Browse Health
Dr. Alexander Kutikov, MD
Associate Professor of Urologic Oncology: Robotic, Laparoscopic, and Traditional Surgical Expertise
6 years of experience
Video profile

Education ?

Medical School Score Rankings
Harvard University (2003) *
  • Currently 4 of 4 apples
Top 25%
Residency
University of PA Health System (2003) *
Fellowship
Fox Chase Cancer Center (2003) *
Urology
* This information was reported to Vitals by the doctor or doctor's office.

Awards & Distinctions ?

Awards  
Patients' Choice Award (2010 - 2013)
Compassionate Doctor Recognition (2010 - 2013)
Top Ten Doctors (2012)
Rhawnhurst
Oncology
Appointments
Fox Chase Cancer Center
Assistant Professor of Surgical Oncology

Affiliations ?

Dr. Kutikov is affiliated with 5 hospitals.

Hospital Affilations

Score

Rankings

  • Montgomery Hospital XXXXX
    900 E Fornance St, Norristown, PA 19401
    • Currently 3 of 4 crosses
    Top 50%
  • Albert Einstein Medical Center
    Medical Oncology
    5501 Old York Rd, Philadelphia, PA 19141
    • Currently 2 of 4 crosses
  • Elkins Park Hospital
    60 Township Line Rd, Elkins Park, PA 19027
  • Fox Chase Cancer Center
    333 Cottman Ave, Philadelphia, PA 19111
  • Mossrehab & Albert Einstein Med Ctr
    60 Township Line Rd, Elkins Park, PA 19027
  • Publications & Research

    Dr. Kutikov has contributed to 40 publications.
    Title Clinical Stage T1 Micropapillary Urothelial Carcinoma Presenting with Metastasis to the Pancreas.
    Date May 2012
    Journal Urology
    Excerpt

    Micropapillary carcinoma of the bladder is an extremely aggressive variant of urothelial carcinoma. Radical cystectomy is the standard treatment for all patients, including those with nonmuscle-invasive disease. We present a patient diagnosed with clinical Stage T1 micropapillary carcinoma of the bladder who was found to have a 2-cm metastasis to the head of the pancreas. To our knowledge, this case represents the first report of a solitary metastatic urothelial carcinoma to the pancreas.

    Title Small Renal Masses Progressing to Metastases Under Active Surveillance: a Systematic Review and Pooled Analysis.
    Date April 2012
    Journal Cancer
    Excerpt

    The authors systematically reviewed the literature and conducted a pooled analysis of studies on small renal masses who underwent active surveillance to identify the risk progression and the characteristics associated with metastases.

    Title Delayed Proximal Ureteric Stricture Formation After Complex Partial Nephrectomy.
    Date March 2012
    Journal Bju International
    Excerpt

    •  To report and review our incidence of delayed ureteric stricture (US) after complex nephron-sparing surgery (NSS).

    Title Intensely Positron Emission Tomography-avid Benign Adrenal Adenoma.
    Date February 2012
    Journal Urology
    Excerpt

    Both positron emission tomography/computed tomography (CT) and adrenal washout studies are highly accurate in differentiating benign from malignant adrenal lesions. Very few data exist to help guide management when the positron emission tomography and CT adrenal findings contradict each other with regard to the malignant potential. We present a patient with a remote history of breast cancer and a new solitary left adrenal mass. A CT washout study suggested a lipid-poor adenoma; however, positron emission tomography/CT demonstrated intense fluorodeoxyglucose uptake, suggesting malignancy. The pathologic evaluation after laparoscopic adrenalectomy revealed a benign adrenal adenoma.

    Title Transrectal Implantation of Electromagnetic Transponders Following Radical Prostatectomy for Delivery of Imrt.
    Date January 2012
    Journal The Canadian Journal of Urology
    Excerpt

    Surgical treatment for men with localized prostate cancer -open, laparoscopic, or robotically-assisted-- remains one of the therapeutic mainstays for this group of patients. Despite the stage migration witnessed in patients with prostate cancer since the introduction of prostate-specific antigen (PSA) screening, detection of extraprostatic disease at the time of surgery and biochemical recurrence following prostatectomy pose significant therapeutic challenges. Radiation therapy (RT) after radical prostatectomy (RP) has been associated with a survival benefit in both the adjuvant and salvage setting. Nevertheless, optimal targeting of the prostate bed following surgery remains challenging. The Calypso 4D Localization System (Calypso Medical Technologies, Seattle, WA, USA) is a target positioning device that continuously monitors the location of three implantable electromagnetic transponders. These transponders can be placed into the empty prostatic bed after prostatectomy to facilitate the delivery of radiation therapy in the post-surgical setting. In this article, we detail our technique for transrectal placement of electromagnetic transponders into the post-prostatectomy bed for the delivery of adjuvant or salvage intensity-modulated radiation therapy. We prefer this technique of post-surgical radiation therapy because it allows for improved localization of the target area allowing for the maximal delivery of the radiation dose while minimizing exposure of surrounding normal tissues. Although emerging, our initial oncologic and functional outcomes have been promising.

    Title Anatomic Features of Enhancing Renal Masses Predict Malignant and High-grade Pathology: a Preoperative Nomogram Using the Renal Nephrometry Score.
    Date October 2011
    Journal European Urology
    Excerpt

    Counseling patients with enhancing renal mass currently occurs in the context of significant uncertainty regarding tumor pathology.

    Title Docetaxel-mediated Apoptosis in Myeloid Progenitor Tf-1 Cells is Mitigated by Zinc: Potential Implication for Prostate Cancer Therapy.
    Date October 2011
    Journal The Prostate
    Excerpt

    Docetaxel-based combination chemotherapy is approved by the FDA for the treatment of metastatic castration-resistant prostate cancer. Unfortunately, docetaxel's efficacy is significantly limited by its considerable toxicity on hematopoietic progenitor cells, thus necessitating dose reduction or even discontinuation of the chemotherapy. Induction of pre-mitotic arrest protects cells against docetaxel-mediated toxicity and affords therapeutic opportunities.

    Title Routine Adrenalectomy is Unnecessary During Surgery for Large And/or Upper Pole Renal Tumors when the Adrenal Gland is Radiographically Normal.
    Date May 2011
    Journal The Journal of Urology
    Excerpt

    Concurrent adrenalectomy during renal surgery for renal cell carcinoma was once routine. More recent data suggest that adrenalectomy should be reserved for tumors 7 cm or greater, particularly those involving the upper pole. We evaluated the radiographic and pathological incidence of adrenal involvement in patients undergoing renal surgery for renal cell carcinoma 7 cm or greater.

    Title Implantation of Electromagnetic Transponders Following Radical Prostatectomy for Delivery of Imrt.
    Date February 2011
    Journal The Canadian Journal of Urology
    Excerpt

    Radiation therapy (RT) after radical prostatectomy (RP) has been associated with a survival benefit in both the adjuvant and salvage setting. Nevertheless, optimal targeting of the prostate bed following surgery remains challenging. The Calypso 4D Localization System (Calypso Medical Technologies, Seattle, WA, USA) is a target positioning device that continuously monitors the location of three implantable electromagnetic transponders. We describe our technique of ultrasound-guided placement of these transponders into the prostate bed for adjuvant and salvage RT.

    Title The Gatekeeper Disparity--why Do Some Medical Schools Send More Medical Students into Urology?
    Date February 2011
    Journal The Journal of Urology
    Excerpt

    Urology continues to be a highly desirable specialty despite decreasing exposure of students to urology in American medical schools. We assessed how American medical schools compare to each other in regard to the number of students that each sends into urological training. We evaluated the reasons why some medical schools consistently send more students into urology than others.

    Title Clinicopathological Outcomes After Radical Cystectomy for Clinical T2 Urothelial Carcinoma: Further Evidence to Support the Use of Neoadjuvant Chemotherapy.
    Date February 2011
    Journal Bju International
    Excerpt

    To evaluate the clinicopathological outcomes for patients with clinical T2 (cT2) urothelial carcinoma treated with radical cystectomy (RC) without neoadjuvant chemotherapy (NC).

    Title Baseline Renal Function Status Limits Patient Eligibility to Receive Perioperative Chemotherapy for Invasive Bladder Cancer and is Minimally Affected by Radical Cystectomy.
    Date January 2011
    Journal Urology
    Excerpt

    To evaluate the proportion of patients with muscle-invasive urothelial carcinoma (UC) who would be eligible to receive cisplatin-based chemotherapy before and after radical cystectomy based on renal function.

    Title Andrew Johnson's Rocky Medical and Political 'calculous'.
    Date January 2011
    Journal Bju International
    Title Cadmium Down-regulates Expression of Xiap at the Post-transcriptional Level in Prostate Cancer Cells Through an Nf-kappab-independent, Proteasome-mediated Mechanism.
    Date December 2010
    Journal Molecular Cancer
    Excerpt

    Cadmium has been classified as a human carcinogen, affecting health through occupational and environmental exposure. Cadmium has a long biological half-life (>25 years), due to the flat kinetics of its excretion. The prostate is one of the organs with highest levels of cadmium accumulation. Importantly, patients with prostate cancer appear to have higher levels of cadmium both in the circulation and in prostatic tissues.

    Title Metanephric Adenofibroma: Robotic Partial Nephrectomy of a Large Wilms' Tumor Variant.
    Date November 2010
    Journal The Canadian Journal of Urology
    Excerpt

    A case of the rare, benign, Wilms' tumor (WT) variant, metanephric adenofibroma (MAF), is presented.

    Title Use of Systemic Therapy and Factors Affecting Survival for Patients Undergoing Cytoreductive Nephrectomy.
    Date August 2010
    Journal Bju International
    Excerpt

    To present a multi-institutional experience evaluating the use of systemic therapy in patients undergoing cytoreductive nephrectomy (CN), as prospective randomized trials showed a survival benefit for CN in patients with metastatic renal cell carcinoma treated with immunotherapy, and these data have been extrapolated to support CN in the era of targeted therapy, but the likelihood that patients with metastatic kidney cancer who undergo CN will receive systemic treatment afterward remains poorly defined.

    Title Robot-assisted Partial Nephrectomy: a Large Single-institutional Experience.
    Date June 2010
    Journal Urology
    Excerpt

    To report experience with 100 robot-assisted partial nephrectomy (RAPN) operations performed at our institution. Nephron-sparing surgery is an established treatment for patients with small renal masses. The laparoscopic approach has emerged as an alternative to open nephron-sparing surgery, but it is recognized to be technically challenging. The robotic surgical system may enable faster and greater technical proficiency, facilitating a minimally invasive approach to more difficult lesions while reducing ischemia time.

    Title Renal Masses Herniating into the Hilum: Technical Considerations of the "ball-valve Phenomenon" During Nephron-sparing Surgery.
    Date April 2010
    Journal Urology
    Excerpt

    To describe our technique to recognize and resect renal tumors "ball-valving" into the sinus. Partial nephrectomy (PN) offers a functional advantage over radical nephrectomy for many cases of localized renal cell carcinoma. However, PN is underutilized particularly in anatomically challenging cases. Often unrecognized is the tendency for central renal tumors to herniate into the renal sinus.

    Title The Impact of Residency Match Information Disseminated by a Third-party Website.
    Date January 2010
    Journal Journal of Surgical Education
    Excerpt

    Over the past 10 years, a dramatic shift has occurred toward web-based applications and information dissemination both for medical students applying to residency programs and for current housestaff seeking specialty-specific information. This shift has been witnessed in urology with adoption of the Internet-based Electronic Residency Application Service for residency application submission. Currently, most residency programs devote significant attention to developing and maintaining an attractive web page, as studies have suggested departmental websites may impact applicants' decisions regarding residency preference lists.(1,2) Recently, some third-party websites have been established to provide information to medical students and residents in a variety of specialties. No studies are available that evaluate the impact of these external websites on residency decision making. In 2003, a website under the domain name www.UrologyMatch.com was created by 2 coauthors (A.K. and T.M.M.) with the purpose of assisting medical students through the American Urological Association (AUA) match process. Additionally, by providing a discussion forum for students, residents, and faculty, it sought to aid with the dissemination of information between urology programs and applicants. The website has been gradually expanded to provide educational content for urology trainees at a wide range of levels. Components of the website include an introduction to the field of urology, a detailed description of the match process, an "expert advice" section from urologic leaders, a library of relevant Internet links, a digital surgical atlas, and program-specific questionnaire responses provided by residency directors and department chairs. A discussion board providing an uncensored forum for visitors is integrated into the website to aid with the dissemination of information between and among urology programs, residents, and applicants. The high usage of this site has suggested that external websites may have a marked impact on the residency application process. The purpose of the current study was to evaluate the role of www.UrologyMatch.com in the AUA match process. During the 2007-2008 urology residency match, we evaluated whether information disseminated through the website influenced medical students' decisions to enter the field of urology and whether this information factored into the generation of residency preference lists. We hypothesized that information on this website played a significant role in decision making throughout the urology residency match experience.

    Title Management of Small Renal Masses.
    Date September 2009
    Journal Seminars in Ultrasound, Ct, and Mr
    Excerpt

    Surgical excision of renal cell carcinoma is the current standard of care for localized disease. Series for small renal masses treated with surgery demonstrate excellent oncologic outcomes with 5-year survival rates over 95%. Minimally invasive ablative technologies, such as cryotherapy and radiofrequency ablation, have recently emerged with similar short- and intermediate-term results. Additionally, recent data on active surveillance have demonstrated survival rates comparable to surgery and ablation in selected patient populations. We review the currently available data regarding the management of small renal masses by excision, ablation, or observation.

    Title Synchronous Metastatic Renal Cell Carcinoma to the Genitourinary Tract: Two Rare Case Reports and a Review of the Literature.
    Date May 2009
    Journal The Canadian Journal of Urology
    Excerpt

    Synchronous metastasis of renal cell carcinoma (RCC) to the ureter or the bladder represents an extremely rare event. We report one case of synchronous metastasis of RCC to the ipsilateral ureter and one case of solitary synchronous metastasis of RCC to the urinary bladder. We review the literature and discuss possible mechanisms of dissemination. We discuss the surgical management of metastases from RCC as well as the surgical options in the treatment of these rare occurrences.

    Title Focal Therapy for Kidney Cancer: a Systematic Review.
    Date May 2009
    Journal Current Opinion in Urology
    Excerpt

    Surgical excision remains the standard of care for treatment of localized small renal masses (SRMs). Laparoscopic and percutaneous minimally invasive ablative technologies are being increasingly employed in current urologic practice. We review recent literature regarding focal ablative treatments of SRMs.

    Title A Case of Synchronous Bilateral Testicular Seminoma.
    Date August 2008
    Journal Nature Clinical Practice. Urology
    Excerpt

    BACKGROUND: A previously healthy 51-year-old man with two children sustained a minor testicular trauma and subsequently sought medical care for persistent discomfort. INVESTIGATIONS: Physical examination, scrotal ultrasonography, Doppler ultrasound evaluation of testicular blood flow, scrotal MRI, measurement of serum tumor markers and testosterone levels, CT of the chest, abdomen and pelvis, intraoperative frozen section analysis and final pathologic analysis. DIAGNOSIS: Bilateral testicular seminoma (clinical stage I). MANAGEMENT: The patient initially underwent radical left orchiectomy with intraoperative frozen section analysis, which returned equivocal results. Final pathologic analysis revealed a 2.5 cm left testicular seminoma without vascular invasion. After careful discussion, he ultimately underwent radical right orchiectomy; pathologic analysis revealed a 2.7 cm right seminoma with vascular invasion. Testosterone replacement therapy was initiated. After further discussion, the patient elected to undergo adjuvant abdominal radiotherapy to a total of 25 Gy. The patient showed no evidence of disease over a post-treatment follow-up period of 24 months.

    Title Communication Between the Ureter and an Aortic Aneurysm Sac After an Abdominal Aortic Aneurysm Repair.
    Date April 2008
    Journal Urology
    Excerpt

    Fistulae between the vasculature and the ureter are rare. We describe a communication between the ureter and the sac of an aortic aneurysm following abdominal aortic aneurysm repair.

    Title Modern Management of Pheochromocytoma.
    Date December 2007
    Journal Nature Clinical Practice. Urology
    Excerpt

    BACKGROUND: A 55-year-old male with poorly controlled hypertension and a history of coronary artery disease presented with a large adrenal mass. The patient also reported a long-standing history of profuse sweating, tinnitus, vomiting and headaches. INVESTIGATIONS: Physical examination, 24-hour urine metanephrine level, CT, MRI and bone scan. DIAGNOSIS: Pheochromocytoma of the left adrenal gland. MANAGEMENT: Preoperative alpha-blockade therapy with phenoxybenzamine followed by open left adrenalectomy.

    Title Laparoscopic and Robotic Complex Upper-tract Reconstruction in Children with a Duplex Collecting System.
    Date September 2007
    Journal Journal of Endourology / Endourological Society
    Excerpt

    PURPOSE: We suggest that when surgical correction is considered to treat a duplicated collecting system with well-functioning moieties, a laparoscopic approach at the renal level is feasible even in cases requiring complex reconstruction. PATIENTS AND METHODS: Six children between the ages of 4 months and 10 years (mean age 5.2 years) presented with urinary-tract infection, incontinence, or pain and underwent transperitoneal laparoscopic reconstruction for duplex collecting system pathology in renal moieties with preserved function. Five patients underwent laparoscopic upper pole-to-lower pole ureteroureterostomies, whereas one patient underwent a complex reconstruction of a long narrowing defect utilizing a Scardino-Prince vertical flap. Four patients underwent conventional laparoscopy, while the da Vinci Surgical System was used during the surgical procedures of the other two patients. RESULTS: The mean operative time was 3.1 hours (range 2.6-4.9 hours) for the entire procedure, including cystoscopic evaluation. Stents were removed 6 weeks postoperatively. The patients were evaluated with retroperitoneal ultrasonography and either intravenous urography or diuretic radionuclide imaging to assess the anatomic integrity of the reconstruction. The presenting symptomatology resolved in all patients. CONCLUSIONS: We believe that complex laparoscopic upper-tract reconstruction in children who benefit from a parenchyma-preserving approach is possible and should be evaluated against open techniques.

    Title Should Renal and Bladder Function Be Our Compass for Management of Vesicoureteral Reflux?
    Date August 2007
    Journal Nature Clinical Practice. Urology
    Title Robot Assisted Pyeloplasty in the Infant-lessons Learned.
    Date January 2007
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Robot assisted pyeloplasty is emerging as an effective tool for treatment of ureteropelvic junction obstruction in the pediatric population. However, access needed for the procedure is difficult in the small abdominal cavity of an infant. We present our experience with infant robot assisted pyeloplasty, along with some lessons learned that render this procedure possible in these small patients. MATERIALS AND METHODS: Nine children 3 to 8 months old (mean 5.6) underwent transperitoneal robot assisted pyeloplasty for ureteropelvic junction obstruction using the da Vinci Surgical System. All patients underwent Anderson-Hynes dismembered pyeloplasty without renal pelvis tapering. Outcome measures included operative time, length of hospital stay, and resolution of obstruction by ultrasonography and/or diuretic radionuclide imaging. RESULTS: All infants successfully underwent robot assisted laparoscopic pyeloplasty without conversion to pure laparoscopy or open procedure. Mean operative time was 122.8 minutes, with a mean console time of 72.1 minutes. Mean hospital stay was 1.4 days. Of the 9 patients 7 (78%) had resolution of or improvement in hydronephrosis, while 2 had no evidence of obstruction based on followup diuretic renography. CONCLUSIONS: Robot assisted pyeloplasty is a safe and effective option in the surgical treatment of infant ureteropelvic junction obstruction. Further long-term studies are needed to confirm the usefulness of robotics in minimally invasive pediatric surgery.

    Title Initial Experience with Laparoscopic Transvesical Ureteral Reimplantation at the Children's Hospital of Philadelphia.
    Date January 2007
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Laparoscopic transvesical ureteral reimplantation with or without robotic assisted surgical devices is being developed as an alternative to open surgery. We review our experience with laparoscopic transvesical ureteral reimplantation. MATERIALS AND METHODS: A total of 32 patients underwent laparoscopic transvesical reimplantation by the same surgeon. Of the patients 5 had primary obstructing megaureters and 27 had vesicoureteral reflux. Transvesical laparoscopic cross-trigonal ureteral reimplantation was performed in patients with reflux, and a Glenn-Anderson reimplantation was used in patients with a primary obstructing megaureter. A pure laparoscopic approach using two 3 mm working ports and a 5 mm camera port was used. RESULTS: The operative success rates were 92.6% and 80% for vesicoureteral reflux and primary obstructing megaureter cases, respectively. Complications included a postoperative urinary leak in 4 patients (12.5%) and ureteral stricture at the neoureterovesical anastomosis in 2 (6.3%). All but 1 complication occurred in patients 2 years or younger with bladder capacity less than 130 cc. CONCLUSIONS: Laparoscopic intravesical reimplantation is in its infancy and appears to have higher complication rates in young patients with small bladder capacity.

    Title Clinical Approach to the Prostate: an Update.
    Date December 2006
    Journal Radiologic Clinics of North America
    Excerpt

    Prostatic disease continues to present clinicians with challenges. Although giant strides have been made in the medical and surgical management of benign prostatic hyperplasia, many fundamental questions about its pathogenesis, progression, and treatment efficacy remain unanswered. Prostate cancer also continues to be an area in which progress is needed despite major recent advancements. Numerous debates that include the value of prostate-specific antigen screening and appropriate roles for each of the numerous therapeutic modalities await resolution. For millions of patients who suffer from prostatitis, a major breakthrough is yet to come. Current treatment regimens for prostatitis remain ineffective at best. Contemporary approaches to the pathogenesis, diagnosis, and treatment of benign prostatic hyperplasia, prostate cancer, and prostatitis are discussed in this review.

    Title Incidence of Benign Pathologic Findings at Partial Nephrectomy for Solitary Renal Mass Presumed to Be Renal Cell Carcinoma on Preoperative Imaging.
    Date November 2006
    Journal Urology
    Excerpt

    OBJECTIVES: To determine the incidence of benign pathologic findings at partial nephrectomy for a solitary renal lesion when preoperative imaging is reviewed by an experienced team of academic genitourinary radiologists. METHODS: From 1996 to 2004, 143 patients underwent resection of a solitary renal lesion for presumed renal cell carcinoma amenable to partial nephrectomy. Our experienced team of genitourinary radiologists interpreted all preoperative imaging scans. Of the 143 patients, 44 underwent partial nephrectomy for a solitary lesion less than 2 cm, 85 for a lesion 2 to 4 cm, and 14 for a lesion greater than 4 cm. RESULTS: Of the 143 solitary masses resected, 23 revealed benign pathologic findings (16.1%). Ten lesions (43.5%) were angiomyolipomas (AMLs), eight (34.8%) were oncocytomas, three (13.0%) were benign Bosniak-type cysts, and one each was a low-grade spindle cell lesion most consistent with mesoblastic nephroma, and a metanephric adenoma. CONCLUSIONS: A significant fraction of small solitary renal masses presumed to be renal cell carcinoma had benign pathologic findings on resection, despite thorough expert radiologic review. Management should favor parenchyma-sparing approaches, because resection serves not only a therapeutic but also a diagnostic function. Patients should be counseled accordingly when faced with the diagnosis of renal mass.

    Title Laparoscopic Pyeloplasty in the Infant Younger Than 6 Months--is It Technically Possible?
    Date May 2006
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Laparoscopic dismembered pyeloplasty is an acceptable option for UPJ obstruction in the pediatric population. We report our initial experience with this approach in infants. MATERIALS AND METHODS: Eight infants 3 to 5 months old (mean 4.5) underwent transperitoneal laparoscopic pyeloplasty for ureteropelvic junction obstruction. All patients underwent dismembered pyeloplasty with renal pelvis tapering. Two patients underwent concomitant pyelolithotomy and 1 underwent contralateral nephrectomy. Outcome measures included operative time, length of hospital stay, and resolution of obstruction by ultrasonography and DRI. RESULTS: Mean operative time was 1.8 hours for the pyeloplasty portion. Mean hospital stay was 1.2 days. The stent was removed 6 weeks postoperatively in all patients except 1. This patient, 1 of the 2 patients who underwent concomitant pyelolithotomy, had development of a new stone while the stent was still indwelling. Laparoscopic pyeloplasty resulted in 100% resolution of UPJ obstruction in this series. CONCLUSIONS: We believe that laparoscopic dismembered pyeloplasty is technically possible in infants younger than 6 months.

    Title Synthesis, Characterization, and Cytotoxicity of a Series of Estrogen-tethered Platinum(iv) Complexes.
    Date December 2004
    Journal Chemistry & Biology
    Excerpt

    Several estrogen-tethered platinum(IV) complexes were prepared and characterized by ESI-MS and (1)H NMR spectroscopy. Their design was inspired by the observation that estrogen receptor-positive cells exposed to the hormone are sensitized to cisplatin. Intracellular reduction of bis-estrogen-cis-diamminedichloroplatinum(IV), BEP(n) (where n = 1-5 methylene groups between Pt and estrogen), occurs to afford cisplatin and two equivalents of the linker-modified estrogen. The ability of BEP(n) to induce overexpression of HMGB1 was established by immunofluorescence microscopy. The cytotoxicity of the compounds was evaluated in ER(+) MCF-7 and ER(-) HCC-1937 human breast cancer cell lines. BEP3 selectively induces overexpression of HMGB1 in MCF-7 cells, compared to HCC-1937 cells, and enhances their sensitivity (IC(50) = 2.1 +/- 0.4 microM versus 3.7 +/- 0.9 microM, respectively) to the compound. The difference in compound activities and the potential of compounds of this class for treating breast and ovarian cancer are discussed.

    Title Enucleation of Renal Cell Carcinoma with Ablation of the Tumour Base.
    Date
    Journal Bju International
    Excerpt

    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. The mean follow-up was 24.9 months. Patients were evaluated for RCC recurrence with cross-sectional imaging at least every 6 months for the first 2 years and then annually thereafter. RESULTS: The mean (median, range) tumour size was 2.8 (2.5, 0.8-7.0) cm. Of the 97 patients only one had disease progression after a mean follow-up of 24.9 months. This patient presented with a solitary grade 2 clear cell RCC and had a local recurrence 30 months after original surgery. CONCLUSIONS: The present series and other available clinical data suggest that enucleation with cavity ablation is an oncologically sound approach that is simple, versatile and obviates the need for renal ischaemia.

    Title Testicular Compartment Syndrome: a New Approach to Conceptualizing and Managing Testicular Torsion.
    Date
    Journal Urology
    Excerpt

    OBJECTIVES: Decompression of compartment syndrome is known to salvage tissues in numerous organ systems. To demonstrate evidence that testes exposed to prolonged ischemia exhibit compartment syndrome physiology and propose a novel technique in treating this phenomenon. METHODS: Three boys, aged 11, 14, and 16 years, with prolonged testicular torsion lasting 6-7 hours were taken to the operating room. All testes appeared dusky and congested on manual detorsion. Testicular fasciotomy was performed by making a longitudinal incision in the tunica albuginea. The coloration of all testes improved dramatically. When the tunica albuginea was reapproximated, each testis returned to an ischemic appearance. The tunica albuginea was again opened. A harvested tunica vaginalis patch was placed over the exposed seminiferous tubules and secured in place. In the case of the 11-year-old boy, a handheld compartment monitor needle was used to measure the compartment pressure at all stages of the procedure. RESULTS: All testes maintained a well-perfused coloration at completion of the procedure. The compartment pressures in the testis of the 11-year-old boy (diastolic pressure 52 mm Hg) were as follows: 34 mm Hg after detorsion, 5 mm Hg after testicular fasciotomy, 46 mm Hg after reapproximation of the tunica albuginea, 3 mm Hg on repeat fasciotomy, and 5 mm Hg after tunica vaginalis patch application. CONCLUSIONS: Testicular compartment pressures appear elevated after prolonged torsion. Testicular fasciotomy, combined with a tunica vaginalis patch, relieved testicular compartment syndrome. Additional investigation is warranted to determine whether this technique affords improved preservation of testicular tissues.

    Title The Clinical and Pathological History of Prostate Cancer Progression in Men with a Prior History of High Grade Prostatic Intraepithelial Neoplasia.
    Date
    Journal The Canadian Journal of Urology
    Excerpt

    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. The number and timing of all biopsies leading to the diagnosis of cancer were assessed. Clinical and pathological features of those patients with eventual disease progression were evaluated. RESULTS: The mean number of biopsies performed before subsequent cancer diagnosis was 5 (range: 3-13). The mean time to the diagnosis of cancer was 29 months (range: 7-83). Men with a history of HGPIN had lower percent positive biopsies at the time of cancer diagnosis (p < 0.001) and smaller volume tumors on final pathology (p = 0.041) compared to men without a history of HGPIN. CONCLUSIONS: Patients with an initial diagnosis of HGPIN on transrectal ultrasound (TRUS) guided biopsy progressed to cancer at a mean of 29 months. The vast majority of patients that progressed to prostate cancer had low volume disease at the time of diagnosis and definitive treatment. Our data indicate the importance of re-evaluation in HGPIN patients and suggest a trend toward low volume disease in carefully followed patients. Prospective data is warranted to adequately define an evidence based biopsy regimen in men with HGPIN.

    Title Percutaneous Vs Surgical Cryoablation of the Small Renal Mass: is Efficacy Compromised?
    Date
    Journal Bju International
    Excerpt

    Study Type - Therapy (systematic review)
Level of Evidence 1b OBJECTIVE: To review and analyse the cumulative literature to compare surgical and percutaneous cryoablation of small renal masses (SRMs). METHODS: A MEDLINE search was performed (1966 to February 2010) of the published literature in which cryoablation was used as therapy for localized renal masses. Residual disease was defined as persistent enhancement on the first post-ablation imaging study, while recurrent disease was defined as enhancement after an initially negative postoperative imaging study, consistent with the consensus definition by the Working Group on Image-Guided Tumor Ablation. Data were collated and analysed using the two-sample Mann-Whitney test and random-effects Poisson regression, where appropriate. RESULTS: In all, 42 studies, representing 1447 lesions treated by surgical (n= 28) or percutaneous (n= 14) cryoablation were pooled and analysed. No significant differences were detected between approaches regarding patient age (median 67 vs 66 years, P= 0.55), tumour size (median 2.6 vs 2.7 cm, P= 0.24),or duration of follow-up (median 14.9 vs 13.3 months, P= 0.40). Differences in rates of unknown pathology also failed to reach statistical significance (14 vs 21%, P= 0.76). The difference in the rate of residual tumour was not statistically different (0.033 vs 0.046, P= 0.25), nor was the rate of recurrent tumour (0.008 vs 0.009, P= 0.44). The reported rate of metastases was negligible in both groups, precluding statistical analysis. CONCLUSIONS: Cryoablation has shown acceptable short-term oncological results as a viable strategy for SRMs. Analysis of the cumulative literature to date shows that surgical and percutaneous cryoablation have similar oncological outcomes.

    Title Co-administration of Piperine and Docetaxel Results in Improved Anti-tumor Efficacy Via Inhibition of Cyp3a4 Activity.
    Date
    Journal The Prostate
    Excerpt

    Docetaxel is the mainline treatment approved by the FDA for castration-resistant prostate cancer (CRPC) yet its administration only increases median survival by 2-4 months. Docetaxel is metabolized in the liver by hepatic CYP3A4 activity. Piperine, a major plant alkaloid/amide, has been shown to inhibit the CYP3A4 enzymatic activity in a cell-free system. Thus, we investigated whether the co-administration of piperine and docetaxel could increase docetaxel's pharmacokinetic activity in vitro and in vivo.

    Title Adrenocortical Carcinoma Masquerading As a Benign Adenoma on Computed Tomography Washout Study.
    Date
    Journal Urology
    Excerpt

    An incidental adrenal mass is a common finding on cross-sectional imaging, with most of these lesions being benign adenomas. Indications for adrenalectomy turn on the likelihood that a mass is malignant or whether it exhibits metabolic activity. Modern imaging is considered highly accurate in differentiating adrenal adenomas from other adrenal pathology. We present a case of a 5-cm adrenal lesion with computed tomography washout characteristics consistent with a benign adenoma, which proved upon resection to be an adrenocortical carcinoma.

    Title Use of Radical Cystectomy As Initial Therapy for the Treatment of High-grade T1 Urothelial Carcinoma of the Bladder: A Seer Database Analysis.
    Date
    Journal Urologic Oncology
    Excerpt

    OBJECTIVES: High-grade T1 (HGT1) bladder cancer represents a heterogeneous disease with an aggressive phenotype. Despite prior reports demonstrating improved cancer-specific mortality (CSM) in patients who receive an early/immediate radical cystectomy (RC), the role of early surgery remains ill-defined. We analyzed the Surveillance Epidemiology and End Results (SEER) database to ascertain the use of RC as an initial therapy for clinical HGT1 bladder cancer. MATERIALS AND METHODS: Using the SEER database from 2004 through 2007, we identified and stratified patients with clinical HGT1 bladder cancer who underwent RC as initial therapy within 1 year of diagnosis. We used χ(2) tests and t-tests to compare characteristics of surgical vs. nonsurgical patients. Cumulative incidence functions and Gray's test for inferences were employed to assess cause-specific mortality outcomes. RESULTS: From 2004 to 2007, 8,467 patients were diagnosed with clinical HGT1 bladder cancer, and 397 (4.7%) patients underwent RC. Patients who underwent RC for clinical HGT1 disease were significantly younger (P < 0.0001) and married (P < 0.0001). Surgical patients also had a significantly improved overall (P = 0.004) and other cause of death (P = 0.0053) survival probabilities yet CSM at 1, 2, and 3 years was not statistically different between the surgical and nonsurgical groups (P = 0.134). CONCLUSIONS: In contrast to the clinically early stage renal and prostate cancers, HGT1 bladder cancer exhibits a higher degree of early progression and potential lethality. Despite routine use of extirpative surgery for T1 lesions of the kidney and prostate, our analysis of the SEER database reveals that definitive surgical therapy is uncommonly employed for HGT1 bladder cancer.

    Similar doctors nearby

    Dr. Jeffrey Tomaszewski

    Urology
    4 years experience
    Philadelphia, PA

    Dr. David Chen

    Urology
    13 years experience
    Philadelphia, PA

    Dr. Marc Smaldone

    Urology
    Philadelphia, PA

    Dr. Michel Pontari

    Urology
    24 years experience
    Philadelphia, PA

    Dr. Teodora Schellato

    Urology
    7 years experience
    Philadelphia, PA

    Dr. Rosalia Viterbo

    Urology
    6 years experience
    Elkins Park, PA
    Search All Similar Doctors