Search

Objective: To compare the durability and complication rates of surgery to implant an inflatable penile prosthesis (IPP) between patients with and without Peyronie's disease (PD)., Patients and Methods: We retrospectively reviewed all patients undergoing IPP surgery at one centre (Memphis) between July 1997 and May 2007. Variables included age at surgery, race, body mass index, presence of PD, brand/type of IPP (two vs three pieces), presence of diabetes mellitus (DM), active tobacco use, and complications. The result were assessed using t-tests, chi-square and regression analysis, with P < 0.05 considered to indicate significant differences., Results: In all, 79 men were analysed (mean age 59.8 years, range 38.1-81.5). Nine (11%) patients had PD and had a IPP implanted, with penile modelling. Overall, 43 (54%) patients had pre-existing DM and 51 (65%) actively used tobacco. At a mean (range) follow-up of 19.6 (0.1-115.3) months, six (8%) patients had component malfunctions. Of these, three had DM and four actively smoked. Of the nine patients with PD, three developed component malfunctions, vs three (4%) who did not have PD (P= 0.002). Both groups had similar infection rates (P= 0.98). The mean (range) time to component malfunction was 4.3 (0.1-9.6) months, which was longer (but not significantly) in the PD group, with a mean (median, range) of 10.9 (6.3, 1.1-9.6) months, than the 3.0 (1.0, 0.2-7.9) months in the group without PD (P= 0.4). Groups were matched for rates of DM (P= 0.1) and tobacco use (P= 0.2). PD was a significant predictor of component malfunction on both univariate (P= 0.001) and multivariate analysis (P= 0.002) when adjusting for age (P= 0.2), body mass index (P= 0.7), DM (P= 0.3) and tobacco use (P= 0.8)., Conclusion: Patients with PD implanted with a IPP, with penile modelling, had significantly higher component malfunction rates. Further, PD independently predicted component malfunction. These findings might be related to stress on the device at the time of surgery, during use, or both. Further study into this relationship is required., (© 2010 THE AUTHORS. JOURNAL COMPILATION © 2010 BJU INTERNATIONAL.)

Objectives: To test the hypothesis that men with prostate cancer (PCA) and preoperative disease features considered favorable for focal treatment would be accurately characterized with transrectal biopsy and prostate magnetic resonance imaging (MRI) by performing a retrospective analysis of a selected cohort of such patients treated with radical prostatectomy (RP)., Methods: A total of 202 patients with PCA who had preoperative MRI and low-risk biopsy criteria (no Gleason grade 4/5, 1 involved core, < 2 mm, PSA density < or = 0.10, clinical stage < or = T2a) were included in the study. Indolent RP pathology was defined as no Gleason 4/5, organ confined, tumor volume < 0.5 mL, and negative surgical margins. MRI ability to locate and determine the tumor extent was assessed., Results: After RP, 101 men (50%) had nonindolent cancer. Multifocal and bilateral tumors were present in 81% and 68% of patients, respectively. MRI indicated extensive disease in 16 (8%). MRI sensitivity to locate PCA ranged from 2% to 20%, and specificity from 91% to 95%. On univariate analysis, MRI evidence of extracapsular extension (P = .027) and extensive disease (P = .001) were associated with nonindolent cancer. On multivariate analysis, only the latter remained as significant predictor (P = .0018)., Conclusions: Transrectal biopsy identified men with indolent tumors favorable for focal treatment in 50% of cases. MRI findings of extracapsular extension and extensive tumor involving more than half of the gland are associated with unfavorable features, and may be useful in excluding patients from focal treatment. According to these data, endorectal MRI is not sufficient to localize small tumors for focal treatment., (2010 Elsevier Inc. All rights reserved.)

Purpose: We evaluated our experience with renal cortical tumors to determine whether tumor size is associated with malignant histology and/or nuclear grade., Materials and Methods: We identified 2,675 patients treated surgically at our institution for renal cell carcinoma or a benign tumor between 1989 and 2007. Histological subtype and tumor size were obtained from our kidney cancer database and logistic regression analysis was performed., Results: Of the 2,675 tumors 311 (12%) were benign and 2,364 (88%) were renal cell carcinoma. The OR for the association of malignancy with tumor size was 1.16 (95% CI 1.11-1.22, p <0.001), indicating that each 1 cm increase in tumor size was associated with a 16% increase in the odds of malignancy. The incidence of benign tumors decreased from 38% for tumors less than 1 cm to 7% for tumors 7 cm or greater. In patients with clear cell renal cell carcinoma each 1 cm increase in tumor size increased the odds of high grade disease (Fuhrman grade 3-4) compared with low grade disease (Fuhrman grade 1-2) by 25% (OR 1.25, 95% CI 1.21-1.30, p <0.001). In this subset the incidence of high grade lesions increased from 0% for tumors less than 1 cm to 59% for tumors greater than 7 cm., Conclusions: Our results confirm previous observations suggesting that the risks of malignancy and high grade tumors increase with tumor size. Patients with small renal masses are at low risk for harboring a high grade clear cell malignancy, which may be useful during initial consultation.

Objective: To evaluate the difference between radiographic size on computed tomography (CT) and the pathological size of renal tumours, in contemporary patients., Patients and Methods: We retrospectively reviewed the records of 521 patients undergoing surgical resection of a renal mass between 2000 and 2007, who had tumour sizes recorded from both preoperative CT and pathological evaluation of the tumour specimen. Data on histological tumour type were also extracted. The paired Student's t-test was used to compare the mean radiographic size as measured on CT with the mean pathological size, with P < 0.05 considered to indicate statistical significance., Results: For all patients, the mean radiographic size and mean pathological size was 4.79 and 4.69 cm, respectively (P = 0.02). Therefore, on average, radiographic size overestimated pathological size by 1 mm. In patients with a tumour of 4-7 cm, radiographic size overestimated pathological size by 0.21 cm (P = 0.007). However, there was no significant difference in patients with a tumour of <4 cm or >7 cm., Conclusions: Using contemporary patients, there was a statistically significant overestimation of renal tumour sizes by CT compared with the pathological assessment. However, the overall difference between radiographic and pathological tumour size was 1 mm, suggesting that CT provides an accurate method with which to estimate renal tumour size.

Objective: To compare haemostasis and other outcomes after the use of bovine-derived or porcine-derived gelatine matrix-thrombin sealants (GMTS) in a continuous series of patients during and for 6 months after laparoscopic partial nephrectomy (LPN)., Patients and Methods: Between October 2006 and September 2007, a consecutive sample of 35 patients with renal tumours underwent LPN by a single surgeon at a referral centre. Group 1 (25 patients) received a bovine-derived GMTS and Group 2 (10 patients) a porcine-derived GMTS. All patients underwent LPN and received one of the two GMTS, applied to the resected bed before sutured renorrhaphy over oxidized nitrocellulose bolsters. Surgical and pathology variables, including ischaemia time, blood loss, tumour size, and serum creatinine values before and after LPN, were measured. Glomerular filtration rates were calculated before and after LPN. Haemostasis was ascertained by visual examination., Results: Intraoperative haemostasis was achieved in all cases. No associated complications occurred within 3 weeks of LPN. The two groups were comparable in age (median, 65 vs 69 years, P = 0.62), gender, tumour number and location, median ischaemia time (34 vs 28 min, P = 0.148), and blood loss (200 vs 150 mL, P = 0.518). One patient in Group 1 developed a urinary fistula. One patient in Group 2 experienced self-limited gross haematuria., Conclusions: Both the porcine- and bovine-derived agents provided acceptable haemostasis without adverse events during LPN and in the early postoperative period. Occurrences of delayed haemorrhage and urinary fistula were not likely to be related to the choice of prothrombotic agent.

Purpose: Bacillus Calmette-Guerin is an effective immunotherapy for carcinoma in situ of the bladder and it reduces recurrence from resected papillary transitional cell carcinoma of the bladder. Many patients receiving bacillus Calmette-Guerin therapy are concurrently taking statin agents, which have known immunomodulatory properties and may alter the performance of bacillus Calmette-Guerin. Some data have suggested that patients taking a statin while on bacillus Calmette-Guerin therapy experience reduced clinical efficacy., Materials and Methods: We conducted a retrospective review of 952 consecutive patients from 1978 through 2006. Time to recurrence and progression to surgery were compared between those taking and those not taking a statin by Kaplan-Meier methods and multivariable Cox regression controlling for stage and grade., Results: There were 245 (26%) patients taking a statin before bacillus Calmette-Guerin therapy and 707 not on statin therapy (74%). A total of 796 patients had recurrence overall with 214 in the statin group and 582 in the other group. Median time to recurrence was similar between those who did and those who did not use a statin. On multivariable analysis statin use was not significantly associated with recurrence (hazard ratio 1.04; 95% CI 0.81, 1.34; p = 0.7) or progression to surgery (hazard ratio 0.77; 95% CI 0.52, 1.13; p = 0.17) after bacillus Calmette-Guerin therapy., Conclusions: This retrospective study in a large cohort of patients showed no statistically significant association between statin use and recurrence or progression to open surgery in patients treated with bacillus Calmette-Guerin for transitional cell carcinoma of the bladder. Based on these data patients should not be discouraged from taking statins while undergoing bacillus Calmette-Guerin treatment.