Urology Commons^™

Bilateral Ureteral-Iliac Artery Fistula In A Patient With Chronic Indwelling Ureteral Stents: A Case Report And Review, Arash Rafiei, Timothy A. Weber, Michael Kongnyuy, Raul Ordorica

Urology Faculty Publications

Ureteral-arterial fistula (UAF) is an exceedingly rare but life-threatening condition warranting emergent intervention. Prompt recognition and management of UAF in suspect patients presenting with gross hematuria are required for a successful outcome. We report a rare subset of UAF involving the bilateral common iliac arteries. The patient underwent successful endovascular stent-grafting to correct the arterial defect and delayed open repair of the ureteral strictures. Timely management has benefited from the collaboration of the involved medical teams, which included emergency medicine, urology, and interventional radiology.

A Rare Case Of A Renal Cell Carcinoma Confined To The Isthmus Of A Horseshoe Kidney, Michael Kongnyuy, Daniel Martinez, Anthony Park, Barrett Mccormick, Justin Parker, Mary Hall

Urology Faculty Publications

Horseshoe kidney (HSK) is the most common renal anomaly. Reports of the incidence of renal cell carcinoma (RCC) in HSK are conflicting. Very few cases of isthmus-located RCC have been reported in the literature. We report a unique case of an isthmus-located RCC. Proper vascular and tumor imaging prior to surgery is key to successful tumor removal.

The Promise Of Novel Molecular Markers In Bladder Cancer, Jahan Miremami, Natasha Kyprianou

Urology Faculty Publications

Bladder cancer is the fourth most common malignancy in the US and is associated with the highest cost per patient. A high likelihood of recurrence, mandating stringent surveillance protocols, has made the development of urinary markers a focus of intense pursuit with the hope of decreasing the burden this disease places on patients and the healthcare system. To date, routine use of markers is not recommended for screening or diagnosis. Interests include the development of a single urinary marker that can be used in place of or as an adjunct to current screening and surveillance techniques, as well identifying a …

Antibiotic Prophylaxis And Reflux: Critical Review And Assessment, Bernarda Viteri Baquerizo, Craig A. Peters

Urology Faculty Publications

The use of continuous antibiotic prophylaxis (CAP) was critical in the evolution of vesicoureteral reflux (VUR) from a condition in which surgery was the standard of treatment to its becoming a medically managed condition. The efficacy of antibiotic prophylaxis in the management of VUR has been challenged in recent years, and significant confusion exists as to its clinical value. This review summarizes the critical factors in the history, use, and investigation of antibiotic prophylaxis in VUR. This review provides suggestions for assessing the potential clinical utility of prophylaxis.

Double Trouble: A Rare Case Of Bilateral Upper Pole Ureteropelvic Junction Obstruction, Craig A. Peters, Nirmal Pathak

Urology Faculty Publications

A 16-year-old girl presented with bilateral back pain caused by bilateral upper pole ureteropelvic junction obstructions; an extremely rare phenomenon. Bilateral robotically assisted upper pole pyeloplasties were preformed at the same setting with an excellent clinical response. Although rare, upper pole ureteropelvic junction obstruction is a defined entity that urologists should be aware of.

Do Not Judge A Kidney By Its Pelvis: A Rare Case Of An Unobstructed Dilated Renal Pelvis, Aaron D. Martin, Craig A. Peters

Urology Faculty Publications

We present a rare case of an unobstructed dilated renal pelvis in a newborn female. Prenatal imaging documented a large abdominal cyst in a stable fetus. Postnatal imaging confirmed persistence of this large cyst but with an unclear etiology. The child was taken to surgery by the pediatric surgeons with concern for a possible harmful nonurologic diagnosis. Intraoperative findings were that of a severely dilated renal pelvis; however, in the absence of an expected ureteropelvic junction obstruction. Reduction pyeloplasty without interference of the ureteropelvic junction proved successful.

A Single-Institution Experience With Metallic Ureteral Stents: A Cost-Effective Method Of Managing Deficiencies In Ureteral Drainage, Adam S. Baumgarten, Tariq S. Hakky, Rafael E. Carrion, Jorge L. Lockhart, Philippe E. Spiess

Urology Faculty Publications

Introduction: The limitations of traditional ureteral stents in patients with deficiencies in ureteral drainage have resulted in frequent stent exchanges. The implementation of metallic stents was introduced to improve the patency rates of patients with chronic upper urinary tract obstruction, obviating the need for frequent stent exchanges. We report our clinical experiences with the use of metallic ureteral stents in the management of poor ureteral drainage.

Materials and Methods: Fifty patients underwent metallic ureteral stent placement from 2009 to 2012. Stent failure was defined as an unplanned stent exchange, need for nephrostomy tube placement, increasing hydronephrosis with stent in place, …

Unclamped Hand-Assisted Laparoscopic Partial Nephrectomy For Predominantly Endophytic Renal Tumors, Jason D. Engel, Stephen B. Williams

Urology Faculty Publications

PURPOSE: To describe our initial experience with unclamped laparoscopic hand-assisted partial nephrectomy for predominantly endophytic renal masses in the setting of relative contraindication to warm ischemia.

MATERIALS AND METHODS: Unclamped laparoscopic hand-assisted partial nephrectomy was performed on eight consecutive patients from June 2009 to March 2010. All patients had predominantly endophytic renal masses with a preferential enhancing rim noted on the pre-operative computed tomography. The unclamped hand-assisted approach was utilized for no warm ischemia, minimal blood loss, and enhanced visualization of the tumor bed with improved operative exposure.

RESULTS: Mean age of the participants was 55.8 years. All patients underwent …

Androgen Receptor-Target Genes In Afircan American Prostate Cancer Disparities, Bi-Dar Wang, Qi Yang, Fernando Bianco, Ramez Andrawis, Thomas W. Jarrett, Harold A. Frazier, Steven R. Patierno, Norman H. Lee

Urology Faculty Publications

The incidence and mortality rates of prostate cancer (PCa) are higher in African American (AA) compared to Caucasian American (CA) men. To elucidate the molecular mechanisms underlying PCa disparities, we employed an integrative approach combining gene expression profiling and pathway and promoter analyses to investigate differential transcriptomes and deregulated signaling pathways in AA versus CA cancers. A comparison of AA and CA PCa specimens identified 1,188 differentially expressed genes. Interestingly, these transcriptional differences were overrepresented in signaling pathways that converged on the androgen receptor (AR), suggesting that the AR may be a unifying oncogenic theme in AA PCa. Gene promoter …

Surgical Management Of A Locally Advanced Symptomatic Recurrence Of Penile Sarcoma Secondary To Prostate Brachytherapy, Tariq S. Hakky, Patrick Espiritu, Alejandro R. Rodriguez, Nicholas Gould, Philippe E. Spiess

Urology Faculty Publications

Background: The surgical management of patients with symptomatic metastatic or locally advanced recurrences involving the penis remains poorly characterized. The aim of the present abstract and video is to detail our experience in the surgical management of a specific patient with a locally advanced symptomatic recurrence of penile sarcoma secondary to prostate cancer treated with primary brachytherapy.

Materials and Methods: A 70 year old male patient initially treated for localized prostate cancer with interstitial brachytherapy at an outside facility developed an unfortunate secondary malignancy consisting of a locally advanced penile sarcoma involving as well the prostate and base of the …

Integrated Next-Generation Sequencing Of 16s Rdna And Metaproteomics Differentiate The Healthy Urine Microbiome From Asymptomatic Bacteriuria In Neuropathic Bladder Associated With Spinal Cord Injury, Derrick E. Foutts, Rembert Pieper, Sebastian Szpakowski, Hans G. Pohl, Susan M. Knoblach, Moo-Jin Suh, Shih-Ting Huang, Inger Ljungberg, Bruce M. Sprague, Sarah K. Lucas, Manolito Torralba, Karen E. Nelson, Suzanne L. Groah

Urology Faculty Publications

Background

Clinical dogma is that healthy urine is sterile and the presence of bacteria with an inflammatory response is indicative of urinary tract infection (UTI). Asymptomatic bacteriuria (ABU) represents the state in which bacteria are present but the inflammatory response is negligible. Differentiating ABU from UTI is diagnostically challenging, but critical because overtreatment of ABU can perpetuate antimicrobial resistance while undertreatment of UTI can result in increased morbidity and mortality. In this study, we describe key characteristics of the healthy and ABU urine microbiomes utilizing 16S rRNA gene (16S rDNA) sequencing and metaproteomics, with the future goal of utilizing this …

Surgical Complications After Robot-Assisted Laparoscopic Radical Prostatectomy: The Initial 1000 Cases Stratified By The Clavien Classification System, Faisal Ahmed, Jonathan Rhee, Douglas Sutherland, Compton Benjamin, Jason D. Engel, Harold Frazier

Urology Faculty Publications

No abstract provided.

Laparo-Endoscopic Single Site Retroperitoneal Partial Nephrectomy: A Novel Concept, Alejandro R. Rodriguez, Tariq Hakky, Philippe E. Spiess

Urology Faculty Publications

Purpose: Various treatment options are available for small incidentally detected kidney masses, including surveillance, partial nephrectomy and probe ablative therapies. When partial nephrectomy is considered, the procedure can be safely approached laparoscopically, either pure or robot assisted, in experienced hands. Laparo-endoscopic single site (LESS) surgery is a novel approach for partial nephrectomies in well selected cases. In this video, we present our experience with the LESS retroperitoneal partial nephrectomy using the Gelpoint device.

Material and Methods: A 63 year old male patient with a BMI of 31, and a history of a T1c prostate cancer, had a 1.5 cm right …

Radical Nephrectomy With Ivc Thrombectomy (Level-Iii) Conducted On Veno-Veno Bypass, Tariq S. Hakky, Lucas R. Wiegand, Devannand Mangar, Angel Alsina, Philippe E. Spiess

Urology Faculty Publications

Introduction: We report a 43 year old man who was diagnosed with a level-I thrombus and was managed on oral sunitinib for two months by a community Urologist. The thrombus progressed to a level-III and he subsequently developed a pulmonary embolus, which required oral anticoagulation. He was then referred to our facility for definitive surgical care. A computed tomography scan demonstrated a 12 by 15 centimeter right renal mass and on magnetic resonance venography of the abdomen a tumor-thrombus extending into the infradiaphragmatic inferior vena cava was noted. Pre-operatively consults with hepatobiliary, vascular, and chest surgeons were obtained.

Methods: The …