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Background: Nurse-led clinics (NLCs) have been developed in several health specialties in recent years. The aim of this analysis is to summarize and appraise the available evidence about the effectiveness of NLCs on the morbidity and mortality outcomes in patients with cardiovascular diseases (CVDs)., Methods: We searched Cochrane databases, MEDLINE, Web of Science, PubMed, EMBASE, Google Scholar, BIOSIS, and bibliography of secondary sources from inception through February 20, 2013. Studies were selected and data were extracted independently by 2 investigators. Eligible studies were randomized trials of NLCs of patients with CVD. Of 56 potentially relevant articles screened initially, 12 trials met the inclusion criteria. The outcomes of interest were all-cause mortality, cardiovascular mortality, nonfatal myocardial infarction, major adverse cardiac events, revascularization, lipids control, and adherence to antiplatelet medications. We performed random-effects meta-analysis to estimate summary risk ratios and quantified between-studies heterogeneity with the I2 statistic., Results: The 12 trials allocated 4886 patients to NLCs and 4954 patients to usual care. The NLC patients had decreased all-cause mortality (odds ratio, 0.78; 95% confidence interval [CI], 0.65-0.95; P < .01) and myocardial infarction (odds ratio, 0.63; 95% CI, 0.39-1.00; P = .05) and had higher adherence to lipid-lowering medication (odds ratio, 1.57; 95% CI, 1.14-2.17; P = .006) compared with controls. They also had increased adherence to antiplatelet therapy compared with controls (odds ratio, 1.42; 95% CI, 1.01-1.98; P = .04). There was no statistically significant difference in the risk of cardiovascular death (odds ratio, 0.68; 95% CI, 0.40-1.15; P = .68), major adverse cardiac events (odds ratio, 0.79; 95% CI, 0.55-1.14; P = .21),or revascularization (odds ratio, 0.87; 95% CI, 0.66-1.16; P = .36) between NLC patients and controls., Conclusions: The available evidence suggests a favorable effect of NLCs on all-cause mortality, rate of major adverse cardiac events, and adherence to medications in patients with CVD.

Proper care of patients with superficial bladder cancer requires the assessment of multiple factors, including an understanding of the natural history of this disease, accurate clinical staging, and the expected efficacy of each drug. The pharmacology of intravesical mytomycin C is discussed in detail, as many of this drug's pharmacological principles are applicable to all intravesical chemotherapeutic agents, including doxorubicin, thiotepa, bacillus Calmette-Guérin, epirubicin, and ethoglucid. The bladder wall, bladder cavity, chemical properties of intravesical chemotherapeutic agents, and tumor considerations are discussed. Suggestions based on pharmacological studies are presented to optimize the efficacy of intravesical chemotherapy.

Purpose: The AMS700 Ultrex penile prosthesis is an example of the design changes that penile prostheses have undergone to improve mechanical reliability. Few studies have reviewed an overall experience with the AMS700 Ultrex prosthesis. We review patient outcomes, surgical complications, and Ultrex cylinder intermediate term mechanical reliability and function., Materials and Methods: Between March 1990 and November 1994, 145 patients 32 to 79 years old (mean age 58) underwent insertion of an AMS700 Ultrex penile prosthesis. At a followup of 6 to 62 months (mean 42) patients were evaluated with a retrospective clinical record review, and patient and partner questionnaires., Results: From the clinical record review of 145 patients our malfunction, reoperation, infection, erosion, major complication and minor complication rates were 8, 13, 2, 3, 13 and 7%, respectively. Patient responses to our questionnaire showed that 85% were satisfied overall, 85% had durable and reliable implant function, 86% had a sustained level of satisfaction with the implant and 83% remained satisfied after a revision for malfunction. Overall, partner satisfaction with the implant was 76%, and 42% reported maintenance of a good or improved nonsexual relationship after prosthesis implantation., Conclusions: Our data demonstrate the intermediate term mechanical reliability and function of the AMS700 Ultrex penile prosthesis, and high patient and partner satisfaction with this implant.

Purpose: To determine whether autocrine motility factor receptor (AMFR) is detectable in the urine of patients with transitional cell carcinoma (TCC) of the bladder., Materials and Methods: We assayed the urine of 89 patients with bladder pathology and 28 normal controls for AMFR. A monoclonal antibody to AMFR was used., Results: All patients with muscle-invasive TCC tested positive for AMFR. Autocrine motility factor receptor was detectable for 80% of superficial tumors, with a correlation between AMFR and tumor grade. Seventy-five percent of control urines tested negative., Conclusions: Autocrine motility factor receptor is detectable in the urine of patients with TCC. Long-term follow-up and refinements in the assay should define the marker's utility for detection and prognosis.

New methods of early detection combined with recent advances in surgical techniques have resulted in more patients undergoing radical surgery for treatment of localized carcinoma of the prostate. Over 350 radical prostatectomies have been performed by our group since January 1987. We review the role of radical prostatectomy in the treatment of prostate cancer and our experience with 100 patients undergoing radical retropubic prostatectomy since the advent of nerve-sparing techniques to preserve potency.

Impotence commonly occurs as a result of treatment of carcinoma of the prostate. We review the etiology, evaluation, and treatment options available for these patients as well as our experience with fifty prostate cancer patients who underwent placement of penile prostheses. Several excellent alternatives are available for patients with impotence resulting from treatment of carcinoma of the prostate.

The management of 10 cases of penile gunshot wounds treated at Henry Ford Hospital from 1982 to 1986 is reviewed. All patients were assaulted by low velocity weapons (handguns). Eight patients had associated injuries, predominantly to the genital region (thigh, pubis, and scrotum). There were 5 urethral injuries; 4 were treated with primary repair, the remaining patient underwent delayed repair, complicated by severe urethral strictures requiring reoperation. Blood at the urethral meatus was suggestive of urethral injury but microscopic hematuria was not. Five penile injuries did not involve the urethra and were treated by debridement and primary wound closure with no immediate or delayed complications. In dealing with these injuries we recommend a high index of suspicion for urethral and regional organ injury and primary urethral closure if at all possible.

Pedal lymphangiography was used in the evaluation of 28 patients with carcinoma of the bladder. Correlation of the lymphangiogram with histologic examination of the surgically excised pelvic and para-aortic nodes was less than 50 per cent and suggests limited applicability of this diagnostic technique in staging bladder cancer.

The recent literature shows our findings on primary urethral neoplasms to be consistent with others, although we did not show an increased incidence of these neoplasms in female over male subjects. Similarly, we recommend an operation with or without irradiation, depending on the stage and location of the lesion. The over-all prognosis of urethral neoplasms remains poor. However, the distal urethral lesions in male and female subjects are easier to approach surgically and seem to be diagnosed earlier in the progression of this disease than the more proximally advanced tumors. These early staged and distal neoplasms greatly improve the changes of long survival. The delay in diagnosis gives this neoplasm its poor prognosis. In men the prognosis probably could be improved by more aggressive evaluation of stricture disease, especially when the need for dilation becomes frequent. In women we believe that the caruncle should be biopsied if it shows signs of progression or remains symptomatic (pain, bleeding and so forth). If a 1 to 2-month course of antimicrobials does not resolve this lesion we recommend biopsy. A relationship between tumor and a diverticulum has been noted in the literature, as in 1 of our cases of adenocarcinoma in a female patient. Whether this relationship could be explained on the basis of recurrent infection and stasis remains theoretical. In conclusion, early diagnosis, accurate staging and aggressive treatments are the means for cure of this disease.

We report a rare case of primary adenocarcinoma of the rete testis. The stage A lesion was managed successfully with orchiectomy and retroperitoneal lymph node dissection. The histopathological features, treatment and prognosis of this unusual malignancy are reviewed.

Vesical neck contractures occur following 5 to 10 per cent of transurethral prostatectomies and an even smaller number of enucleative prostatectomies. Recurrences following both conservative and surgical treatment are common and present management problems to the urologist. Seven patients with recurrent vesical neck contractures were managed with reresection and steroid injection. One hundred per cent of patients responded to this although 1 patient required two procedures. The use of hydrocortisone sodium succinate (Solu-Cortef) versus triamcinolone acetonide (Kenalog) preparations are discussed.

Forty-five patients with symptomatic Stage D carcinoma of the prostate were treated with bilateral orchiectomy. Serum testosterone levels were obtained before orchiectomy, seven days after and a six-month intervals. With relapse after orchiectomy remission patients were treated with diethylstilbesterol (DES) 1 mg. daily. After bilateral complete orchiectomy 40 patients had serum testosterone levels in the anorchic range (21.5 to 39.7 ng./dl) while 5 had testosterone levels between 117 and 187 ng./dl. The mean remission response after orchiectomy was 9.1 months (three to twenty-four months) in the anorchic group and 9.4 months in the imcomplete anorchic group. Mean relapse response to estrogen therapy in the anorchic group was four months (one to six months). While in the incomplete anorchic group mean relapse response to estrogen therapy was 20.8 months (one to sixty). Serum testosterone levels in the imcomplete group decreased with estrogen therapy while those in the anorchic group were stable with estrogen therapy. Our findings suggest that bilateral complete orchiectomy does not always provide serum testosterone levels in the anorchic range. Subsequently these patients show an improved mean response to oral estrogen therapy.

Tumor cells from direct harvests and short term cultures were karyotyped from 15 patients with transitional cell carcinoma of the bladder. There were two tumors with an apparently normal diploid karyotype, eight with counts up to 50 and with marker chromosomes, and five with counts of 60 or more and with markers. The median duration between recurrences was 3 months for the near-diploid, and 3 months for the near-polyploid tumors. One patient whose tumor was normal diploid had a recurrence at 5 months and the second patient whose tumor had normal diploid tumor had no recurrence over 15 months. Four tumors (27% of the series) had a rearrangement involving band 3p14: three had +der(5)t(3;5)(p14;p14) and one had +der(6)t(1;3;6)(q21;p14;p23). Duplication 3p14----3pter was observed in four tumors, and deletion 11p15----11pter in five. Three other abnormalities were observed in three cases each: deletion 5p14----5pter, duplication 1q23----1q32 and deletion 6q21----6qter. Trisomy 7 was observed as a sole clonal abnormality in one carcinoma in situ. Thirteen of 15 patients had recurrence of their tumor. Tumor progression (either in stage or grade) was evident in seven recurrent tumors. Among the seven with tumor progression, three had 11p deletion, two had 11p deletion plus 3p duplication, one had 3p duplication, and one had trisomy 7. Four of the five that had 11p deletion underwent cystectomy and three have died. Three of eight near-diploid tumors progressed and four of five near-tetraploid tumors progressed. It will be important to characterize any cytogenetic changes that are of prognostic value, since the categorization of bladder tumors by other methods has been problematic.

Epidermoid cysts are rare benign tumors of the testicle whose management is controversial. Only 186 cases have been reported, and most were treated with radical orchiectomy. We report 2 cases managed with local excision, and we review the world literature.

Since 1959, 39 cases of eosinophilic cystitis have been reported in the literature. Eosinophilic cystitis is a rare form of allergic cystitis in patients who usually have a strong allergic history. It mimics other forms of intractable cystitis, such as interstitial cystitis, tuberculosis and bladder neoplasms. It is caused by various antigens that form immune complexes at the bladder level and stimulate eosinophilic infiltration. Food allergens, medications, topical agents and parasites have been implicated. The diagnosis is made by excluding all other forms of cystitis.

Three groups of dogs underwent testicular ischemia for a 3-hour period. Group I (10 animals) was not subsequently perfused. Group II (10 animals) underwent subsequent perfusion by a new in vivo reversible method via the internal spermatic artery with heparinized saline. Group III (5 animals) underwent perfusion with Sacks' solution. At 3 weeks' time the histology of the testes of the three groups was compared. Group I showed a 75.5% decrease in the germinal epithelium. Group II showed a 21.4% decrease. Group III showed a 31.8% decrease. The survival rate of the germinal epithelium in the two perfused groups was significantly improved (P less than 0.01).