To compare the accuracy of multiparametric magnetic resonance imaging (MP-MRI) with the Partin tables and Memorial Sloan-Kettering (MSK) nomogram for predicting extracapsular extension (ECE) in prostate cancer and to create a tool for clinicians to estimate pathologic ECE risk.

Methods: A retrospective review of 112 patients who underwent 3T MP-MRI of the prostate and radical prostatectomy was performed. Regression analyses were carried out to identify predictors of ECE.

Impact of post prostate biopsy hemorrhage on multiparametric magnetic resonance imaging.

Introduction: Hemorrhage induced by prostate biopsy can interfere with the interpretation of prostate magnetic resonance imaging (MRI).

Materials And Methods: We reviewed 101 patients who had prostate multiparametric MRI (MP-MRI) and radical prostatectomy.

Results: On MRI obtained within 4 weeks following the biopsy, hemorrhage was seen in 26/36 (72.

Bladder perforation secondary to primary systemic amyloidosis.

Amyloidosis is a disorder of protein folding characterized by extracellular aggregation and deposition of amyloid protein fibrils. Light-chain amyloidosis, also known as primary systemic amyloidosis, is the most common form of the disease. We present a case of an 84-year-old male with a history of systemic primary amyloidosis causing genitourinary, cardiac, and autonomic dysfunction who presented with hematuria and hypotension secondary to bladder perforation.

Multiparametric magnetic resonance imaging localizes established extracapsular extension of prostate cancer.

Objective: To define the accuracy of multiparametric magnetic resonance imaging (MP-MRI) for identifying focal and established extracapsular extension (ECE) in various zones of the prostate.

Methods: Between 2010 and 2013, 342 patients underwent MP-MRI of the prostate (3T, no endorectal coil with axial perfusion and diffusion images). The findings of the images were reported as negative, suspicious, or positive for ECE by a single expert radiologist.

Pudendal artery pseudoaneurysm after robot-assisted laparoscopic radical prostatectomy.

Pseudoaneurysms in urology, especially for pelvic surgeries, are rare. We report a patient who presented with late recurrent hematuria due to formation of an accessory pudendal artery pseudoaneurysm (Clavien grade III) after robot-assisted laparoscopic radical prostatectomy.

Anastomotic leak after robot-assisted laparoscopic radical prostatectomy: evaluation with MDCT cystography with multiplanar reformatting and 3D display.

Objective: This article reviews the pattern of anastomotic leak after robot-assisted laparoscopic radical prostatectomy (RALRP) on MDCT cystography with multiplanar reformatting and 3D display and discusses key surgical procedures to explain intraperitoneal leak and the incidence and clinical significance of anastomotic leak.

Conclusion: RALRP is a minimally invasive surgery for localized prostate cancer, and its use has increased recently. Intraperitoneal extension of vesicourethral anastomotic leak after RALRP can occur, which is not associated with radical retropubic prostatectomy.

Comparative analysis of minimally invasive partial nephrectomy techniques in the treatment of localized renal tumors.

Objective: To report our initial experience with robot-assisted laparoscopic partial nephrectomy compared with traditional laparoscopic partial nephrectomy.

Methods: A retrospective review of the Johns Hopkins minimally invasive urologic surgery database identified 207 consecutive patients who had undergone laparoscopic or robotic-assisted laparoscopic partial nephrectomy from 2007 to 2011 by a single surgeon. The patient demographics and pathologic, operative, and perioperative outcomes were compared between the surgical techniques.

Robotic-assisted versus traditional laparoscopic partial nephrectomy: comparison of outcomes and evaluation of learning curve.

Objectives: To examine the transition to robot-assisted laparoscopic partial nephrectomy (RALPN) from pure laparoscopic partial nephrectomy (LPN) and investigate the learning curve (LC). RALPN has emerged as a minimally invasive alternative to nephron-sparing surgery.

Methods: A total of 150 consecutive patients were identified who underwent LPN or RALPN in the initial experience of a single surgeon since 2006.

Retroperitoneal hibernoma in a 28-year-old man.

Retroperitoneal hibernomas are rare, with only a handful of cases reported in the literature. These benign lesions are composed primarily of brown fat and can include varying amounts of white fat, myxoid material, and spindled cells, which makes their imaging characteristics highly variable. Here we present a series of images taken in a 28-year-old-man with pathologically confirmed retroperitoneal hibernoma.

Microperforations of surgical gloves in urology: minimally invasive versus open surgeries.

Introduction: Surgical glove integrity is important in preventing wound infections and reducing patient mortality. Rates of perforations have been studied in many surgical subspecialties, but glove perforations specific to urology have not been investigated previously. This study aims to determine the incidence of glove perforations during urological surgeries and to investigate differences between open, laparoscopic, and endoscopic procedures.

Laparoscopic resection of local recurrence after previous radical nephrectomy for clinically localized renal-cell carcinoma: perioperative outcomes and initial observations.

Background And Purpose: Local recurrence is rare after radical nephrectomy for clinically localized renal-cell carcinoma (RCC). Aggressive open surgical resection of isolated local recurrence has been shown to offer durable local control and potential improvement in cancer-specific survival. The objective of this study is to assess early outcomes on a select group of patients who underwent laparoscopic resection of isolated local recurrence after radical nephrectomy for clinically localized RCC.