Saul Boyarsky

Carcinosarcoma of the Prostate: Report of a Case With Ultrastructural Observations

A carcinosarcoma of the prostate was examined by light and electron microscopy. The epithelial component was comprised of adenosquamous carcinoma. The stromal component demonstrated osseous and cartilaginous differentiation, and appeared mesenchymal by fine structure analysis. Despite aggressive therapy the patient died with disseminated disease 5 months after diagnosis.

Practical measures to reduce medical expert witness bias.

To minimize bias by the testifying clinician, particularly in professional liability cases, six practical measures should be used: 1. testify for both the plaintiff and the defense in different cases; 2. assess the merits of the case separately from agreeing to testify; 3. insist on reviewing all the records thoroughly; 4. develop a solid medical posture for each case; 5. review the case in a balanced, critical manner; and, 6. articulate carefully the standard of care in his words before expressing it in deposition or at trial. The expert must stay within his role and duty as expert witness to remain effective.

Discounting Surgical Benefits Enucleation versus Resection of the Prostate

This manuscript introduces and demonstrates a modification of the popular cost-effectiveness methodology. Because arbitrarily selected discount rates for future health effects can radically change the cost-effect ratio, the determinants of the ratio—differences in the present values of effects and costs—are examined for a wide range of discount rates. Treatment selection then follows directly from explicit judgments about expected patient longevity and appropriate combinations of cost and effect discount rates. The decision to select resection or enucleation of a benign prostatic hypertrophy is developed with data from a small number of clinical patients from Washington University.

Urological and behavioral approach to the treatment of secondary impotence.

Psychogenic impotence is far more common than organic impotence and may co-exist with or be a result of it. Psychological principles of therapy may be needed for all impotent patients treated by the urologist. These principles include 1) re-education in sexual function, 2) removal of pressure for male performance, 3) bringing existing performance fears to the surface for therapy, 4) teaching patients techniques to deal with the fears, 5) teaching the partner proper cooperation and 6) improving the communications between the 2 partners.

Ureteral Dimensions and Specifications for Bioengineering Modeling

Publisher Summary This chapter discusses ureteral dimensions and specifications for bioengineering modeling. Ureter is an adaptive organ, functioning as an adaptive system that alters one or more of its characteristics and dimensions to meet its functional requirements. A new ureter must be actively contractile so that it empties and sterilizes itself completely. It must carry no residual urine and should imitate normal rhythms, bolus volumes, and functional demands. A new ureter must be patent and offer low resistance to the elaboration of urine by the nephron. It should not absorb urinary constituents and should have a smooth lumen that provides no nidus for calculus formation, infection, or obstruction. It should allow only unidirectional flow with no retrograde peristalsis or reflux. The wall of the new ureter must be tolerated biologically and immunologically, and should not secrete substances into the urinary tract.

Prostatic Health Status Index

A prostatic health status index (PHSI) can serve as a quantitative yardstick for decision-making about costs, money, operative indications, operative results, and the efficacy of drug therapy. We have evolved such an index based on the conventional urological work-up by combining the signs and symptoms and the presence or absence of health for determining the economic implications of benign prostatic hypertrophy (BPH). Cost-effectiveness is the analytical tool most commonly used by economists to measure the efficiency of resource utilization for medical care. Essentially, it asks the question, “Is the money being spent for the best results?”

Surgical Implications of Ureteral Neurology

Ureteral nerves have been dissected, described, photographed and successfully stimulated. Acceleration of peristalsis by sympathomimetic drugs has been easily demonstrated. Critical experiments have a

Informed Consent: Recent Changes in the Law

Physicians have the legal duty to disclose all risks and consequences of a proposed procedure. This duty must be understood as a reversal of previous legal doctrine. Disclosure is adequate only when a patient has enough information from that disclosure to decide for himself which way he wants to go and what treatment he wants to choose from among the options available to him. Relevance of disclosure, not fullness, is the criterion of sufficiency. The idea that the doctor or the profession knows best what the patient should do has been rejected as a legal standard in the District of Columbia, California, New York, Wisconsin, Kansas and Rhode Island. It is expected that more states will follow this trend. The informed part of the doctrine of informed consent is only the tip of an iceberg of social change.

Can a urologic nurse contribute to management of secondary impotence in an office setting

A practicing urologist with a properly trained nurse can form a dual (male, female) sex therapy team. We have found that such a team will improve sexual history-taking from both partners, provide a more holistic approach to patient management, help avoid certain misdiagnoses, and improve case selection for penile surgery. A nurse can assist with the workup, preoperative and postoperative care, counseling, and if so trained, the actual surgery.

Principles of Bladder Function

Bladder rhythm is an important concept of physiology. Bladder physiology can be described by the classifical organ model, by the urodynamic model and by the neurophysiological model. The organ model deals with the coordinated functions of the smooth muscle in the detrusor and bladder neck, and of the skeletal muscle of the urethra and external sphincter. The urodynamic model describes the bladder capacity, shape, pressure gradients, flow rate and outflow resistance by the armamentarium of a urodynamics laboratory. The neurophysiological model describes the innervation, pathways, and the centers in the spinal cord and brain stem dealing with the control, coordination, integration, onset and cessation of the micturition. Once these concepts are understood, specific urodynamic abnormalities can be suggested from specific features of the patient’s history, physical examination, cystoscopy and intravenous urograms. Urethrovesical coordination is controlled by many reflexes. Continence should be classified and quantitated in order to be rationally treated. The various surgical procedures for the management of incontinence are analyzed in terms of their underlying physiological effects.