Christopher R. Mitchell

Operational Characteristics of 11C-Choline Positron Emission Tomography/Computerized Tomography for Prostate Cancer with Biochemical Recurrence After Initial Treatment

PURPOSE We examined the performance of (11)C-choline positron emission tomography/computerized tomography for its ability to delineate prostate cancer distribution and extent after initial therapy. MATERIALS AND METHODS A consecutive series retrospective review was performed of all patients with prostate cancer who were evaluated using (11)C-choline positron emission tomography/computerized tomography from September 2007 to November 2010 at the Mayo Clinic. Statistical analysis was performed to determine the sensitivity, specificity, positive predictive value, negative predictive value and prostate specific antigen threshold for the detection of recurrent lesions. RESULTS In the study period 176 patients with biochemical recurrence after primary treatment failure underwent (11)C-choline positron emission tomography/computerized tomography. Using patient based analysis (11)C-choline positron emission tomography yielded a sensitivity, specificity, positive predictive value and negative predictive value of 93%, 76%, 91% and 81%, respectively. Of the 176 positron emission tomography/computerized tomography scans performed 56 (32%) were deemed clinically useful as defined by the ability to identify lesions not delineated using conventional imaging, thereby prompting changes in clinical management. The optimal prostate specific antigen for lesion detection was 2.0 ng/ml. On multivariate analysis prostate specific antigen at positron emission tomography (HR 1.37, p = 0.04) and clinical stage at initial diagnosis of prostate cancer (HR 5.19, p = 0.0035) were significant predictors of positive (11)C-choline positron emission tomography/computerized tomography. CONCLUSIONS (11)C-choline positron emission tomography/computerized tomography performs well in men with biochemical recurrence after primary treatment failure. The optimal prostate specific antigen value for lesion detection is approximately 2.0 ng/ml. We found that (11)C-choline positron emission tomography/computerized tomography substantially enhances the rate of prostate cancer lesion detection by approximately 32% beyond what can be garnered using conventional imaging techniques and at a lower prostate specific antigen value.

20‐year survival after radical prostatectomy as initial treatment for cT3 prostate cancer

Study Type – Therapy (case series)

Renal Function Outcomes in Patients Treated With Partial Nephrectomy Versus Percutaneous Ablation for Renal Tumors in a Solitary Kidney

PURPOSE Partial nephrectomy is the recommended management for small renal masses. Percutaneous ablation is safe and effective with comparable short-term cancer specific survival. Currently to our knowledge data are lacking on the impact of thermal ablation on renal function preservation. We examined the impact on renal function of partial nephrectomy vs percutaneous ablation in patients with a solitary kidney. MATERIALS AND METHODS We performed a retrospective review to identify patients with a solitary kidney who underwent partial nephrectomy or percutaneous ablation at Mayo Clinic Rochester between 2003 and 2009. Preoperative characteristics and 3-month posttreatment renal function were compared using the Wilcoxon rank sum, chi-square and Fisher exact tests. RESULTS During the study period 50 patients underwent percutaneous ablation and 62 underwent partial nephrectomy. At partial nephrectomy no ischemia was used in 30 cases (48%), a median of 28 minutes of cold ischemia was used in 26 (42%) and a median of 18 minutes of warm ischemia was used in 6 (10%). Patients who underwent partial nephrectomy were younger (median age 62.5 vs 68.5 years, p = 0.01) and harbored larger tumors (median 3.5 vs 2.5 cm, p = 0.005) with higher nephrometry scores (median 9 vs 7, p = 0.03). At 3-month posttreatment followup no differences were noted between the 2 groups in glomerular filtration rate (p = 0.91), change in glomerular filtration rate (p = 0.77) or change in chronic kidney disease stage (p = 0.87). Similar results were observed when adjusting for age, tumor size and nephrometry score on multivariate analysis. CONCLUSIONS With judicious use of ischemia partial nephrectomy, even for more complex tumors, has short-term renal function outcomes similar to those of percutaneous ablation.

Efficacy of Holmium Laser Enucleation of the Prostate in Patients With Non-neurogenic Impaired Bladder Contractility: Results of a Prospective Trial

OBJECTIVE To examine the outcomes of men with detrusor underactivity or acontractility undergoing holmium laser enucleation of the prostate (HoLEP). METHODS A prospective case series between 2009 and 2012 was performed to examine short-term outcomes of men with urodynamic evidence of detrusor hypocontractility or acontractility because of a non-neurogenic etiology and concurrent benign prostatic obstruction (BPO), undergoing HoLEP. RESULTS Fourteen patients with detrusor hypocontractility and 19 patients with acontractility and evidence of BPO underwent HoLEP during the study period. Median age was 71.5 and 75 years, respectively. Preoperatively, 5 (35.7%) men with hypocontractility and 19 (100%) men with acontractility had catheter-dependent urinary retention for a median of 3 and 9 months, respectively. At a median follow-up of 24.7 months, all 5 (100%) men with hypocontractility and 18 of 19 (94.7%) men with acontractility were voiding spontaneously without the need for intermittent catheterization. Individuals with hypocontratile bladders had statistically significant improvements in American Urological Association Symptom Index (21.5 vs 3; P = .014), maximum urine flow (Qmax, 10 vs 21 mL/s; P = .001), and postvoid residual (250 vs 53 mL; P = .007) from baseline to postoperative assessments. In patients with an acontractile bladder, 15 of 19 (78.9%) displayed significant return of detrusor contractility, whereas 4 of 19 (21.1%) were voiding exclusively by Valsalva effort on follow-up urodynamic study. Postoperatively, patient satisfaction, as ascertained by American Urological Association Symptom Index, was high for both groups. CONCLUSION Intermediate follow-up results indicate that HoLEP is a viable management option for men with BPO and detrusor hypocontractility. Furthermore, detrusor acontractility does not appear to adversely affect postoperative results, with return of spontaneous urination and demonstration of detrusor contractility allowing for efficient voiding, in over 95% of patients.

Does body mass index "dilute" the predictive property of prostate-specific antigen for tumor volume at radical prostatectomy?

OBJECTIVE To evaluate the effect of the body mass index (BMI) as it relates to the predictive value of the preoperative prostate-specific antigen (PSA) level regarding the tumor volume at radical prostatectomy. Stage migration with the widespread use of PSA screening is well documented; however, the association between the PSA level and tumor volume is less defined. Additionally, the effect of obesity on the serum PSA level might cause relative hemodilution and account for the decreased predictive ability of the PSA level to determine the tumor volume in the modern era. METHODS We identified 14 293 patients who had undergone radical prostatectomy for prostate cancer from 1987 to 2007 and had a documented BMI. Using the clinicopathologic variables, we examined the relationship among the BMI, preoperative PSA level, and tumor volume at radical prostatectomy using multiple linear regression analysis. RESULTS An elevated BMI was associated with an increased pathologic Gleason score (P < .0001), increased tumor volume (P < .0001), and increased prostate size (P < .0001). The preoperative PSA level correlated significantly with the tumor volume (P < .0001). No significant correlation was found between the BMI and preoperative PSA level (P = .39). On multivariate analysis, controlling for the BMI, the preoperative PSA level remained a significant predictor of the tumor volume (P < .0001). The interaction between the preoperative PSA level and BMI in the prediction of the tumor volume was not statistically significant (P = .56), suggesting that the BMI does not affect the association between the PSA level and tumor volume. CONCLUSION Our results have shown that the predictive ability of the PSA level for tumor volume is not affected by the BMI. There does not appear to be a need to correct the serum PSA level in relation to the BMI when used in preoperative prediction models of the tumor volume.

Holmium laser enucleation (HoLEP) and photoselective vaporisation of the prostate (PVP) for patients with benign prostatic hyperplasia (BPH) and chronic urinary retention.

To evaluate short‐term outcomes of holmium laser enucleation of the prostate (HoLEP) and photoselective vaporisation of the prostate (PVP) in patients with benign prostatic hyperplasia (BPH) and chronic urinary retention (CUR).

MP28-17 LUBRIGLIDE SEQUENTIAL URETERAL DILATORS®: A SAFE AND EFFECTIVE METHOD OF URETERAL DILATION TO FACILITATE PRIMARY URETEROSCOPIC INTERVENTION.

during procedures. However none of the studies in the literature have shown the effect of the ureterorenoscopy on renal hemodynamics objectively. In this study we presented our preliminary results of an ongoing study about the renal artery Doppler ultrasonography findings of patients who underwent flexible ureterorenoscopy for kidney stone. METHODS: Patients with kidney stone and designated for retrograde intrarenal surgery (RIRS) with flexible ureterorenoscopy included the study. Renal artery Doppler ultrasonography were done to all patients before anesthesia induction on the operation table and 24 hours later after procedure. Peak systolic velocity (PSV), end diastolic velocity (ESV) and resistive index (RI) measurements were compared statistically. Wilcoxon sum rank test was used to evaluate preand postRIRS renal artery Doppler measurements. RESULTS: A total of 18 patients included the study. Demographic and clinical variables of the patients were presented in Table-1. There were no statistical differences between pre and postRIRS measurements of kidney hemodynamics (Table-2). CONCLUSIONS: RIRS is a minimal invasive treatment method of kidney stone. Our preliminary results showed that renal hemodynamics are not being affected of stone treatment with RIRS procedure.

Percutaneous Nephrolithotomy for a 2,8-Dihydroxyadenine Stone in a Horseshoe Kidney

Abstract Introduction: A 30-year-old healthy man presented for evaluation of a 6-month history of left-sided flank pain and microscopic hematuria. Work-up revealed a large stone of low attenuation within the left renal moiety of a horseshoe kidney. Additionally, dual-energy computed tomography (CT) scanning was performed to characterize the stone preoperatively. Materials and Methods: The patient was taken to the operating room for percutaneous nephrolithotomy. The stone was unable to be reached with the rigid nephroscopy, and flexible nephroscopy was performed. This revealed a large stone floating within the renal pelvis. The stone was noted to be round and red, and have an irregular textured appearance. The stone was first fragmented using the holmium laser and subsequently with ultrasonic lithotripsy where fragments could be reached. Once all fragments were removed, the collecting system was inspected and papillary biopsies were obtained. Results: Gross examination demonstrated a uniform rough surface ...