Surgeon, Urologist


Accepting new patients
Fox Chase - Burholme
Fox Chase Cancer Center
333 Cottman Ave
Philadelphia, PA 19111
215-728-6900
Locations and availability (1)

Education ?

Medical School Score
Stony Brook University
  • Currently 2 of 4 apples
Residency
UPMC Presbyterian/Shadyside (2010) *
Urology
Fellowship
Fox Chase Cancer Center (2012) *
Urology
* This information was reported to Vitals by the doctor or doctor's office.

Awards & Distinctions ?

Associations
Society of Urologic Oncology
American Urological Association

Affiliations ?

Dr. Smaldone is affiliated with 1 hospitals.

Hospital Affilations

  • Fox Chase Cancer Center
    333 Cottman Ave, Philadelphia, PA 19111
  • Publications & Research

    Dr. Smaldone has contributed to 79 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 Active Surveillance: a Potential Strategy for Select Patients with Small Renal Masses.
    Date February 2012
    Journal Future Oncology (london, England)
    Excerpt

    Increased abdominal imaging has led to the significant incidental detection of clinically localized renal masses. While the gold standard remains surgical excision, mortality rates from kidney cancer remain relatively unchanged implying that a proportion of small renal masses may be indolent tumors that do not require surgical intervention. As a result, active surveillance has emerged as an alternative management strategy in select patients with significant competing risks. Although the contemporary literature characterizing the natural history of untreated small renal masses is limited, recent data demonstrate that many incidental renal masses demonstrate slow growth kinetics with a low rate of progression to metastatic disease over an intermediate time period. Prospective trials are necessary to define entry and intervention criteria for active surveillance protocols.

    Title Familial Clustering of Sporadic Kidney Cancer: Insufficient Evidence to Recommend Routine Screening in Unaffected Kin.
    Date February 2012
    Journal European Urology
    Title Adjuvant and Neoadjuvant Therapies in High-risk Renal Cell Carcinoma.
    Date December 2011
    Journal Hematology/oncology Clinics of North America
    Excerpt

    The standard of care for renal cell carcinoma (RCC) is surgical resection as a monotherapy or as part of a multimodal approach. A significant number of patients undergoing surgery for localized RCC experience recurrence, suggesting that there are some individuals in whom surgical excision is necessary but insufficient because of the presence of micrometastatic disease at diagnosis. This review summarizes current algorithms used to identify patients at high risk for disease recurrence following the surgical resection of RCC, the outcomes of contemporary adjuvant systemic therapy trials, and the rationale supporting the use of neoadjuvant therapy.

    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 Real-time Tomographic Reflection in Facilitating Percutaneous Access to the Renal Collecting System.
    Date September 2011
    Journal Journal of Endourology / Endourological Society
    Excerpt

    Real-time tomographic reflection is a novel technique that uses a geometrically fixed arrangement of a conventional ultrasound transducer, a transducer-incorporated monitor, and a half-silvered mirror. This device, dubbed the Sonic Flashlight, generates a virtual anatomically scaled image, obviating the need for a separate monitor. It may therefore facilitate invasive procedures, such as percutaneous access to the kidney. This proof-of-concept study assesses the feasibility of this technique for renal imaging and concomitant needle puncture guidance.

    Title Management of Bladder Cancer Following Solid Organ Transplantation.
    Date July 2011
    Journal Advances in Urology
    Excerpt

    Objective. Present our experience managing bladder cancer following liver and renal transplantation. Methods. Single institution retrospective review of patients diagnosed with bladder urothelial carcinoma (BUC) following solid organ transplantation between January 1992 and December 2007. Results. Of the 2,925 renal and 2,761 liver transplant recipients reviewed, we identified eleven patients (0.2%) following transplant diagnosed with BUC. Two patients with low grade T1 TCC were managed by TURBT. Three patients with CIS and one patient with T1 low grade BUC were treated by TURBT and adjuvant BCG. All four are alive and free of recurrence at a mean follow-up of 51 ± 22 months. One patient with T1 high grade BUC underwent radical cystectomy and remains disease free with a follow-up of 98 months. Muscle invasive TCC was diagnosed in four patients at a median of 3.6 years following transplantation. Two patients are recurrence free at 24 and 36 months following radical cystectomy. Urinary diversion and palliative XRT were performed in one patient with un-resectable disease. Conclusions. Bladder cancer is uncommon following renal and liver transplantation, but it can be managed successfully with local and/or extirpative therapy. The use of intravesical BCG is possible in select immunosuppressed patients.

    Title Cesium 131 Versus Iodine 125 Implants for Prostate Cancer: Evaluation of Early Psa Response.
    Date February 2011
    Journal The Canadian Journal of Urology
    Excerpt

    Given the shorter half-life of cesium-131 (Cs-131) compared to iodine-125 (I-125), we hypothesized that initial PSA outcomes may differ. We compare initial PSA outcomes in men undergoing Cs-131 prostate brachytherapy to men treated with I-125.

    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 Renal Access by Urologist or Radiologist During Percutaneous Nephrolithotomy.
    Date February 2011
    Journal Journal of Endourology / Endourological Society
    Excerpt

    We evaluated percutaneous access for percutaneous nephrolithotomy (PCNL) that was obtained by interventional radiologists or urologists at a single academic institution and compared access outcomes and complications.

    Title Bc-819, a Plasmid Comprising the H19 Gene Regulatory Sequences and Diphtheria Toxin A, for the Potential Targeted Therapy of Cancers.
    Date January 2011
    Journal Current Opinion in Molecular Therapeutics
    Excerpt

    BC-819 (DTA-H19), in development by BioCancell Therapeutics Inc, under license from the Hebrew University of Jerusalem, is a double-stranded DNA plasmid carrying the gene for the A subunit of diphtheria toxin under the regulation of the H19 gene promoter. H19, a paternally imprinted, oncofetal gene, encodes an RNA that acts as a riboregulator. Expressed at substantial levels in embryonic and malignant tissues, but minimally or not expressed in adult tissues, elevated H19 RNA expression has been observed in over 30 malignancies prompting investigation into its utility as a targeted therapeutic agent. While most in vivo studies have investigated BC-819 for the treatment of bladder cancer, recent studies have also yielded encouraging results in NSCLC,colon, pancreatic and ovarian cancers. A phase I/IIa clinical trial in patients with non-muscle invasive bladder cancer receiving intravesical BC-819 reported mild local toxicity and complete and partial response rates of 22 and 44%, respectively. At the time of publication, a phase IIb trial was ongoing in patients with bladder cancer, while phase I/II clinical trials in patients with ovarian and pancreatic cancer were accruing participants. This review provides a focused summary of the existing experimental evidence demonstrating the effectiveness of the plasmid construct, early clinical outcomes and a discussion of the potential role of BC-819 as a targeted cancer therapy.

    Title Immunotherapeutic Agents for the Management of Bcg Refractory Non-muscle Invasive Bladder Cancer.
    Date January 2011
    Journal Minerva Urologica E Nefrologica = The Italian Journal of Urology and Nephrology
    Title Changes in Renal Function Following Nephroureterectomy May Affect the Use of Perioperative Chemotherapy.
    Date January 2011
    Journal European Urology
    Excerpt

    Nephroureterectomy alone fails to adequately treat many patients with advanced upper tract urothelial carcinoma (UTUC). Perioperative platinum-based chemotherapy has been proposed but requires adequate renal function.

    Title Editorial Comment.
    Date December 2010
    Journal The Journal of Urology
    Title Increased Nerve Growth Factor in Neurogenic Overactive Bladder and Interstitial Cystitis Patients.
    Date December 2010
    Journal The Canadian Journal of Urology
    Excerpt

    Studies have suggested that pathology of the lower urinary tract can be detected by following changes in urinary proteins. We evaluated urine nerve growth factor (NGF) levels from patients with a variety of urologic conditions to examine NGF's role as a future biomarker.

    Title Botulinum Toxin Therapy for Neurogenic Detrusor Overactivity.
    Date November 2010
    Journal The Urologic Clinics of North America
    Excerpt

    Detrusor injection of botulinum toxin (BTX) has shown great promise in the treatment of neurogenic detrusor overactivity (NDO) refractory to conservative therapy. Despite a paucity of prospective evidence, there exists a growing consensus that BTX injection therapy is a well-tolerated, low-risk therapy. Injections result in substantial subjective improvement in continence and quality of life. Moreover, assessment of urodynamic parameters demonstrates objective changes: (1) an increase in maximum cystometric capacity; (2) when applicable, a reduction in maximal detrusor voiding pressures; and (3) an increase in bladder compliance in cases where baseline bladder compliance measures were abnormal. While BTX bladder injection offers both objective and subjective measures of incontinence control, treatment duration is limited by the gradual reinnervation of injected tissue over an approximately 6- to 9-month interval. However, repeat injection cycles do appear to achieve similar levels of efficacy. The objective of this review is to provide a focused summary of the current body of literature, investigating the safety and efficacy of bladder BTX injection in patients with NDO.

    Title Natural Orifice Transluminal Endoscopic Surgery (notes): Current Experience and Urologic Applications.
    Date October 2010
    Journal The Canadian Journal of Urology
    Excerpt

    Natural orifice transluminal endoscopic surgery (NOTES) has attracted considerable recent attention for its potential to allow traditional abdominal procedures to be performed without a transabdominal incision. With considerable experience in the development and application of minimally invasive techniques, urologists have played a significant role in early experimental NOTES efforts and have contributed to early investigations in human subjects accordingly. However, adoption of these techniques has been limited due to cumbersome endoscopic equipment and concerns regarding peritonitis from failed viscerotomy closure. Experience with use of NOTES in human subjects is limited, and studies comparing NOTES to conventional minimally invasive techniques are lacking. Until adequate endoscopes are developed to facilitate a pure NOTES approach, multiple portals of entry will be necessary to facilitate both urologic and non-urologic reconstructive and extirpative procedures. Our aim is to evaluate NOTES techniques, portals of entry, early clinical experiences, and the application of NOTES to urologic surgery.

    Title Outcomes of Percutaneous Nephrolithotomy Stratified by Body Mass Index.
    Date July 2010
    Journal Journal of Endourology / Endourological Society
    Excerpt

    Obesity places surgical patients at a greater risk of complications. The effects of obesity on outcomes and complications from percutaneous nephrolithotomy (PCNL) are not well defined.

    Title Contemporary Surgical Management of Pediatric Urolithiasis.
    Date July 2010
    Journal The Urologic Clinics of North America
    Excerpt

    With miniaturization of instruments and refinement of surgical technique, the management of pediatric stone disease has undergone a dramatic evolution. While shock wave lithotripsy (SWL) is still commonly used to treat upper tract calculi, the use of ureteroscopy (URS) has dramatically increased and is now the procedure of choice for upper tract stone burdens less than 1.5cm at centers with significant experience. Percutaneous nephrolithotomy (PCNL) has replaced open surgical techniques for the treatment of large stone burdens greater than 2cm, with efficacy and complication rates similar to the adult population. Large institutional series demonstrate comparable stone-free and complication rates with SWL, URS, and PCNL, but concerns remain with these techniques regarding renal development and damage to the pediatric urinary tract. Randomized controlled trials comparing the efficacy of SWL and URS for upper tract stone burdens are needed to reach consensus regarding the most effective primary treatment modality in children.

    Title The Impact of Obesity on Overall and Cancer Specific Survival in Men with Prostate Cancer.
    Date June 2010
    Journal The Journal of Urology
    Excerpt

    We examined the impact of obesity on disease specific and overall survival in patients with prostate cancer.

    Title Editorial Comment.
    Date April 2010
    Journal The Journal of Urology
    Title Factors Affecting Blood Loss During Percutaneous Nephrolithotomy Using Balloon Dilation in a Large Contemporary Series.
    Date April 2010
    Journal Journal of Endourology / Endourological Society
    Excerpt

    Renal hemorrhage is a common and worrisome complication of percutaneous nephrolithotomy (PNL). We review factors affecting blood loss and transfusion requirements in a large contemporary series of patients undergoing PNL utilizing balloon dilation.

    Title Investigational Therapies for Non-muscle Invasive Bladder Cancer.
    Date April 2010
    Journal Expert Opinion on Investigational Drugs
    Excerpt

    Bacillus Calmette-Guérin (BCG) is currently the most effective adjuvant intravesical agent at preventing disease recurrence and the only therapy shown to inhibit disease progression in non-muscle invasive bladder cancer (NMIBC). However, recurrence rates as high as 30% and significant local/systemic toxicity have resulted in an increased interest in the use of alternative intravesical agents. AREAS COVERED IN THE REVIEW: Our aim is to discuss recent clinical trial evidence utilizing novel intravesical agents for treatment of NMIBC. A systematic literature review was performed via the National Center for Biotechnology Information databases to identify pertinent studies from 2000-2009.

    Title Management of Benign Ureteral Strictures in the Endoscopic Era.
    Date January 2010
    Journal Journal of Endourology / Endourological Society
    Excerpt

    During the past decade, endoscopic management has emerged as the first-line treatment of benign ureteral strictures. We reviewed our experience with the management of benign ureteral strictures to determine the success rate of endoscopic surgery in a contemporary series and assessed the viability of surgical reimplantation in the modern era.

    Title Eligibility for Active Surveillance and Pathological Outcomes for Men Undergoing Radical Prostatectomy in a Large, Community Based Cohort.
    Date January 2010
    Journal The Journal of Urology
    Excerpt

    We analyzed competing active surveillance criteria in men who underwent radical prostatectomy in relation to outcome data in a large, community based cohort.

    Title Percutaneous Nephrolithotomy in Children.
    Date December 2009
    Journal Journal of Endourology / Endourological Society
    Excerpt

    To review the history of percutaneous nephrolithotomy (PCNL) in children, describe technical considerations, including advancements in equipment, and discuss future directions.

    Title Estimating Postoperative Mortality and Morbidity Risk of Radical Cystectomy with Continent Diversion Using Predictor Equations.
    Date November 2009
    Journal The Journal of Urology
    Excerpt

    The POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) and Portsmouth POSSUM predictor equations are scoring systems validated in the general surgery literature that estimate postoperative morbidity and mortality risk. We tested the validity of POSSUM and Portsmouth POSSUM in patients undergoing radical cystectomy with continent diversion.

    Title Robotic-assisted Laparoscopic Extravesical Ureteroneocystostomy for Management of Adult Ureteral Duplication with Upper Pole Prostatic Urethral Insertion.
    Date November 2009
    Journal Jsls : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
    Excerpt

    A 55-year-old male presented with progressive lower urinary tract symptoms and renal colic. The workup revealed a complete left ureteral duplication with a hydronephrotic upper pole moiety inserting into the prostatic urethra. Using a 5-port transperitoneal robotic-assisted laparoscopic technique, an extravesical upper pole ureteroneocystostomy was performed. Clinical follow-up and repeat imaging documented symptomatic and radiographic improvement. Robotic-assisted laparoscopic reconstructive techniques are feasible and efficacious in the management of adult ureteral anomalies.

    Title Strategies to Enhance the Efficacy of Intravescical Therapy for Non-muscle Invasive Bladder Cancer.
    Date October 2009
    Journal Minerva Urologica E Nefrologica = The Italian Journal of Urology and Nephrology
    Excerpt

    Transitional cell carcinoma (TCC) is the second most common urologic malignancy, and 70% of patients present with superficial, or non-muscle invasive disease (NMIBC). Bacillus Calmette-Guerin (BCG), currently the most effective intravesical agent at preventing disease recurrence, is the only therapy shown to inhibit disease progression. Unfortunately, approximately 20% of patients discontinue BCG due to local and systemic toxicity and more than 30% show evidence of recurrence; this has led to increased interest in alternate chemotherapeutic agents. Induction intravesical chemotherapy has shown comparable efficacy to BCG in select patients and the immediate perioperative instillation of chemotherapeutic agents has become standard of care. Clinical trial evidence demonstrating the efficacy of BCG plus interferon 2B, gemcitabine and anthracyclines (doxorubicin, epirubicin, valrubicin) in patients refractory or intolerant to BCG is accumulating. Phase I trials investigating alternative agents such as apaziquone, taxanes (docetaxel, paclitaxel), and suramin are reporting promising data. Current efforts are also being directed towards optimizing the administration of existing chemotherapeutic regimens, including the use of novel modalities including hyperthermia, photodynamic therapy, magnetically targeted carriers, and liposomes. Despite recent enthusiasm for new intravesical agents, radical cystectomy remains the treatment of choice for patients with NMIBC who have failed intravesical therapy and select patients with naive T1 tumors and aggressive features. Our aim in this report is to provide a comprehensive review of contemporary intravesical therapy options for NMIBC with an emphasis on emerging agents and novel treatment modalities.

    Title The Application of Endoscopic Techniques in the Management of Upper Tract Recurrence After Cystectomy and Urinary Diversion.
    Date October 2009
    Journal Journal of Endourology / Endourological Society
    Excerpt

    Although nephroureterectomy remains the gold-standard therapy for upper tract recurrence of transitional cell carcinoma after cystectomy and urinary diversion, conservative endoscopic techniques are increasingly being utilized for surveillance and management of recurrent low-grade upper tract lesions. A retrograde or antegrade approach is technically feasible and can be an effective alternative in patients with significant medical comorbidities, chronic renal insufficiency, bilateral disease, or solitary renal units. Recent series have expanded the utility of these procedures to include solitary, low-grade, and completely resectable tumors in patients with normal contralateral kidneys who are willing to accept lifelong surveillance for recurrence. With increasing experience and improvements in endoscopic equipment, the endourologic management of upper tract recurrence after cystectomy and lower urinary tract reconstruction is an appealing option in select patients. The difficulties with urinary tract access, preservation of renal function, and oncologic efficacy must all be taken into consideration in these complex patients. The aims of this report are to review the outcomes of contemporary series of upper tract recurrence of transitional cell carcinoma managed endoscopically, and to discuss the application of endourologic techniques in patients who have undergone cystectomy and lower urinary tract reconstruction.

    Title Editorial Comment.
    Date September 2009
    Journal Urology
    Title Clinical Implications of Hypoxia Inducible Factor in Renal Cell Carcinoma.
    Date July 2009
    Journal Urologic Oncology
    Excerpt

    Management of renal cell carcinoma (RCC) has made considerable strides in the past decade, due in large part to identification of the von Hippel Lindau (VHL) tumor suppressor as a negative regulator of hypoxia inducible factor alpha (HIF-alpha) protein expression. Stabilization of HIF-alpha appears to be critical for renal tumorigenesis, and is observed even in VHL-independent RCC. Thus, an understanding of the pathways that regulate expression and activation of the different HIF-alpha isoforms is key to delineating the mechanism of renal transformation and for the development of novel therapeutics. A number of agents targeting HIF-alpha or its transcriptionally-regulated genes have shown promise in treatment of RCC. However, more effective treatment strategies are still needed. This report provides a directed review of recent discoveries defining the role of HIF in renal tumorigenesis and their relevance to the clinical advances in targeted therapy for advanced RCC.

    Title Endourologic Management of Upper Tract Transitional Cell Carcinoma Following Cystectomy and Urinary Diversion.
    Date June 2009
    Journal Advances in Urology
    Excerpt

    Traditionally, nephroureterectomy is the gold standard therapy for upper tract recurrence of transitional cell carcinoma (TCC) following cystectomy and urinary diversion. With advances in endoscopic equipment and improvements in technique, conservative endourologic management via a retrograde or antegrade approach is technically feasible with acceptable outcomes in patients with bilateral disease, solitary renal units, chronic renal insufficiency, or significant medical comorbidities. Contemporary studies have expanded the utility of these techniques to include low-grade, low-volume disease in patients with a normal contralateral kidney. The aim of this report is to review the current outcomes of conservative management for upper tract disease and discuss its application and relevance in patients following cystectomy with lower urinary tract reconstruction.

    Title Differential Expression of Functional Cannabinoid Receptors in Human Bladder Detrusor and Urothelium.
    Date April 2009
    Journal The Journal of Urology
    Excerpt

    Although cannabinoid receptor expression has been demonstrated in human brain and other peripheral neuronal tissues, definitive expression of these receptors in the human bladder has not been reported. Consequently we investigated the expression of functional cannabinoid 1 and 2 receptors in human bladder detrusor and urothelium.

    Title Inguinal Canal Recurrence of Colorectal Adenocarcinoma Following Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy.
    Date March 2009
    Journal The Canadian Journal of Urology
    Excerpt

    Peritoneal carcinomatosis, the second most common cause of death among patients with colorectal carcinoma, may be managed with cytoreductive surgery and adjuvant intraoperative peritoneal hyperthermic chemotherapy (IHPC). We present the case of a 35-year-old male with locally recurrent colorectal adenocarcinoma in the inguinal canal and testis following intraperitoneal debulking and IPHC. When communicating with the peritoneal cavity, the inguinal canal may act as an anatomic sanctuary site and allow peritoneal carcinomatosis to escape the effects of intraperitoneal chemotherapy.

    Title Endourological Management of Pediatric Stone Disease: Present Status.
    Date January 2009
    Journal The Journal of Urology
    Excerpt

    The incidence of nephrolithiasis in the pediatric population has been steadily increasing. The miniaturization of endoscopic instruments and improvement in imaging modalities have facilitated safe and effective endourological treatment in this patient population. We reviewed the current status of pediatric stone disease management.

    Title Delayed Presentation of Iliopsoas Abscess from Ureterosigmoidostomy Stump Fistulization 30 Years Following Nephrectomy.
    Date October 2008
    Journal The Canadian Journal of Urology
    Excerpt

    Although rarely used today for supravesical urinary diversion, ureterosigmoidostomy was commonly utilized in patients with bladder exstrophy. We report an unusual case of iliopsoas abscess developing 30 years after an ipsilateral nephrectomy in a patient with bladder exstrophy who had undergone ureterosigmoidostomy for urinary diversion more than 50 years prior. The etiology appeared to be persistent ureteral reflux and fistulization from a patent ureterosigmoidostomy stump. After percutaneous drainage of the abscess and intravenous antibiotic therapy, the patient was managed with complete excision of the ureterosigmoid anastomoses and creation of an ileal conduit urinary diversion.

    Title Effect of Skin-to-stone Distance on Shockwave Lithotripsy Success.
    Date October 2008
    Journal Journal of Endourology / Endourological Society
    Excerpt

    PURPOSE: We evaluated the effect of increased body habitus on stone-free rates after shockwave lithotripsy (SWL), determined by three reproducible skin-to-stone distances (SSDs) on CT. PATIENTS AND METHODS: We retrospectively reviewed the records of 85 patients with preoperative CT scans available on Stentor Radiology Imaging who underwent SWL with the unmodified Dornier HM3 lithotripter from 2002 to 2007. SSDs were measured at the following angles: 0 degrees (vertical), 30 degrees, and 90 degrees (horizontal). Successful therapy was defined as stone free (residual fragments <2 mm) on follow-up imaging. Data were analyzed using descriptive statistics, Student t test, and the Fisher exact test. RESULTS: Four hundred and eighty patients underwent SWL at our institution from 2002 to 2007; 85 patients (50.6% men, mean age 50.8 +/- 15.7 years, mean body mass index [BMI] 28.8 +/- 6.6 kg/m2) had preoperative CT scans available for review. On follow-up imaging (142.7 +/- 217.2 days), 49.4% of patients were stone free. Mean SSDs (vertical, 30 degrees, horizontal) in patients who were stone-free v those with residual stone were 104.3 +/- 26.2 mm v 102.6 +/- 29.9 mm (P = 0.79), 103.9 +/- 28.2 mm v 101.0 +/- 31.5 mm (P = 0.66), and 106.6 +/- 25.3 mm v 107.1 +/- 29.3 mm (P = 0.94), respectively. CONCLUSIONS: Multiple variables have been shown to be associated with SWL success. In our sample of patients with preoperative CT scans, SSD was found to have no effect on SWL success.

    Title Conservative Management of Synchronous Bilateral Blunt Renal Injuries.
    Date October 2008
    Journal The Canadian Journal of Urology
    Excerpt

    The kidney is the most commonly injured urologic organ, with most injuries occurring unilaterally. We report a rare case of synchronous bilateral renal hematomas in an 87 year old restrained driver involved in a motor vehicle accident and briefly review the management of renal trauma, including the indications for operative intervention. This case demonstrates that in select cases bilateral renal injuries can be managed conservatively.

    Title Drainage Characteristics and Differential Function of the Horseshoe Kidney: What is Typical?
    Date October 2008
    Journal Journal of Endourology / Endourological Society
    Excerpt

    PURPOSE: To describe the drainage and differential function of the horseshoe kidney. PATIENTS AND METHODS: A retrospective review of mercaptoacetyltriglycine (MAG3) nuclear renograms from 1991 to 2007 was performed. Nineteen patients with horseshoe kidney who had not undergone previous renal surgery were identified. All studies were reviewed, and patient information was gathered. Drainage characteristics and differential function were determined. RESULTS: Nineteen primary MAG3 studies were found, representing 38 evaluable renal units. For these units altogether, the median t1/2 was 11 minutes. A t1/2 of 10 minutes or less was found in 18 units (47%), while 12 units (32%) showed a t1/2 longer than 20 minutes. The relative function difference mean was 24.6%. The number of patients with a relative function difference greater than 10% was 11 (57%), and those with a relative function difference greater than 20% was 7 (37%). CONCLUSION: Horseshoe kidney is associated with fairly high rates of poor renal drainage and elevated differential function.

    Title Long-term Results of Selective Partial Cystectomy for Invasive Urothelial Bladder Carcinoma.
    Date September 2008
    Journal Urology
    Excerpt

    OBJECTIVES: We reviewed our experience with partial cystectomy to assess local control and survival rates, and to identify pathologic predictors for recurrence. METHODS: From 1995 to 2005, 25 patients with urothelial carcinoma underwent partial cystectomy with curative intent. As protocol, patients with primary solitary muscle-invasive bladder tumors underwent preoperative localized radiotherapy, administration of a single dose of intravesical chemotherapy at the time of partial cystectomy, and postoperative intravesical Bacillus Calmette-Guérin therapy. We reviewed clinical and pathologic data to identify variables associated with disease recurrence. RESULTS: We analyzed data from 25 patient records meeting review criteria (72% male, mean age 65.1 +/- 9.8 years). At time of transurethral resection of a bladder tumor (TURBT), all had a solitary primary T2 (68%) or T1HG (32%) lesion with no evidence of carcinoma in situ. At follow-up (mean 45.3 +/- 30.7 months), 5-year recurrence-free, disease-specific, and overall survival rates were 64%, 84%, and 70%, respectively. At a mean of 18.0 +/- 15.6 months, 8% of patients experienced intravesical non-muscle-invasive tumor recurrences and were treated with TURBT and intravesical chemotherapy. Twenty percent recurred with locally advanced tumors or visceral metastasis and were treated with systemic chemotherapy, local resection or cystectomy, or both. On univariate analysis, only tumor size at time of partial cystectomy (P = .03) was significantly associated with tumor recurrence. CONCLUSIONS: Partial cystectomy offers adequate control of localized invasive urothelial carcinoma in carefully selected patients with solitary primary tumors. Lifelong follow-up with cystoscopy and abdominal imaging is recommended to detect recurrence.

    Title Validation of the Fournier's Gangrene Severity Index in a Large Contemporary Series.
    Date September 2008
    Journal The Journal of Urology
    Excerpt

    In this study we identified prognostic factors for survival and validated the accuracy of the Fournier's gangrene severity index in patients with Fournier's gangrene.

    Title Bladder Diverticulum Arising Adjacent to an Ectopic Ureter Presenting As a Cystic Mass.
    Date August 2008
    Journal The Canadian Journal of Urology
    Excerpt

    Acquired bladder diverticula due to bladder outlet obstruction are not uncommon in the adult male population. Congenital diverticula originate adjacent to the trigone and are rarely diagnosed in adults. We report an unusual case of a diverticulum arising adjacent to an ectopic ureter located on the left lateral wall near the dome of the bladder. Although the diverticulum appeared to be congenital, its large size was likely a result of high pressure voiding. The patient underwent a transurethral resection of the prostate to reduce his bladder outlet obstruction, and subsequently underwent an open diverticulectomy.

    Title Laparoscopic Nephrectomy Using the Enseal Tissue Sealing and Hemostasis System: Successful Therapeutic Application of Nanotechnology.
    Date August 2008
    Journal Jsls : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
    Excerpt

    The potential impact of nanotechnology in the field of urology is broad with diagnostic and therapeutic benefits that have only recently begun to be explored. Application of nanotechnology principles to tissue and vessel sealing during laparoscopic procedures may reduce associated thermal injury and inflammatory response. We report our initial experience using the EnSeal Tissue Sealing and Hemostasis System during laparoscopic nephrectomy and discuss its potential advantages and disadvantages compared with those of contemporary technologies.

    Title Neuromodulation Versus Neurotoxin for the Treatment of Refractory Detrusor Overactivity: for Neurotoxin.
    Date June 2008
    Journal Nature Clinical Practice. Urology
    Title Re: Extended Urethral Mobilization in Incised Plate Urethroplasty for Severe Hypospadias: a Variation in Technique to Improve Chordee Correction. A. Bhat J Urol 2007; 178: 1031-1035.
    Date May 2008
    Journal The Journal of Urology
    Title Safety and Efficacy of Flexible Ureterorenoscopy and Holmium:yag Lithotripsy for Intrarenal Stones in Anticoagulated Cases.
    Date March 2008
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We compared perioperative outcomes in patients undergoing ureterorenoscopy and Ho:YAG lithotripsy for renal calculi with or without anticoagulation. MATERIALS AND METHODS: We reviewed the records of all patients undergoing flexible ureterorenoscopy and Ho:YAG lithotripsy for renal calculi at 2 institutions from 2001 to 2007. We identified 37 patients on anticoagulation with Coumadin, clopidogrel or aspirin in whom anticoagulation therapy was not discontinued before surgery. Data on the anticoagulation group were retrospectively compared to those on a contemporary matched cohort of 37 controls without anticoagulation who underwent a similar operative procedure. The 2 groups were compared with regard to the stone-free rate, and intraoperative and postoperative complications with specific reference to bleeding and thromboembolism. RESULTS: The 2 groups were matched for stone size, stone location, number of stones, bilateral procedures and concomitant ureteral stones. Anticoagulation group patients were older (58.2 vs 50.4 years, p = 0.0209) and had a greater American Society of Anesthesiologists score (2.8 vs 1.9, p <0.0001) compared to the control group. No procedure had to be terminated in the anticoagulation group due to poor visibility from bleeding. The median postoperative hemoglobin decrease was greater in the anticoagulation group than in the control group (0.6 vs 0.2 gm/dl, p <0.0001). The stone-free rate (81.1% vs 78.4%, p = 0.7725), intraoperative complications (0% vs 3%, p = 0.3140), postoperative complications (11% vs 5%, p = 0.3943) and hemorrhagic or thromboembolic adverse events were comparable in the 2 groups. CONCLUSIONS: When necessary, ureterorenoscopy and Ho:YAG lithotripsy can be performed safely and efficaciously for renal calculi in patients on anticoagulation therapy without the need for perioperative manipulation.

    Title Computerized Tomography Findings in Pediatric Renal Trauma--indications for Early Intervention?
    Date March 2008
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We sought to determine if initial computerized tomography findings in pediatric patients suffering blunt renal trauma with urinary extravasation were predictive of the need for operative intervention. MATERIALS AND METHODS: A total of 17 patients with grade IV blunt renal trauma and urinary extravasation were identified between 2000 and 2007. Each computerized tomogram was reviewed to determine location, size and number of sites of extravasation, as well as the presence of contrast material in the ipsilateral ureter. These findings were compared with subsequent ureteral stent placement, percutaneous urinoma drainage, angiographic embolization and nephrectomy. RESULTS: A total of 13 male and 4 female patients (mean age 11.1 years) were identified. Eight patients (47%) required delayed intervention. Conservative treatment was unsuccessful in patients with absence of contrast material in the ipsilateral ureter and large separation of the upper and lower poles, and in 3 of 5 patients with multiple areas of extravasation and 4 of 5 patients with transfusion requirements. The diameter (9.6 vs 9.7 mm, p = 0.96) and location of extravasation were not predictive of subsequent intervention. Two of 5 patients with posterior extravasation required intervention, both for symptomatic urinoma. CONCLUSIONS: Early ureteral stent placement may be considered for pediatric patients with blunt renal trauma who demonstrate absence of contrast material in the ipsilateral ureter, since clinical indications for stent placement will likely develop. Further study may show if wide separation of the upper and lower poles, multiple areas of extravasation and transfusion requirement are factors in the decision for early intervention.

    Title Staged Retrograde Endoscopic Lithotripsy As Alternative to Pcnl in Select Patients with Large Renal Calculi.
    Date March 2008
    Journal Journal of Endourology / Endourological Society
    Excerpt

    BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) is currently the gold standard for management of large renal calculi. PCNL is associated, however, with a higher complication rate, degree of risk, and longer recovery period compared with ureteroscopy. In a selected group of patients who were not ideal candidates for PCNL because of extenuating health factors, a staged retrograde endoscopic approach was used to manage upper urinary tract calculi. METHODS: We conducted a retrospective review of 23 patients (selected because of comorbidities, obesity, anatomy, and previous treatment failure as poor candidates for PCNL) who underwent staged retrograde endoscopic lithotripsy to manage upper urinary tract calculi. Lithotripsy was based on the application of small-diameter fiberoptic ureteroscopes and the holmium laser. Successful therapy was defined as total fragmentation of stone burden on repeated imaging. Data were analyzed using descriptive statistics. RESULTS: Of the 468 patients who underwent ureteroscopy at our institution from 2003 to 2006, 23 patients (52% men, 57.70 +/- 11.44 years of age) were treated with retrograde endoscopic procedures for upper urinary tract calculi (52.2% lower pole). Stone burden at the initial procedure was 2.13 +/- 2.34 stones with a total linear length of 30.91 +/- 14.28 mm and an estimated total stone volume of 12,040.78 +/- 11101.54 cc (median value, 7,234.00 cc). There were no intraoperative complications; three patients were admitted postoperatively for observation. Ten 43.5%) patients (progressed to second-stage procedures (34.6 +/- 10.8 days apart). After repeated imaging, 73.9% of patients were stone free (88% lower pole), and 8.7% progressed to further intervention. Total linear stone length <4 cm and estimated calculus volume > or =15,000 cc predicted treatment failure (40%, 42.9%). CONCLUSIONS: Percutaneous methods of managing renal stones have an increased rate of complications compared with ureteroscopy. In patients with complex medical histories, upper urinary tract calculi <4 cm can be safely and effectively managed using a staged retrograde endoscopic approach.

    Title Ureteroscopic Management of Lower-pole Stones in a Pediatric Population.
    Date January 2008
    Journal Journal of Endourology / Endourological Society
    Excerpt

    PURPOSE: We report our experience with ureteroscopy to treat lower-pole calculi in children. PATIENTS AND METHODS: A retrospective review was conducted of all ureteroscopic procedures for lower-pole stone disease at a pediatric institution from 2000 through 2005. A total of 13 girls and 8 boys with a mean age of 15 years (range 1-20 years) underwent flexible ureteroscopy for lower-pole calculi. The mean stone burden was 12 mm. Stone-free status was defined by postoperative abdominal radiography, CT, or ultrasonography. RESULTS: Ureteral stenting was performed preoperatively in 38% and postoperatively in 71% of the patients. Ureteral-access sheaths were placed in 43%. There were no intraoperative or postoperative complications. With a mean follow-up of 11 months, 76% of the children were stone-free. The success rate for stones <15 mm was 93% v 33% for stones > or =15 mm (P = 0.01). CONCLUSION: Ureteroscopy and laser lithotripsy are safe and effective in children with lower-pole calculi. Ureteroscopy can be considered a primary treatment option for children with lower-pole calculi <15 mm.

    Title Extended-spectrum Beta-lactamase Gram-negative Sepsis Following Prostate Biopsy: Implications for Use of Fluoroquinolone Prophylaxis.
    Date December 2007
    Journal The Canadian Journal of Urology
    Excerpt

    Extended-spectrum beta-lactamase (ESBL) producing organisms are resistant to penicillins, cephalosporins, aminoglycosides, trimethoprim-sulfamethoxazole, aztreonam, and most fluoroquinolones. We report a case of a 72-year old man who developed septic shock with an ESBL organism after a transrectal ultrasound (TRUS)-guided prostate biopsy despite having received fluoroquinolone prophylaxis. The patient recovered with intravenous ertapenem. Fluoroquinolone resistant bacteria are increasing in prevalence. This needs to be recognized when the antibiotic choice for pre-procedure prophylaxis is made.

    Title Stuttering Priapism Associated with Hereditary Spherocytosis.
    Date November 2007
    Journal The Canadian Journal of Urology
    Excerpt

    Stuttering priapism is a clinical phenomenon that occurs commonly in certain patient populations, including sickle cell anemia and other hematologic dyscrasias. Although the mechanism is still not completely understood, treatment is focused on prevention of recurrence in the outpatient setting, and immediate detumescence and minimizing corporal fibrosis in the acute setting. We present a case of stuttering priapism in a 44 year-old male with hereditary spherocytosis and discuss the pathophysiology and clinical management of this entity.

    Title Is Ureteroscopy First Line Treatment for Pediatric Stone Disease?
    Date November 2007
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We report our current outcomes for ureteroscopic management of pediatric stone disease. MATERIALS AND METHODS: We carried out a retrospective review of all ureteroscopic procedures for kidney or ureteral calculi performed between 2001 and 2005. Stone location and size, preoperative and postoperative stenting, intraoperative dilation, use of ureteral access sheath, stone-free rates and complications were noted. RESULTS: A total of 100 patients (58% female, mean age 13.2 years) underwent 115 procedures. Stones were located in the renal pelvis in 6% of patients, upper pole in 10%, mid ureter in 11%, lower pole in 17%, proximal ureter in 19% and distal ureter in 37%. Mean stone size was 8.3 mm (median 7.0), with a mean of 1.5 stones per patient. Preoperative stenting was used in 54% of patients, and a stent was placed postoperatively in 76%. Ureteral coaxial dilators and ureteral access sheaths were used in 70% and 24% of patients, respectively. There were no major intraoperative complications, although 5 patients required stent placement for ureteral perforation or extravasation. One patient had a ureteral stricture requiring ureteral reimplantation. Mean followup was 10.1 months (median 2.6). Stone-free rate was 91% on followup ultrasound, abdominal radiography or computerized tomography. Seven patients required staged ureteroscopic procedures to achieve stone-free status. While the number of percutaneous nephrolithotomy and shock wave lithotripsy cases remained stable, the number of ureteroscopic cases increased 7-fold during this period. CONCLUSIONS: Improved ureteroscopic access to stones throughout the pediatric urinary tract and stone-free rates that are comparable to the adult population have led to the adoption of ureteroscopy as first line therapy in children at our institution.

    Title Advances in Pediatric Urologic Laparoscopy.
    Date August 2007
    Journal Thescientificworldjournal
    Excerpt

    The spectrum of laparoscopic surgery in children has undergone a dramatic evolution. Initially used as a diagnostic modality for many pediatric urologists, complex as well as reconstructive procedures are now being performed laparoscopically. Laparoscopic orchiopexy and nephrectomy are well established and are being performed at many centers. Laparoscopic partial nephrectomy, adrenalectomy, and dismembered pyeloplasty series have reported shortened hospital stays and operative times that are comparable to that of open techniques or are decreasing with experience. The initial experiences with laparoscopic ureteral reimplantation and laparoscopic-assisted bladder reconstructive surgery have been described, reporting encouraging results with regards to feasibility, hospital stay, and cosmetic outcome. This report will provide a directed review of the literature to establish the current indications for laparoscopy in pediatric urologic surgery.

    Title Laparoscopy in Paediatric Urology: Present Status.
    Date August 2007
    Journal Bju International
    Excerpt

    The spectrum of laparoscopic surgery in children has developed dramatically; what was initially used as a diagnostic method to identify an impalpable testis is now commonly used for complex reconstructive procedures such as pyeloplasty. Laparoscopic orchidopexy and nephrectomy are well established and are used at many centres. Laparoscopic partial nephrectomy, adrenalectomy and dismembered pyeloplasty series have reported shorter hospital stays and operative times that are comparable with that of open techniques, and/or decreasing with experience. The initial experiences with laparoscopic ureteric re-implantation and laparoscopically assisted bladder reconstructive surgery are reported, with encouraging results for feasibility, hospital stay, and cosmetic outcome.

    Title Paratesticular Rhabdomyoma in a Young Adult: Case Study and Review of the Literature.
    Date May 2007
    Journal Journal of Pediatric Surgery
    Excerpt

    Paratesticular rhabdomyoma is a rare benign tumor, which usually presents as a painless mass in the scrotum or groin. We report the first case of a locally invasive paratesticular rhabdomyoma in a 17-year-old male teenager who presented with chronic scrotal pain. We further review the current literature of this rare tumor.

    Title Giant Idiopathic Renal Arteriovenous Fistula Requiring Urgent Nephrectomy.
    Date April 2007
    Journal Urology
    Excerpt

    Idiopathic renal arteriovenous fistulas (AVFs) with acute hemorrhage are exceedingly rare. However, a rare entity such as a renal AVF may be overlooked and have disastrous consequences, requiring an urgent management decision between endovascular or surgical treatment. We report the case of a 61-year-old man, who presented with painless gross hematuria and clot retention. Computed tomography revealed a giant renal arteriovenous malformation, in the absence of any clinical stigmata such as hypertension or congestive heart failure. Gross hematuria resulted from AVF erosion into the collecting system. Given the size of the AVF, endovascular coil embolization was attempted but deemed too risky, necessitating urgent nephrectomy.

    Title Complete Ureteral Stent Encrustation Managed with Serial Nephroscopy and Laser Lithotripsy.
    Date April 2007
    Journal Urology
    Excerpt

    Encrustation is a well-established complication of retained biomaterials in the urinary tract. Severe stent encrustation is a potentially serious complication of prolonged indwelling ureteral stenting often managed with open surgery when endoscopic techniques are unsuccessful. We present a case of a 2800-mm2 stent encrustation managed with serial nephroscopy and laser lithotripsy.

    Title Minimally Invasive Surgery for Urologic Disease in Children.
    Date March 2007
    Journal Nature Clinical Practice. Urology
    Excerpt

    This article is a comprehensive review of the current indications and recent literature pertaining to laparoscopic techniques in pediatric urology. Basic concepts such as instrumentation, anesthetic considerations, and complications are reviewed. Specific techniques and indications are also explored. As the field of pediatric urology continues to expand, it still lags behind adult urology. With improvements in technology, however, and with new surgeons entering the field with a basic laparoscopic background, pediatric urologic laparoscopy continues to progress. Currently, procedures such as laparoscopic exploration for undescended testicles and laparoscopic nephrectomy are accepted as the 'gold standard', and are performed at most institutions. Other procedures, such as laparoscopic pyeloplasty and laparoscopic reconstructive surgery, have only recently been introduced and are primarily available at centers with surgeons experienced in laparoscopy. It is our hope that minimally invasive surgical approaches to urologic conditions will become available to all children and become commonplace at most institutions.

    Title Subcutaneous Reservoir Placement During Penile Prosthesis Implantation.
    Date February 2007
    Journal The Canadian Journal of Urology
    Excerpt

    Currently, the prosthesis of choice for patients undergoing penile prosthesis surgery is a three piece inflatable device, as this provides optimal inflation and deflation when compared to a one or two piece prosthesis. However, prior pelvic surgery or radiation therapy can obliterate the retropubic space and make placement of the reservoir required for a three piece prosthesis difficult. We report a novel location for reservoir placement in a man who had undergone multiple pelvic surgeries after suffering a severe pelvic crush injury.

    Title Immunosuppressive Preconditioning or Induction Regimens : Evidence to Date.
    Date December 2006
    Journal Drugs
    Excerpt

    The success of solid organ transplantation has been directly related to the development of immunosuppressive drug therapies. Preconditioning or induction therapy was developed to reduce early immunological and nonimmunological renal injury, with the goal of increasing long-term graft survival. However, the routine induction of immunological tolerance to solid organ allograft is currently not achievable because of the morbidity and mortality related to the immunosuppressive regimens themselves. The different therapeutic preconditioning or induction agents and their associated effects on cellular rejection, graft survival outcomes and the need for multiagent post-transplant maintenance therapy are reviewed.

    Title Case Report: Bilateral Ureteral Obstruction Secondary to Aspergillus Bezoar.
    Date September 2006
    Journal Journal of Endourology / Endourological Society
    Excerpt

    Ureteral obstruction as a result of a primary aspergillus infection is rare. Early clinical suspicion in immunosuppressed patients is essential to diagnosis. We report a case of a 50-year-old diabetic woman presenting with acute renal failure, sepsis, and bilateral ureteral obstruction. Initial management included bilateral percutaneous nephrostomy tubes. Urine culture from both the left and right renal pelvis grew Aspergillus flavus. The left-sided obstruction resolved with antifungal therapy. However, her right ureteral obstruction persisted and was managed with ureteroscopy and removal of the fungal bezoar.

    Title Resection of Recurrent Inferior Vena Cava Tumor After Radical Nephrectomy for Renal Cell Carcinoma.
    Date May 2006
    Journal Urology
    Excerpt

    Management of recurrent tumor in the inferior vena cava (IVC) after radical nephrectomy is surgically challenging. We report 3 cases of recurrent renal cell carcinoma within the IVC managed by three different surgical techniques. One patient was treated with tumor thrombus removal and primary cavotomy closure. The second patient was treated with IVC ligation and removal without vascular reconstruction. A third patient was treated with IVC wall excision and placement of a bovine pericardium graft. Although technically difficult, repeat resection of IVC tumor recurrence after nephrectomy for renal cell carcinoma is an acceptable method of treatment.

    Title Impact of Interrupted Leptin Pathways on Ventilatory Control.
    Date October 2004
    Journal Journal of Applied Physiology (bethesda, Md. : 1985)
    Excerpt

    Leptin deficiency in ob/ob mice produces marked depression of the hypercapnic ventilatory response, particularly during sleep. We now extend our previous findings to determine whether 1) leptin deficiency affects the hypoxic ventilatory response and 2) blockade of the downstream excitatory actions of leptin on melanocortin 4 receptors or inhibitory actions on neuropeptide Y (NPY) pathways has an impact on hypercapnic and hypoxic sensitivity. We have found that leptin-deficient ob/ob mice have the same hypoxic ventilatory response as weight-matched wild-type obese mice. There were no differences in the hypoxic sensitivity between agouti yellow mice and weight-matched controls, or NPY-deficient mice and wild-type littermates. Agouti yellow mice, with blocked melanocortin pathways, exhibited a significant depression of the hypercapnic sensitivity compared with weight-matched wild-type controls during non-rapid eye movement sleep (5.8 +/- 0.7 vs. 8.9 +/- 0.7 ml x min(-1) x %CO(2)(-1), P < 0.01), but not during wakefulness. NPY-deficient transgenic mice exhibited a small increase in the hypercapnic ventilatory response compared with wild-type littermates, but this was only present during wakefulness. We conclude that interruption of leptin pathways does not affect hypoxic sensitivity during sleep and wakefulness but that melanocortin 4 blockade is associated with depressed hypercapnic sensitivity in non-rapid eye movement sleep.

    Title Testicular Ischemia Following Open Prostatectomy.
    Date May 2004
    Journal The Journal of Urology
    Title Female Gender Exacerbates Respiratory Depression in Leptin-deficient Obesity.
    Date January 2002
    Journal American Journal of Respiratory and Critical Care Medicine
    Excerpt

    Obese females are less predisposed to sleep-disordered breathing and have higher serum leptin levels than males of comparable body weight. Because leptin is a powerful respiratory stimulant, especially during sleep, we hypothesized that the elevated leptin level is necessary to maintain normal ventilatory control in obese females. We examined ventilatory control during sleep and wakefulness in male and female leptin-deficient obese C57BL/6J-Lep(ob) mice, wild-type C57BL/6J mice with dietary-induced obesity and high serum leptin levels, and normal weight wild-type C57BL/6J mice. Both male and female C57BL/6J-Lep(ob) mice had depressed hypercapnic ventilatory response (HCVR) in comparison with wild-type animals. In comparison with male C57BL/6J-Lep(ob) mice, female C57BL/6J-Lep(ob) mice had reduced HCVR and respiratory drive (a ratio of tidal volume to inspiratory time) both during non-rapid eye movement (NREM) sleep and wakefulness. In contrast, the HCVR did not differ between sexes in wild-type mice during NREM sleep and wakefulness, but was lower in females during REM sleep. Thus, leptin deficiency in female obesity is even more detrimental to hypercapnic ventilatory control during wakefulness and NREM sleep than in obese, leptin-deficient males.

    Title Muscle Derived Stem Cell Therapy for Stress Urinary Incontinence.
    Date
    Journal World Journal of Urology
    Excerpt

    AIM: The aim of this article is to discuss the potential of muscle-derived stem cells (MDSCs) for rhabdosphincter regeneration and to review the early clinical experiences with its application in patients with stress urinary incontinence. RESULTS: In anatomical and functional studies of the human and animal urethra, the middle urethral contained rhabdosphincter is critical for maintaining continence. Transplanted stem cells have the ability to undergo self-renewal and multipotent differentiation, leading to sphincter regeneration. In addition, such cells may release, or be engineered to release, neurotrophins with subsequent paracrine recruitment of endogenous host cells to concomitantly promote a regenerative response of nerve-integrated muscle. CONCLUSION: Cell-based therapies are most often associated with the use of autologous multipotent stem cells, such as bone marrow stromal cells. However, harvesting bone marrow stromal stem cells requires a general anesthetic, can be painful, and has variable yield of stem cells upon processing. In contrast, with appropriate experience, alternative autologous adult stem cells such as muscle-derived stem cells and adipose-derived stem cells can be obtained in large quantities and with minimal discomfort.

    Title Prostate Brachytherapy After Ileal Pouch-anal Anastomosis Reconstruction.
    Date
    Journal Urology
    Excerpt

    OBJECTIVE: To determine the safety of prostate brachytherapy in patients with clinically localized prostate cancer who have undergone proctocolectomy with ileal pouch-anal anastomosis (IPAA). METHODS: We performed a retrospective chart review of patients with a prior history of IPAA reconstruction who underwent prostate brachytherapy at our institution. Clinical records were reviewed for demographic characteristics, postoperative dosimetry, changes in bowel function, and oncologic outcomes. Data were analyzed using descriptive statistics. RESULTS: Five patients with an IPAA underwent prostate brachytherapy for clinically localized prostate cancer. Mean time from colorectal reconstruction to prostate brachytherapy was 6.3 years. Adequate dosimetry (mean D90 114.9%, mean V100 91.1%, mean R100 0.76 mL) was achieved in each patient. Bowel frequency worsened in the immediate postoperative period in all patients, but all patients returned to their baseline bowel pattern by 4 months after their procedure. Serious complications, such as J-pouch ulcers, fistulas, or fecal incontinence, did not occur in these patients. CONCLUSIONS: Prostate brachytherapy is a safe treatment option in patients with clinically localized prostate cancer and a history of proctocolectomy and IPAA reconstruction.

    Title When is Prior Ureteral Stent Placement Necessary to Access the Upper Urinary Tract in Prepubertal Children?
    Date
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We studied the possibility that age, height, weight and body mass index could be used to predict the likelihood of successful ureteroscopic access to the upper urinary tract without previous stent placement in prepubertal children. MATERIALS AND METHODS: We retrospectively reviewed all ureteroscopic procedures for upper tract calculi in prepubertal children from 2003 to 2007. We compared age, height, weight and body mass index in patients who underwent successful primary flexible ureteroscopic access and in those who required initial stent placement to perform ureteroscopy. RESULTS: Successful primary ureteroscopic access to the upper tract was achieved in 18 of 30 patients (60%). There was no difference in mean age (9.9 vs 9.5 years, p = 0.8), height (132 vs 128 cm, p = 0.6), weight (37 vs 36 kg, p = 0.86) or body mass index (19.3 vs 20.5 kg/m(2), p = 0.55) between patients with successful vs unsuccessful upper tract access. Locations that prevented access to the upper urinary tract were evenly distributed among the ureteral orifice, iliac vessels and ureteropelvic junction. CONCLUSIONS: Age, height, weight and body mass index could not predict the likelihood of successful ureteroscopic access to the upper tract. Placement of a ureteral stent for passive ureteral dilation is not necessary for successful ureteroscopic access to the renal pelvis in prepubertal children. An initial attempt at ureteroscopy, with placement of a ureteral stent if upper tract access is unsuccessful, decreases the number of procedures while maintaining a low complication rate.

    Title Minimally Invasive Treatment of Vesicoureteral Reflux.
    Date
    Journal The Urologic Clinics of North America
    Excerpt

    Vesicoureteral reflux (VUR) is a common problem in childhood, affecting approximately 1% to 2% of the pediatric population. Mild cases of VUR are likely to resolve spontaneously, but high-grade VUR may require surgical correction. Pediatric urologists are familiar with open antireflux operations, which can be accomplished with minimal operative morbidity. Minimally invasive endoscopic and laparoscopic techniques that now exist may serve to reduce morbidity further. This article reviews the endoscopic materials, techniques, and outcomes in the treatment of VUR in addition to the techniques and outcomes of laparoscopic and robotic ureteroneocystotomy.

    Title Percutaneous Resection of Upper Tract Transitional Cell Carcinoma in a Solitary Kidney After Cystectomy and Continent Orthotopic Urinary Diversion.
    Date
    Journal Journal of Endourology / Endourological Society
    Title Rebuttal.
    Date
    Journal Journal of Endourology / Endourological Society
    Title Multiplex Analysis of Urinary Cytokine Levels in Rat Model of Cyclophosphamide-induced Cystitis.
    Date
    Journal Urology
    Excerpt

    OBJECTIVES: The urinary proteome is a potential easily accessible source of biomarkers for inflammatory bladder diseases, including interstitial cystitis. In the present study, we subjected rat urine to multiplex cytokine analysis in an attempt to identify an inflammatory signature of the temporal course of cyclophosphamide (CYP)-induced cystitis. METHODS: Rat urine was collected for 12 hours after CYP injection (150 mg/kg) for multiplex analysis of 14 cytokines by a multiple antigen bead assay (Luminex 100 IS). Urine from each void was collected, and the voiding frequency was determined. The bladder tissue was analyzed for cytokines levels and histologic evidence of inflammation. RESULTS: Significant changes were noted in the urine levels of all cytokines with respect to baseline at 2, 4, 6, and 10 hours after CYP injection. Elevation was noted at all times for most cytokines, except for monocyte chemotactic protein-1, which had a 5-fold decrease at 2 hours. The urine and tissue levels of interleukin (IL)-1beta, IL-4, and growth-related oncogene/keratinocyte-derived chemokine correlated significantly, with a positive Spearman correlation also noted for granulocyte-macrophage colony-stimulating factor, monocyte chemotactic protein-1-1, IL-18, and interferon-gamma. The tissue levels for most cytokines, except for IL-2, and urinary frequency were significantly elevated in the CYP-treated rats compared with the control vehicle-treated rats. The hints of severe inflammation in the bladder indicated by the urinary cytokines were confirmed by bladder histologic examination and the tissue cytokine levels at necropsy. CONCLUSIONS: The progression of CYP-induced cystitis was clearly reflected in the urine matrix by the temporal and quantitative changes in the cytokine levels. Additional delineation of urine and bladder tissue cytokine expression might yield biomarkers for cystitis.

    Title Stem Cell Therapy for Urethral Sphincter Regeneration.
    Date
    Journal Minerva Urologica E Nefrologica = The Italian Journal of Urology and Nephrology
    Excerpt

    In anatomical and functional studies of the human and animal urethra, the middle urethral contained rhabdosphincter is critical for maintaining continence. Transplanted stem cells may have the ability to undergo self renewal and multipotent differentiation, leading to sphincter regeneration. In addition, such cells may release, or be engineered to release, neurotrophins with subsequent paracrine recruitment of endogenous host cells to concomitantly promote a regenerative response of nerve-integrated muscle. Cell-based therapies are most often associated with the use of autologous multipotent stem cells, such as the bone marrow stromal cells. However, harvesting bone marrow stromal stem cells is difficult, painful, and may yield low numbers of stem cells upon processing. In contrast, alternative autologous adult stem cells such as muscle derived stem cells (MDSCs) and adipose-derived stem cells (ADSCs) can be easily obtained in large quantities and with minimal discomfort. This chapter aims to discuss the neurophysiology of stress urinary incontinence (highlighting the importance of the middle urethra); current injectable cell sources for endoscopic treatment; and the potential of MDSCs for the delivery of neurotrophic factors.

    Title The Evolution of the Endourologic Management of Pediatric Stone Disease.
    Date
    Journal Indian Journal of Urology : Iju : Journal of the Urological Society of India
    Excerpt

    In the 1980s, the advent of shock wave lithotripsy (SWL) revolutionized pediatric stone management and is currently the procedure of choice in treating most upper tract calculi < 1.5 cm in children. However, with miniaturization of instruments and refinement of surgical technique the management of pediatric stone disease has undergone a dramatic evolution over the past twenty years. In a growing number of centers, ureteroscopy (URS) is now being performed in cases that previously would have been treated with SWL or percutaneous nephrolithotomy (PCNL). PCNL has replaced open surgical techniques for the treatment of large stone burdens> 2 cm with efficacy and complication rates similar to the adult population. Recent results of retrospective reviews of large single institution series demonstrate stone free and complication rates with URS comparable to PCNL and SWL but concerns remain with these techniques regarding renal development and damage to the pediatric urinary tract. Randomized controlled trials comparing the efficacy of SWL and URS for upper tract stone burden are needed to reach consensus regarding the most effective primary treatment modality in children. This report provides a comprehensive review of the literature evaluating the indications, techniques, complications, and efficacy of endourologic stone management in children.

    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.


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