John Pendleton

Utility of serial urinary cytology in the initial evaluation of the patient with microscopic hematuria

BackgroundWe determine the utility of serial urinary cytologies in patients presenting with microscopic hematuria who were evaluated with upper and lower urinary tract studies to rule out a malignancy.MethodsTwo hundred and thirty-seven patients with the diagnosis of microscopic hematuria were evaluated at an inner-city tertiary care hospital. Of these 239 patients, 182 patients had 405 cytologies obtained as part of their evaluation for hematuria. In addition, all patients had their lower urinary tract and upper tract thoroughly evaluated.ResultsTwo hundred and seventy four cytology samples were read as normal, 104 (26%) as atypia, 7 (2%) as suspicious/malignant, and 20 (5%) as unsatisfactory. Seventeen patients (9.3%) had biopsy confirmed bladder cancer. Of these 17 patients, 2 had normal cytology, 11 had atypia, and 5 had suspicious/malignant. No patient had a positive cytology and a negative biopsy. Overall the number of hematuric patients harboring bladder cancer was small (7%). Cytology #1 detected 4 cases of cancer, cytology #2 detected an additional case and cytology #3 did not detect any additional cancers.ConclusionBecause of this low prevalence of bladder cancer in patients presenting with microscopic hematuria and the low sensitivity of detecting bladder cancers, the utility of urinary cytology in the initial evaluation of patients with hematuria may be minimal. The exact role of urinary cytology in the evaluation of hematuria is unknown.

Impact of fellowship training on pathologic outcomes and complication rates of radical prostatectomy

The study was conducted to assess the results of radical prostatectomy (RP) performed by fellowship‐trained surgeons in the first year of independent practice.

Prostate Cancer Knowledge and Screening Attitudes of Inner-City Men

Background. We hypothesized that inner-city men are less knowledgeable about prostate health. Methods. The prostate cancer knowledge and screening attitudes of 100 inner-city men (median age 62±11 years) seen at a urology clinic were assessed through a 30-item questionnaire administered before and after an educational intervention. Results. Overall, intervention led to significantly better mean knowledge scores (47% before vs 80% after; P<.0001) but did not affect mean screening attitude scores. Conclusions. Although educational interventions might improve prostate cancer knowledge and screening rates among inner-city men, other approaches must also be considered.

Positive surgical margins at radical prostatectomy: importance of intra-operative bladder neck frozen sections

OBJECTIVE To determine if intraoperative frozen sections of the bladder neck during radical prostatectomy (RP) could decrease the incidence of final positive surgical margins at the bladder neck. MATERIALS AND METHODS This prospective cohort study included 51 consecutive men who underwent anatomic RP at University of Florida & Shands Jacksonville. All patients had intraoperative frozen section of bladder neck sent for analysis. Preoperative, operative, and postoperative data were collected and analyzed. MAIN OUTCOME MEASURES Outcome measures were intraoperative bladder neck margin status, final pathologic bladder neck margin status, and postoperative urinary complications. Median follow-up for the 51 patients was 22 months. RESULTS The final positive surgical margin rate was 20% (10 patients). An additional three patients had positive surgical margins at the bladder neck intraoperatively. These patients then had a wider resection of the affected bladder neck until the frozen sections were negative for cancer or prostatic tissue. Final pathologic evaluation of bladder neck margin was negative for tumor or persistent prostatic tissue in all 51 men. CONCLUSION With intra-operative frozen sections, we were able to obtain a negligible positive bladder neck margin rate. Surgeons who are still on the learning curve for RP should consider intra-operative frozen section of the bladder neck.

The Feasibility of Expectant Management with Inner-city Men with Newly Diagnosed Localized Prostate Cancer

Objective. To determine the compliance rate for treatment recommendations consistent with expectant management of inner-city men with prostate cancer. Methods. Twenty-seven out of 560 men who underwent biopsy of the prostate were found to harbor cancer and opted for expectant management. Clinic and hospital records were reviewed for adherence to follow-up schema. Results. Of the 27 men on expectant management, 22 men (82%) adhered to strict follow-up schema. At 6-month follow-up, there were no significant changes in clinicopathologic features (e.g., prostate specific antigen (PSA), Gleason score, and stage). With a median follow-up of 12 months, only 2 men demonstrated a rise of more than 30% from baseline PSA (repeat biopsy demonstrated persistent low grade, low stage disease). Conclusions. Our findings imply that expectant management may be feasible in inner-city settings. Thus, in subsequent expectant management trials, inner-city men should be actively recruited.

The use of enoxaparin to prevent venous thromboembolism in patients undergoing radical retropubic prostatectomy: feasibility and utility

OBJECTIVE To assess the utility of enoxaparin in prevention of venous thromboembolism (VTE) in men poorly compliant with pneumatic compression stockings (PCS) in the immediate postoperative period after a radical retropubic prostatectomy (RP). MATERIALS AND METHODS This retrospective study included 47 men who underwent RP at an inner-city tertiary care hospital. All patients were started on enoxaparin 40 mg subcutaneously 6-8 hours postoperatively and daily while hospitalized. Preoperative, operative, and postoperative data were collected and analyzed. Median follow-up was 18 months. RESULTS Median patient age was 64 +/- 7 years, median prostate-specific antigen level was 4.9 ng/mL and median prostate biopsy-determined Gleason score was 6. Forty-one men (87%) underwent a pelvic lymph node dissection. Median operative time was 181 minutes (range 164-450 minutes). Median estimated blood loss was 700 mL. Approximately 36% of the men wore PCS the recommended > 19 hours/day. On average PCS were worn 10.3 +/- 7.5 hours/day. Postoperative complications were not increased in this cohort. Two patients developed pulmonary embolism requiring long-term anticoagulation. There were no mortalities. CONCLUSIONS In men non-compliant with PCS, initiation of enoxaparin in the immediate postoperative setting was well-tolerated and maintained a low (4%) rate of VTE. Thus, enoxaparin may be useful in adjunct with PCS in these patients.