Albert A. Samadi

Laparoscopic orchiopexy : report of 203 cases with review of diagnosis, operative technique, and lessons learned

BACKGROUND AND PURPOSE Proper management of the nonpalpable testicle requires an accurate diagnosis. Laparoscopic orchiopexy (LO) has become the standard for diagnosis and treatment. We classified the location of nonpalpable testicles, reviewed the technique of LO in detail, and report the results of our series, the largest described to date. PATIENTS AND METHODS We compiled the records of all cryptorchid patients seen between 1994 and 2002. Those with testicles located near the internal inguinal ring and those with nonpalpable testicles underwent laparoscopy and LO in the same session. The 173 patients underwent 203 procedures, all performed by the senior authors. RESULTS The undescended testicles were right-sided in 33% of patients, left-sided in 53%, and bilateral in 14%. Six testicles were excluded because of hypotrophy (N=4) or agenesis of the vas deferens (N=2). At laparoscopy, 58% of the testicles were at the iliac vessels or higher (high intra-abdominal), 22% were between the iliac vessels and the internal ring (low intra-abdominal), 16% were peeping, 3% were intracanicular, and 1% were retrovesical. Standard LO was performed in 70.5% of the patients, with the remainder being treated by laparoscopic Fowler-Stephens orchiopexy. There have been four cases of testicular atrophy, all after Fowler-Stephens procedures. Two were virgin gonads, and the other two had previously been subjected to extensive orchiolysis. Only 3% of the patients required repeat surgery because of an unsatisfactory testicular location. CONCLUSION The reported success rate for LO of intra-abdominal testicles has far exceeded that of open repair (95% v 76%). It is our belief that minimal manipulation of the testicle during dissection, a wider peritoneal window, and sparse use of electrocautery will result in adequate testicular position even for high intra-abdominal gonads with minimal risk of atrophy.

Holmium laser enucleation for large (greater than 100 mL) prostate glands

Background: To evaluate the holmium laser enucleation of the prostate (HoLEP) using the transurethral soft tissue morcellator (TUSTM), as a primary surgical treatment for symptomatic benign prostatic hyperplasia (BPH) with prostate glands > 100 mL.

Glyoxalase I phenotype as a potential risk factor for prostate carcinoma

OBJECTIVES To elicit a possible link between glyoxalase I (Gly-I), a detoxifying enzyme, and the incidence of prostate cancer (PCa), we investigated Gly-I phenotypic expression in the prostatic tissue and red blood cells (RBCs) from patients with PCa. METHODS Eighty-seven clinical specimens, including 42 PCa tissue samples, 20 RBC samples, and 25 matched pair (prostate and RBC) samples from patients at prostatectomy were examined. The Gly-I phenotypes in these specimens were assessed by nondenaturing starch-polyacrylamide gel electrophoresis. RESULTS Of the 87 patients, 63 (72.4%) were white, 15 (17.2%) were black, and 9 (10.4%) were another ethnicity (eg, Hispanic, Asian, Indian). Three Gly-I phenotypes were detected in these specimens as fast, intermediate, and slow-moving bands on the gel. The fast phenotype was the most common form found in the white (34 [54%] of 63) and black (8 [53.3%] of 15) patients, but the third ethnic group was too small for proper analysis. To validate this finding, the data from the white patients were compared with the Gly-I phenotypic frequencies in U.S. populations. The data analysis confirmed that a higher incidence (54%) of the fast type in our white patients was statistically significant (P <0.0001) compared with its phenotypic frequency of 30.6% in the general U.S. white population. CONCLUSIONS The significantly high frequency (P <0.0001) of the fast Gly-I phenotype was detected among patients with PCa, suggesting it is a potential risk factor for PCa. Whether its increased incidence in whites reflects the lack of sample numbers for other ethnic groups needs additional investigation.

Chemosensitization of Carmustine with Maitake β-Glucan on Androgen-Independent Prostatic Cancer Cells: Involvement of Glyoxalase I

OBJECTIVE To improve the poor efficacy (< 10%) of chemotherapy for patients with hormone-refractory prostate cancer, we investigated a possible cytotoxic effect of carmustine/beta-glucan combination on prostatic cancer PC-3 cells, focusing on a glutathione-dependent detoxifying enzyme, glyoxalase I (Gly-I). METHODS Carmustine (BCNU) is an anticancer agent and a putative inhibitor of Gly-I, while beta-glucan is a unique, nontoxic polysaccharide extracted from maitake mushrooms. The cytotoxic effects of BCNU or other anticancer agents with beta-glucan on PC-3 cells were assessed by cell-viability testing and Gly-I activity was measured using the spectrophotometric method. RESULTS BCNU, 5-fluorouracil (5-FU), and methotrexate (MTX) were capable of inducing approximately a 50% reduction in cell viability at 72 hours, while etoposide, cisplatin, and mitomycin C were all ineffective. Only the combination of BCNU (50 micro ;mol) and beta-glucan (60 micro g/mL) exhibited an enhanced cytotoxicity with an approximate 90% cell viability reduction, but little improvement was seen with any combinations of 5-FU, MTX, or beta-glucon. Gly-I assays revealed that such a profound (approximately 90%) cell death was accompanied by an approximate 80% reduction in Gly-I activity by 6 hours. CONCLUSION This study demonstrates a sensitized cytotoxic effect of BCNU with beta-glucan in PC-3 cells, which was associated with a drastic (approximately 80%) inactivation of Gly-I. Therefore, the BCNU/beta-glucan combination may help to improve current treatment efficacy by targeting Gly-I, which appears to be critically involved in prostate cancer viability.

Salvage Extracorporeal Shockwave Lithotripsy After Failed Distal Ureteroscopy

BACKGROUND AND PURPOSE When intervention is necessary, controversy remains as to the best treatment modality for stones of the distal ureter. In general, ureteroscopy is favored over extracorporeal shockwave lithotripsy (SWL) as the treatment of choice for distal ureteral stones. Although uncommon, ureteroscopy failures have traditionally necessitated repeat ureteroscopy to retrieve retained stone fragments. We evaluated the efficacy of salvage SWL for failed primary distal ureteroscopy in the community setting. PATIENTS AND METHODS From December 1989 to December 2000, 6099 patients underwent SWL with the Dornier HM4 lithotripter at our institution. We retrospectively identified 31 patients who had undergone the SWL after a failed distal ureteroscopy. RESULTS The average stone size in these patients was 9.4 mm, the average time interval from ureteroscopy to SWL was 17.2 days, and the average number of shockwaves delivered was 2386. All patients had had stents placed after ureteroscopy. Twenty-seven patients (87%) had resolution of their stone burden after one SWL session. The remaining four patients underwent additional procedures. CONCLUSIONS Ureteroscopy is an effective modality for the treatment of distal ureteral stones. However, when unsuccessful, a salvage procedure may be necessary. Extracorporeal lithotripsy is a less invasive procedure with comparable success rates in the distal ureter. This report suggests that salvage SWL is an appropriate option for patients in whom distal ureteroscopic stone extraction fails.