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Introduction: Some urologists choose not to offer penile prostheses because of concern over malpractice liability., Aim: The aim of this study was to assess whether urologists performing penile prosthesis surgery are placed at a greater malpractice risk., Main Outcome Measures: Percentage of malpractice suits from prosthesis surgery and other urological procedures that result in payment, average resulting payout from these cases, and category of legal issue that ultimately resulted in payout., Methods: A database from the Physician Insurers Association of America, an association of malpractice insurance companies covering physicians in North America, was analyzed to quantitatively compare penile implant surgery to other urological procedures in medicolegal terms., Results: Compared to other common urological procedures, penile implant is comparable and on the lower end of the spectrum in terms of both the percentage of malpractice suits that result in payment and the amount ultimately paid in indemnity from those cases. Additionally, issues of informed consent play the largest role in indemnities for all urological procedures, whereas surgical technique is the most important issue for prosthesis surgery., Conclusions: Urologists who are adequately trained in prosthetic surgery should not avoid penile implant procedures for fear of malpractice suits. A focus on communication and informed consent can greatly reduce malpractice risk for urological procedures.

Background and Objectives: Horseshoe kidney is a relatively common renal fusion anomaly. There are increasing reports of successful laparoscopic management of surgical disease in this entity. Xanthogranulomatous pyelonephritis (XGP) is an inflammatory condition of chronically obstructed and infected kidneys that is typically refractory to medical management. XGP has been regarded as a contraindication to laparoscopic surgery. Successful laparoscopic nephrectomies have been reported, albeit with high conversion and complication rates. In this report, we describe successful laparoscopic heminephrectomy for a horseshoe kidney moiety that was subsequently shown to have pathologic features of XGP., Methods: We report the case of a woman who underwent laparoscopic heminephrectomy for XGP of a horseshoe kidney. We discuss surgical technique and patient outcome. We also performed and report on a focused review of the relevant literature., Results: Pure laparoscopic heminephrectomy was completed by a transperitoneal approach. The patient was discharged the day after surgery., Conclusions: Laparoscopy is a viable approach for the management of XGP in horseshoe kidneys. However, this is a challenging procedure that should be the domain of advanced laparoscopic surgeons.

Introduction: Patients with erectile dysfunction (ED) who have failed oral or intracavernosal erectogenic therapy may benefit from inflatable penile prosthesis (IPP) placement. Such individuals commonly include patients with diabetes mellitus or chronic renal insufficiency. Complications of IPP placement include erosion and infection. Most often, infection of IPPs involves skin flora that are hypothesized to be introduced at the time of device placement and persist as a biofilm, causing clinical infection as a result of failure of containment by host defense mechanisms., Aim: In this report, we describe a renal transplant patient with a Salmonella infection of an IPP following a diarrheal illness. To our knowledge, this organism has not been implicated in penile prosthesis infection., Main Outcome Measures: The clinical course of, and microbiological data pertinent to, this patient are summarized. Additionally, a limited literature review was undertaken and is here summarized., Methods: Retrospective review of medical record documentation., Results: This patient was found to have a Salmonella infection of his IPP with ensuing device erosion. Following urgent device removal and culture-specific antibiotic therapy, he was discharged from the hospital at his baseline functional status and renal function., Conclusions: This is the first report of which we are aware in which Salmonella penile prosthesis infection is described. While this man's immunocompromised status may have made him more vulnerable to device infection, the literature is generally supportive of IPP placement in the transplant population when other modes of ED treatment have failed. Moreover, we postulate a hematogenous mechanism for device seeding in this patient.

Purpose: Patients with autosomal dominant polycystic kidney disease have significant morbidity due to large kidney size and the resultant compression of adjacent organs. Surgical extirpation is limited to the most severe cases due to the risk of complications. Typically surgical extirpation of autosomal dominant polycystic kidney disease kidneys and renal transplantation are performed in staged fashion. The additive risks of these 2 procedures have been a barrier to a simultaneous surgical approach. The risks include transplant compromise due to cyst rupture, bleeding, adjacent organ injury and anti-HLA antibody sensitization from transfusion in cases of pretransplant nephrectomy. We reviewed the results of and graft survival data on bilateral nephrectomy for autosomal dominant polycystic kidney disease with simultaneous live donor renal transplantation., Materials and Methods: From August 2003 to November 2007, 20 sets of kidneys were removed in patients with autosomal dominant polycystic kidney disease, followed by simultaneous live donor transplantation. We retrospectively reviewed the outcomes in terms of surgical time, complications, length of stay, transfusion rate and transplant kidney status., Results: A total of 20 sets of kidneys were removed and these patients then underwent immediate live donor renal transplantation. Mean operative time was 190 minutes for the bilateral nephrectomy portion alone with an average estimated blood loss of 723 cc. Complications were rare and well tolerated. Mean hospital stay was 7.2 days for this procedure. Graft survival was 100% and all patients reported relief of symptoms., Conclusions: Bilateral nephrectomy and immediate transplantation in patients with autosomal dominant polycystic kidney disease can be done with minimal morbidity. Preliminary studies show that patients may have significant improvement in quality of life from this procedure and graft viability is not compromised.

Purpose: To recapitulate the generation of cancer stem cells in the context of an intact animal using a retroviral vector capable of in vivo delivery of oncogenes to primitive endothelial and hematopoietic stem cells., Experimental Design: Targeting of these progenitors was achieved using transgenic mice in which the avian TVA retroviral receptor was placed under the control of the stem cell leukemia (scl/tal-1) gene promoter and SCL +19 enhancer., Results: Injection of an avian retrovirus encoding polyoma middle T (PyMT), an oncogene that transforms endothelial cells, caused rapid lethality in all SCL-TVA mice but not in control TVA(-) littermates. The infected animals exhibited hemorrhagic foci in several organs. Histopathologic analysis confirmed the presence of hemangiomas and the endothelial origin of the PyMT-transformed cells. Surprisingly, the transformed endothelial cells contained readily detectable numbers of TVA(+) cells. By contrast, normal blood vessels had very few of these cells. The presence of TVA(+) cells in the lesions suggests that the cells originally infected by PyMT retained stem cell characteristics. Further analysis showed that the tumor cells exhibited activation of the phosphatidylinositol 3-kinase/Akt and S6/mammalian target of rapamycin pathways, suggesting a mechanism used by PyMT to transform endothelial progenitors in vivo., Conclusions: We conclude that this experimental system can specifically deliver oncogenes to vascular endothelial progenitors in vivo and cause a fatal neoplastic disease. This animal model should allow the generation of endothelial cancer stem cells in the natural environment of an immunocompetent animal, thereby enabling the recapitulation of genetic alterations that are responsible for the initiation and progression of human malignancies of endothelial origin.