Ryan W. Dobbs

Microscopic haematuria at time of diagnosis is associated with lower disease stage in patients with newly diagnosed bladder cancer

To determine whether the severity of haematuria (microscopic or gross) at diagnosis influences the disease stage at presentation in patients diagnosed with bladder cancer.

Incidence and clinical characteristics of lower urinary tract symptoms as a presenting symptom for patients with newly diagnosed bladder cancer

PURPOSE The incidence of lower urinary tract symptoms (LUTS) as the sole presenting symptom for bladder cancer has traditionally been reported to be low. The objective of this study was to evaluate the prevalence and clinical characteristics of newly diagnosed bladder cancer patients who presented with LUTS in the absence of gross or microscopic hematuria. MATERIALS AND METHODS We queried our database of bladder cancer patients at the Atlanta Veterans Affairs Medical Center (AVAMC) to identify patients who presented solely with LUTS and were subsequently diagnosed with bladder cancer. Demographic, clinical, and pathologic variables were examined. RESULTS 4.1% (14/340) of bladder cancer patients in our series presented solely with LUTS. Mean age and Charlson Co-morbidity Index of these patients was 66.4 years (range = 52-83) and 3 (range = 0-7), respectively. Of the 14 patients in our cohort presenting with LUTS, 9 (64.3%), 4 (28.6%), and 1 (7.1%) patients presented with clinical stage Ta, carcinoma in Situ (CIS), and T2 disease. At a median follow-up of 3.79 years, recurrence occurred in 7 (50.0%) patients with progression occurring in 1 (7.1%) patient. 11 (78.6%) patients were alive and currently disease free, and 3 (21.4%) patients had died, with only one (7.1%) death attributable to bladder cancer. CONCLUSIONS Our database shows a 4.1% incidence of LUTS as the sole presenting symptom in patients with newly diagnosed bladder cancer. This study suggests that urologists should have a low threshold for evaluating patients with unexplained LUTS for underlying bladder cancer.

Re-examination of the natural history of high-grade T1 bladder cancer using a large contemporary cohort.

INTRODUCTION High-grade T1 (HGT1) bladder cancer represents a clinical challenge in that the urologist must balance the risk of disease progression against the morbidity and potential mortality of early radical cystectomy and urinary diversion. Using two non-muscle invasive bladder cancer (NMIBC) databases, we re-examined the rate of progression of HG T1 bladder cancer in our bladder cancer populations. MATERIALS AND METHODS We queried the NMIBC databases that have been established independently at the Atlanta Veterans Affairs Medical Center (AVAMC) and the University of Pennsylvania to identify patients initially diagnosed with HGT1 bladder cancer. Demographic, clinical, and pathologic variables were examined as well as rates of recurrence and progression. RESULTS A total of 222 patients were identified; 198 (89.1%) and 199 (89.6%) of whom were male and non-African American, respectively. Mean patient age was 66.5 years. 191 (86.0%) of the patients presented with isolated HG T1 disease while 31 (14.0%) patients presented with HGT1 disease and CIS. Induction BCG was utilized in 175 (78.8%) patients. Recurrence occurred in 112 (50.5%) patients with progression occurring in only 19 (8.6%) patients. At a mean follow-up of 51 months, overall survival was 76.6%. Fifty two patients died, of whom only 13 (25%) patient deaths were bladder cancer related. CONCLUSIONS In our large cohort of patients, we found that the risk of progression at approximately four years was only 8.6%. While limited by its retrospective nature, this study could potentially serve as a starting point in re-examining the treatment algorithm for patients with HG T1 bladder cancer.

All Men Are Created Equal: Benign Prostatic Hyperplasia, Surgery, and Politics

or much of history, the prostate remained a rela-tivelyunderstudiedorgan.GalencreditstheancientGreek anatomist Herophilus for his description ofthe seminal vesicles and ducts, but the first description ofthe human prostate gland was not until the Venetiananatomist Nicolo Massa during the 16th century.

MP43-14 SONIC HEDGEHOG REGULATION OF SPROUTING IN PENILE PROJECTING NEURONS

response was measured by cavernosal nerve stimulation. The relaxant and contractile responses of CC were obtained from in vitro studies. Western blotting and immunohistochemistry were used to evaluate protein expression and localization of neuronal nitric oxide synthase (NOS), endothelial NOS, CSE, CBS, oxidative stress (inducible NOS and nuclear factor kappa B), hypoxia (hypoxia-inducible factor-1a) and fibrosis (transforming growth factor beta 1) markers. The relative area of smooth muscle to collagen using Masson trichrome staining was determined. RESULTS: Our data were reported in Table 1. Combined treatment completely restored enhanced bladder weight, decreased in vivo erectile responses, in vitro electrical field stimulation (EFS)-mediated and endothelium-dependent acetylcholine (ACh)-induced relaxation of CC in the PBOO group, while partial improvement with monotherapy. Contractile responses of CC in obstructed rats were lower than in control rats, which were increased in all treatments groups (Table 1). The combined treatment modulated alteration of protein expressions and decreased ratio of smooth muscle to collagen in obstructed rats. CONCLUSIONS: We firstly indicated that successful combination with H2S donor and PDE5i therapy provided the recovery of erectile function, the progression of ischemia-related functional and morphological penile changes in obstruction. H2S and NO most probably may have a synergistic effect on the structure of penile tissue and molecular regulation of erectile function, and be beneficial for improving clinical outcomes in men with ED and BPH/LUTS.

MP6-04 THE IMPACT OF TRAINING DENSITY ON PROSTATE CANCER DETECTION: AN ANALYSIS OF OVER 2000 PROSTATE BIOPSY CASES PERFORMED BY UROLOGY RESIDENTS

INTRODUCTION AND OBJECTIVES: There is wide variability in the number of prostate biopsies performed by residents. Residency programs reported a vast range in number of cases per trainee in 2010 and 2011 (13-540, 17-329, respectively). This study investigates the impact of caseload density (number of biopsies completed over a given time period) on the likelihood of a positive biopsy result. METHODS: We examined 2,046 prostate biopsy procedures performed by first-year urology residents. Residents were divided into high-density (HD; first 10 cases in 15 days) and low-density (LD; first 10 cases in >15 days) training groups. The primary endpoint was the likelihood of cancer diagnosis. The frequency of cancer detection in the initial 10 cases was compared to that of the subsequent cases using generalized estimating equation models that account for correlated observations and control for multiple covariates. RESULTS: High-density training achieved significantly more consistent results compared to LD training. In the HD group, the odds ratios (OR) of detecting cancer ranged from 0.83 (p1⁄40.50) to 1.09 (p1⁄40.84) when comparing the first 10 cases with subsequent sets of 10 cases up to 50 cases (Figure). The cancer detection rate was unchanged comparing the first 50 cases with the subsequent 50-100 cases (OR1⁄41.40, p1⁄40.06) and >100 cases (OR1⁄41.17, p1⁄40.16). In contrast, LD residents showed significant and progressive improvement in their ability to detect prostate cancer during the first 50 procedures (OR up to 2.54, p1⁄40.018) before reaching a plateau at 41-50 cases. CONCLUSIONS: Training density may play an important role in medical and surgical residency education. For prostate biopsy, high-density training (first ten cases within 15 days) appears to result in more consistent cancer detection rate during subsequent procedures. We conclude that high-density training is likely to achieve earlier attainment of proficiency thereby obviating the need for large case numbers and allowing residents more time to master other procedures.