Paul K. Hegarty

What surgical resection margins are required to achieve oncological control in men with primary penile cancer

To evaluate the surgical excision margin required for local oncological control in primary penile cancers, as patients with penile cancer who undergo radical amputation suffer marked psychological, functional and cosmetic sequelae, and although organ‐sparing surgery has improved the quality of life of these men, the optimum surgical excision margin to achieve oncological control is unknown.

ICUD-EAU international consultation on bladder cancer 2012: Screening, diagnosis, and molecular markers

CONTEXT AND OBJECTIVE To present a summary of the 2nd International Consultation on Bladder Cancer recommendations on the screening, diagnosis, and markers of bladder cancer using an evidence-based strategy. EVIDENCE ACQUISITION A detailed Medline analysis was performed for original articles addressing bladder cancer with regard to screening, diagnosis, markers, and pathology. Proceedings from the last 5 yr of major conferences were also searched. EVIDENCE SYNTHESIS The major findings are presented in an evidence-based fashion. Large retrospective and prospective data were analyzed. CONCLUSIONS Cystoscopy alone is the most cost-effective method to detect recurrence of bladder cancer. White-light cystoscopy is the gold standard for evaluation of the lower urinary tract; however, technology like fluorescence-aided cystoscopy and narrow-band imaging can aid in improving evaluations. Urine cytology is useful for the diagnosis of high-grade tumor recurrence. Molecular medicine holds the promise that clinical outcomes will be improved by directing therapy toward the mechanisms and targets associated with the growth of an individual patients tumor. The challenge remains to optimize measurement of these targets, evaluate the impact of such targets for therapeutic drug development, and translate molecular markers into the improved clinical management of bladder cancer patients. Physicians and researchers eventually will have a robust set of molecular markers to guide prevention, diagnosis, and treatment decisions for bladder cancer.

Port-site Hernias Occurring After the Use of Bladeless Radially Expanding Trocars

OBJECTIVES To compare and review the incidence of port-site hernias after use of bladeless radially dilating trocars after noticing a unique hernia entity developing in some patients. A review of the relevant published data is presented. METHODS We retrospectively identified patients who were diagnosed or treated for postoperative hernias at our institution between 2004 and 2007 using a departmental morbidity database. All patients had laparoscopic urologic surgery for malignant conditions using bladeless radially dilating trocars. RESULTS Of 1055 consecutive patients who underwent laparoscopic urologic oncology surgery between 2004 and 2007, a total of 7 patients (0.66%) were identified with trocar-site hernias. All hernias occurred using 12-mm bladeless radially dilating trocars without fascial closure. All hernias were confirmed by computed tomography of the abdomen and 6 by surgical findings. Of the 7 patients, 4 had an intrafascial incisional hernia; the small bowel herniated through a defect in the transversalis and internal oblique fasciae, but the external oblique fascia was intact. The intrafascial hernias were not evident on physical examination owing to an intact external oblique fascia. CONCLUSIONS While rare, trocar-site herniation after use of bladeless radially dilating trocars is a potentially serious complication of laparoscopic surgery. A large proportion of these may be partial-wall or intrafascial hernias. It is important to increase awareness among laparoscopic surgeons of the possibility of intrafascial incisional hernias, as physical findings are subtle and early computed tomography diagnosis is necessary for timely surgical intervention.

Erectile function after posterior urethroplasty for pelvic fracture‐urethral distraction defect injuries

To determine the specific effect of pelvic fracture‐urethral distraction defect (PFUDD) injuries on erectile function (EF) in men after pelvic fractures, and to compare EF to that found in other studies of men who sustained pelvic fractures, as currently the relationship between erectile dysfunction (ED) and PFUDD has not been elucidated using validated questionnaires.

Priming prostate carcinoma cells for increased apoptosis is associated with up-regulation of the caspases.

The potential to prime prostatic carcinoma cell lines for apoptosis represents an exciting strategy for the treatment of patients with this disease. The ability and the underlying molecular mechanisms involved in sensitizing both androgen‐sensitive and androgen‐insensitive cell types to a range of apoptotic‐inducing agents are investigated by the authors.

Contemporary management of penile cancer

The standard of treatment of penile cancer is to cure patients without functional or cosmetic compromise in most cases. In the UK, the National Institute for Clinical Excellence recommends the management of penile cancer in centres receiving 25 new cases annually, or covering a population of 4 million. Supra-regional penile cancer centres must be able to offer curative and palliative multidisciplinary treatment, including access to reconstructive surgery. In this article we review the current understanding and management of penile cancer.

Penile cancer: organ-sparing techniques

To compare the oncological safety of treating patients with penile cancer with conservative techniques developed to preserve function, cosmesis and psychological well‐being with more radical ablative strategies.

Primary prevention and vaccination for penile cancer

The outcome of penile cancer is proportional to the stage at presentation. Strategies aimed at primary prevention would have a clear advantage, both for the individual and in terms of health economics. A number of preventative measures could be employed, including circumcision, smoking cessation, education on hygiene and human papillomavirus (HPV) prevention. There is a high prevalence of HPV infection associated with penile cancer worldwide. The recent development of HPV vaccines has facilitated interest in their use for the prevention of penile cancer. In this article we review the literature surrounding penile cancer prevention and HPV vaccination in men.

A Prospective Study of Total Glans Resurfacing for Localized Penile Cancer to Maximize Oncologic and Functional Outcomes in a Tertiary Referral Network

Purpose: Penile cancer is a rare malignancy worldwide, representing only 1% of all cancers affecting men. There are little data outlining the comparative effectiveness of penile preservation techniques and to our knowledge no guidelines regarding their use currently exist. Outcomes data reporting is nonstandardized and followup is not measured consistently. The aim of this study was to analyze the outcomes of total glans resurfacing in terms of oncologic control, form and function in localized penile cancer. Materials and Methods: From 2013 to 2015, 19 prospectively enrolled patients underwent total glans resurfacing. Demographics, cosmesis, patient satisfaction and disease recurrence were assessed at followup to quantify oncologic and functional outcomes. At 3 months of followup patients completed the IIEF (International Index of Erectile Function) questionnaire detailing erectile and sexual function, and general satisfaction using a visual analog scale. All statistical analysis was performed with Prism® 6. Results: No perioperative complications were experienced. Of the patients 94.7% had complete graft take with a median cosmesis score of 5 of 5 on the visual analog scale. There was 1 local and no regional nodal recurrence at a mean followup of 23 months. One‐year progression‐free and overall survival rates were 100% and the 1‐year recurrence‐free survival rate was 95%. Of the patients 81% reported an improved sex life postoperatively. Conclusions: Total glans resurfacing is a viable and acceptable option for glans preservation in patients with localized penile cancer. It demonstrates acceptable functional and oncologic outcomes. We believe that total glans resurfacing should be considered in all cases of localized penile cancer.

Effects of Cyclic Stretch On Prostatic Cells in Culture

PURPOSE The fundamental process in the development of benign prostatic hyperplasia (BPH) is a loss of homeostasis between cell proliferation and apoptosis. Prostatic smooth muscle cells contract under adrenergic control. The response of a cell to stretch may have a role in the pathogenesis of BPH. MATERIALS AND METHODS Monolayer cultures of human prostatic stromal and epithelial cell lines were exposed to cyclic stretch for 48 hours. RESULTS Cyclic stretch conferred resistance to etoposide induced apoptosis. Underlying this apoptotic resistance was increased expression of the anti-apoptotic Bcl-2 family of proteins. As measured by thymidine incorporation, the rate of proliferation also increased in benign epithelial cells under cyclic stretch conditions. Furthermore, an increase in the production of platelet-derived growth factor by stromal cells and transforming growth factor-beta by epithelial cells occurred under such conditions. CONCLUSIONS The observed changes in proliferation and apoptosis may contribute to the understanding of BPH, ultimately leading to therapeutic and preventive applications.