Robert M. Turner

NADPH Oxidase NOX4 Supports Renal Tumorigenesis by Promoting the Expression and Nuclear Accumulation of HIF2α

Most sporadically occurring renal tumors include a functional loss of the tumor suppressor von Hippel Lindau (VHL). Development of VHL-deficient renal cell carcinoma (RCC) relies upon activation of the hypoxia-inducible factor-2α (HIF2α), a master transcriptional regulator of genes that drive diverse processes, including angiogenesis, proliferation, and anaerobic metabolism. In determining the critical functions for HIF2α expression in RCC cells, the NADPH oxidase NOX4 has been identified, but the pathogenic contributions of NOX4 to RCC have not been evaluated directly. Here, we report that NOX4 silencing in VHL-deficient RCC cells abrogates cell branching, invasion, colony formation, and growth in a murine xenograft model RCC. These alterations were phenocopied by treatment of the superoxide scavenger, TEMPOL, or by overexpression of manganese superoxide dismutase or catalase. Notably, NOX4 silencing or superoxide scavenging was sufficient to block nuclear accumulation of HIF2α in RCC cells. Our results offer direct evidence that NOX4 is critical for renal tumorigenesis and they show how NOX4 suppression and VHL re-expression in VHL-deficient RCC cells are genetically synonymous, supporting development of therapeutic regimens aimed at NOX4 blockade.

Pediatric Laparoscopic and Robot-Assisted Laparoscopic Surgery: Technical Considerations

Laparoscopy has become an effective modality for the treatment of many pediatric urologic conditions that need both extirpative and reconstructive techniques. Laparoscopic procedures for urologic diseases in children, such as pyeloplasty, orchiopexy, nephrectomy, and bladder augmentation, have proven to be safe and effective with outcomes comparable to those of open techniques. Given the steep learning curve and technical difficulty of laparoscopic surgery, robot-assisted laparoscopic surgery (RAS) is increasingly being adopted in pediatric patients worldwide. Anything that can be performed laparoscopically in adults can be extended into pediatric practice with minor technical refinements. We review the role of laparoscopic and RAS in pediatric urology and provide technical considerations necessary to perform minimally invasive surgery successfully.

Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Infants

PURPOSE Laparoscopic pyeloplasty and open pyeloplasty have comparable efficacy for ureteropelvic junction obstruction in pediatric patients. The role of laparoscopic pyeloplasty in infants is less well defined. We present our updated experience with laparoscopic pyeloplasty in children younger than 1 year. MATERIALS AND METHODS We retrospectively reviewed the records of all 29 infants treated with transperitoneal laparoscopic pyeloplasty for symptomatic and/or radiographic ureteropelvic junction obstruction from May 2005 to February 2012. Patients were followed with renal ultrasound at regular intervals. Treatment failure was defined as the inability to complete the intended procedure, persistent radiographic evidence of obstruction and/or the need for definitive adjunctive procedures. RESULTS Transperitoneal laparoscopic pyeloplasty was performed in 29 infants 2 to 11 months old (mean age 6.0 months) weighing 4.1 to 10.9 kg (mean ± SD 7.9 ± 1.6). Followup was available in all except 5 patients (median 13.9 months, IQR 7.7-23.8). Mean operative time was 245 ± 44 minutes. All cases were completed laparoscopically. Three postoperative complications were reported, including ileus, superficial wound infection and pyelonephritis. Two patients had persistent symptomatic and/or radiographic evidence of obstruction, and required reoperative pyeloplasty. The overall success rate was 92%. CONCLUSIONS Laparoscopic pyeloplasty in infants remains a technically challenging procedure limited to select centers. Our early experience revealed a success rate comparable to that of other treatment modalities with minimal morbidity.

The Relationship of Industry Payments to Prescribing Behavior: A Study of Degarelix and Denosumab

Introduction: The influence of financial ties to pharmaceutical companies remains controversial. We assessed a potential relationship between pharmaceutical payments and prescription patterns for degarelix and denosumab. Methods: We compared Medicare Provider Utilization and Payment Data: Physician and Other Supplier PUF (Public Use File) (Medicare B) data containing 2012 claims with data on Open Payments (Physician Payments Sunshine Act) for the second half of 2013. Urologists and medical oncologists who billed Medicare for degarelix or denosumab were cross referenced in both databases and payments were aggregated into a consolidated data set. Adjusted beneficiary count and total Medicare reimbursement were compared according to the receipt of Sunshine payment. An association between Sunshine payment amount and total Medicare reimbursement was also assessed. Results: Of the 160 prescribers of degarelix and 1,507 prescribers of denosumab 91 (57%) and 854 (57%), respectively, received Sunshine payment. Degarelix prescribers who received Sunshine payment had higher median total Medicare reimbursement (

Effect of a concomitant urologic procedure on outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

13,257 vs

Short-term Outcomes of Intraoperative Cell Saver Transfusion During Open Partial Nephrectomy.

9,554, p = 0.01). Denosumab prescribers who received Sunshine payment had higher median adjusted beneficiary count (55 vs 50, p <0.001) and median total Medicare reimbursement (

Urology Payments from Industry in the Sunshine Act

69,620 vs

Epidemiology of the Small Renal Mass and the Treatment Disconnect Phenomenon

60,732, p <0.001). On multivariable analysis receipt of Sunshine payment (adjusted median difference

Variations in Preoperative Use of Bone Scan Among Medicare Beneficiaries Undergoing Radical Cystectomy

5,844, 95% CI 937–10,749) and oncology specialty (adjusted median difference

Biopsy Perineural Invasion in Prostate Cancer Patients Who Are Candidates for Active Surveillance by Strict and Expanded Criteria

34,380, 95% CI 26,715–42,045) were independently associated with total Medicare reimbursement for denosumab. Conclusions: In the case of degarelix and denosumab there is a weak association between pharmaceutical company payments and prescriber prescription behavior patterns.