Urology Commons^™

Identifying Barriers To Patient Acceptance Of Active Surveillance: Content Analysis Of Online Patient Communications., Mark V Mishra, Michele Bennett, Armon Vincent, Olivia T Lee, Costas D Lallas, Edouard J Trabulsi, Leonard G Gomella, Adam P Dicker, Timothy N Showalter

Department of Urology Faculty Papers

OBJECTIVES: Qualitative research aimed at identifying patient acceptance of active surveillance (AS) has been identified as a public health research priority. The primary objective of this study was to determine if analysis of a large-sample of anonymous internet conversations (ICs) could be utilized to identify unmet public needs regarding AS.

METHODS: English-language ICs regarding prostate cancer (PC) treatment with AS from 2002-12 were identified using a novel internet search methodology. Web spiders were developed to mine, aggregate, and analyze content from the world-wide-web for ICs centered on AS. Collection of ICs was not restricted to any specific geographic region of …

Pten Loss Mediated Akt Activation Promotes Prostate Tumor Growth And Metastasis Via Cxcl12/Cxcr4 Signaling, M Conley-Lacomb, Allen Saliganan, Pridvi Kandagatla, Yong Q. Chen, Michael L. Cher, Sreenivasa R. Chinni

Wayne State University Associated BioMed Central Scholarship

Abstract

Introduction

The chemokine CXCL12, also known as SDF-1, and its receptor, CXCR4, are overexpressed in prostate cancers and in animal models of prostate-specific PTEN deletion, but their regulation is poorly understood. Loss of the tumor suppressor PTEN (phosphatase and tensin homolog) is frequently observed in cancer, resulting in the deregulation of cell survival, growth, and proliferation. We hypothesize that loss of PTEN and subsequent activation of Akt, frequent occurrences in prostate cancer, regulate the CXCL12/CXCR4 signaling axis in tumor growth and bone metastasis.

Methods

Murine prostate epithelial cells from PTEN^+/+, PTEN ^+/− , and PTEN^−/− (prostate …

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 …

Prostate Cancer: Can Multiparametric Mr Imaging Help Identify Patients Who Are Candidates For Active Surveillance?, B. Turkbey, H. Mani, O. Aras, J. Ho, A. Hoang, A. R. Rastinehad, H. Agarwal, V. Shah, M. Bernardo, P. L. Choyke, +8 Additional Authors

Journal Articles

PURPOSE: To determine whether multiparametric magnetic resonance (MR) imaging can help identify patients with prostate cancer who would most appropriately be candidates for active surveillance (AS) according to current guidelines and to compare the results with those of conventional clinical assessment scoring systems, including the D'Amico, Epstein, and Cancer of the Prostate Risk Assessment (CAPRA) systems, on the basis of findings at prostatectomy. MATERIALS AND METHODS: This institutional review board-approved HIPAA-compliant retrospectively designed study included 133 patients (mean age, 59.3 years) with a mean prostate-specific antigen level of 6.73 ng/mL (median, 4.39 ng/mL) who underwent multiparametric MR imaging at 3.0 …

Use Of Desipramine For The Treatment Of Overactive Bladder Refractory To Antimuscarinic Therapy, J. H. Hillelsohn, S. Rais-Bahrami, N. Bagadiya, M. Kashan, G. H. Weiss

Journal Articles

Purpose: To evaluate the use of desipramine in the treatment of overactive bladder (OAB). Materials and Methods: We retrospectively evaluated 43 patients who were treated with desipramine for OAB refractory to antimuscarinic therapy. These OAB patients were stratified by the presence or absence of bladder pain. Results: Forty-three patients were evaluated with a mean follow up time of 12.2 +/- 4.6 months. The mean age of the patients was 71 16 years. Twelve patients (28%) discontinued desipramine, 9 due to perceived lack of efficacy, 2 due to central anticholinergic side effects, and 1 due to the development of oropharyngeal sores. …

Comparison Of Endorectal Coil And Nonendorectal Coil T2w And Diffusion-Weighted Mri At 3 Tesla For Localizing Prostate Cancer: Correlation With Whole-Mount Histopathology, B. Turkbey, M. J. Merino, E. C. Gallardo, V. Shah, O. Aras, A. R. Rastinehad, W. M. Linehan, B. J. Wood, P. A. Pinto, P. L. Choyke, +3 Additional Authors

Journal Articles

PURPOSE: To compare utility of T2-weighted (T2W) MRI and diffusion-weighted MRI (DWI-MRI) obtained with and without an endorectal coil at 3 Tesla (T) for localizing prostate cancer. MATERIALS AND METHODS: This Institutional Review Board-approved study included 20 patients (median prostate-specific antigen, 8.4 ng/mL). Patients underwent consecutive prostate MRIs at 3T, first with a surface coil alone, then with combination of surface, endorectal coils (dual coil) followed by robotic assisted radical prostatectomy. Lesions were mapped at time of acquisition on dual-coil T2W, DWI-MRI. To avoid bias, 6 months later nonendorectal coil T2W, DWI-MRI were mapped. Both MRI evaluations were performed by …

Efficacy Of Robot-Assisted Radical Cystectomy In Advanced Bladder Cancer: Results From The International Radical Cystectomy Consortium (Ircc), A. Al-Daghmin, E. C. Kauffman, Y. Shi, K. Badani, M. D. Balbay, E. Canda, P. Dasgupta, R. Ghavamian, L. Richstone, K. A. Guru, +24 Additional Authors

Journal Articles

OBJECTIVES: To characterize the surgical feasibility and outcomes of robot-assisted radical cystectomy (RARC) for pathologic T4 bladder cancer. SUBJECTS/PATIENTS: Retrospective evaluation of a prospectively maintained IRCC database was conducted for 1118 patients who underwent RARC between 2003 and 2012. We dichotomized patients based on pathologic stage (10 days, and 90-day readmission were significantly associated with complications in pT4 patients. Meanwhile, BMI, LOS >10 days, grade 3-5 complications, 90-day readmission, smoking, previous abdominal surgery and neoadjuvant chemotherapy were significantly associated with mortality in pT4 patients. On multivariate analysis, BMI was an independent predictor of complications in pT4 patients, but not for …

Urinary Tract Infections And Post-Operative Fever In Percutaneous Nephrolithotomy, J. Gutierrez, A. Smith, P. Geavlete, H. Shah, A. R. Kural, M. De Sio, J. H. A. Sesmero, A. Hoznek, J. De La Rosette

Journal Articles

To review the incidence of UTIs, post-operative fever, and risk factors for post-operative fever in PCNL patients. Between 2007 and 2009, consecutive PCNL patients were enrolled from 96 centers participating in the PCNL Global Study. Only data from patients with pre-operative urine samples and who received antibiotic prophylaxis were included. Pre-operative bladder urine culture and post-operative fever (> 38.5A degrees C) were assessed. Relationship between various patient and operative factors and occurrence of post-operative fever was assessed using logistic regression analyses. Eight hundred and sixty-five (16.2%) patients had a positive urine culture; Escherichia coli was the most common micro-organism found …

Stereotactic Body Radiotherapy For Localized Prostate Cancer: Disease Control And Quality Of Life At 6 Years, A. J. Katz, M. Santoro, F. Diblasio, R. Ashley

Journal Articles

Background: Stereotactic body radiotherapy (SBRT) may yield disease control for prostate cancer in a brief, hypofractionated treatment regimen without increasing treatment toxicity. Our report presents a 6-year update from 304 low- (n = 211), intermediate- (n = 81), and high-risk (n = 12) prostate cancer patients who received CyberKnife SBRT. Methods: The median PSA at presentation was 5.8 ng/ml. Fifty-seven patients received neoadjuvant hormonal therapy for up to one year. The first 50 patients received a total dose of 35 Gy in 5 fractions of 7 Gy. The subsequent 254 patients received a total dose of 36.25 Gy in 5 …

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 …

Silent Uterine Rupture Of Scarred Uterus--An Unusual Presentation As Amniocele, Aisha Syed Wali, Tahira Naru

Department of Obstetrics & Gynaecology

Obstetricians should be aware of the possibility of silent rupture of scarred uterus. Ultrasound has an important role in the diagnosis of silent uterine rupture. A case of silent uterine rupture with foetal demise, that remained undiagnosed for many weeks, is described.

An Unusual Combination Of Extra-Adrenal Pheochromocytoma And Arteriovenous Malformation Of The Ureter In A Young Adult, Ali Khawaja, Wajahat Aziz, Syed Muhammad Nazim, Farhat Abbas

Section of Urology

We present a case of a 24-year-old gentleman who presented with painless pan haematuria for 2 weeks. During the workup, he was diagnosed to have a retrocaval mass after a CT scan while cystoscopy revealed a polypoidal pulsating lesion in the left ureter. After surgical manipulation of the retrocaval mass, the blood pressure of the patient raised to 260/130 mm Hg. It was completely resected and diagnosed as extra-adrenalpheochromocytoma (paraganglioma) after histopathology. The lesion in the ureter was completely excised and fulgurated and diagnosed as anarteriovenous malformation. To the best of our knowledge, this is the first patient to be …

Renal Arteriovenous Malformation: An Unusual Cause Of Recurrent Haematuria, Mazhar Ali, Wajahat Aziz, Farhat Abbas

Section of Urology

A 54-year-old woman presented with gross painless haematuria. Initial workup showed no abnormality except mild hydronephrosis on CT scan. Cystoscopy and retrograde pyelography did not find any gross lesion and her urine cytology was also negative. She had recurrent haematuria so her CT was reviewed with the radiologist with clinical suspicion of arteriovenous malformation (AVM) which was suggested by relatively increased contrast density in the hemiazygous vein and renal vein in the arterial phase. She underwent angioembiolisation of left renal AVM after which her haematuria settled.