Justin Parker

Current and emerging bladder cancer urinary biomarkers.

Bladder cancer continues to be one of the most common malignancies. Those who have been already diagnosed are at high risk for recurrence, especially if the pathology demonstrates high-grade disease. Diagnosis and surveillance is reliant on invasive evaluation with cystoscopy. Urinary cytology has been used to aid in diagnosis, but its use is limited. Other assays have been developed that may aid in clinical decision making. The ultimate goal will be the development of a highly sensitive and specific urinary marker for bladder cancer. This would provide a noninvasive means of diagnosing the disease and limit the number of unnecessary cystoscopies. This article will review the currently available urinary bladder cancer markers. It will also review new and investigational urinary markers that have shown promise for future clinical use.

Penile Rehabilitation: The Evolutionary Concept in the Management of Erectile Dysfunction

A compromise in erectile function is commonly experienced after radical prostatectomy and has been attributed to injury to vascular, neurogenic, and smooth muscle. The concept of rehabilitation after organ injury is not a novel concept and is one that has been applied to all aspects of medicine. Penile rehabilitation has been classically defined as the use of a device or pharmacologic agent to aid erectile function recovery after radical prostatectomy. Here we redefine penile rehabilitation as the use of any device, medication, or intervention to promote male sexual function as a primer before and after any insult to the penile erectile physiologic axis. We also review the epidemiology, rational and current literature on penile rehabilitation after prostatectomy.

Tips and Tricks of Inflatable Penile Prosthesis Reservoir Placement: A Case Presentation and Discussion

INTRODUCTION There have been many advances in the inflatable penile prosthesis (IPP) since the 1970s. While these devices were initially fraught with mechanical malfunction, the most recent models prove to be much more reliable. Although reservoir complications are not common, when they do occur, it typically involves damage to the surrounding tissues. The ability to recognize and treat these complications is paramount for any surgeon that routinely places IPPs. AIM The aim of this article was to present a unique reservoir-related complication as well as perform a literature review of reservoir-related complications and techniques for reservoir placement, and provide a summary of dimensions and technical aspects of commonly used reservoirs. METHODS We reviewed a unique reservoir-related complication that presented to our institution with urinary retention and constipation. We also reviewed reservoir-related complications since 1984, reviewed the most recent surgical techniques involved in reservoir placement, and summarized the dimensions and technical characteristics of both the American Medical System and Coloplast reservoirs. MAIN OUTCOME MEASURE A reservoir-related complication that resulted in urinary retention and constipation is the main outcome measure. RESULTS Although uncommon, reservoir complications do occur. The most common case report complication in the published literature is bladder erosion followed by external iliac compression, ileal conduit erosion, and small bowel obstruction. The case that presented at our institution was the result of a reservoir that was improperly placed in the perineum, causing urinary retention and constipation due to the compression of the bulbar urethra and rectum. CONCLUSIONS In this era, mechanical failures of IPP reservoirs are rare as most complications occur due to damage of the surrounding tissues. Prevention, diagnosis, and treatment of these complications are important for any surgeon that implants IPPs.

Advancements in the Management of Urologic Chronic Pelvic Pain: What is New and What Do We Know?

Prostatitis is one of the most common urologic diagnoses in men of all ages. The etiology of this problem remains poorly understood. No uniform solitary treatment is known for chronic prostatitis. As a result, a multimodal approach is most likely to demonstrate benefit for this disease. Various treatment modalities have included the use of both pharmacologic and nonpharmacologic treatments. In addition, multiple interventional techniques including the injection of botulinum toxin, transurethral needle ablation of the prostate, microwave thermotherapy, neuromodulation, and, most recently, extracorporeal shockwave therapy have been utilized with varying degrees of benefit.

A Novel Approach for the Treatment of Radiation-Induced Hemorrhagic Cystitis with the GreenLight ™ XPS Laser

ABSTRACT Introduction: The treatment of pelvic malignancies with radiotherapy can develop severe sequelae, especially radiation-induced hemorrhagic cystitis. It is a progressive disease that can lead to the need for blood transfusion, hospitalizations, and surgical interventions. This tends to affect the quality of life of these patients, and management can at times be difficult. We have evaluated the GreenLight Xcelerated Performance System (XPS) with TruCoag, although primarily used for management of benign prostatic hypertrophy (BPH), for the treatment of radiation-induced hemorrhagic cystitis. Materials and Methods: After International Review Board (IRB) approval, a retrospective chart review was performed in addition to a literature search. A series of four male patients, mean age of 81 years, with radiation-induced hemorrhagic cystitis secondary to radiotherapy for pelvic malignancies (3 prostate cancer, 1 rectal cancer) were successfully treated with the GreenLight laser after unsuccessful treatment with current therapies described in the literature. Results: All four patients treated with the GreenLight laser had resolution of their hematuria after one treatment and were discharge from the hospital with clear urine. Conclusion: The GreenLight XPS laser shows promising results for the treatment of patients with radiation-induced hemorrhagic cystitis, and deserves further evaluation and validation, especially since there is limited data available in the literature regarding the use of this technology for the treatment of this devastating condition.

Superficial Dorsal Vein Injury/Thrombosis Presenting as False Penile Fracture Requiring Dorsal Venous Ligation

Introduction Conditions mimicking penile fracture are extremely rare and have been seldom described. Aim To describe a patient with false penile fracture who presented with superficial dorsal vein injury/thrombosis managed with ligation. Methods A 33-year-old male presented with penile swelling and ecchymosis after intercourse. A penile ultrasound demonstrated a thrombosed superficial dorsal vein but also questionable fracture of the tunica albuginea. As the thrombus was expanding, he was emergently taken to the operating room for exploration and required only dorsal venous ligation. Results Postoperatively, patients Sexual Health Inventory for Men score was 23, and he had no issues with erections or sexual intercourse. Conclusion Early exploration of patients with suspected penile fracture provides excellent results with maintenance of erectile function. Also, in the setting of dorsal vein thrombosis, ligation preserves the integrity of the penile tissues and avoids unnecessary complications from conservative management. Rafiei A, Hakky TS, Martinez D, Parker J, and Carrion R. Superficial dorsal vein injury/thrombosis presenting as false penile fracture requiring dorsal venous ligation.

A History of the Penile Implant to 1974

Impotence has plagued mankind for over a millennium. One of the earliest references on record was found in India, in the Sushruta Samhita, around the eighth century BC. Historically, it was an ailment believed to have its roots in psychogenic, religious, and supernatural etiologies. Therefore, the treatment of impotence involved the use of potions, aphrodisiacs, ointments, and prayers, which to this day still play a large role in certain cultures. This mindset of impotence secondary to non-organic causes remained the mainstay in the scientific community until well into the 20th century. In fact, in the early to mid-1900s, psychologists or psychiatrists treated impotence more than 95% of the time, often with the use of empiric treatment with testosterone. As David Stafford-Clark, described in his article, “The Etiology and Treatment of Impotence,” published in 1954, “A dogmatic, but reasonably safe generalization would be that at least 90% of all cases of impotence, relative or complete, are psychogenic in origin.” Before 1974, very few urologists were involved in the management and treatment of erectile dysfunction (ED), because the underlying pathophysiology of impotence remained to be elucidated.

Suspected Penile Fracture After Xiaflex Injection and Use of a VED

CLINICAL PRESENTATION A62-year-old Caucasian man presented to the emergency department for evaluation of penile pain and swelling. The patient had a history of Peyronie’s disease and elected to undergo collagenase clostridium histolyticum (CCH) injections in an effort to decrease his approximately 40° leftward phallic curvature. The patient had received multiple cycles of treatment and most recently finished cycle number 3, injection 2. Two days after this injection, in direct violation of the recommendations from the treating urologist, the patient used a vacuum erection device (VED) on the left lateral aspect of his penis, which caused the sudden onset of stabbing pain and eventual detumescence. The patient’s symptoms ultimately prompted the patient to present to the hospital 7 days after the injury. During that week, the patient had increasing penile swelling and ecchymosis. The patient did have 3 nocturnal erections over this time, but described each event as painful and achieving only partial rigidity. At the time of presentation to the hospital, the patient’s physical examination revealed swelling and significant ecchymosis of the phallus extending into the penoscrotal area (Fig. 1). The bruising affected the patient’s glans penis and discolored the right side of his penis more than the left. On the left lateral midshaft of the patient’s phallus, however, there was a tender, mobile, indurated mass with overlying ecchymosis most consistent with a subcutaneous hematoma. There was no blood per urethra and the patient denied hematuria. Given the patient’s history and physical examination, high concern was raised for a penile fracture vs a penile hematoma. Discordant factors for a corporal rupture in the clinical history were the slow loss of erection at the time of injury and the spontaneous partial erections the patient had experienced since the incident. Considering the confounding factors above, magnetic resonance imaging (MRI) was utilized to further elucidate the extent of the patient’s injury. An MRI of the pelvis without contrast was obtained, which revealed a focal disruption along the ventrallateral aspect of the left tunica albuginea (Fig. 2). The defect measured 1.1 cm in length and was associated with a small overlying hematoma in the same area where the patient had received his CCH injection and used his VED. The underlying corpus cavernosa appeared otherwise normal; the tunica albuginea on the right appeared normal without disruption. No urethral injury was identified and the urinary bladder was normal.

A Rare Case of the Simultaneous, Multifocal, Metastatic Renal Cell Carcinoma to the Ipsilateral Left Testes, Bladder, and Stomach.

We describe the rare case of a 68-year-old gentleman with the history of a hand-assisted laparoscopic left radical nephrectomy for a T2bN0M1 clear cell renal cell carcinoma (RCC). Seven years after surgery and with clean surveillance imaging for metastasis/recurrence the patient presented with three separate tumors suspicious for malignancy. A bladder lesion was found during workup for hematuria, a stomach lesion during diagnostic endoscopy, and a testicular lesion during self-exam. He underwent transurethral resection of bladder tumor, left inguinal orchiectomy, and upper endoscopic ensnarement. All specimens surprisingly showed RCC by histology and immunostaining. These three sites are rare for RCC metastasis and simultaneous presentation is even rarer, further emphasizing the importance of continuous and careful follow-up in this patient population, despite what could appear as complete remission.

A large cellular angiofibroma of the male pelvis presenting with obstructive voiding: A case report and review of the literature

Cellular angiofibromas (CAF) are rare, benign soft-tissue tumours. The diagnosis of CAF is important given the heavy resemblance to other tumours. Herein, we describe a case of a rapidly growing, very large (13.5 cm) CAF located in the deep pelvis of a middle-aged male who presented with difficulty voiding.