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INTRODUCTION AND OBJECTIVE:Prostate cancer referrals to high volume, academic cancer centers are common. Consulting urologic oncologists decide if outside prostate biopsy over-reads by internal pat...

INTRODUCTION AND OBJECTIVE:MRI-ultrasound fusion biopsies (MRI-bx) have improved detection of clinically significant prostate cancer. However, there is still debate on the role of MRI-bx as an adju...

INTRODUCTION AND OBJECTIVE:Leibovich score has been a standard method to predict recurrences in renal cell carcinoma (RCC). Recently, GRade, Age, Nodes, and Tumor (GRANT) score was proposed as an a...

INTRODUCTION AND OBJECTIVE:Clinical practice guidelines recommend antibiotic prophylaxis for transrectal prostate biopsy. However, infectious complications following biopsy have been an emerging co...

INTRODUCTION AND OBJECTIVE:Urinary stone disease affects approximately 10% of the United States (US) population. For symptomatic disease, surgical interventions, including ureteroscopy (URS), extra...

INTRODUCTION AND OBJECTIVES:We hypothesized that ureteral stent urine culture (UC) results may predict urinary tract infection(UTI)-related readmissions following robotic radical cystectomy with il...

INTRODUCTION AND OBJECTIVES:Ureteroenteric Strictures (UES) are a potential long-term complication of Radical Cystectomy with Urinary Diversion (RCUD). Renal scintigraphy findings associated with U...

To review the diagnosis and management of all stages of bladder cancer with an emphasis on studies and developments within the last year.Cystoscopy remains the gold standard for diagnosis of bladder tumors, though fluorescent light and urinary biomarkers can both improve the sensitivity of cancer detection. Management of high-risk patients with nonmuscle invasive cancer continues to be controversial, with a number of risk assessment tools developed to help stratify patients to cystectomy or bladder-sparing regimens. Intravesical therapy is utilized both as a one-time perioperative regimen and as a weekly regimen, and research continues in the development of agents for bacillus Calmette-Guerin-refractory superficial bladder cancer. In patients undergoing cystectomy, evidence supports the need for an adequate lymphadenectomy. Although there are limited data on robotic assisted radical cystectomy, initial reports suggest that an appropriate lymph node dissection can be performed. The role of bladder-sparing modalities as well as the use of adjuvant and neoadjuvant therapies is still debated. Trials investigating these therapies continue to seek to improve both oncologic outcomes and quality of life for patients with invasive bladder cancer.Progress continues in bladder cancer diagnosis and management, and we anticipate that future work will further advance the care of patients with this disease.

Preeclampsia is characterized by hypertension, dyslipidemia, and increased systemic inflammatory response and has been associated with an increased maternal risk of cardiovascular disease later in life. Low-grade chronic inflammation is a risk factor for cardiovascular disease. This study examined changes in inflammatory markers prospectively during pregnancy, the current inflammatory status of women who had a pregnancy complicated by preeclampsia 20 years previously against matched controls, and the association between inflammatory genes and risk of preeclampsia in a case (n=106) control (n=212) study. In control pregnancies (n=34), mean interleukin-10 (IL-10) levels increased 38% (P=0.012) and tumor necrosis factor-α (TNF-α) by 33% (P=0.024) between the first and third trimesters. The mean preeclampsia group IL-10 and TNF-α rose by 43% (P=0.013 andP=0.0065, respectively) from the first to the third trimester. In women with preeclampsia only, plasma IL-6 increased from the first to the third trimester (1.66 [2.04] to 2.94 [2.47] pg/mL;P=0.0004). Twenty years after the index pregnancy, women who had had preeclampsia demonstrated significantly higher IL-6 to IL-10 ratio (3.96 [6.07] versus 2.12 [1.89];P=0.034) compared with a healthy index pregnancy 20 years previously, that persisted after adjustment for smoking and current body mass index. The IL-1β (C-511T), IL-6 (G-174C), TNF-α (G-308A), E-selectin (S128R), intercellular adhesion molecule-1 (K469E), and C-reactive protein (C1059G) polymorphisms were not associated with risk of developing preeclampsia. In conclusion, preeclampsia is associated with short- and long-term changes in inflammatory status.

Objective: To assess whether waist circumference at the first antenatal visit predicts risk of developing hypertension later in pregnancy. Methods: Pregnant women with singleton pregnancies (n = 1142, median age 29 years, interquartile range 25–32 years, 387 primigravidas) were recruited at their first antenatal visits. Using standardized methods, midwives determined the weights, heights (for calculation of body mass index [BMI]), and waist circumferences of all women. Eighty-two women developed pregnancy-induced hypertension, and 21 developed preeclampsia (hypertension with proteinuria). Results: The median waist circumference between 6 and 16 weeks’ gestation was 79 cm (interquartile range 72–84 cm), and there was no significant relationship between waist circumference and gestational age. Greater waist circumference was noted in subjects who subsequently developed pregnancy-induced hypertension (median 81 versus 77 cm, Mann-Whitney U test, P = .002) or preeclampsia (median 80 versus 77 cm, P = .02). The conventional, nonpregnant waist circumference action level of 80 cm gave a Mantel-Haenszel odds ratio (OR) for pregnancy-induced hypertension of 1.8 (95% confidence interval [CI] 1.1, 2.9) and for preeclampsia of 2.7 (95% CI 1.1, 6.8), compared with waists of less than 80 cm. Body mass index values were higher in women who developed pregnancy-induced hypertension (median 26 versus 24, P = .001) or preeclampsia (median 26 versus 24, P = .02). The conventional action limit for a BMI of 25 had an OR for pregnancy-induced hypertension of 2.0 (95% CI 1.2, 3.4) and for preeclampsia of 1.9 (95% CI 0.7, 4.8). Results were similar when the analysis was restricted to data from primigravidas. Conclusion: We conclude that waist circumference up to 16 weeks’ gestation can predict pregnancy-induced hypertension and preeclampsia. Therefore, waist circumference could form the basis for health promotion involving raising awareness of the importance of or urging weight reduction for women planning pregnancies.

BACKGROUND Calcitonin gene-related peptide (CGRP) is a potent dilator of normal epicardial coronary vessels in humans, but its effects on myocardial blood flow and atheromatous coronary vessel diameter are unknown. METHODS AND RESULTS Seven patients were entered for study of the effects of CGRP on coronary blood flow and 13 for the comparison of its effects on normal and atheromatous coronary arteries. In the first seven patients, left anterior descending artery (LAD) diameter at an angiographically normal site, coronary sinus oxygen saturation (CSO2S), systemic blood pressure, and heart rate were measured during intracoronary infusion of increasing concentrations of CGRP (up to 200 ng/ml at 2 ml/min) followed by intracoronary adenosine (0.267 micrograms/ml at 2 ml/min) and finally intracoronary glyceryl trinitrate (GTN) (5 micrograms/ml at 2 ml/min). CGRP dilated the normal segment of the LAD by 22.6 +/- 8% (mean +/- 95% confidence interval), p less than 0.001, with only a small increase in CSO2S from 40.1 +/- 2.7% to 47.3 +/- 2.7%, p less than 0.001. Adenosine, a potent dilator of myocardial resistance vessels, caused no further increase in LAD diameter but caused a rise in CSO2S from 47.3 +/- 2.7% to 76.0 +/- 2.7%, p less than 0.001. GTN caused no further increase in LAD diameter. As heart rate-blood pressure product remained unchanged throughout the study, the increase of CSO2S indicated only a small increase in myocardial blood flow after CGRP infusion. In 13 patients with atheromatous coronary artery disease, the effects of intracoronary CGRP at angiographically normal sites, stenoses, angiographically normal sites immediately adjacent to stenoses, and sites of coronary artery wall irregularity were compared after intracoronary infusion of a single dose of CGRP (200 ng/ml at 2 ml/min) followed by intracoronary GTN (5 micrograms/ml at 2 ml/min). At these four sites, CGRP resulted in dilatation by 17.0 +/- 5.6%, 15.3 +/- 12.1% (NS), 7.6 +/- 5.4% (NS), and 15.9 +/- 7.8%, respectively. There was no significant further dilatation after GTN at any of the four sites. CONCLUSIONS These data indicate that CGRP has little effect in humans at rest on coronary resistance vessels in nonischemic myocardium but causes marked dilatation of normal arteries and variable dilatation of atheromatous epicardial arteries.