Brett A. Laven

Impact of surgical margin status on long-term cancer control after radical prostatectomy.

To determine whether previously described technical modifications that significantly decreased the positive surgical margin (PSM) rate have translated into improved long‐term cancer control, as SM status is generally recognized as an independent risk factor for biochemical recurrence (BR) after radical retropubic prostatectomy (RRP), and is the only factor that can be modified by surgical technique.

Birth Weight, Abdominal Obesity and the Risk of Lower Urinary Tract Symptoms in a Population Based Study of Swedish Men

PURPOSE Lower urinary tract symptoms and obesity are prominent health problems. Low birth weight increases the adult risk of adiposity and insulin resistance, which may increase sympathetic activity and potentially lower urinary tract symptoms. Results of obesity and lower urinary tract symptoms studies are conflicting, and low birth weight and lower urinary tract symptoms relationships have not been investigated. MATERIALS AND METHODS This cross-sectional study examines lower urinary tract symptoms, body measures, activity, birth weight and lifestyle data collected by questionnaire from 1997 to 1998. Overall 27,858 men were analyzed and odds ratios calculated after excluding those with cancer, cerebrovascular accident, diabetes and incomplete information. RESULTS After adjustment for age, activity level, smoking, alcohol, coffee intake and body mass index, a significant positive association was seen between abdominal obesity (waist-to-hip ratio) and moderate to severe lower urinary tract symptoms. The risks of moderate to severe and severe lower urinary tract symptoms were 22% (95% CI 1.09-1.37) and 28% (95% CI 1.01-1.63) higher, respectively, for the top vs the lowest abdominal obesity quartile. The risk of nocturia (twice or more per night) was 1.16 (95% CI 1.02-1.33) in men in the top compared to the bottom waist-to-hip ratio quartile. Men with low birth weight (less than 2,500 gm) had a 61% (95% CI 1.12-2.30) higher risk of severe lower urinary tract symptoms compared to men with normal birth weight (2,500 to 3,999 gm). Men in the top waist-to-hip ratio quartile who had low birth weight had twice the risk of severe lower urinary tract symptoms (95% CI 1.29-3.02) compared to men with normal birth weight and in the lowest waist-to-hip ratio quartile. CONCLUSIONS Low birth weight and abdominal adiposity are associated with increased risk of moderate to severe lower urinary tract symptoms in adults. Further investigations are needed to determine if decreases in obesity can ameliorate lower urinary tract symptoms.

Detection of alpha-methylacyl-coenzyme A racemase in postradiation prostatic adenocarcinoma

OBJECTIVES To assess the utility of alpha-methylacyl-coenzyme A racemase (AMACR), also known as P504S, immunohistochemistry in the detection of postradiation prostatic adenocarcinoma in surgical specimens. Pathologic diagnosis of postradiation prostate cancer is difficult because of the radiation-induced cytologic changes in benign and malignant epithelial cells. AMACR/P504S is a recently identified molecular marker for prostatic adenocarcinoma. It has been demonstrated that AMACR is overexpressed in the vast majority of prostatic adenocarcinoma cases by cDNA microarray, RNA analysis, Western blotting, and immunohistochemistry. METHODS A total of 80 prostate glands, including 40 irradiated prostate specimens (28 with adenocarcinoma and 12 benign prostates) and 40 nonirradiated prostate specimens (20 with adenocarcinoma and 20 benign prostates), were examined. The specimens were obtained after salvage radical prostatectomy (n = 25), transurethral resection (n = 4), or needle biopsy (n = 11). All samples were immunohistochemically analyzed for AMACR. RESULTS All 48 carcinoma cases (28 of 28 irradiated and 20 of 20 nonirradiated specimens) showed strongly positive AMACR/P504S immunostaining. AMACR immunostaining was negative for all irradiated (n = 12) and nonirradiated (n = 20) benign prostates, as well as the irradiated benign glands adjacent to carcinoma. 34betaE12 confirmed the presence of basal cells in all benign prostates (32 of 32) and the absence of basal cells in carcinoma (0 of 48). CONCLUSIONS Our results demonstrate that AMACR is a highly specific and sensitive indicator of postradiation prostate cancer. AMACR immunostaining facilitates the challenging differentiation between prostatic adenocarcinoma and radiation-induced atypia in benign prostatic epithelium and may be of exceptional value in limited needle biopsies.

Nonsurgical management of benign prostatic hyperplasia in men with bladder calculi

OBJECTIVES To assess the outcome of men with bladder calculi who did not undergo transurethral resection of the prostate after endoscopic stone removal. Bladder calculi associated with benign prostatic hyperplasia (BPH) have historically been an absolute indication for transurethral resection of the prostate. METHODS A retrospective analysis of the results of 23 men who underwent endoscopic removal of bladder calculi with subsequent medical management of BPH symptoms was performed. Inclusion criteria included men with bladder stones secondary to BPH, serum creatinine 1.6 mg/dL or less, no evidence of hydronephrosis, and no history of acute urinary retention or neurogenic bladder. The International Prostate Symptom Score and postvoid residual urine volume before and after treatment and the incidence of bladder stone recurrence and associated complications were recorded. All patients were treated with either an alpha-receptor blocker or alpha-receptor blocker and finasteride after bladder stone removal. RESULTS The follow-up after endoscopic removal of the bladder calculi averaged 30.0 months (range 6 to 96). The International Prostate Symptom Score before and after treatment was 18.3 and 9.4 (P <0.01), respectively. The postvoid residual urine volume before and after treatment was 354 and 179 mL (P <0.01), respectively. Urinary tract infection, acute urinary retention, recurrent calculi, chronic renal insufficiency, or renal failure developed in 21.7% (n = 5), 17.4% (n = 4), 17.4% (n = 4), 4.3% (n = 1), and 0% (n = 0) of the 23 men, respectively. Overall, 18 (78%) did not have any complications. CONCLUSIONS Many men with bladder stones can be successfully and safely treated with transurethral stone removal and medical management of BPH.

A pilot study of ice‐slurry application for inducing laparoscopic renal hypothermia

To assess, in a pilot study, the feasibility of delivering a microparticulate ice slurry (MPS) to provide regional hypothermia, as renal cooling during laparoscopic procedures is cumbersome and inefficient.

Recurrent Giant Cell Carcinoma Of The Bladder

Primary nonurothelial tumors of the bladder are rare, accounting for less than 1% of all bladder cancers.1 To date only 3 cases of osteoclast-like giant cell tumors of the bladder have been reported in the literature.2, 3 Each of these cases was successfully treated with transurethral resection, without evidence of recurrence. To our knowledge we report the first case of recurrent giant cell carcinoma of the bladder.

Do Omega-3 Dietary Fatty Acids Lower Prostate Cancer Risk? A Review of the Literature

Prostate cancer mortality rates vary widely around the world. Studies on the effects of environment, nutrition and migration on prostate cancer rates suggest that diet plays a pivotal role in the development of the disease. Animal and in vitro studies on prostate cancer indicate that omega (ω)-3 fatty acids, especially the long-chain polyunsaturated fatty acids (PUFA), inhibit carcinogenesis. Conversely, there is salient evidence that (ω)-6 PUFA such as linoleic acid (LA) and arachidonic acid (AA) increase prostate cancer risk. The main sources of human dietary long-chain (ω)-3 PUFA are fatty fish and fish oils. To date, however, epidemiological findings on fatty fish consumption and prostate cancer risk have been inconclusive. A possible mechanism for the anticarcinogenic effect of (ω)-3 PUFA is the suppression of AA-derived eicosanoid biosynthesis, whereby (ω)-3 PUFA compete with (ω)-6 PUFA for enzymes in parallel pathways of eicosanoid synthesis, thus decreasing the production of (ω)-6-derived, tumor-promoting eicosanoids in favour of anti-inflammatory, 3-series eicosanoids. In the present review, we present current knowledge on the association between omega (ω)-3 PUFA and prostate cancer risk.

Necrotic Pancreatic Graft Causing Acute Urinary Retention

Urologic complications are frequently encountered after pancreas transplantation with a graft duodenocystostomy. Urinary infections, hematuria, and irritative voiding symptoms are some of the most frequent complications with a bladder-drained pancreas allograft. While voiding dysfunction is common in these patients due to underlying neuropathy, to our knowledge, we report the first case of obstructive uropathy in a female due to retained necrotic graft material.