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Urology / Nephrology News From Medical News Today
Hemorrhage Following Percutaneous Renal Surgery: Characterization Of Angiographic Findings
Fri, 05 Sep 2008 04:00:00 -0700
UroToday.com - If there is only one journal you read this month the Journal of Endourology contains a plethora of excellent scientific articles including award winning papers from the World Congress of Endourology Meeting 2007. This paper is one of the first-prize winners and demonstrates that angioembolization should be the first line of management for bleeding following percutaneous renal access surgery.
Plexxikon Initiates Phase 1 Trial for PLX5568 - First-in-Class Drug For The Treatment of Pain and Polycystic Kidney Disease
Fri, 05 Sep 2008 03:00:00 -0700
Plexxikon Inc. announced that it has initiated a Phase 1 human clinical trial for PLX5568, a novel kinase inhibitor targeted for the treatment of at least two major indications with unmet medical needs: pain as well as polycystic kidney disease (PKD). PLX5568 has demonstrated robust preclinical efficacy in multiple pain models, including neuropathic pain as well as acute and inflammatory pain. In addition, PLX5568 has demonstrated compelling efficacy in multiple preclinical models of PKD.
Pediatric And Adolescent Transperineal Anastomotic Urethroplasty
Fri, 05 Sep 2008 03:00:00 -0700
UroToday.com - This study out of Cairo, Egypt by Dr. El-Sheikh, et al., examined the outcome of the open reconstructive technique in adolescent patients with posterior urethral distraction injuries. They presented 15 patients between 5 and 17 years of age with posterior urethral distractions due to motor vehicle accidents. They utilized a perineal approach to achieve a tension-free spatulated anastomosis. The mean follow-up was 28.4 months.
BMC Urology - Latest articles
Nonoperative management of blunt renal trauma: is routine early follow-up imaging necessary?
John B Malcolm, Ithaar H Derweesh, Reza Mehrazin, Christopher J DiBlasio, David D Vance, Salil Joshi, Robert W Wake and Robert Gold Wed, 03 Sep 2008 00:00:00 -0000
Background: There is no consensus on the role of routine follow-up imaging during nonoperative management of blunt renal trauma. We reviewed our experience with nonoperative management of blunt renal injuries in order to evaluate the utility of routine early follow-up imaging. Methods: We reviewed all cases of blunt renal injury admitted for nonoperative management at our institution between 1/2002 and 1/2006. Data were compiled from chart review, and clinical outcomes were correlated with CT imaging results. Results: 207 patients were identified (210 renal units). American Association for the Surgery of Trauma (AAST) grades I, II, III, IV, and V were assigned to 35 (16%), 66 (31%), 81 (39%), 26 (13%), and 2 (1%) renal units, respectively. 177 (84%) renal units underwent routine follow-up imaging 24-48 hours after admission. In three cases of grade IV renal injury, a ureteral stent was placed after serial imaging demonstrated persistent extravasation. In no other cases did follow-up imaging independently alter clinical management. There were no urologic complications among cases for which follow-up imaging was not obtained. Conclusions: Routine follow-up imaging is unnecessary for blunt renal injuries of grades I-III. Grade IV renovascular injuries can be followed clinically without routine early follow-up imaging, but urine extravasation necessitates serial imaging to guide management decisions. The volume of grade V renal injuries in this study is not sufficient to support or contest the need for routine follow-up imaging.
Artificial neural network (ANN) velocity better identifies benign prostatic hyperplasia but not prostate cancer compared with PSA velocity
Carsten Stephan, Nicola Buker, Henning Cammann, Hellmuth-Alexander Meyer, Michael Lein and Klaus Jung Tue, 02 Sep 2008 00:00:00 -0000
Background: To validate an artificial neural network (ANN) based on the combination of PSA velocity (PSAV) with a %free PSA-based ANN to enhance the discrimination between prostate cancer (PCa) and benign prostate hyperplasia (BPH). Methods: The study comprised 199 patients with PCa (n=49) or BPH (n=150) with at least three PSA estimations and a minimum of three months intervals between the measurements. Patients were classified into three categories according to PSAV and ANN velocity (ANNV) calculated with the %free based ANN "ProstataClass". Group 1 includes the increasing PSA and ANN values, Group 2 the stable values, and Group 3 the decreasing values. Results: 71% of PCa patients typically have an increasing PSAV. In comparison, the ANNV only shows this in 45% of all PCa patients. However, BPH patients benefit from ANNV since the stable values are significantly more (83% vs. 65%) and increasing values are less frequently (11% vs. 21%) if the ANNV is used instead of the PSAV. Conclusions: PSAV has only limited usefulness for the detection of PCa with only 71% increasing PSA values, while 29% of all PCa do not have the typical PSAV. The ANNV cannot improve the PCa detection rate but may save 11-17% of unnecessary prostate biopsies in known BPH patients.
ProCOC: The prostate cancer outcomes cohort study
Martin Umbehr, Thomas M Kessler, Tullio Sulser, Glen Kristiansen, Nicole Probst, Johann Steurer and Lucas M Bachmann Tue, 17 Jun 2008 00:00:00 -0000
Background: Despite intensive research over the last several decades on prostate cancer, many questions particularly those concerning early diagnosis and the choice of optimal treatment for each individual patient, still remain unanswered. The goal of treating patients with localized prostate cancer is a curative one and includes minimizing adverse effects to preserve an adequate quality of life. Better understanding on how the quality of life is affected depending on the treatment modality would assist patients in deciding which treatment to choose; furthermore, the development of prognostic biomarkers that indicate the future course of the illness is a promising approach with potential and the focus of much attention. These questions can be addressed in the context of a cohort study.Methods/DesignThis is a prospective, multi-center cohort study within the canton of Zurich, Switzerland. We will include patients with newly diagnosed localized prostate cancer independently of treatment finally chosen. We will acquire clinical data including quality of life and lifestyle, prostate tissue specimen as well as further biological samples (blood and urine) before, during and after treatment for setup of a bio-bank. Assessment of these data and samples in the follow up will be done during routine controls. Study duration will be at least ten years. Influence of treatment on morbidity and mortality, including changes in quality of life, will be identified and an evaluation of biomarkers will be performed. Further we intend to set up a bio-bank containing blood and urine samples providing research of various natures around prostate cancer in the future.DiscussionWe presume that this study will provide answers to pertinent questions concerning prognosis and outcomes of men with localised prostate cancer.
Optimized haemostasis in nephron-sparing surgery using small-intestine submucosa
Jörg Simon, Robert de Petriconi, Michael Meilinger, Richard E Hautmann and Georg Bartsch Tue, 29 Apr 2008 00:00:00 -0000
Background: The indications for nephron-sparing surgery are expanding constantly. One major contributing fact for this development is the improvement of haemostatic techniques following excision of the tumor. Nevertheless, postoperative bleeding complications still occur. To prevent this, we prospectively studied the effect of application of small-intestine submucosa (SIS) over the renal defect. Methods: We performed 55 nephron-sparing surgeries applying SIS between 08/03 and 10/06 in 53 pts. (mean age: 59 yrs., range 29 – 79 yrs.). After resection of the renal tumor and application of a haemostyptic agent, we used SIS to secure and apply compression on the defect. Results: The final pathology revealed clear-cell and papillary carcinoma, papillary adenoma, oncocytoma, and angiomyolipoma in 39 (70.9%), 6 (10.9), 1 (1.8%), 2 (3.6%) and 7 (12.7%) patients, respectively. The 45 malignant lesions (81.8%) were classified as pT1a and pT1b in 35 (77.8%) and 10 (22.2%) patients, respectively. The median tumor size was 4.5 cm (range: 1.3 – 13 cm). The median operating time was 186 min (range: 90 – 260 min). 18 (32.7%) procedures were performed without ischemia. 23 (41.8%) and 14 (25.5%) cases were operated in in-situ cold and warm ischemia, respectively. The median intraoperative blood loss was 730 cc (range: 100 – 2500 cc). No open operative revision was indicated due to postoperative bleeding complications. Furthermore, there was no necessity to substitute persistent blood loss from the drains postoperatively. No urinoma occurred. Conclusion: SIS is a highly effective and easy-to-use instrument for preventing postoperative bleeding and urinary fistula complications in nephron-sparing surgery.
Androgenic dependence of exophytic tumor growth in a transgenic mouse model of bladder cancer: a role for thrombospondin-1
Aimee M Johnson, Mary J O'Connell, Hiroshi Miyamoto, Jiaoti Huang, Jorge L Yao, Edward M Messing and Jay E Reeder Wed, 23 Apr 2008 00:00:00 -0000
Background: Steroid hormones influence mitogenic signaling pathways, apoptosis, and cell cycle checkpoints, and it has long been known that incidence of bladder cancer (BC) in men is several times greater than in women, a difference that cannot be attributed to environmental or lifestyle factors alone. Castration reduces incidence of chemically-induced BC in rodents. It is unclear if this effect is due to hormonal influences on activation/deactivation of carcinogens or a direct effect on urothelial cell proliferation or other malignant processes. We examined the effect of castration on BC growth in UPII-SV40T transgenic mice, which express SV40 T antigen specifically in urothelium and reliably develop BC. Furthermore, because BC growth in UPII-SV40T mice is exophytic, we speculated BC growth was dependent on angiogenesis and angiogenesis was, in turn, androgen responsive. Methods: Flat panel detector-based cone beam computed tomography (FPDCT) was used to longitudinally measure exophytic BC growth in UPII-SV40T male mice sham-operated, castrated, or castrated and supplemented with dihydrotestosterone (DHT). Human normal bladder and BC biopsies and mouse bladder were examined quantitatively for thrombospondin-1 (TSP1) protein expression. Results: Mice castrated at 24 weeks of age had decreased BC volumes at 32 weeks compared to intact mice (p = 0.0071) and castrated mice administered DHT (p = 0.0233; one-way ANOVA, JMP 6.0.3, SAS Institute, Inc.). Bladder cancer cell lines responded to DHT treatment with increased proliferation, regardless of androgen receptor expression levels. TSP1, an anti-angiogenic factor whose expression is inhibited by androgens, had decreased expression in bladders of UPII-SV40T mice compared to wild-type. Castration increased TSP1 levels in UPII-SV40T mice compared to intact mice. TSP1 protein expression was higher in 8 of 10 human bladder biopsies of normal versus malignant tissue from the same patients. Conclusion: FPDCT allows longitudinal monitoring of exophytic tumor growth in the UPII-SV40T model of BC that bypasses need for chemical carcinogens, which confound analysis of androgen effects. Androgens increase tumor cell growth in vitro and in vivo and decrease TSP1 expression, possibly explaining the therapeutic effect of castration. This effect may, in part, explain gender differences in BC incidence and implies anti-androgenic therapies may be effective in preventing and treating BC.
Sutureless prepuceplasty with wound healing by second intention: An alternative surgical approach in children's phimosis treatment
Efstratios Christianakis Tue, 04 Mar 2008 00:00:00 -0000
Background: A new technique for the treatment of children's phimosis is presented that minimizes the repairing time, the postoperative complications and maintains the physical foreskin appearance intact. Methods: Eightyseven children with phimosis were treated with this new developed technique, between 2003 and 2005. Sutureless prepuceplasty creates a permanent surgical extension of the close prepuce. Stretching and retraction of phimotic foreskin reveals a tight prepuce ring that is cutting in its dorsal surface longitudinally. Rarely triple symmetric incisions in the preputial outlet are necessary. The foreskin is loose and moves absolutely free in bilateral courses. The wounds are healing by second intention. Antisepsis, steroids and Elicina cream, (which contains allantoin, collagen, elastin, glycolic acid and vitamins A, D, and E) should apply daily, for twenty to thirty days. Results: The foreskin is moving in centripetal or efferent courses absolutely loosely, painlessly and bloodlessly. The mean time of follow-up was 27 months (one to four years). No complications were observed. Conclusion: Sutureless prepuceplasty may present an acceptable alternative in children's phimosis reconstruction.
Current Opinion in Urology - Current Table Of Contents
Editorial introductions.
Page: viiDOI: 10.1097/MOU.0b013e32830d7fae
Advances in diagnosis and follow-up in kidney cancer.
Page: 447DOI: 10.1097/MOU.0b013e32830a4efcAuthors: Rioja, Jorge; de la Rosette, Jean JMCH; Wijkstra, Hessel; Laguna, M Pilar
The staging of renal cell carcinoma.
Page: 455DOI: 10.1097/MOU.0b013e32830a4f36Authors: Shuch, Brian; La Rochelle, Jeff C; Pantuck, Allan J; Belldegrun, Arie S
Minimally invasive nephron-sparing surgery.
Page: 462DOI: 10.1097/MOU.0b013e32830a4f10Authors: Berger, Andre; Crouzet, Sebastien; Canes, David; Haber, Georges-Pascal; Gill, Inderbir S
Probe ablative treatment for small renal masses: cryoablation vs. radio frequency ablation.
Page: 467DOI: 10.1097/MOU.0b013e32830a735bAuthors: Goel, Raj K; Kaouk, Jihad H
Cytoreductive nephrectomy in metastatic renal cell carcinoma.
Page: 474DOI: 10.1097/MOU.0b013e32830a4f21Authors: Margulis, Vitaly; Matin, Surena F; Wood, Christopher G
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