Repeat prostate biopsy and the incremental risk of clinically insignificant prostate cancer.

Objectives: To determine the incremental risk of diagnosis of clinically insignificant prostate cancer with serial prostate biopsies.

Methods: We reviewed our institutional radical prostatectomy (RP) database comprising 2411 consecutive patients undergoing RP. We then stratified patients by the prostate biopsy on which their cancer was diagnosed and correlated biopsy number with the risk of clinically insignificant disease and adverse pathology at radical prostatectomy.

A thorough pelvic lymph node dissection in presence of positive margins associated with better clinical outcomes in radical cystectomy patients.

Objectives: To evaluate the effect of positive surgical margins in patients with muscle-invasive transitional cell carcinoma of the bladder on survival.

Methods: A retrospective evaluation of a prospectively maintained radical cystectomy database consisting of the data from 344 patients was performed. Cox regression analysis was done, and Kaplan-Meier tables were developed to evaluate the contribution of this finding to clinical outcomes.

The clinical and pathological history of prostate cancer progression in men with a prior history of high grade prostatic intraepithelial neoplasia.

Objectives: The natural history of high grade prostatic intraepithelial neoplasia (HGPIN) is incompletely understood limiting evidence based recommendations regarding screening and repeat biopsy intervals. Our objective was to evaluate the natural history of HGPIN to better assess the time frame to disease progression and the pathological findings at the time of progression to cancer.

Methods And Materials: We retrospectively reviewed 74 consecutive patients with an initial diagnosis of HGPIN.

Hydronephrosis is an independent predictor of poor clinical outcome in patients treated for muscle-invasive transitional cell carcinoma with radical cystectomy.

Objectives: The purpose of this study was to assess the prognostic significance of hydronephrosis on pathologic and clinical outcomes in muscle-invasive bladder cancer.

Methods: We performed a retrospective evaluation of a prospectively maintained cystectomy database and identified patients with hydronephrosis on preoperative imaging. Of a total of 306 patients, 57 (19%) had unilateral hydronephrosis and 17 (6%) had bilateral hydronephrosis.

Enucleation of renal cell carcinoma with ablation of the tumour base.

Objective: To retrospectively assess the effectiveness of cancer control with enucleation of renal cell carcinoma (RCC), which is surgically expedient, allows preservation of maximal renal parenchyma, and makes intraoperative renal ischaemia unnecessary, by two surgeons routinely enucleating renal tumours and ablating the tumour bed with argon beam and the Nd-YAG laser.

Patients And Methods: Between 1996 and 2006 at our institution, 97 patients had RCC enucleated, with ablation of the tumour base. Patients with lesions other than RCC and those with von Hippel-Lindau disease or Birt-Hogg-Dube syndrome were excluded from the study.

Minimal tumor volume may provide additional prognostic information in good performance patients after radical prostatectomy.

Objectives: The significance of tumor volume (TV) as a predictor of biochemical failure after radical prostatectomy (RP) remains debatable. TV determinants can also entail significant time and cost. Estimating TVs using an asymmetric categorical classification system provides an economical alternative to determining this parameter.

Impact of the percentage of positive biopsy cores on the further stratification of primary grade 3 and grade 4 Gleason score 7 tumors in radical prostatectomy patients.

Objectives: To examine whether the percentage of core biopsies positive can further stratify Gleason score 7 patients with primary Gleason grade into precise prognostic groups.

Methods: Between 1991 and 1999, 379 radical prostatectomy patients were found to have pathologic Gleason 7 tumors. The patients were divided into primary grade 3 or 4.

Impact of multiple biopsy cores on predicting final tumor volume in prostate cancer detected by a single microscopic focus of cancer on biopsy.

Objectives: To compare the impact that the number of biopsy cores have on final pathologic findings when minimal disease is detected at biopsy. Discordance has been noted between transrectal ultrasound-guided biopsy results and tumor volume even when minimal amounts of tumor are found on biopsy.

Methods: We identified patients who had undergone radical retropubic prostatectomy for a single microscopic focus of adenocarcinoma from a prospectively maintained surgical database.

Vena caval transection during retroperitoneoscopic nephrectomy: report of the complication and review of the literature.

Purpose: Major vascular injuries are uncommon but serious complications of laparoscopic surgery. Early recognition and conversion to an open procedure may be required to avoid further complications. We report 2 cases in which the vena cava was transected during retroperitoneoscopic nephrectomy, and review the literature.

Identification of clinically significant prostate cancer by prostate-specific antigen screening.

Background: The importance of screening for early-stage prostate cancer has been debated in the literature. However, there are well-established prognostic factors (Gleason score [GS], pretreatment prostate-specific antigen [PSA], and percent positive biopsy findings [%+Bx]) that predict biologically aggressive disease. These factors, together with a patient's age and general state of health, will permit physicians to project the effect of a prostate tumor over the patient's expected lifetime.

Color and power Doppler sonography in the diagnosis of prostate cancer: comparison between vascular density and total vascularity.

Objective: Advances in color flow Doppler (CFD) and power Doppler imaging (PDI) have potential for prostate cancer diagnosis. Previous reports based on qualitative assessment suggest that hypervascularity increases likelihood of prostate cancer. Our objective was to compare 2 methods of vascularity assessment using PDI: total vascularity (TV) and vascular density (VD).

Comparative analysis of blood plasma epidermal growth factor concentrations, hormonal profiles and semen parameters of fertile and infertile males.

The relationship between male reproductive function and the blood plasma level of epidermal growth factor (EGF) is of interest in the light of the role that circulating EGF appears to play in regulating mouse spermatogenesis. We measured the concentrations of EGF in the blood plasma of 39 fertile men (sperm count > 20 x 10(6)/ml) and compared them with those of 31 infertile men (sperm < 20 x 10(6)/ml). Blood plasma levels of follicle stimulating hormone (FSH), luiteinising hormone (LH), prolactin and testosterone were also determined.

Retrospective review of flow patterns following retropubic prostatectomy.

Aim Of This Study: We retrospectively evaluated penile inflows in 103 previously potent individuals who underwent standard nerve sparing radical retropubic prostatectomy (RRP) for the treatment of prostate cancer. No effort to identify or spare the accessory pudendal artery (APA) was made in any case. Our goal was to investigate the role of the accessory internal pudendal artery (APA) in the maintenance of erections in this population.

Percutaneous varicocele embolization versus surgical ligation for the treatment of infertility: changes in seminal parameters and pregnancy outcomes.

Purpose: To compare the success of percutaneous varicocele embolization to surgical ligation with regard to changes in semen characteristics and pregnancy outcome.

Materials And Methods: Infertility records from 346 men who underwent correction of their varicocele for infertility (surgical ligation 149; embolization 197) were reviewed retrospectively. Preprocedural and postprocedural semen analyses and pregnancy outcomes were obtained with use of chart and telephone follow-up.

Development of prostate cancer after pituitary dysfunction: a report of 8 patients.

Objectives: Eight patients with a history of pituitary dysfunction were seen in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania for evaluation of their prostate carcinoma. Because prostate cancer is a hormonally responsive cancer, hormonal abnormalities from pituitary dysfunction may have played a role in its development. In addition, many patients with pituitary dysfunction receive exogenous hormonal replacement.

A multivariable analysis of clinical factors predicting for pathological features associated with local failure after radical prostatectomy for prostate cancer.

Purpose: A multivariate analysis is used to determine the predictive value of pretreatment clinical indicators on pathologic features associated with local failure after radical prostatectomy in patients with prostate cancer.

Methods And Materials: A retrospective review of the pathologic findings of 235 patients with adenocarcinoma of the prostate treated between 1990 and 1993 with a radical retropubic prostatectomy was performed. The preoperative clinical data including the serum prostate specific antigen, clinical stage, Gleason sum, and endorectal magnetic resonance scan findings are used to identify patients prior to definitive treatment who would be at high risk for having pathologic features associated with local failure at radical prostatectomy.

Interstitial emphysema associated with epidural anesthesia for extracorporeal shock-wave lithotripsy.

Interstitial emphysema was noted on abdominal radiographs in 38 (15%) of the first 150 patients treated by extracorporeal shock-wave lithotripsy at our hospital. All 38 patients had undergone successful or attempted epidural anesthesia for the lithotripsy. This finding was not seen in any patient who had not undergone epidural puncture.

Kidney changes after extracorporeal shock wave lithotripsy: CT evaluation.

Computed tomography (CT) was performed in 50 patients before and after extracorporeal shock wave lithotripsy (ESWL) to determine the effects of ESWL on the kidney and perinephric tissues. Bilateral treatments were performed in three patients. Post-ESWL scans demonstrated subcapsular hematomas in eight (15%) patients (two large, six small, none symptomatic) and intrarenal hematomas in two (4%) patients.

Distribution of a seminal plasma-associated protein kinase inhibitor in normal, oligozoospermic, and vasectomized men.

Human sperm-free seminal plasma contains an inhibitor, which is protein in nature, of the histone kinase present in seminal plasma. Since protein kinase inhibitors have been observed to be present in spermatozoa, the objective of the present study was to determine whether this seminal plasma-associated enzyme inhibitor originates from the sperm, or whether it is a component of accessory secretion(s) comprising the seminal plasma. Sperm-free seminal plasma from normospermic (greater than 20 X 10(6) sperm/ml), oligozoospermic (less than or equal to 20 X 10(6) sperm/ml), and vasectomized donors was obtained, and inhibitor-enriched fractions were prepared by (NH4)2SO4 fractionation and gel filtration.

Erectile failure following pelvic trauma: a review of pathophysiology, evaluation, and management, with particular reference to the penile prosthesis.

Twenty-five inflatable and two semi-rigid rod type penile prostheses have been implanted in 27 patients with erectile failure following pelvic trauma. Reoperation was required in 13 patients in the inflatable prosthesis group but ultimate success and satisfaction were achieved in 92%. The etiology of erectile failure following various types of trauma is reviewed, as well as the approach to the evaluation of erectile failure in such a patient.

The contractile and metabolic effects of acute ischemia on the rabbit urinary bladder.

The present study determined the effect of 1 hour of in vivo ischemia on the response of the rabbit urinary bladder to specific autonomic agonists and on the intracellular adenosine triphosphate content. A 48 per cent decrease in the contractile response of the base to the alpha agonist methoxamine was noted. A 42 per cent decrease in the response of the bladder body to bethanechol was found.

Transureteroureterostomy in spinal cord injury patients for persistent vesicoureteral reflux: 6 to 14-year followup.

We did a long-term followup for spinal cord injury patients who had undergone transureteroureterostomy for persistent reflux after failed vesicoureteroplasty. Particular attention was paid to the complications that are unique to these patients and include the trapping of ureteral calculi, recurrent vesicoureteral reflux and bladder hypertrophy with vesicoureteral junction obstruction. Caution is advised in using this procedure in the spinal cord injury patient because of these problems despite the over-all success in maintaining the patency of the anastomosis.