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Partial gland ablation (PGA) using high-intensity focused ultrasound (HIFU) is currently under investigation for clinically significant prostate cancer (Cs-PCa). Our primary objective was to assess the role of systematic control biopsies following HIFU-PGA in a cohort of Cs-PCa patients.We studied a single-center retrospective cohort of 77 men treated with HIFU-PGA between October 2015 and December 2019. Patients with unilateral Cs-PCa, defined as Gleason grade group (GGG) ≥2, with visible lesion on multiparametric magnetic resonance imaging (mpMRI) and prostate specific antigen (PSA) ≤15 ng/ml were included. All patients underwent mpMRI with systematic and targeted biopsies before and after HIFU-PGA. The primary outcome was the rate of Cs-PCa at control biopsy within 1 year of treatment. Logistic regression was performed to identify predictive factors of our primary outcome.Median age was 67 years (IQR 61-71), median PSA was 7 ng/ml (IQR 5.5-8.9). Pre-treatment biopsies revealed 48 (62.3%) GGG2 lesions, 24 (31.2%) GGG3 and 5 (6.5%) GGG4 lesions. Cs-PCa was found in 24 (31.2%) patients at systematic control biopsy post-HIFU; Cs-PCa was in the treated lobe for 18 (27%) patients. No variables were identified as significant predictors of Cs-PCa at control biopsy, including PSA kinetics and control mpMRI. Median followup time was 17 months (95% CI 15-21). Median time to any retreatment was 32 months (95% CI 23-42).Systematic control biopsy within a year after PGA for Cs-PCa can identify the presence of residual Cs-PCa in up to a third of patients. From our early experience, control biopsy should be systematically offered patients regardless of PSA kinetics or control mpMRI results.

We assessed whether a combination of the fibrin tissue adhesive Tisseel® (human fibrinogen and thrombin) plus the hemostatic matrix FloSeal® (bovine derived gelatin matrix/human thrombin) could safely replace the conventional deep medullary suture without compromising outcomes.Laparoscopic mid pole and one-third partial nephrectomy was performed on the right kidney of 12 female pigs. The only difference between the 2 groups of 6 pigs each was the use of a fibrin tissue adhesive plus hemostatic matrix combination in group 2 instead of the deep medullary running suture in control group 1. Renal scans and angiograms were performed at baseline and before sacrifice at 5-week followup. Retrograde in vivo pyelogram was also done.No significant difference was seen in operative parameters or postoperative course between the groups. Renal scans revealed a statistically insignificant trend toward greater uptake loss in group 1 and angiograms showed 3 major vessel occlusions in that group. No active bleeding was detected. Those 3 kidneys had significantly poorer postoperative uptake on renal scan than that of other kidneys (18.6% vs 39.4%, p = 0.013). Only 1 small asymptomatic pseudoaneurysm was noted in group 1. No urine leakage was found in either group. No major vessel occlusion, pseudoaneurysm or urinary complications developed in group 2.Even after deep one-third partial nephrectomy FloSeal with concurrent Tisseel appeared sufficient to control major medullary vascular injuries and replace the deep medullary conventional suture without compromising operative outcomes. The potential advantages seen during functional and vascular examinations by decreasing the risk of unnecessary segmental vessel occlusion need further clinical evaluation.

Vascular targeted photodynamic therapy with WST11 (TOOKAD® Soluble) is in phase III clinical trials of an interstitial transperineal approach for focal therapy of prostate cancer. We investigated the safety and efficacy of the endourethral route in the context of benign prostatic hyperplasia in the dog model.An optical laser fiber was positioned in the prostatic urethra of 34 dogs, including 4 controls. It was connected to a 753 nm diode laser at 200 mW/cm fluence, delivering 200 to 300 J. WST11 (5 to 15 mg/kg) was infused intravenously in 2 modes, including continuous, starting 5 to 15 minutes before and during illumination, or a bolus 5 to 10 minutes before illumination. Prostate ultrasound, cystourethrogram, urodynamics and histopathology were performed. Followup was 1 week to 1 year.Endourethral WST11 vascular targeted photodynamic therapy was uneventful in all except 1 dog, which experienced urinary retention but reached the 1-week end point. All prostates except those in controls showed hemorrhagic lesions. They consisted of 2 levels of concentric alterations, including periurethral necrosis with endothelial layer destruction and adjacent inflammation/atrophy with normal blood vessels. Prostatic urethral width increased as early as 6 weeks after treatment, while prostatic volume decreased, reaching 25% by 18 to 26 weeks. A parallel decrease in urethral pressure at 6 weeks lasted up to 1 year.We confirmed the vascular effect of endourethral WST11 vascular targeted photodynamic therapy. To our knowledge we report for the first time that the resulting periurethral necrosis led to significant, sustained widening of the prostatic urethra, accompanied by long-term improvement in urodynamic parameters. These findings support future clinical applications of this minimally invasive approach to benign prostatic hyperplasia.

We examined the usefulness, reliability and applicability of the smoothness metric of the ProMIS hybrid simulator (Haptica, Dublin, Ireland) for a urology residency program.A total of 15 urology residents divided into junior and senior cohorts were followed prospectively for 6 training sessions. Validated McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) laparoscopic tasks were used. The ProMIS hybrid simulator smoothness parameter, a unit-free metric of movement efficiency, was recorded using 3-dimensional visual tracking technology. Results were compared between cohorts at the midpoint and end of the defined training sessions. End of study junior means were also retrospectively compared to senior mid training means. Statistical significance was determined using the Mann-Whitney U test (alpha = 0.05).Statistically significant differences between 8 junior and 7 senior cohorts were measured in all MISTELS tasks. A statistically significant performance variation was also detected at the mid and end testing times. When juniors and seniors were compared between sessions 1 and 3, and 4 and 6, statistically significant performance improvements were noted. Lastly, statistical differences were also maintained when mid session senior means were compared to end of session junior means. A 38% improvement in task completion in the senior cohort as well as a 10-fold decrease in variance was observed compared to a 12% improvement in juniors, indicating greater efficiency of movement in seniors.The laparoscopic smoothness metric in the hybrid simulator demonstrated construct validity by effectively differentiating between experienced and novice urology residents using validated MISTELS tasks. The outcome suggests that the hybrid simulator smoothness metric is a valuable asset in residency programs for preparatory training for live operative experience, allowing improved trainee assessment.

Purpose: To compare the retropubic and transvaginal approaches in terms of the length of gracilis muscle available for female urethral graciloplasty.Materials and Methods: Two groups of female cadavers were submitted to bilateral gracilis muscle dissection, followed by urethral graciloplasty using either the standard retropubic approach or the transvaginal approach. The two groups were studied in terms of various muscle characteristics, in particular the length of muscle that could effectively be wrapped around the bladder neck.Results: Because muscle transfer to the perineum was more direct, the transvaginal approach provided a greater functional length of gracilis for effective periurethral wrapping than the retropubic approach (mean: 8.4 cm. versus 5.2 cm., p = 0.0022).Conclusion: The transvaginal approach allows a more “proximal” graciloplasty and should therefore be evaluated clinically to provide circumferential bladder neck support without tension.

We assessed the ability of laser induced autofluorescence spectroscopy to distinguish neoplastic urothelial bladder lesions from normal or nonspecific inflammatory mucosa.Three different pulsed laser excitation wavelengths were used successively: 308 nm. (xenium chloride excimer laser), 337 nm. (nitrogen laser) and 480 nm. (coumarin dye laser). The excitation light was delivered by a specially devised multifiber catheter connected to a 1 mm. core diameter silica monofiber introduced through the working channel of a standard cystoscope with saline irrigation. The captured fluorescence light was focused onto an optical multichannel analyzer detection system. Device performance was evaluated in 25 patients after obtaining consent and immediately before transurethral resection of a bladder tumor. Spectroscopic results were compared with histological findings.At 337 and 480 nm. excitation wavelengths the overall fluorescence intensity of bladder tumors was clearly decreased compared to normal urothelial mucosa regardless of tumor stage and grade. At the 308 nm. excitation wavelength the shape of the tumor spectra, including carcinoma in situ, was markedly different from that of normal or nonspecific inflammatory mucosa. No absolute intensity determinations were required in this situation, since a definite diagnosis could be established based on the fluorescence intensity ratio at 360 and 440 nm.This spectroscopic study could be particularly useful to design a simplified autofluorescence imaging device for detection of occult urothelial neoplasms.

Purpose: To assess the ability of argon laser-induced autofluorescence spectroscopy (LIAFS) to discriminate normal from tumor human urothelial cells.Materials and Methods: Emission spectra of single living cells excited at 488 nm. have been studied with a confocal microspectrofluorimeter.Results: Cellular autofluorescence appeared as a broad band with a maximum in the same “green” spectral range, 550 to 560 nm., probably corresponding to oxidized flavoprotein emission. However, the maximum autofluorescence intensity of normal urothelial cells was much higher, 10 times (p less than 0.0001) that of any of the tumor cell types tested.Conclusion: These results, suggesting a significantly reduced oxidized flavoprotein concentration in tumor urothelial cells, should prompt us to evaluate argon LIAFS as a potential tool to detect occult urothelial severe dysplasia and carcinoma in situ.

INTRODUCTION AND OBJECTIVES: We present a randomized controlled prospective study using BackStopTM (Pluromed Inc, Woburn, MA), a novel reverse thermosensitive, water soluble polymer that is injected above the stone as a low viscosity gel, and which rapidly transitions to a high viscosity gel at body temperature, thereby occluding the ureter and preventing retrograde stone migration during intracorporeal lithotripsy. After fragmentation is completed and concretions extracted, conventional irrigation with saline dissolves the polymer, which is then flushed out. METHODS: A total of sixty-eight eligible subjects have been consented and randomly assigned to either the experimental group (BackStopTM) or the control group (no anti-retropulsion device). All subjects were indicated for ureteroscopic lithotripsy to treat single, radiopaque stones located in the proximal ureter. Primary endpoints include a determination of the effectiveness of BackStopTM in preventing retrograde stone migration during intracorporeal lithotripsy and an assessment of its “removal” via dissolution. The volume used, stone free rates and necessity of secondary procedures, if any, were also documented. RESULTS: The rate of stone retropulsion in the BackStop group was 8.8% (3/34) compared to 52.9% (18/34) in the control group (p=.0002). CONCLUSIONS: BackStop safely and significantly reduces the incidence of retropulsion of ureteral stones during intracorporeal lithotripsy.