Jordan Steinberg

Complications of tension-free vaginal tape surgery: a multi-institutional review

To analyse the complications of tension‐free vaginal tape (TVT) surgery, a minimally invasive alternative for treating patients with stress urinary incontinence (SUI), at six institutions, and to review the management of these complications and their effect on patient outcome.

Active surveillance for selected patients with renal masses: updated results with long-term follow-up.

The objective of the current study was to evaluate the outcome of a surveillance strategy in patients with renal masses.

Utility of Urine Cytology in the Workup of Asymptomatic Microscopic Hematuria in Low-risk Patients

OBJECTIVES To evaluate performance and cost-effectiveness of voided cytology in patients with pure asymptomatic microscopic hematuria (AMH). Although voided cytology has been validated for use in patients with a history of urothelial carcinoma (UC), its use in low-risk patients with AMH is controversial. METHODS A total of 200 consecutive low-risk patients (median age, 64 years) with AMH were referred to the urology clinic between 2005 and 2007. All underwent cystoscopy, upper tract imaging, and voided urinary cytology. Results of voided cytology were classified as positive, atypical, or negative. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and costs were calculated. RESULTS None had positive cytology, 23 (11.5%) had atypical cytology, and 177 (88.5%) had negative urinary cytology. Of 200 patients, 8 (4%) were found to have low-grade UC of bladder via cystoscopy; the cytology was negative in 4 patients and atypical in 4. Of 8, 4 were Ta and 4 were pT1 tumors. There was no upper urinary tract or renal malignancy identified. If atypical cytology was considered as positive, the sensitivity, specificity, PPV, and NPV of cytology were 50%, 90%, 17%, and 98%, respectively. If atypical cytology was considered as negative, the sensitivity, specificity, PPV, and NPV of cytology were 0%, 100%, 0%, and 96%, respectively. Cost of performing urinary cytology was estimated at

Contemporary management of muscle-invasive bladder cancer

262.50 per patient. CONCLUSIONS Although this study supports evaluating patients with AMH because a significant percentage of patients will have UC, voided urine cytology added a significant cost without any diagnostic benefit in the work-up of low-risk patients with AMH.

Can digital rectal examination or transrectal ultrasonography biopsy findings predict the side of nodal metastasis in prostate cancer

Over the past decade, there have been a number of substantial changes in the treatment of invasive bladder cancer. Muscle-invasive bladder cancer is an aggressive disease that often presents at an advanced stage with or without distant metastases. The potential for cure is highest when the disease is confined to the bladder. Optimal management depends on our understanding of disease biology, refinements to our clinical staging, and improvements in the quality of treatment. This review will focus on the contemporary management of muscle-invasive urothelial carcinoma of the bladder and will discuss the role of radical cystectomy, extended lymphadenectomy, neoadjuvant/ adjuvant chemotherapy, and various forms of bladderpreservation strategies.

Prospective analysis of sensitivity and specificity of urinary cytology and other urinary biomarkers for bladder cancer.

PURPOSE To assess the use of several preoperative parameters in predicting the side of pelvic lymph node metastasis in patients with prostate cancer. MATERIALS AND METHODS A retrospective chart review (January 1982 to February 2004) identified 106 men with pathology proven lymph node positive prostate cancer for whom complete medical records were available. RESULTS The median serum prostate-specific antigen at diagnosis was 11 ng/ml with the clinical stage T1C in 9 patients, T2 in 68, and T3 in 29. The Gleason score on transrectal ultrasonography (TRUS) biopsy was < or =6 in 13, 7 in 41, and > or =8 in 52. A total of 93 patients had documented pretreatment digital rectal examination (DRE) findings: 54 had a unilaterally suspicious DRE, and 31 had a bilaterally suspicious DRE. Of patients with a unilaterally positive DRE, 30 had ipsilateral lymph node metastasis, 16 contralateral, and 8 bilateral. DRE showed a 71% sensitivity and 29% false-negative rate in predicting the side of nodal metastasis. A total of 98 patients had documented TRUS biopsy findings: 37 had unilaterally positive TRUS biopsies and 61 bilaterally positive biopsies. Of patients with unilaterally positive TRUS biopsies, 20 had ipsilateral lymph node metastasis, 11 contralateral, and 6 bilateral. TRUS biopsies showed an 86% sensitivity and 14% false-negative rate in predicting the side of nodal metastasis. CONCLUSIONS DRE and TRUS biopsies do not accurately predict the side of pelvic lymph node metastasis and should not determine the extent of the pelvic lymphadenectomy.