Urology Commons^™

Targeting Dna Repair In Metastatic Castration-Resistant Prostate Cancer (Mcrpc): Genomic Screening For A Clinical Trial Of Rucaparib, Alan Bryce, Mitchell E. Gross, Charles Redfern, Nicholas Vogelzang, Matthew Rettig, Thomas Stanton, Julie N. Graff, Sandhya Srinivas, Andrea Loehr, Wassim Abida

Articles, Abstracts, and Reports

Objectives: The high prevalence of men with mCRPC carrying pathogenic mutations in DNA damage repair (DDR) genes may have implications for clinical treatment, as poly(ADP-ribose) polymerase (PARP) inhibitors, such as rucaparib, have shown preliminary evidence of activity in these patients. The ongoing phase 2 TRITON2 study (NCT02952534) is evaluating rucaparib in mCRPC patients harboring a deleterious germline or somatic mutation in BRCA1, BRCA2, ATM, or other DDR gene. Here we present results from genomic screening of tissue and plasma samples from mCRPC patients.

Methods: Comprehensive genomic profiling was performed by Foundation Medicine, Inc., using FFPE tumor tissue and plasma ...

Application Of Alvimopan As A Component Of Enhanced Recovery After Surgery (Eras) Protocol For Patients Undergoing Radical Cystectomy And Diversion (C&D), Thomas Hardacker, Md, Mba, May Jean Counsilman, Md, Benjamin H. Rudnick, Md, Edouard J. Trabulsi, Md, James R. Mark, Md, Leonard G. Gomella, Md, Mark J. Mann, Md, Costas D. Lallas, Md, Scott G. Hubosky, Md

House Staff Quality Improvement and Patient Safety Posters

Introduction

• Radical cystectomy with urinary diversion (C&D) is performed for patients with muscle-invasive bladder cancer (MIBC) or refractory carcinoma in situ (CIS)
• C&D patients receive one of several types of diversion depending on their age, comorbidities, functional status, and extent of disease (Figure 1)
• Post-operative length of stay (LOS) can be prolonged (9-11 days) and 30 day readmission rates and mortality elevated (30% and 1.5%); return of bowel function usually the rate-limiting step to discharge
• Enhanced Recovery After Surgery (ERAS) protocols utilize pre-, intra-, and postoperative elements in order to improve return of bowel function and decrease LOS
• Alvimopan is a μ-opioid receptor antagonist commonly included in ERAS, and limits deleterious effects of narcotics on the GI system
• The goal of this analysis was to determine the effect of Alvimopan on post-operative LOS and 30 day readmission in patients undergoing C&D

Second-Harmonic Generation Microscopy Analysis Reveals Proteoglycan Decorin Is Necessary For Proper Collagen Organization In Prostate., Kirby R. Campbell, Rajeev Chaudhary, Monica Montano, Renato V. Iozzo, Wade A. Bushman, Paul J. Campagnola

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Collagen remodeling occurs in many prostate pathologies; however, the underlying structural architecture in both normal and diseased prostatic tissues is largely unexplored. Here, we use second-harmonic generation (SHG) microscopy to specifically probe the role of the proteoglycan decorin (Dcn) on collagen assembly in a wild type (wt) and Dcn null mouse (Dcn  -    /    -  ). Dcn is required for proper organization of collagen fibrils as it regulates size by forming an arch-like structure at the end of the fibril. We have utilized SHG metrics based on emission directionality (forward-backward ratio) and relative conversion efficiency, which are both related to the SHG coherence length ...

Examining The Relationship Between Urinary Pathogens, Antibiotic Exposure And Urolithiasis, Jennifer Bjazevic

Electronic Thesis and Dissertation Repository

Urinary stone disease is a highly prevalent urological condition; however, the pathophysiology remains poorly understood. Growing evidence suggests a relationship between urinary tract infections, antibiotic exposure and the development of urolithiasis. In this project, we utilized a dietary Drosophila melanogaster model and a calcium oxalate crystal adhesion assay to further investigate the impact of a urinary pathogen and antibiotics on calcium stone formation. We demonstrated that both a non-urease producing strain of Escherichia coli and the antibiotics, ciprofloxacin and trimethoprim-sulfamethoxazole, increased calcium stone formation. In addition, our preliminary work suggests that biomineralization agents such as osteopontin and zinc appear to ...

Reducing Catheter Associated Urinary Tract Infections (Cauti) By Decreasing Use Of Indwelling Catheters, Joanne Chapman, Brenda Clark, Brian Jumper, Carrie Strick

Maine Medical Center

Background:

Catheter Associated Urinary Tract Infections (CAUTI) are considered a preventable hospital-acquired infection [2]. Centers for Medicaid and Medicare no longer reimburse hospitals for preventable CAUTIs [2]. A concerted effort to decrease our indwelling urinary catheter (IUC) rate has led to a decrease in the number of infections related to these catheters at Maine Medical Center (MMC) in Portland, Maine. Starting in 2012 as a result of The Joint Commission National Patient Safety Goal, the inter-professional CAUTI committee focus has been on decreasing utilization of IUC[1]. After an initial large decrease in utilization, the rates have flattened. The effort ...

Microbiota Signatures In Type-2 Diabetic Patients With Chronic Kidney Disease - A Pilot Study, Gratiela P. Gradisteanu, Roxana A. Stoica, Laura Petcu, Ariana Picu, Adrian P. Suceveanu, Teodor Salmen, Diana S. Stefan, Cristian Serafinceanu, Mariana Carmen Chifiriuc, Anca P. Stoian

Journal of Mind and Medical Sciences

The human microbiota is paramount for normal host physiology. Altered host-microbiome interactions are part of the pathogenesis of numerous common ailments. Currently, much emphasis is placed on the involvement of the microbiome in the pathogenesis of type-2 diabetes mellitus (T2DM), impaired glucose tolerance, and other metabolic disorders (i.e. obesity). Several studies found highly significant correlations of specific intestinal bacteria with T2DM. A better understanding of the role of the microbiome in diabetes and its complications might provide new insights in the development of new therapeutic principles.

Our pilot study investigates the microbiota patterns in Romanian type-2 diabetic patients with ...

Primary Renal Hydatid Cyst – A Review, Lucian Iorga, Radu Anghel, Dragos Marcu, Bogdan Socea, Camelia C. Diaconu, Ovidiu G. Bratu, Liliana F. Andronache, Stana Paunica, Dan Liviu Dorel Mischianu

Journal of Mind and Medical Sciences

The aim of this study was to analyze the clinical presentation, diagnosis and treatment of primary renal hydatidosis. A thorough review of the literature was made using the PubMed database. Cystic echinococcosis is a disease that results from infection with the larval stage of Echinococcus granulosus, a tiny tapeworm found in dogs (definitive host), sheep, cattle, goats, foxes and pigs, amongst others (intermediate hosts).

Humans are accidentally intermediate hosts, who become infected by direct contact with infected dogs, by ingesting contaminated raw or undercooked vegetables or by drinking contaminated water. Renal involvement by hydatid disease is uncommon (less than 3-4 ...

Engaging Emergency Department Patients In The Creation Of A Shared Decision-­Making Tool Regarding Ct Scanning In Kidney Stones: Challenges To Traditional Stakeholder Engagement, Elizabeth M. Schoenfeld, Connor J. Houghton, Pooja P. Patel, Leonora Merwin, Kathleen M. Mazor, Erik Hess, Charles Scales, Maggie Breslin, Peter K. Lindenauer

Kathleen M. Mazor

Background: Every year approximately 2 million patients are seen in US EDs for suspected renal colic, and the majority receive CT scans. The objective of our study was to develop a stakeholder-informed conversation aid to help clinicians use SDM regarding CT scanning in patients with suspected renal colic.

Methods: Using a published decision aid development framework, and under the direction of a multi-disciplinary Steering Committee, we engaged a diverse set of stakeholders via qualitative methods. EM clinicians, urologists, radiologists, researchers, and emergency department patients participated in focus groups and semi-structured interviews. All groups were recorded, transcribed, and analyzed in an ...

Engaging Emergency Department Patients In The Creation Of A Shared Decision-­Making Tool Regarding Ct Scanning In Kidney Stones: Challenges To Traditional Stakeholder Engagement, Elizabeth M. Schoenfeld, Connor J. Houghton, Pooja P. Patel, Leonora Merwin, Kathleen M. Mazor, Erik Hess, Charles Scales, Maggie Breslin, Peter K. Lindenauer

Community Engagement and Research Symposia

Background: Every year approximately 2 million patients are seen in US EDs for suspected renal colic, and the majority receive CT scans. The objective of our study was to develop a stakeholder-informed conversation aid to help clinicians use SDM regarding CT scanning in patients with suspected renal colic.

Methods: Using a published decision aid development framework, and under the direction of a multi-disciplinary Steering Committee, we engaged a diverse set of stakeholders via qualitative methods. EM clinicians, urologists, radiologists, researchers, and emergency department patients participated in focus groups and semi-structured interviews. All groups were recorded, transcribed, and analyzed in an ...

Robotic-Assistance Does Not Enhance Standard Laparoscopic Technique For Right-Sided Donor Nephrectomy., Xiaolong S Liu, Hadley W Narins, Warren R Maley, Adam M Frank, Costas D. Lallas

Adam M. Franks, MD

OBJECTIVE: To examine donor and recipient outcomes after right-sided robotic-assisted laparoscopic donor nephrectomy (RALDN) compared with standard laparoscopic donor nephrectomy (LDN) and to determine whether robotic-assistance enhances LDN.

MATERIALS & METHODS: From December 2005 to January 2011, 25 patients underwent right-sided LDN or RALDN. An IRB-approved retrospective review was performed of both donor and recipient medical charts. Primary endpoints included both intraoperative and postoperative outcomes.

RESULTS: Twenty right-sided LDNs and 5 RALDNs were performed during the study period. Neither estimated blood loss (76.4 mL vs. 30 mL, P = .07) nor operative time (231 min vs. 218 min, P = .61) were ...

Improving Midstream Urine Collection For Urine Culture Through The Use Of A Novel Device, Flipcatch, Christopher Neely, Dante Varotsis, Helen Xu

Phase 1

Background : A midstream, clean-catch urine sample is the gold standard for diagnosing urinary tract infections and determining treatment. The current method of collection is not standardized, frustrating both patients and providers. The current method results in a high rate of contaminated samples (30-40%), which often need to be repeated in order to obtain a diagnosis and antibiotic susceptibility data. A design project was conducted in order to create a more effective urine collection device with the goals of decreasing contamination and improving patient and provider experience.

Methods : We conducted interviews of patients, allied health professionals, physicians, and clinical microbiologists involved ...

Is Electroacupuncture Effective In Improving Quality Of Life For Women With Urinary Incontinence?, Shelby Kaminsky

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective evidence based medicine (EBM) review is to determine whether or not “Is electroacupuncture effective in improving quality of life for women with urinary incontinence?”

STUDY DESIGN: A systematic review of 3 peer-reviewed studies published between the years of 2014 and 2017.

DATA SOURCES: Two randomized placebo-controlled studies and one comparative study evaluating if electroacupuncture (EA) and/or the use of tolterodine improves the quality of life and therapeutic effects of those with urinary incontinence (UI). Sources were selected from PubMed and Cochrane Library based off of their relevance to the clinical question and the ...

A Randomized Controlled Trial Of A Modified Cystoscopy Technique, Khalil Hetou

Electronic Thesis and Dissertation Repository

Introduction

Pain, anxiety and embarrassment are well documented feelings in patients undergoing ambulatory diagnostic cystoscopy. In this study, we explored utilizing Peak-end theory in improving pain perception in patients undergoing diagnostic cystoscopy.

Materials and Methods

We conducted a randomized clinical trial at the London Health Sciences Center for patients undergoing an ambulatory diagnostic cystoscopy for the first time. Males and females as well as allocation ratios were 1:1. The control arm received a standard cystoscopy. In the intervention arm the cystoscope was left for additional 2 minutes without further manipulation in the bladder before scope removal. The primary outcome ...

A Randomized Control Trial Of Anti-Inflammatory Regional Hypothermia On Urinary Continence During Robot-Assisted Radical Prostatectomy., Linda M Huynh, Douglas Skarecky, James R Porter, Christian Wagner, Jorn Witt, Timothy Wilson, Clayton Lau, Thomas E Ahlering

Articles, Abstracts, and Reports

The present study seeks to present a single-blind, randomized control trial of a hypothermic anti-inflammatory device, the endorectal cooling balloon (ECB), to assess whether regional hypothermia could improve 90-day and time to pad-free continence following robot-assisted radical prostatectomy (RARP). Five high-volume surgeons at three institutions had patients randomized (1:1) to regional hypothermia with ECB versus control. Patients were blinded to device use, as it was inserted and removed intraoperatively. Knowledge of device use was restricted to the operating room personnel only; recovery room and ward nursing staff were not informed of device use and instructed to indicate such if ...

Performance Of Prostate Cancer Recurrence Nomograms By Obesity Status: A Retrospective Analysis Of A Radical Prostatectomy Cohort., Charnita Zeigler-Johnson, Aaron Hudson, Karen Glanz, Elaine Spangler, Knashawn H Morales

Department of Medical Oncology Faculty Papers

BACKGROUND: Obesity has been associated with aggressive prostate cancer and poor outcomes. It is important to understand how prognostic tools for that guide prostate cancer treatment may be impacted by obesity. The goal of this study was to evaluate the predicting abilities of two prostate cancer (PCa) nomograms by obesity status.

METHODS: We examined 1576 radical prostatectomy patients categorized into standard body mass index (BMI) groups. Patients were categorized into low, medium, and high risk groups for the Kattan and CaPSURE/CPDR scores, which are based on PSA value, Gleason score, tumor stage, and other patient data. Time to PCa ...

A Brief Review Of The Literature On The Malignant Ureteral Obstruction, Sorin Lupu, Adrian Brînză, Bogdan Socea, Dragos Marcu, Ileana Peride, Ana Maria Alexandra Stanescu, Tiberiu P. Neagu, Laurian Maxim

Journal of Mind and Medical Sciences

Malignant ureteral obstruction (MUO) caused by a primarily urological tumor or secondary to a late-stage malignancy can be difficult for the urologist to manage. Due to a lack of clinical data on the management of MUO, every case is particular and should be aborted individually.

Lack of specific treatment, either palliative or definitive, can severely damage renal function and lifetime expectancy in patients, causing even more damage that could otherwise be avoided.

Prompt management directed at the recovery of renal function is the main goal in such cases. Even after urinary flow is restored, life threatening post-obstructive diuresis needs to ...

Validation Of Updated Partin’S Table In Pakistani Patients Undergoing Radical Prostatectomy For Prostate Cancer, Nazim Muhammad, Farhat Abbas, Nuzhat Faruqui, Muhammad Islam, Zubair Ahmad

Farhat Abbas

Objectives: To establish the usefulness and validity of 2007 Partin’s table in our population with prostate cancer.
Materials and methods: Between January 1998 to June 2009, all patients with clinically localized carcinoma prostate who were treated with intent of radical retro-pubic prostatectomy (RRP) were included. Clinical, operative and pathological data was gathered. All biopsy and final histopathology Gleason scores were re-assigned in a double blind manner. Pre-operative serum PSA, TNM clinical stage and biopsy Gleason scores were plotted on Partin’s table and its predictive value and pathological findings of specimen were compared and analyzed by using Receiver operating ...

Modification And Implementation Of Nccn Guidelines On Prostate Cancer In The Middle East And North Africa Region., Waleed A. Hassen, Farrok A. Karsan, Farhat Abbas

Farhat Abbas

Abstract

A prostate cancer committee was established to modify the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Prostate Cancer for adaptation and implementation in the Middle East and North Africa (MENA) region. The objective was to enhance the multidisciplinary approach to the treatment of prostate cancer. The committee, comprising regional experts in the fields of urologic, medical, and radiation oncology, reviewed the 2009 version of the NCCN Guidelines on Prostate Cancer and suggested modifications based on the unique needs of the regions determined through published evidence and local expertise. The committee identified several areas in the NCCN Guidelines ...

Granular Cell Tumors Of The Urinary Bladder, Farhat Abbas, Amanullah Memon, Tanya Siddiqi, Naila Kayani Naila Kayani, Nazim Ali Ahmad

Farhat Abbas

Abstract

BACKGROUND:

Granular cell tumors (GCTs) are extremely rare lesions of the urinary bladder with only nine cases being reported in world literature of which one was malignant. Generally believed to be of neural origin based on histochemical, immunohistochemical, and ultrastructural studies; they mostly follow a clinically benign course but are commonly mistaken for malignant tumors since they are solid looking, ulcerated tumors with ill-defined margins.

MATERIALS AND METHODS:

We herein report two cases of GCTs, one benign and one malignant, presenting with gross hematuria in a 14- and a 47-year-old female, respectively.

RESULTS:

Histopathology revealed characteristic GCTs with positive ...

Examining Relationships Between Age At Diagnosis And Health-Related Quality Of Life Outcomes In Prostate Cancer Survivors., Christine J. Kurian, Amy Leader, Melissa S.Y. Thong, Scott W. Keith, Charnita Zeigler-Johnson

Department of Medical Oncology Faculty Papers

BACKGROUND: Patient reports of health related quality of life can provide important information about the long-term impact of prostate cancer. Because patient symptoms and function can differ by age of the survivor, the aim of our study was to examine patient-reported quality of life and prostate symptoms by age at diagnosis among a registry of Dutch prostate cancer survivors.

METHODS: A population of 617 individuals from the Patient Reported Outcomes Following Initial Treatment and Long-Term Evaluation of Survivorship (PROFILES) database was surveyed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) and prostate symptom ...