Dr Gill focuses on all aspects of surgical treatment of urologic malignancies and is experienced in both open and minimally invasive surgery including robotic surgery. He has collaborated with multiple subspecialists and has published on many facets of urologic oncology. Dr Gill’s practice and research also focuses on benign prostatic hyperplasia (BPH) and he offers all minimally invasive therapies for this condition. He is also actively involved in developing and studying new minimally invasive devises for the treatment of BPH.
- Cancer > Urologic Oncology
- Bladder Cancer
- Kidney Cancer
- Benign Prostatic Hyperplasia
- Prostate Cancer
- Testicular Tumors
- Ureteral Cancer
- minimially invasive BPH surgery
- Penile Cancer
- Urethral Cancer
- Urologic Cancers
- Laser prostate surgery
- Bladder Cancer - Urologic Oncology
- Radical nerve sparing prostatectomy
- robotic prostatectomy
- Radical cystectomy
- Laparoscopic kidney surgery
Program Director, Residency program (2006 - Present)
Clerkship Director, Urology (1998 - 2005)
Boards, Advisory Committees, Professional Organizations
Fellow, Center for innovation in Global Health, Stanford University (2016 - Present)
Residency: Royal College of Physician of Ireland (1982) Ireland
Internship: Kenyatta National Hosp (1978)
Medical Education: University Of Nairobi (1977) Kenya
Fellowship: Perelman School of Medicine University of Pennsylvania (1991) PA
Board Certification: Urology, American Board of Urology (1995)
Residency: Institute Of Urology (1987) England
Current Research and Scholarly Interests
Benign Prostatic Hyperplasia- Evaluation of new minimally invasive techniques. HIFU and cryotherapy are being evaluated as a image guided minimally invasive technique for the treatment of symptomatic BPH
Prostate Active Surveillance Study
The Prostate Active Surveillance Study (PASS) is a research study for men who have chosen active surveillance as a management plan for their prostate cancer. Active surveillance is defined as close monitoring of prostate cancer with the offer of treatment if there are changes in test results. This study seeks to discover markers that will identify cancers that are more aggressive from those tumors that grow slowly.
S1602: Different Strains of BCG With or Without Vaccine in High Grade Non- Muscle Invasive Bladder Cancer
This randomized phase III trial studies Tokyo-172 strain bacillus Calmette-Guerin (BCG) solution with or without a vaccination using Tokyo-172 strain BCG to see how well it works compared with TICE BCG solution in treating patients with bladder cancer that has not spread to muscle. BCG is a non-infectious bacteria that when instilled into the bladder may stimulate the immune system to fight bladder cancer. Giving different versions of BCG with vaccine therapy may prevent bladder cancer from returning.
Standard-Dose Combination Chemotherapy or High-Dose Combination Chemotherapy and Stem Cell Transplant in Treating Patients With Relapsed or Refractory Germ Cell Tumors
This randomized phase III trial studies how well standard-dose combination chemotherapy works compared to high-dose combination chemotherapy and stem cell transplant in treating patients with germ cell tumors that have returned after a period of improvement or did not respond to treatment. Drugs used in chemotherapy, such as paclitaxel, ifosfamide, cisplatin, carboplatin, and etoposide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving chemotherapy before a stem cell transplant stops the growth of cancer cells by stopping them from dividing or killing them. Giving colony-stimulating factors, such as filgrastim or pegfilgrastim, and certain chemotherapy drugs, helps stem cells move from the bone marrow to the blood so they can be collected and stored. Chemotherapy is then given to prepare the bone marrow for the stem cell transplant. The stem cells are then returned to the patient to replace the blood-forming cells that were destroyed by the chemotherapy. It is not yet known whether high-dose combination chemotherapy and stem cell transplant are more effective than standard-dose combination chemotherapy in treating patients with refractory or relapsed germ cell tumors.
"REDUCE" - A Clinical Research Study To Reduce The Incidence Of Prostate Cancer In Men Who Are At Increased Risk
This 4-year study will compare how safe and effective an oral investigational medicine is (compared to placebo) in preventing the development of prostate cancer in men that are defined by the study entrance criteria as being at an increased risk for prostate cancer. Study visits to the clinic will occur every 6 months for up to 4 years (10 clinic visits), and a prostate biopsy will be performed at 2 and 4 years of treatment.
Stanford is currently not accepting patients for this trial. For more information, please contact Kristin Hirabayashi, (650) 736 - 1362.
Hypofractionated Radiotherapy for Localized Prostate Cancer (With CyberKnife or With IMRT)
To demonstrate that a hypo-fractionated course of radiotherapy (ie. an accelerated radiotherapy course where fewer but larger doses of radiotherapy are given) is both safe and effective in the treatment of low-risk localized prostate cancer.
Stanford is currently not accepting patients for this trial. For more information, please contact Gillian McFarlane, (650) 721 - 2034.
Imaging During Surgery in Diagnosing Patients With Prostate, Bladder, or Kidney Cancer
This pilot clinical trial studies imaging during surgery in diagnosing patients with prostate, bladder, or kidney cancer. New diagnostic imaging procedures, may find prostate, bladder, or kidney cancer
Stanford is currently not accepting patients for this trial. For more information, please contact Mark Gonzalgo, 650-725-5544.
Microarray Analysis of Gene Expression in Prostate Tissues
The purpose of this study is to investigate gene expression profiles and biologic features of prostate tissue and how they relate to prostate cancer development and growth.
Stanford is currently not accepting patients for this trial. For more information, please contact Cancer Clinical Trials Office, 650-498-7061.
Photoacoustic Imaging (PAI) of the Prostate: A Clinical Feasibility Study
The purpose of our study is to image human prostate tissue using a transrectal photoacoustic imaging probe.
Stanford is currently not accepting patients for this trial. For more information, please contact Sri-Rajasekhar Kothapalli, 650-498-7061.
Prostate Artery Embolization With Embosphere Microspheres Compared to TURP for Benign Prostatic Hyperplasia
The purpose of this study is to evaluate improvement of symptoms from benign prostatic hyperplasia (BPH) as assessed by the International Prostate Symptom Score (IPSS) for prostatic artery embolization (PAE) using Embosphere Microspheres compared to conventional transurethral resection of the prostate (TURP).
Stanford is currently not accepting patients for this trial. For more information, please contact Denise Haas, 650-736-1252.
Quality of Life Following Radical Prostatectomy
This study will utilize the Expanded Prostate Cancer Index Composite questionnaire to learn what impact the surgery has upon the participant's sense of health, sexual and urinary quality of life.
Stanford is currently not accepting patients for this trial. For more information, please contact Denise Haas, 650-736-1252.
Retroperitoneal Lymph Node Dissection in Treating Patients With Testicular Seminoma
This phase II trial studies how well retroperitoneal lymph node dissection (RPLND) works in treating patients with stage I-IIa testicular seminoma. The retroperitoneum is the space in the body behind the intestines that is typically the first place that seminoma spreads. RPLND is a surgery that removes lymph nodes in this area to treat testicular seminoma and may experience fewer long-term toxicities, such as a second cancer, cardiovascular disease, metabolic syndrome (pre-diabetes), or lung disease.
Stanford is currently not accepting patients for this trial. For more information, please contact Cancer Clinical Trials Office (CCTO), 650-498-7061.
S1314, Co-expression Extrapolation (COXEN) Program to Predict Chemotherapy Response in Patients With Bladder Cancer
The primary focus of this study is to see if looking at tumor biomarkers using a program called coexpression extrapolation or "COXEN" may predict a patient's response to chemotherapy before surgery.
Stanford is currently not accepting patients for this trial. For more information, please contact Preeti Chavan, 650-723-5957.
Safety and Pharmacology Study of Atezolizumab Alone and in Combination With Bacille Calmette-Guérin (BCG) in High-Risk Non-Muscle-Invasive Bladder Cancer (NMIBC) Participants
This Phase Ib/II study is designed to assess the safety, tolerability, pharmacokinetics, immunogenicity, patient reported outcomes (PROs), and preliminary anti-tumor activity of atezolizumab administered by intravenous (IV) infusion alone and in combination with intravesical BCG in high-risk NMIBC participants. The study will be conducted in following cohorts: Cohort 1A, Cohort 1B, Cohort 2, and Cohort 3. Atezolizumab will be administered at a fixed dose of 1200 milligrams (mg) every 3 weeks (q3w) for a maximum of 96 weeks. BCG will be administered to evaluate dose-limiting toxicities (DLTs), maximum tolerated dose (MTD), or maximum administered dose (MAD). De-escalation will be allowed for up to three dose levels of BCG (full dose [50 mg], 66 percent [%] of a full dose, and 33% of a full dose [Cohort 1B only]). After the MTD or MAD is determined for Cohort 1B, this dose will be used for all subsequent participants enrolled into Cohorts 1B, 2, and 3, unless the MTD is determined to be 33% of a full BCG dose. If MTD is determined to be 33% of a full BCG dose, then, no participants will be enrolled into Cohorts 2 and 3 until an assessment of the safety and activity of the combination of atezolizumab plus 33% of a full BCG dose is completed.
Stanford is currently not accepting patients for this trial. For more information, please contact Cancer Clinical Trials Office (CCTO), 650-498-7061.
Ultrasound Elastography in Diagnosing Patients With Kidney or Liver Solid Focal Lesions
This clinical trial studies ultrasound elastography in diagnosing patients with kidney or liver solid focal lesions. New diagnostic procedures, such as ultrasound elastography, may be a less invasive way to check for kidney or liver solid focal lesions.
Stanford is currently not accepting patients for this trial. For more information, please contact Juergen Willmann, 650-725-1812.
- Independent Studies (5)
- Implementation of a Reduced Opioid Utilization Protocol for Radical Cystectomy BLADDER CANCER 2020; 6 (1): 33–42
Anatomical study of the prostatic urethra using vinyl polysiloxane casts.
BACKGROUND: There are limited studies describing the detailed nonhistologic anatomy of the prostatic urethra. We studied radical prostatectomy specimens to describe the ex vivo anatomical details of its shape and size.METHODS: We conducted an observational study examining the prostatic urethra anatomy. Prostatic urethra casts (molds) were made using vinyl polysiloxane immediately after fresh specimens had been retrieved following prostatectomy for organ-confined prostate cancer. The following measurements were taken from the casts: anterior length, posterior length, maximal diameter, bladder neck to verumontanum, verumontanum to apex length, and prostate urethral angle (PUA). Prostate volume was calculated using the ellipsoid formula: ((p/6)*transverse*length*height).RESULTS: Thirty-three prostatic urethral casts were obtained. The mean prostate volume was 38.59cc. The mean PUA was 127.6°. The mean transverse, apex, and length of the prostate were 4.65, 4.06, and 3.63cm, respectively. The mean distance from the verumontanum to sphincter was 1.2cm. The ratio between the anterior and posterior length of the prostatic urethra was 0.82cm and did not correlate with prostatic size (Figure 8).CONCLUSION: The distance from the verumontanum to the apex does not change with prostate size; it is uniform with a mean length of 1.2cm. The anterior length, posterior length, and maximum diameter of the prostatic urethra increase with prostate size. The mean difference between the anterior and posterior length is 0.8cm and did not correlate with prostate size. Urethral angulation decreased with prostate size but was not significant. Information obtained from this study is of value designing prostatic stents and devices for benign prostatic hyperplasia.
View details for DOI 10.1002/pros.23937
View details for PubMedID 31825529
IMPLEMENTATION OF A REDUCED OPIOID UTILIZATION PROTOCOL FOR RADICAL CYSTECTOMY
LIPPINCOTT WILLIAMS & WILKINS. 2019: E1196–E1197
View details for Web of Science ID 000473345204010
Native Kidney Cytomegalovirus Nephritis and Cytomegalovirus Prostatitis in a Kidney Transplant Recipient.
Transplant infectious disease : an official journal of the Transplantation Society
We present a case of cytomegalovirus (CMV) native kidney nephritis and prostatitis in a CMV D+/R- kidney transplant recipient who had completed six months of CMV prophylaxis four weeks prior to the diagnosis of genitourinary CMV disease. The patient had a history of benign prostatic hypertrophy and urinary retention that required self-catheterization to relieve high post-voiding residual volumes. At 7 months post-transplant, he was found to have a urinary tract infection, moderate hydronephrosis of the transplanted kidney, and severe hydroureteronephrosis of the native left kidney and ureter, and underwent native left nephrectomy and transurethral resection of the prostate. Histopathologic examination of kidney and prostate tissue revealed CMV inclusions consistent with invasive CMV disease. This case highlights that CMV may extend beyond the kidney allograft to involve other parts of the genitourinary tract, including the native kidneys and prostate. Furthermore, we highlight the tissue-specific risk factors that preceded CMV tissue invasion. In addition to concurrent diagnoses, health care providers should have a low threshold for considering late-onset CMV disease in high-risk solid organ transplant recipients presenting with signs and symptoms of genitourinary tract pathology. This article is protected by copyright. All rights reserved.
View details for PubMedID 30203504
Readmission Rate and Causes at 90-Day after Radical Cystectomy in Patients on Early Recovery after Surgery Protocol
2017; 3 (1): 51–56
Background: Radical cystectomy (RC) is associated with high risk of early and late perioperative complications, and readmissions. The Enhanced Recovery After Surgery (ERAS) protocol has been applied to RC showing decreased hospital stay without increased morbidity. Objective: To evaluate the specific causes of hospital readmissions in RC patients treated before and after adoption of an ERAS protocol at our institution. Methods: We retrospectively evaluated the outcome of 207 RC patients on ERAS protocol at the Stanford University Hospital from January 2012 to December 2014. We focused on early (30-day) and late (90-day) postoperative readmission rate and causes. Results were compared with a pre-ERAS consecutive series of 177 RC patients from January 2009 to December 2011. Results: In the post-ERAS time period a total of 56 patients were readmitted, 41 within the first 30 days after surgery (20%) and 15 within the following 60 days (7%). Fever, often associated with dehydration, was the most common reason for presentation to the hospital, accounting for 57% of all readmissions. At 90 days infection accounted for 53% of readmissions. Of all the patients readmitted during the first 90 days after surgery, 32 had positive urine cultures, mostly caused by Enterococcus faecalis isolated in 18 (56%). Readmission rates did not increase since the introduction of the ERAS protocol, with an incidence of 27% in the post-ERAS group versus 30% in the pre-ERAS group. Conclusions: Despite accurate adherence to most recent perioperative antibiotic guidelines, the incidence of readmissions after RC due to infection still remains significant.
View details for PubMedID 28149935
View details for PubMedCentralID PMC5271433
Diagnosis and Surgical Management of Uroenteric Fistula
SURGICAL CLINICS OF NORTH AMERICA
2016; 96 (3): 583-?
Uroenteric fistulae can occur between any part of the urinary tract and the small and large bowel. Classification is generally based on the organ of origin in the urinary tract and the termination of the fistula in the segment of the gastrointestinal tract. Surgery is often necessary. Congenital fistulae are rare, with most being acquired. Uroenteric fistulae most frequently occur in a setting of inflammatory bowel disease. Imaging often helps in the diagnosis. Management of urinary fistulae includes adequate nutrition, diversion of the urinary tract, diversion of the gastrointestinal tract, treatment of underling inflammatory process or malignancy, and surgery.
View details for DOI 10.1016/j.suc.2016.02.012
View details for Web of Science ID 000378582400014
View details for PubMedID 27261796
- PROSTATE CANCER YIELD IN MRI LESIONS VARIES ACROSS RADIOLOGISTS ELSEVIER SCIENCE INC. 2016: E42
Patterns of urinary catheter consults in a tertiary care hospital
CANADIAN JOURNAL OF UROLOGY
2013; 20 (6): 7046-7049
We reviewed the consultation patterns for difficult urethral catheter placement in tertiary care hospitals and developed a treatment algorithm for this common request.We identified all urethral catheter consults obtained by urology residents at three tertiary care hospitals from October 2009 through October 2010. Only consults for inability to place urethral catheter by the referring team were included; hematuria or clot retention were excluded. Patient age, date of consultation, consulting service, prior urologic history, initial number of attempts, and final outcome were recorded.Eighty-one consults were recorded. Seventy-seven (96%) were male; the median age was 65 years. The most common consulting services were internal medicine (35%), intraoperative consults (17%), and the intensive care unit (17%). In 90% of cases, an initial attempt at catheter placement was attempted; 62% of these were made by nurses. Over half of patients had known urologic pathology. In 70% of cases, successful placement without other adjuncts was achieved by the urology resident. Twenty percent of patients required cystoscopic manipulation; nine percent required suprapubic tube placement.Catheterization was achieved without adjunct procedures in the majority of consults. These results support an algorithm in which all patients without a prior history of lower urinary tract pathology should undergo an initial placement attempt by the primary service physician. They also underscore the need for educational efforts to improve non-urologists' comfort level with placement of a standard Foley or Coudé catheter.
View details for Web of Science ID 000328717300009
View details for PubMedID 24331347
Applicators for magnetic resonance-guided ultrasonic ablation of benign prostatic hyperplasia.
2013; 48 (6): 387-394
The aims of this study were to evaluate in a canine model applicators designed for ablation of human benign prostatic hyperplasia (BPH) in vivo under magnetic resonance imaging (MRI) guidance, including magnetic resonance thermal imaging (MRTI), determine the ability of MRI techniques to visualize ablative changes in prostate, and evaluate the acute and longer term histologic appearances of prostate tissue ablated during these studies.An MRI-compatible transurethral device incorporating a tubular transducer array with dual 120° sectors was used to ablate canine prostate tissue in vivo, in zones similar to regions of human BPH (enlarged transition zones). Magnetic resonance thermal imaging was used for monitoring of ablation in a 3-T environment, and postablation MRIs were performed to determine the visibility of ablated regions. Three canine prostates were ablated in acute studies, and 2 animals were rescanned before killing at 31 days postablation. Acute and chronic appearances of ablated prostate tissue were evaluated histologically and were correlated with the MRTI and postablation MRI scans.It was possible to ablate regions similar in size to enlarged transition zone in human BPH in 6 to 18 minutes. Regions of acute ablation showed a central "heat-fixed" region surrounded by a region of more obvious necrosis with complete disruption of tissue architecture. After 31 days, ablated regions demonstrated complete apparent resorption of ablated tissue with formation of cystic regions containing fluid. The inherent cooling of the urethra using the technique resulted in complete urethral preservation in all cases.Prostatic ablation of zones of size and shape corresponding to human BPH is possible using appropriate transurethral applicators using MRTI, and ablated tissue may be depicted clearly in contrast-enhanced magnetic resonance images. The ability accurately to monitor prostate tissue heating, the apparent resorption of ablated regions over 1 month, and the inherent urethral preservation suggest that the magnetic resonance-guided techniques described are highly promising for the in vivo ablation of symptomatic human BPH.
View details for DOI 10.1097/RLI.0b013e31827fe91e
View details for PubMedID 23462673
Surgical outcomes and complications associated with presurgical tyrosine kinase inhibition for advanced renal cell carcinoma (RCC)
UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS
2013; 31 (3): 379-385
Tyrosine kinase inhibitors (TKI) have dramatically changed the management paradigm of advanced renal cell carcinoma (RCC) and are increasingly being used preoperatively to achieve cytoreduction.To review our case series of post-TKI surgical procedures to add to the current perioperative efficacy and complication profile.Between October 2006 and February 2010, 14 cytoreductive nephrectomies, radical nephrectomies, and metastectomies were performed after neoadjuvant sunitinib or sorafenib for advanced RCC. During the same time frame, a control group of 73 consecutive patients underwent radical nephrectomy, cytoreductive nephrectomy, or metastectomy in the absence of prior systemic therapy. We compared the incidence of perioperative complications and outcomes after surgical procedures between the two cohorts.Median preoperative renal mass size was 11 cm (6.7-24.2 cm). Primary tumor shrinkage was seen in 57%; median shrinkage was 18% (8%-25%). The median treatment period was 17 weeks, and the median time from TKI discontinuation was 2 weeks. Compared with a control group and after adjusting for confounding covariates, presurgical TKI use was not associated with a significant increase in perioperative complications (50% vs. 40%, P = 0.25) or perioperative bleeding (36% vs. 34%, P = 0.97) but was associated with increased incidence and grade of intraoperative adhesions (86% vs. 58%, P = 0.001; grade 3 vs. 1, P = 0.002).Compared with the published reports, we observed less hemorrhagic and wound healing issues but a significant increase in incidence and severity of intraoperative adhesions, which can present a formidable technical challenge. Potential reasons for our lower complication rate could be increased time from TKI discontinuation to surgery, longer time to postoperative TKI re-initiation, increased use of preoperative angioembolization, and the lack of preoperative bevacizumab administration. Presurgical TKI therapy can permit effective surgical cytoreduction with a safety and complication profile equivalent to that of non-TKI-nephrectomy; however safety data continue to evolve, and preoperative TKI use requires further prospective investigation.
View details for DOI 10.1016/j.urolonc.2011.01.005
View details for PubMedID 21353796
Focal ablation of prostate cancer: four roles for magnetic resonance imaging guidance
CANADIAN JOURNAL OF UROLOGY
2013; 20 (2): 6672-6681
There is currently a great deal of interest in the possible use of focal therapies for prostate cancer, since such treatments offer the prospect for control or cure of the primary disease with minimal side effects. Many forms of thermal therapy have been proposed for focal ablation of prostate cancer, including laser, high intensity ultrasound and cryotherapy. This review will demonstrate the important roles that magnetic resonance imaging (MRI) guidance can offer to such focal ablation, focusing on the use of high intensity ultrasonic applicators as an example of one promising technique.Transurethral and interstitial high intensity ultrasonic applicators, designed specifically for ablation of prostate tissue were tested extensively in vivo in a canine model. The roles of MRI in positioning the devices, monitoring prostate ablation, and depicting ablated tissue were assessed using appropriate MRI sequences.MRI guidance provides a very effective tool for the positioning of ablative devices in the prostate, and thermal monitoring successfully predicted ablation of prostate tissue when a threshold of 52 ºC was achieved. Contrast enhanced MRI accurately depicted the distribution of ablated prostate tissue, which is resorbed at 30 days.Guidance of thermal therapies for focal ablation of prostate cancer will likely prove critically dependent on MRI functioning in four separate roles. Our studies indicate that in three roles: device positioning; thermal monitoring of prostate ablation; and depiction of ablated prostate tissue, MR techniques are highly accurate and likely to be of great benefit in focal prostate cancer ablation. A fourth critical role, identification of cancer within the gland for targeting of thermal therapy, is more problematic at present, but will likely become practical with further technological advances.
View details for PubMedID 23587506
Prostate specific antigen: the past, present and future.
2013; 6 (4): 175-178
To review current data available on use of prostate specific antigen for screening healthy men for prostate cancer.Literature was reviewed and the guidelines from, American cancer Society, American Urologic Association was reviewed.Current screening protocols lead to over diagnosis of prostate cancer. This often results in unnecessary biopsy procedures and treatments.We must consider the benefit of screening and treatment with the harms of over diagnosis and over treatment. Newer imaging modalities like magnetic resonance imaging have to be evaluated further.
View details for DOI 10.1159/000343535
View details for PubMedID 24917739
View details for PubMedCentralID PMC3783281
LONG-TERM OUTCOMES FROM A PROSPECTIVE TRIAL OF STEREOTACTIC BODY RADIOTHERAPY FOR LOW-RISK PROSTATE CANCER
52nd Annual Meeting of the American-Society-for-Therapeutic-Radiation-Oncology (ASTRO)
ELSEVIER SCIENCE INC. 2012: 877–82
Hypofractionated radiotherapy has an intrinsically different normal tissue and tumor radiobiology. The results of a prospective trial of stereotactic body radiotherapy (SBRT) for prostate cancer with long-term patient-reported toxicity and tumor control rates are presented.From 2003 through 2009, 67 patients with clinically localized low-risk prostate cancer were enrolled. Treatment consisted of 36.25 Gy in 5 fractions using SBRT with the CyberKnife as the delivery technology. No patient received hormone therapy. Patient self-reported bladder and rectal toxicities were graded on the Radiation Therapy Oncology Group scale (RTOG).Median follow-up was 2.7 years. There were no grade 4 toxicities. Radiation Therapy Oncology Group Grade 3, 2, and 1 bladder toxicities were seen in 3% (2 patients), 5% (3 patients), and 23% (13 patients) respectively. Dysuria exacerbated by urologic instrumentation accounted for both patients with Grade 3 toxicity. Urinary incontinence, complete obstruction, or persistent hematuria was not observed. Rectal Grade 3, 2, and 1 toxicities were seen in 0, 2% (1 patient), and 12.5% (7 patients), respectively. Persistent rectal bleeding was not observed. Low-grade toxicities were substantially less frequent with QOD vs. QD dose regimen (p = 0.001 for gastrointestinal and p = 0.007 for genitourinary). There were two prostate-specific antigen (PSA), biopsy-proven failures with negative metastatic workup. Median PSA at follow-up was 0.5 ± 0.72 ng/mL. The 4-year Kaplan-Meier PSA relapse-free survival was 94% (95% confidence interval, 85%-102%).Significant late bladder and rectal toxicities from SBRT for prostate cancer are infrequent. PSA relapse-free survival compares favorably with other definitive treatments. The current evidence supports consideration of stereotactic body radiotherapy among the therapeutic options for localized prostate cancer.
View details for DOI 10.1016/j.ijrobp.2010.11.054
View details for Web of Science ID 000299239900063
View details for PubMedID 21300474
MR Imaging-guided Cryoablation for the Treatment of Benign Prostatic Hyperplasia
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY
2011; 22 (10): 1427-1430
A patient with benign prostatic hyperplasia presented with chronic lower urinary tract symptoms despite prior surgery and continued medical therapy. Using a magnetic resonance imaging-guided transperineal approach, two cryoprobes were placed into the transition zone of the prostate gland, and two cryoablation freeze-thaw cycles were performed. At 10 weeks after treatment, the frequency of nocturia had decreased from once every 1.5 hours to once per night, urinary peak flow rates had increased from 5.1 mL/s to 10.3 mL/s, and postvoid residual urinary bladder volume had decreased from 187 mL to 58 mL. Improved flow rates and symptoms remained stable 16 weeks after treatment.
View details for DOI 10.1016/j.jvir.2011.08.010
View details for PubMedID 21961982
Safety and feasibility of the prostatic urethral lift: a novel, minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH)
2011; 108 (1): 82-88
• To investigate the Prostatic Urethral Lift (PUL) procedure, a novel, minimally invasive treatment for symptomatic benign prostatic hyperplasia (BPH), which aims to mechanically open the prostatic urethra without ablation or resection. • To demonstrate the safety and feasibility of this procedure and to make an initial assessment of effectiveness.• The PULprocedure was performed on 19 men in Australia. • Small suture-based implants were implanted transurethrally under cystoscopic visualisation to separate encroaching lateral prostatic lobes. • Patients were evaluated at 2 weeks and 3, 6, and 12 months after PUL.• All cases were successfully completed with no serious or unexpected adverse events (AEs). • Between two and five sutures were delivered in each patient and the prostatic urethral lumen was visually increased in all patients. • Reported postoperative AEs were typically mild and transient and included dysuria and haematuria. • Follow-up cystoscopy at 6 months in a subset of patients showed no calcification. Histological findings from two of three patients who progressed to transurethral resection of the prostate for return of symptoms showed no evidence of inflammation related to the implanted materials. • The mean International Prostate Symptom Score was reduced by 37% at 2 weeks and 39% at 1 year after PUL as compared with baseline.• We demonstrated in this initial experience that the PUL procedure is safe and feasible. • The safety profile of the PUL procedure appears favourable; most patients reported sustained symptom relief to 12 months with minimal morbidity • PUL therefore warrants further study as a new option for the many patients who seek an alternative to current therapies.
View details for DOI 10.1111/j.1464-410X.2011.10342.x
View details for Web of Science ID 000291928500018
View details for PubMedID 21554526
- RACIAL DISPARITIES IN THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA ELSEVIER SCIENCE INC. 2011: E690
- PRACTICE PATTERNS OF PELVIC LYMPH NODE DISSECTION FOR RADICAL CYSTECTOMY FROM THE VETERANS AFFAIRS CENTRAL CANCER REGISTRY (VACCR) ELSEVIER SCIENCE INC. 2011: E562
Melanoma of the penis with scintigraphically-guided sentinel node biopsy.
Indian journal of urology : IJU : journal of the Urological Society of India
2010; 26 (3): 429-430
Melanoma of the penis is an uncommon cancer. We present the case of a 73-year-old male with penile melanoma and non palpable lymph nodes. Lymphoscintigraphy was applied to locate the sentinel lymph nodes for dissection. His lymph nodes were negative for melanoma and he has been disease-free for 1 year with careful surveillance.
View details for DOI 10.4103/0970-1591.70587
View details for PubMedID 21116368
View details for PubMedCentralID PMC2978448
Laparoscopic Management of Ureteral Endometriosis: The Stanford University Hospital Experience With 96 Consecutive Cases
JOURNAL OF UROLOGY
2009; 182 (6): 2748-2752
We report the clinical characteristics and the principles of laparoscopic management of ureteral endometriosis at our institution.We retrospectively reviewed the charts of patients with ureteral endometriosis.Preoperatively 97% of patients complained of pain but only a third had urinary symptoms. The left ureter was affected in 64% of cases and disease was bilateral in 10%. Four patients had hydroureter and 2 had hydronephrosis.To our knowledge this report represents the largest series of laparoscopically treated, pathologically confirmed ureteral endometriotic cases to date. It confirms that laparoscopic diagnosis and management of ureteral endometriosis are safe and efficient. All patients who undergo laparoscopy for endometriosis should be evaluated for possible ureteral involvement regardless of the presence or absence of urinary symptoms, or prior radiological evaluation since undiagnosed ureteral disease may result in loss of renal function.
View details for DOI 10.1016/j.juro.2009.08.019
View details for PubMedID 19837436
Identification, molecular characterization, clinical prognosis, and therapeutic targeting of human bladder tumor-initiating cells
PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA
2009; 106 (33): 14016-14021
Major clinical issues in bladder cancer include the identification of prediction markers and novel therapeutic targets for invasive bladder cancer. In the current study, we describe the isolation and characterization of a tumor-initiating cell (T-IC) subpopulation in primary human bladder cancer, based on the expression of markers similar to that of normal bladder basal cells (Lineage-CD44(+)CK5(+)CK20(-)). The bladder T-IC subpopulation was defined functionally by its enriched ability to induce xenograft tumors in vivo that recapitulated the heterogeneity of the original tumor. Further, molecular analysis of more than 300 bladder cancer specimens revealed heterogeneity among activated oncogenic pathways in T-IC (e.g., 80% Gli1, 45% Stat3, 10% Bmi-1, and 5% beta-catenin). Despite this molecular heterogeneity, we identified a unique bladder T-IC gene signature by gene chip analysis. This T-IC gene signature, which effectively distinguishes muscle-invasive bladder cancer with worse clinical prognosis from non-muscle-invasive (superficial) cancer, has significant clinical value. It also can predict the progression of a subset of recurring non-muscle-invasive cancers. Finally, we found that CD47, a protein that provides an inhibitory signal for macrophage phagocytosis, is highly expressed in bladder T-ICs compared with the rest of the tumor. Blockade of CD47 by a mAb resulted in macrophage engulfment of bladder cancer cells in vitro. In summary, we have identified a T-IC subpopulation with potential prognostic and therapeutic value for invasive bladder cancer.
View details for DOI 10.1073/pnas.0906549106
View details for PubMedID 19666525
STEREOTACTIC BODY RADIOTHERAPY FOR LOCALIZED PROSTATE CANCER: INTERIM RESULTS OF A PROSPECTIVE PHASE II CLINICAL TRIAL
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
2009; 73 (4): 1043-1048
The radiobiology of prostate cancer favors a hypofractionated dose regimen. We report results of a prospective Phase II clinical trial of stereotactic body radiotherapy (SBRT) for localized prostate cancer.Forty-one low-risk prostate cancer patients with 6 months' minimum follow-up received 36.25 Gy in five fractions of 7.25 Gy with image-guided SBRT alone using the CyberKnife. The early (<3 months) and late (>6 months) urinary and rectal toxicities were assessed using validated quality of life questionnaires (International Prostate Symptom Score, Expanded Prostate Cancer Index Composite) and the Radiation Therapy Oncology Group (RTOG) toxicity criteria. Patterns of prostate-specific antigen (PSA) response are analyzed.The median follow-up was 33 months. There were no RTOG Grade 4 acute or late rectal/urinary complications. There were 2 patients with RTOG Grade 3 late urinary toxicity and none with RTOG Grade 3 rectal complications. A reduced rate of severe rectal toxicities was observed with every-other-day vs. 5 consecutive days treatment regimen (0% vs. 38%, p = 0.0035). A benign PSA bounce (median, 0.4 ng/mL) was observed in 12 patients (29%) occurring at 18 months (median) after treatment. At last follow-up, no patient has had a PSA failure regardless of biochemical failure definition. Of 32 patients with 12 months minimum follow-up, 25 patients (78%) achieved a PSA nadir =0.4 ng/mL. A PSA decline to progressively lower nadirs up to 3 years after treatment was observed.The early and late toxicity profile and PSA response for prostate SBRT are highly encouraging. Continued accrual and follow-up will be necessary to confirm durable biochemical control rates and low toxicity profiles.
View details for DOI 10.1016/j.ijrobp.2008.05.059
View details for Web of Science ID 000264257400013
View details for PubMedID 18755555
MR Imaging-guided Percutaneous Cryoablation of the Prostate in an Animal Model: In Vivo Imaging of Cryoablation-induced Tissue Necrosis with Immediate Histopathologic Correlation
32nd Annual Meeting of the Society-of-Interventional-Radiology (SIR)
ELSEVIER SCIENCE INC. 2009: 252–58
To evaluate the feasibility of magnetic resonance (MR) imaging-guided percutaneous cryoablation of normal canine prostates and to identify MR imaging features that accurately predict the area of tissue damage at a microscopic level.Six adult male mixed-breed dogs were anesthetized, intubated, and placed in a 0.5-T open MR imaging system. A receive-only endorectal coil was placed, and prostate location and depth were determined on T1-weighted fast spin-echo (FSE) MR imaging. After placement of cryoprobes and temperature sensors, three freezing protocols were used to ablate prostate tissue. Ice ball formation was monitored with T1-weighted FSE imaging. Tissue necrosis area was assessed with contrast-enhanced weighted MR imaging and compared with histopathologic findings.A total of 12 cryolesions (mean size, 1.2 cm) were bilaterally created in six prostates. Ice ball formation was oval and signal-free on T1-weighted FSE sequences in all cases. Postprocedural contrast-enhanced MR imaging typically showed a nonenhancing area of low signal intensity centrally located within the frozen area, surrounded by a bright enhancing rim in all cases. On histopathologic examination, two distinct zones were identified within cryolesions. Centrally, a necrotic zone with complete cellular destruction and hemorrhage was found. Between this necrotic zone and normal glandular tissue, a zone of fragmented and intact glands, interstitial edema, and rare acute inflammatory cells was seen. Correlation between nonenhancement on contrast-enhanced weighted MR images and tissue necrosis on pathologic examination was consistent within all six dogs.MR imaging-guided cryoablation of the prostate is technically feasible. The nonenhancing area on postablation contrast-enhanced weighted MR imaging accurately predicts the area of cryoablation-induced tissue necrosis on pathologic analysis.
View details for DOI 10.1016/j.jvir.2008.10.030
View details for PubMedID 19091600
Gross hematuria from an ileal conduit as a first presentation of portal hypertension
NATURE CLINICAL PRACTICE UROLOGY
2008; 5 (10): 569-573
A 76-year-old man who underwent cystoprostatectomy with ileal conduit urinary diversion for muscle-invasive bladder cancer presented to his urologist 4 years later with episodes of spontaneous gross hematuria filling his ostomy bag with fresh clots.Physical examination, urine culture, urine cytology, peripheral smear, complete blood count, loopogram, CT-intravenous pyelogram, loop endoscopy, bilateral ureteroscopy, liver function tests, CT angiography, (99m)Tc-tagged red cell scan, hepatitis panel, measurement of transjugular wedge pressure, transjugular liver biopsy with pathologic analysis and re-evaluation of CT angiogram.Hematuria secondary to portal hypertension.The patient initially underwent revision of the ureteroileal anastomosis on the basis of the results of the (99m)Tc-tagged red cell scan, but hematuria recurred 9 months later. Once the hepatology service identified portal hypertension, the patient was taken to the operating room for ligation of a large venous communication between the ileal conduit and a branch of the inferior epigastric vein. He recovered well and was asymptomatic for 8 months. He was followed up by the hepatology service for his newly diagnosed portal hypertension secondary to cirrhosis.
View details for DOI 10.1038/ncpuro1192
View details for Web of Science ID 000259638000012
View details for PubMedID 18711411
- Molecular profiling reveals heterogeneity of active self-renewal pathways in bladder cancer stem cells AMER ASSOC CANCER RESEARCH. 2008
Postoperative prostate-specific antigen velocity independently predicts for failure of salvage radiotherapy after prostatectomy
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
2008; 70 (5): 1472-1477
Identification of patients most likely to benefit from salvage radiotherapy (RT) using postoperative (postop) prostate-specific antigen (PSA) kinetics.From 1984 to 2004, 81 patients who fit the following criteria formed the study population: undetectable PSA after radical prostatectomy (RP); pathologically negative nodes; biochemical relapse defined as a persistently detectable PSA; salvage RT; and two or more postop PSAs available before salvage RT. Salvage RT included the whole pelvic nodes in 55 patients and 4 months of total androgen suppression in 56 patients. The median follow-up was >5 years. All relapses were defined as a persistently detectable PSA. Kaplan-Meier and Cox proportional hazards multivariable analysis were performed for all clinical, pathological, and treatment factors predicting for biochemical relapse-free survival (bRFS).There were 37 biochemical relapses observed after salvage RT. The 5-year bRFS after salvage RT for patients with postop prostate-specific antigen velocity < or = 1 vs. >1 ng/ml/yr was 59% vs. 29%, p = 0.002. In multivariate analysis, only postop PSAV (p = 0.0036), pre-RT PSA level < or = 1 (p = 0.037) and interval-to-relapse >10 months (p = 0.012) remained significant, whereas pelvic RT, hormone therapy, and RT dose showed a trend (p = approximately 0.06). PSAV, but not prostate-specific antigen doubling time, predicted successful salvage RT, suggesting an association of zero-order kinetics with locally recurrent disease.Postoperative PSA velocity independently predicts for the failure of salvage RT and can be considered in addition to high-risk features when selecting patients in need of systemic therapy following biochemical failure after RP. For well-selected patients, salvage RT can achieve high cure rates.
View details for DOI 10.1016/j.ijrobp.2007.08.014
View details for Web of Science ID 000254660800028
View details for PubMedID 17935902
- Eggshell bladder: Complete bladder encrustation after ureteroscopy and laser lithotripsy UROLOGY 2007; 69 (2): 382-383
Reliability of small amounts of cancer in prostate biopsies to reveal pathologic grade
2006; 67 (6): 1229-1234
To examine grade reliability when biopsies contain very small amounts of prostate cancer. Prostate biopsy findings are known to undergrade prostate cancer compared with the pathologic specimens yet remain the only grade guiding disease management.The presence of a clinically significant grade change from biopsy cores to matched prostatectomy specimens was examined in 371 patients. The biopsies were characterized for primary and secondary Gleason grade, number of positive cores, and total linear length of cancer. The pathologic specimens were characterized for cancer volume and relative percentage by grade. The rates of upgrading or downgrading were tested against all clinical and biopsy information for any significant predictive value.The overall rate of upgrading was 40.7% and downgrading was 16.1%. Upgrading was constant and independent of any clinical or biopsy tumor volume indexes. Specifically, when cancer was present in only one biopsy core and measured 2 mm or less (n = 48), it was just as predictive of the pathologic grade as that from any greater number of positive cores and any greater extent of cancer length present. Downgrading was less frequent for biopsies with small amounts of cancer.Histologic grading from small amounts of cancer in prostate biopsies is reliable and not more prone to grading errors. A repeat biopsy for these patients may not be indicated.
View details for DOI 10.1016/j.urology.2005.12.031
View details for PubMedID 16765184
Preoperative PSA velocity is an independent prognostic factor for relapse after radical prostatectomy
JOURNAL OF CLINICAL ONCOLOGY
2005; 23 (25): 6157-6162
Preoperative prostate-specific antigen (PSA) velocity (PSAV), or the rate of PSA rise before diagnosis, predicts for risk of cancer death after radical prostatectomy (RP). We evaluated the relative merit of established preoperative factors, including biopsy indices and preoperative PSAV, for their impact on relapse after RP.The outcomes of 202 men who underwent RP were reviewed. Biopsies were characterized for grade, percentage positive cores, and total linear tumor length. Surgical specimens were characterized for cancer volume, relative percentage by grade, extracapsular extension, and margin status. Univariate and multivariate analyses were performed with respect to relapse-free survival after RP.Thirty-one patients relapsed after RP (defined as PSA > or = 0.2 ng/mL), with a median time to failure of 16 months. Median follow-up was 48 months. Kaplan-Meier relapse-free survival at 5 years was 89%, compared with 73% for PSAV < or = 2 v > 2 ng/mL/year (P = .003). On multivariate analysis, only the biopsy Gleason sum (P < .008; relative risk, > 4.8) and the preoperative PSAV (P < .04; relative risk, 3.0 to 4.7) remained significant. Patients with a PSAV of > 2 ng/mL/year were more likely to be pT3 (P = .007), have positive margins (P = .01), have tumors > 1 mL (P = .05), and possess > 10% grade 4/5 tumors (P = .04).The preoperative PSAV is a significant independent clinical factor predicting for relapse after RP and also predicts for larger, more aggressive, and more locally advanced tumors. Its inclusion will be useful in risk stratification, evaluation for alternatives to surgery, and patient selection for neoadjuvant or adjuvant therapies as part of randomized clinical trials.
View details for DOI 10.1200/JCO.2005.01.2336
View details for Web of Science ID 000231606300041
View details for PubMedID 16135482
Curvilinear transurethral ultrasound applicator for selective prostate thermal therapy
2005; 32 (6): 1555-1565
Thermal therapy offers a minimally invasive option for treating benign prostatic hyperplasia (BPH) and localized prostate cancer. In this study we investigated a transurethral ultrasound applicator design utilizing curvilinear, or slightly focused, transducers to heat prostatic tissue rapidly and controllably. The applicator was constructed with two independently powered transducer segments operating at 6.5 MHz and measuring 3.5 mm x 10 mm with a 15 mm radius of curvature across the short axis. The curvilinear applicator was characterized by acoustic efficiency measurements, acoustic beam plots, biothermal simulations of human prostate, ex vivo heating trials in bovine liver, and in vivo heating trials in canine prostate (n=3). Each transducer segment was found to emit a narrow acoustic beam (max width <3 mm), which extended the length of the transducer, with deeper penetration than previously developed planar or sectored tubular transurethral ultrasound applicators. Acoustic and biothermal simulations of human prostate demonstrated three treatment schemes for the curvilinear applicator: single shot (10 W, 60 s) schemes to generate narrow ablation zones (13 x 4 mm, 52 degrees C at the lesion boundary), incremental rotation (10 W, 10 degrees/45 s) to generate larger sector-shaped ablation zones (16 mm x 180 degrees sector), and rotation with variable sonication times (10 W, 10 degrees/15-90 s) to conform the ablation zone to a predefined boundary (9-17 mm x 180 degrees sector, 13 min total treatment time). During in vivo canine prostate experiments, guided by MR temperature imaging, single shot sonications (6 W/transducer, 2-3 min) with the curvilinear applicator ablated 20 degree sections of tissue to the prostate boundary (9-15 mm). Multiple adjacent sonications ("sweeping") ablated large sections of the prostate (180 degrees) by using the MR temperature imaging to adjust the power (4-6.4 W/transducer) and sonication time (30-180 s) at each 10 degrees rotation such that the periphery of the prostate reached 52 degrees C before the next rotation. The conclusion of this study was that the curvilinear applicator produces a narrow and penetrating ultrasound beam that, when combined with image guidance, can provide a precise technique for ablating target regions with a contoured outer boundary, such as the prostate capsule, by rotating in small steps while dynamically adjusting the net applied electrical power and sonication time at each position.
View details for DOI 10.1118/1.1924314
View details for Web of Science ID 000229908600015
View details for PubMedID 16013714
MRI-guided interstitial ultrasound thermal therapy of the prostate: A feasibility study in the canine model
2005; 32 (3): 733-743
The feasibility of MRI-guided interstitial ultrasound thermal therapy of the prostate was evaluated in an in vivo canine prostate model. MRI compatible, multielement interstitial ultrasound applicators were developed using 1.5 mm diameter cylindrical piezoceramic transducers (7 to 8 MHz) sectored to provide 180 degrees of angular directional heating. Two in vivo experiments were performed in canine prostate. The first using two interstitial ultrasound applicators, the second using three ultrasound applicators in conjunction with rectal and urethral cooling. In both experiments, the applicators were inserted transperineally into the prostate with the energy directed ventrally, away from the rectum. Electrical power levels of 5-17 W per element (approximately 1.6-5.4 W acoustic output power) were applied for heating periods of 18 and 48 min. Phase-sensitive gradient-echo MR imaging was used to monitor the thermal treatment in real-time on a 0.5 T interventional MRI system. Contrast-enhanced T1-weighted images and vital-stained serial tissue sections were obtained to assess thermal damage and correlate to real-time thermal contour plots and calculated thermal doses. Results from these studies indicated a large volume of ablated (nonstained) tissue within the prostate, extending 1.2 to 2.0 cm from the applicators to the periphery of the gland, with the dorsal margin of coagulation well-defined by the applicator placement and directionality. The shape of the lesions correlated well to the hypointense regions visible in the contrast-enhanced T1-weighted images, and were also in good agreement with the contours of the 52 degrees C threshold temperature and t43 > 240 min. This study demonstrates the feasibility of using directional interstitial ultrasound in conjunction with MRI thermal imaging to monitor and possibly control thermal coagulation within a targeted tissue volume while potentially protecting surrounding tissue, such as rectum, from thermal damage.
View details for DOI 10.1118/1.1861163
View details for Web of Science ID 000227910600010
View details for PubMedID 15839345
Antibiotic susceptibility profiles of new probiotic Lactobacillus and Bifidobacterium strains
INTERNATIONAL JOURNAL OF FOOD MICROBIOLOGY
2005; 98 (2): 211-217
The antimicrobial susceptibilities and presence of plasmids in four new probiotic lactic acid bacteria (LAB) strains, Lactobacillus rhamnosus HN001 (DR20) HN067, Lactobacillus acidophilus HN017 and Bifidobacterium lactis HN019 (DR10), were determined. Resistance to 18 commonly used antibiotics was assessed by disk diffusion. The three Lactobacillus strains had similar antibiotic susceptibility profiles to those of Lactobacillus plantarum strain HN045 and two commercial probiotic Lactobacillus strains, GG and LA-1. The B. lactis strain HN019 had a similar profile to three commercial probiotic B. lactis strains (Bb12, HN049 and HN098). All 10 strains were sensitive to the Gram-positive spectrum antibiotics erythromycin and novobiocin, the broad-spectrum antibiotics rifampicin, spectinomycin, tetracycline and chloramphenicol and the beta-lactam antibiotics penicillin, ampicillin and cephalothin. By contrast, most strains were resistant to the Gram-negative spectrum antibiotics fusidic acid, nalidixic acid and polymyxin B and the aminoglycosides neomycin, gentamicin, kanamycin and streptomycin. All three L. rhamnosus strains (HN001, HN067 and GG) were resistant to vancomycin and several strains were also resistant to cloxacillin. Of the four new probiotic strains, only L. rhamnosus HN001 contained plasmids; however, a plasmid-free derivative of HN001 had the same antibiotic susceptibility profile as the parent strain.
View details for DOI 10.1016/j.ijfoodmicro.2004.05.011
View details for Web of Science ID 000227015900011
View details for PubMedID 15681048
- Biothermal modeling of transurethral ultrasound applicators for MR-guided prostate thermal therapy Conference on Treatment of Tissue: Energy Delivery and Assessment III SPIE-INT SOC OPTICAL ENGINEERING. 2005: 220–227
Preoperative PSA velocity predicts for relapse after radical prostatectomy
47th Annual Meeting of the American-Society-for-Therapeutic-Radiology-and-Oncology
ELSEVIER SCIENCE INC. 2005: S293–S293
View details for Web of Science ID 000232083301018
Radiotherapy after radical prostatectomy: Does transient androgen suppression improve outcomes?
44th Annual Meeting of the American-Society-for-Therapeutic-Radiology-and-Oncology
ELSEVIER SCIENCE INC. 2004: 341–47
The long-term biochemical relapse-free survival and overall survival were compared for patients receiving either radiotherapy (RT) alone or radiotherapy combined with a short-course of total androgen suppression for failure after radical prostatectomy.Between 1985 and 2001, a total of 122 patients received RT after radical prostatectomy at our institution. Fifty-three of these patients received a short-course of total androgen suppression (TAS) 2 months before and 2 months concurrent with RT with a nonsteroidal antiandrogen and an luteinizing hormone-releasing hormone (LHRH) agonist (combined therapy group); the remaining 69 patients received RT alone. Treatment failure was defined after postoperative RT as a detectable PSA >0.05 ng/mL. Clinical and treatment variables examined included: presurgical PSA, clinical T stage, pathologic Gleason sum (pGS), seminal vesicle (SV) involvement, lymph node involvement, surgical margins, pre-RT PSA, prostate dose, pelvic irradiation, indication for postoperative RT (salvage or adjuvant), and time interval between surgery and RT. Minimum follow-up after postoperative RT was 1 year and median follow-up was 5.9 years (maximum, 14 years) for patients receiving RT alone, and 3.9 years (maximum, 11 years) for patients receiving RT with TAS (combined therapy group). Kaplan-Meier analysis was performed for PSA failure-free survival (bNED) and for overall survival (OS). Cox proportional hazards multivariable analysis examined the influence all clinical and treatment variables predicting for bNED and OS.The median time to PSA failure after postoperative RT was 1.34 years for the combined therapy group and 0.97 years for the RT alone group (p = 0.19), with no failures beyond 5 years. At 5 years, the actuarial bNED rates were 57% for the combined therapy group compared with 31% for the RT alone group (p = 0.0012). Overall survival rates at 5 years were 100% for the combined therapy group compared with 87% for the RT alone group (p = 0.0008). For pGS
or=8 the 5-year bNED rates were 65% for combined therapy and 17% for RT alone (p = 0.075). The 5-year OS rates for pGS or=8 was 100% for combined therapy and 54% for RT alone (p = 0.04). On multivariable analysis, only SV involvement (p = 0.0145) and the addition of short-course TAS to postoperative RT (p = 0.0019) were significant covariates predicting for bNED and, similarly, approached significance for overall survival (p = 0.0594 and p = 0.0856, respectively).Radiotherapy combined with a short-course TAS after radical prostatectomy appears to confer a PSA relapse-free survival advantage and possibly an overall survival advantage when compared with RT alone. The hypothesis that a transient course of androgen suppression with salvage or adjuvant RT after prostatectomy improves outcomes will need to be tested in a randomized trial.
View details for DOI 10.1016/j.ijribp.2003.10.015
View details for Web of Science ID 000221440800002
View details for PubMedID 15145146
Gender differences in radical cystectomy: Complications and blood loss
2004; 63 (6): 1095-1099
To review the impact of gender on blood loss, transfusions, and complications. Radical cystectomy is technically different between men and women. Unique to women, dissection of the anterior vaginal wall can be associated with added blood loss.We analyzed the records of 262 consecutive patients who underwent radical cystectomy for urothelial carcinoma from March 1993 to March 2003. The perioperative variables, amount of blood loss, transfusion requirements, need for intensive care, length of hospitalization, and 30-day complications were examined.Women accounted for 24% (n = 63) of this series and had a median operative blood loss of 1.4 L compared with 0.5 L in men (P = 0.001). The transfusion rate was 82% in women and 55% in men (P = 0.001), with the median number of units transfused greater in women (3 U versus 2 U, P = 0.043). Also, 31% of women needed intensive care compared with 15% of men (P = 0.004). The median postoperative stay was similar at 9 days for women and 8 days for men (P = 0.099). The incidence of complications was not significantly different statistically between the gender groups, occurring in 43% of women and 33% of men (P = 0.161). Major complications occurred in 8% of women and 7.5% of men, and the most common minor complication was ileus, reported in 19% of women and 14% of men.Although the overall complications and length of hospital stay were similar between the gender groups, radical cystectomy in women was associated with greater blood loss, transfusion requirements, and intensive care needs.
View details for DOI 10.1016/j.urology.2004.01.29
View details for Web of Science ID 000222000400022
View details for PubMedID 15183957
Extended prostate biopsy scheme improves reliability of Gleason grading: Implications for radiotherapy patients
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
2004; 59 (2): 386-391
With sextant prostate biopsies, there is up to a 1-in-3 chance that the underlying pathologic Gleason grade is higher. Knowledge of the underlying grade might have significantly altered the therapeutic recommendations and management for patients electing radiotherapy for localized prostate cancer (e.g., eligibility for brachytherapy, androgen suppression with external beam radiotherapy, elective pelvic radiotherapy). This study examines the concordance patterns between biopsy and matched radical prostatectomy Gleason grade among patients undergoing an extended 10-core biopsy scheme to assess its reliability compared to sextant biopsies.Seventy-eight consecutive patients underwent an extended 10-core peripheral zone biopsy scheme (sextant plus two lateral mid and two lateral base biopsies) and subsequent radical prostatectomy at this institution between mid-2000 and mid-2003. No patient received androgen suppression. All histologic grading were made by a single pathologist (J.E.M.). Needle biopsies were characterized for location, linear involvement of cancer within positive cores, and total number of positive cores. Radical prostatectomy specimens were step-sectioned at 3-mm intervals and were characterized for total cancer volume and percentage of each Gleason grade present. Clinical parameters available included digital rectal exam, preoperative PSA, and ultrasound prostate volume. A "clinically significant" upgrading of the biopsy was defined as any of the following: (1) a biopsy Gleason score (bGS) of 6 to a pathologic GS (pGS) of 7 or higher, (2) a bGS 3 + 4 to a pGS of 4 + 3 or higher, and (3) a bGS of 7 to a pGS of 8 or higher. Statistical analyses were performed on the patterns Gleason score concordance between biopsies and matched radical prostatectomies.An exact Gleason score match between biopsy and prostatectomy was observed in 62% of patients using the sextant biopsy scheme (SB), an upgrading of 1 or more grade points was seen in 25% and a downgrading of 1 or more points in 13% for SB. These rates of grade discordance are comparable to those of published sextant series. An exact match using the extended biopsy scheme (EB) was 63% (p = 0.61 compared with SB), whereas upgrading was 13% (p = 0.045 compared with SB) and downgrading was 24% (p = 0.06 compared with SB). A "clinically significant" upgrading as defined here was present in 38.1% of the SB group compared with 23.1% of the EB group (p = 0.039). For patients with bGS of 6, a clinically significant upgrading occurred in 66.7% with SB and in 36.8% with EB (p = 0.068). Upgrading of the primary Gleason grade from 3 to 4/5 was seen in 41.8% for the SB and in 25.5% for the EB group (p = 0.078). No clinical factors (T-stage, PSA, prostate volume, % positive cores, linear extent of cancer) were found to predict for a clinically significant upgrading of biopsies on logistic regression analysis.The extended 10-core biopsy scheme significantly improves on sextant biopsies in predicting the underlying pathologic Gleason score for prostate cancer. In particular, it is superior to sextant biopsies in revealing the presence of an underlying high-grade component. The potential clinical impact this improvement has for patients ultimately selecting radiotherapy suggests that an extended biopsy scheme should become the standard of care. Nevertheless, even with this improvement, there still remains up to a 1-in-5 chance that the underlying grade will be higher.
View details for DOI 10.1016/j.ijrobp.2003.10.014
View details for Web of Science ID 000221440800008
View details for PubMedID 15145152
Highly directional transurethral ultrasound applicators with rotational control for MRI-guided prostatic thermal therapy
PHYSICS IN MEDICINE AND BIOLOGY
2004; 49 (2): 189-204
Transurethral ultrasound applicators with highly directional energy deposition and rotational control were investigated for precise treatment of benign prostatic hyperplasia (BPH) and adenocarcinoma of the prostate (CaP). Two types of catheter-based applicators were fabricated, using either 90 degrees sectored tubular (3.5 mm OD x 10 mm) or planar transducers (3.5 mm x 10 mm). They were constructed to be MRI compatible, minimally invasive and allow for manual rotation of the transducer array within a 10 mm cooling balloon. In vivo evaluations of the applicators were performed in canine prostates (n = 3) using MRI guidance (0.5 T interventional magnet). MR temperature imaging (MRTI) utilizing the proton resonance frequency shift method was used to acquire multiple-slice temperature overlays in real time for monitoring and guiding the thermal treatments. Post-treatment T1-weighted contrast-enhanced imaging and triphenyl tetrazolium chloride stained tissue sections were used to define regions of tissue coagulation. Single sonications with the 90 degrees tubular applicator (9-15 W, 12 min, 8 MHz) produced coagulated zones covering an 80 degrees wedge of the prostate extending from 1-2 mm outside the urethra to the outer boundary of the gland (16 mm radial coagulation). Single sonications with the planar applicator (15-20 W, 10 min, approximately 8 MHz) generated thermal lesions of approximately 30 degrees extending to the prostate boundary. Multiple sequential sonications (sweeping) of a planar applicator (12 W with eight rotations of 30 degrees each) demonstrated controllable coagulation of a 270 degrees contiguous section of the prostate extending to the capsule boundary. The feasibility of using highly directional transurethral ultrasound applicators with rotational capabilities to selectively coagulate regions of the prostate while monitoring and controlling the treatments with MRTI was demonstrated in this study.
View details for DOI 10.1088/0031-9155/49/2/0020
View details for Web of Science ID 000220421700002
View details for PubMedID 15083666
Gene expression patterns in renal cell carcinoma assessed by complementary DNA microarray
AMERICAN JOURNAL OF PATHOLOGY
2003; 162 (3): 925-932
Renal cell carcinoma comprises several histological types with different clinical behavior. Accurate pathological characterization is important in the clinical management of these tumors. We describe gene expression profiles in 41 renal tumors determined by using DNA microarrays containing 22,648 unique cDNAs representing 17,083 different UniGene Clusters, including 7230 characterized human genes. Differences in the patterns of gene expression among the different tumor types were readily apparent; hierarchical cluster analysis of the tumor samples segregated histologically distinct tumor types solely based on their gene expression patterns. Conventional renal cell carcinomas with clear cells showed a highly distinctive pattern of gene expression. Papillary carcinomas formed a tightly clustered group, as did tumors arising from the distal nephron and the normal kidney samples. Surprisingly, conventional renal cell carcinomas with granular cytoplasm were heterogeneous, and did not resemble any of the conventional carcinomas with clear cytoplasm in their pattern of gene expression. Characterization of renal cell carcinomas based on gene expression patterns provides a revised classification of these tumors and has the potential to supply significant biological and clinical insights.
View details for PubMedID 12598325
MR-guided conformal heating of canine prostate using interstitial applicators
Conference on Thermal Treatment of Tissue: Energy Delivery and Assessment II
SPIE-INT SOC OPTICAL ENGINEERING. 2003: 220–226
View details for Web of Science ID 000184241000021
Magnetic resonance guided directional transurethral ultrasound thermal therapy
Conference on Thermal Treatment of Tissue: Energy Delivery and Assessment II
SPIE-INT SOC OPTICAL ENGINEERING. 2003: 192–199
View details for Web of Science ID 000184241000018
- Partial nephrectomy and caval thrombectomy for renal cell carcinoma in a solitary kidney with an accessory renal vein BJU INTERNATIONAL 1999; 83 (1): 142-143
Management of radiation-induced urologic complications
32nd San Francisco Cancer Symposium
KARGER. 1999: 120–126
View details for Web of Science ID 000171088100011
Histological and clinical findings in 896 consecutive prostates treated only with radical retropubic prostatectomy: Epidemiologic significance of annual changes
JOURNAL OF UROLOGY
1998; 160 (6): 2412-2417
Recognizing that the unprecedented increase in new cases of prostate cancer between 1988 and 1996 actually peaked in 1992 and has now returned to baseline, we examined our clinical and histological database for annual trends in 896 consecutive men treated only with radical prostatectomy for clinical stages T1c to T2c from 1988 to 1996.All radical prostatectomy specimens were examined prospectively in 3 mm. step sections by 1 pathologist. Using multiple logistic regression for dichotomous variables and multiple linear regression for continuous variables, both corrected for age, we assessed the annual trends for significant changes in T1c versus T2 clinical stages, preoperative serum prostate specific antigen (PSA), cancer volume, percent Gleason grade 4/5 in the cancer, location of the cancer in the transition or peripheral zone, organ confined status, seminal vesicle invasion, positive surgical margins, prostate weight and presence of clinically insignificant cancers (less than 0.5 cc in volume).There were no significant annual changes in the proportion of percent Gleason grade 4/5 cancer, serum PSA, prostate weight or clinically insignificant cancers less than 0.5 cc, and the annual changes for cancer volume were only of moderate significance. T1c cancers increased from 10% in 1988 to 73% in 1996 (p=0.0001), organ confined cancers from 40 to 75% (p=0.0001) and transition zone cancers from 10 to 21% (p=0.003). Seminal vesicle invasion decreased from 18 to 5% (p=0.001) and positive surgical margins from 30 to 14 (p=0.006). Mean patient age changed from 65 to 62 years (p=0.0001).We believe that the extraordinary rise and fall in prostate cancer detection rates from 1990 to 1994 primarily removed previously undetected T2 cancers from the pool at large, leaving impalpable T1c cancers as the primary reservoir of prostate cancers in the United States. Importantly, cancer volume, percent Gleason grade 4/5 cancer, serum PSA and cancers less than 0.5 cc have not had a highly significant change during these critical 9 years. These data argue strongly that current PSA testing has not resulted in the detection of clinically insignificant cancers, and that PSA screening should be expanded and not restricted.
View details for Web of Science ID 000076876300009
View details for PubMedID 9817394
Pelvi-ureteric junction obstruction treated with Acucise (TM) retrograde endopyelotomy
BRITISH JOURNAL OF UROLOGY
1998; 82 (1): 8-11
To determine the efficacy of retrograde endopyelotomy for the treatment of pelvi-ureteric junction (PUJ) obstruction using the Acucise ureteric balloon cutting catheter.Between February 1995 and July 1997, 13 consecutive patients with primary PUJ obstruction underwent Acucise endopyelotomy at our institution. The mean follow-up was 17.7 months (range 7-33). The success of the procedure was based on objective patency on follow-up diuretic isotopic renography and the subjective resolution of symptoms.The treatment was successful by objective criteria in eight of 13 patients and by subjective criteria in nine. The mean operative duration was 33 min (range 25-45) and all 13 patients were discharged within 24 h of the procedure. There were no major complications, such as vascular injury requiring transfusion. There were no delayed failures, as all failures occurred within 3 months of the procedure. Of the four total failures, two patients have successfully undergone open pyeloplasty and one other was found to have a crossing vessel at the lower pole at the time of the operation.In this small series. Acucise endopyelotomy was a safe procedure that offered effective, expeditious first-line treatment for PUJ obstruction. All failures occurred soon after treatment and did not hinder subsequent open pyeloplasty. Further studies with additional patients and a longer follow-up are warranted to determine the long-term efficacy of this promising new treatment.
View details for Web of Science ID 000074856900003
View details for PubMedID 9698655
Testicular teratoma with a unique mode of spread and spontaneous maturation
1998; 61 (2): 119-120
Chylous ascites, a rare compliation following retroperitoneal lymph node dissection, has not been reported as a means of spread of testicular cancer. This report describes a unique path of spread of testicular cancer which also appears to spontaneously mature at the metastatic site.
View details for Web of Science ID 000078171200011
View details for PubMedID 9873253
Prospective multicenter ProLase II clinical trial of neodymium:yttrium-aluminum-garnet laser prostatectomy
1997; 50 (1): 63-65
To assess the clinical efficacy of neodymium:yttrium-aluminum-garnet (YAG) laser coagulation prostatectomy using a broad-angle, divergent-beam, side-firing fiber.Eighty adult men with voiding symptoms caused by benign prostatic hyperplasia were enrolled in a prospective multicenter study of free-beam neodymium:YAG laser prostatectomy performed with the ProLase II side-firing delivery fiber. Voiding outcomes were assessed at 3, 6, and 12 months postoperatively.At 1-year follow-up, peak urinary flow rates were increased by 105%, postvoid residual urine volumes had decreased by 38%, and the AUA symptom index had decreased by 60%. Serious treatment-related complications occurred in 3 of 80 patients (3.8%). The reoperation rate through 1-year follow-up was 2.7%.Neodymium:YAG laser prostatectomy performed with the ProLase II delivery fiber has proven safe and efficacious with durable results through 1 year in the relief of symptomatic bladder outlet obstruction due to benign prostatic hyperplasia.
View details for Web of Science ID A1997XJ07600011
View details for PubMedID 9218020
Furuncular myiasis of the scrotum
INFECTIONS IN UROLOGY
1997; 10 (4): 102-104
View details for Web of Science ID A1997XK13100002
LASER PROSTATECTOMY PERFORMED WITH A RIGHT-ANGLE-FIRING NEODYMIUM-YAG LASER FIBER AT 60 WATTS POWER SETTING
JOURNAL OF UROLOGY
1995; 153 (5): 1502-1505
A total of 50 patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia was entered into a prospective trial of laser prostatectomy performed with the right-angle firing neodymium:YAG laser fiber at 60 watts power setting. Mean estimated resectable prostatic weight was 30 gm. with a mean prostatic urethral length of 3.3 cm. Nine patients (18%) were in urinary retention requiring catheterization before treatment. Mean energy delivery was 30,834 joules (range 14,400 to 127,800) with a mean operative time of 31 minutes. Efficacy of treatment was assessed at 3, 6 and 12 months postoperatively by standardized American Urological Association symptom scores, peak urinary flow rates and post-void residual urine volumes. At preoperative baseline the mean symptom score was 20.8, mean peak urinary flow rate 7.6 cc per second, and mean post-void residual urine volume 353 cc. At 1 year postoperatively mean symptom score was 8.4, mean peak urinary flow rate was 18.7 cc per second and mean post-void residual urine volume was 175 cc. Two patients required retreatment for residual tissue. There were 6 complications including 5 bladder neck contractures requiring incision (10%) and 1 case of postoperative prostatitis requiring antibiotic therapy (2%). Of 37 evaluable sexually active patients 31 (84%) reported preservation of antegrade ejaculation postoperatively.
View details for Web of Science ID A1995QR57400042
View details for PubMedID 7536256
COMPARATIVE-STUDY OF LASER VERSUS ELECTROCAUTERY PROSTATIC RESECTION - 18-MONTH FOLLOW-UP WITH COMPLEX URODYNAMIC ASSESSMENT
JOURNAL OF UROLOGY
1995; 153 (1): 94-97
A total of 25 patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia was entered into a prospective, randomized trial comparing prostatectomy done with the Urolase right angle firing neodymium:YAG laser fiber and standard transurethral electroresection of the prostate. Efficacy of treatment, as assessed by standardized American Urological Association symptom scores, patient assessment of symptom improvement, peak urinary flow rates, post-void residual urine volumes and complex urodynamic evaluation, including assessment of opening pressure and maximum detrusor voiding pressure, was equivalent for the 2 treatment groups through 1 year. Ultrasonic assessment of prostatic volumes at 1 year showed a mean decrease in total volume of 59% for standard electrocautery resection compared to 28% for laser prostatectomy. Symptom scores and peak urinary flow rates remained equivalent for both groups through 18 months.
View details for Web of Science ID A1995PW16700033
View details for PubMedID 7526006
CHARACTERIZATION OF TISSUE EFFECTS PRODUCED BY THE PROLASE-II LATERAL-FIRING NEODYMIUM-YAG LASER FIBER IN THE CANINE PROSTATE
LASERS IN SURGERY AND MEDICINE
1994; 15 (2): 185-190
The immediate and long term-effects of neodymium:YAG laser treatment with the ProLase II lateral-firing laser fiber in the canine prostate were evaluated. Fourteen male dogs, aged 3 years and older with established benign prostatic hyperplasia, underwent endoscopic ablation of the prostate using the ProLase II fiber. Subjects were treated at laser power settings of 60 watts (6 dogs), 75 watts (4 dogs), or 90 watts (3 dogs), with a mean total energy delivery of 15,000 joules. One dog underwent a sham procedure and served as a normal control. Prostates were examined grossly and histologically at 48 hours, 2 weeks, 4 weeks, or 8 weeks post-treatment. The cross-sectional diameter and volume of tissue ablation were measured in each prostate. Histological studies of the extent of thermal injury to the prostatic tissue and the course of healing of the prostatic urethra were performed. The mean cross-sectional diameter of tissue ablation was 28.6 +/- 4.7 mm and mean volume of tissue ablation was 8.2 +/- 5.1 cc. No statistically significant difference in diameter or volume of tissue ablation was noted between varying power settings. Histological studies showed extensive tissue necrosis with hemorrhage and an acute inflammatory cell infiltrate at 48 hours. By 8 weeks, total resolution of both necrosis and inflammatory changes with complete re-epithelialization of the prostatic urethra was observed.
View details for Web of Science ID A1994PN39100004
View details for PubMedID 7528315
DOSIMETRY STUDIES UTILIZING THE UROLASE RIGHT-ANGLE FIRING NEODYMIUM-YAG LASER FIBER
LASERS IN SURGERY AND MEDICINE
1994; 14 (2): 145-154
Neodymium:YAG laser application was performed with the Urolase right angle laser fiber in a potato model and then in vivo in 29 canine prostates in an attempt to define dosimetry and optimal treatment parameters required to maximize tissue ablation and treatment efficacy. Depth and volume of prostatic tissue ablation for single, continuous laser applications with the Urolase fiber were measured at variable power settings from 20 to 60 watts, while holding total energy delivery constant. Peak tissue ablation was observed at 40 watts--up to a maximum of 21 mm tissue penetration in the canine model with a mode of 15 mm. The mean depth of tissue destruction at 40 watts power setting was 15.7 mm, with a mean volume of tissue ablation of 5.5 cc. The mean depth of tissue penetration at 40 watts was more than 30% greater than that observed at 60 watts, and the mean volume of tissue ablation was more than 60% greater than that observed at 60 watts. Holding the power setting constant at 40 watts, the extent of tissue ablation was measured for variable treatment times from 60 to 120 seconds. As treatment time was increased from 60 to 90 seconds, tissue ablation increased significantly. However, beyond 90 seconds of continuous laser application at 40 watts, a plateau in tissue effects was observed, with no real increase in tissue ablation between 90 and 120 seconds. Interruption or discontinuous laser application produced tissue effects which were significantly less than those observed for a single continuous 90 second laser treatment.
View details for Web of Science ID A1994NB50600006
View details for PubMedID 7514255
UROLASE LASER PROSTATECTOMY IN PATIENTS ON WARFARIN ANTICOAGULATION - A SAFE TREATMENT ALTERNATIVE FOR BLADDER OUTLET OBSTRUCTION
1993; 42 (6): 738-740
Three patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia underwent laser prostatectomy using a Neodymium:YAG source delivered with the Urolase right-angle laser fiber. All patients had significant underlying medical problems, and all were fully anticoagulated with oral warfarin (mean prothrombin time 17 seconds). Two were in urinary retention with indwelling catheters preoperatively. Laser prostatectomy was performed in each case without change in the medical regimen, including continuous warfarin dosing. No complications occurred, and in particular, no early or late bleeding episodes were encountered. All are symptomatically improved and catheter-free on follow-up. Laser prostatectomy provides a new and safe therapeutic option in the management of these high-risk patients.
View details for Web of Science ID A1993ML92700033
View details for PubMedID 7504851
FUNCTIONAL AND URODYNAMIC CHARACTERISTICS OF AN ILEAL NEOBLADDER
JOURNAL OF UROLOGY
1993; 149 (5): 1072-1076
We examined the urodynamic characteristics and symptoms of 28 patients who had undergone the Stanford pouch bladder substitution following cystoprostatectomy. Urodynamics were obtained a mean of 18 months (range 6 to 43) after construction of the neobladder. Mean cystometric capacity was 699 cc (range 366 to 1,370). All patients voided by the Valsalva maneuver and achieved good peak flow rates (mean 19 cc per second). Of the patients 23 emptied to near completion with a mean post-void residual of 34 cc, while 5 had post-void residuals of greater than 150 cc (mean 630 cc). The neobladders demonstrated good compliance for the storage of urine, with a mean basal pressure of less than 15 cm. water at volumes of less than 500 cc at which most bladders function, and of 22.4 cm. water (range 1 to 72) at 100% capacity. Phasic neobladder contractions were present during filling cystometrography. While the number increased at higher neobladder volumes, the mean length and mean pressure did not. The mean pressure of contractions was less than 40 cm. water at lower and higher volumes. Daytime continence was attained in 26 of 28 patients (93%), while 17 (61%) attained nighttime continence. Of these 17 patients 14 (82%) had to void at least once at night to stay dry. Daytime incontinent patients had decreased neobladder compliance at high volumes compared to daytime continent patients (p < 0.05) but there was no difference in the maximal urethral closure pressure or the pressure of phasic contractions between these 2 groups. No difference was found in any urodynamic parameter between nighttime continent and incontinent patients. Patients with poor emptying ability (defined as a post-void residual of more than 150 cc) had increased neobladder compliance relative to patients with good emptying ability, as well as a statistically significant increased capacity (1,067 cc versus 623 cc). There was no difference in any important urodynamic parameter between patients who had and had not received postoperative chemotherapy. We conclude that a neobladder constructed from detubularized ileum achieves adequate capacity at low pressures with a satisfactory continence rate. Most patients empty the bladder to completion by Valsalva's maneuver. Low compliance at high volumes appears to be a factor in daytime incontinence.
View details for Web of Science ID A1993LA46400032
View details for PubMedID 8483213
INCIDENCE AND MANAGEMENT OF AUTONOMIC DYSREFLEXIA AND OTHER INTRAOPERATIVE PROBLEMS ENCOUNTERED IN SPINAL-CORD INJURY PATIENTS UNDERGOING EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY WITHOUT ANESTHESIA ON A 2ND-GENERATION LITHOTRIPTOR
JOURNAL OF UROLOGY
1993; 149 (5): 1064-1067
Spinal cord injury patients are at increased risk for urolithiasis and many will require treatment, most commonly with extracorporeal shock wave lithotripsy. New, second generation lithotripsy devices allow treatment without tub immersion, and without general or regional anesthesia for most patients. Spinal cord injury patients, with loss of sensation below the level of injury, would seem to be ideal candidates for such treatment. We present our experience with 20 consecutive spinal cord injury patients treated without anesthesia on the Medstone STS second generation lithotriptor. All patients were awake and experienced no direct sensation from the shock waves. All but 1 patient (T12 level), however, experienced autonomic dysreflexia, with significant elevations in systolic blood pressure (mean increase 44 mm. Hg, maximum 74) and diastolic blood pressure (mean increase 24 mm. Hg, maximum 61), with reflex bradycardia (mean decrease -22 beats per minute). Autonomic dysreflexia was successfully treated in this setting with short-acting sublingual nifedipine. Associated bradycardia was treated with atropine in 6 patients. Preoperative bowel preparation proved to be useful in spinal cord injury patients to maximize stone imaging and may decrease autonomic dysreflexia if this is caused by shock waves impacting on the distended bowel. Other problems included uncontrolled skeletal muscle spasms elicited by shock waves, which proved to be troublesome in maintaining patient position and stone localization. Muscle spasms were decreased with benzodiazepines. Care was also observed in spinal cord injury patients to pad all pressure points on the hard, dry treatment surfaces associated with second generation lithotriptors and, thus, prevent skin breakdown.
View details for Web of Science ID A1993LA46400030
View details for PubMedID 8483211
RESPONSE OF THE WHOLE BLADDER-URETHRA MODEL (RABBIT) TO AUTONOMIC DRUGS
NEUROUROLOGY AND URODYNAMICS
1990; 9 (2): 165-169
View details for Web of Science ID A1990CZ06600008
FUNCTIONAL AND BIOCHEMICAL-ALTERATIONS IN THE RABBIT URINARY-BLADDER FOLLOWING ILEOCYSTOPLASTY
JOURNAL OF UROLOGY
1989; 142 (3): 860-864
Although the use of ileocystoplasty has increased significantly in recent years, very little is known concerning the smooth muscle properties of the implanted bowel segment. In a previous study, preliminary evidence was presented which indicated that the pharmacological response of the cytoplastic ileal segment to autonomic agonists changed toward that of the bladder. The present study extends and expands these preliminary observations on the physiology and pharmacology of augmentation cystoplasty. Augmentation cystoplasty with detubularized ileum was carried out in 16 rabbits. In vivo and in vitro physiological and pharmacological studies were carried out one and three months after surgery. The results can be summarized as follows: 1) in-vivo CMG at one month was similar to that of the preoperative bladder, but at three months there was a 24% increase in capacity, with the presence of multiple phasic contractions beginning at a volume of approximately 65% of capacity. 2) The frequency and magnitude of spontaneous activity in the cystoplastic ileum did not significantly alter from that of the normal ileum. 3) Cystoplastic ileum responded to muscarinic stimulation differently from the normal ileum. The bladder responded with an increase in the tension whereas the ileum responded with an increase in the frequency and amplitude of phasic contractions. The cystoplastic ileum responded with a pronounced sustained contraction with phasic contractions superimposed. The tonic contraction at three months was of a significantly greater magnitude than that at one month. 4) The qualitative and quantitative response to field stimulation of the cystoplastic ileum was altered from that of the ileum towards that of the bladder. 5) The normal bladder contains greater amount of creatine phosphate and lesser amounts of creatine than the normal ileum. Cystoplasty, after three months induced a change in the ileal segment towards the bladder (increased creatine phosphate and decreased creatine). 6) The normal ileum was found to have greater number of muscarinic receptors than the normal bladder whereas the cystoplastic ileum at three months was intermediate.
View details for Web of Science ID A1989AN25700074
View details for PubMedID 2570168
PHARMACOLOGICAL COMPARISON OF THE ISOLATED WHOLE URETHRA MODEL TO URETHRAL STRIP METHODOLOGY
1989; 39 (3): 192-199
Urethral strips provide a sensitive method for quantitative pharmacology; however, it is not clear if the physiological response of the whole urethra to pharmacological agents can be extrapolated from these data. The intent of this study was to investigate whether the linear contraction of strips is consistent with the ability of the intact urethra to alter resistance to flow. To measure the effect of drugs on the ability of the intact urethra to alter resistance to flow in the absence of endogenous influences, we developed an in vitro whole rabbit urethra model. We characterized the effect of norepinephrine in the absence and presence of alpha-adrenergic antagonists (prazosin, yohimbine, and LY253352) on intraurethral pressure which was measured during constant saline infusion using a Statham pressure transducer. We compared this to the contractile function of urethral strips. The pA2 values for alpha-adrenergic antagonists, LY253352, prazosin, and yohimbine were 8.17 +/- 1.5, 6.49 +/- 1.2, and 5.58 +/- 0.9, respectively, as determined in the whole urethra. The pA2 values for these antagonists determined in urethral strips were as follows: LY253352 8.72 +/- 1.2; prazosin 7.52 +/- 1.5, and yohimbine 5.6 +/- 0.84. Pharmacologically, the whole urethra model and isolated strips appeared to respond similarly to alpha-adrenergic agonists and antagonists, and thus both models would be suitable for pharmacological studies on the normal urethra.
View details for Web of Science ID A1989AX51800008
View details for PubMedID 2587624
ADENOCARCINOMA OF THE URINARY-BLADDER
BRITISH JOURNAL OF UROLOGY
1989; 64 (2): 138-142
We report 40 patients seen over a 15-year period with a histological diagnosis of adenocarcinoma of the bladder; 18 patients had primary adenocarcinoma of the bladder, arising either from the urachus or from glandular metaplasia of the urothelium, and the other 22 had secondary lesions representing invasion from adjacent structures, notably prostate, colon and ovary. In this latter group symptoms related to the primary lesion were variable. The distinction between primary and secondary neoplasm is an important one and was rarely made on the basis of endoscopic or clinical findings alone. Urachal tumours were more common in females, whereas primary and secondary vesical adenocarcinomas were more common in males. The urachal tumours also occurred in a younger age group. Most of the adenocarcinomas, urachal or primary, were already advanced at the time of diagnosis. All tumours were palpable bimanually after resection and were at least T2 or T3. In the urachal carcinomas the results of partial cystectomy were disappointing because of the high rate of local recurrence and death from metastases. Primary non-urachal vesical adenocarcinoma carried an even poorer prognosis if non-radical surgery was carried out. The mean survival was 13 months. Radiotherapy was not effective in urachal and primary adenocarcinomas as these tumours are generally radioresistant. The treatment of secondary adenocarcinoma was governed by the primary site of the tumour. Radical surgery combined with chemotherapy and radiotherapy appeared to give the longest survival in the colonic tumours. Patients with prostatic cancer had a poorer survival rate than those with the same stage tumour but without bladder involvement, with renal failure secondary to obstructive uropathy being the commonest cause of death.
View details for Web of Science ID A1989AL37700007
View details for PubMedID 2765779
COMPARATIVE-STUDY OF 2 COMPUTERIZED SEMEN MOTILITY ANALYZERS
1988; 20 (5): 433-440
Semen analysis is one of the primary tests carried out to investigate the infertile male. Subjective evaluation of semen is often prone to observer bias and error. To eliminate this, a number of computerized semen analyzers have recently been introduced into the market and we have evaluated two of the more popular models, the Cell Soft Semen Analyzer and the Hamilton Thorn Motility Analyzer (HTM 2000). The Cell Soft identifies sperm on the basis of user defined values for cell size and luminosity whereas the Hamilton Thorn identifies sperm by motility, and then applies the computer-calculated average size and luminosity of all moving objects to non moving sperm cells. Semen samples from 25 normal donors and 25 subfertile patients were analyzed using these two models of computerized semen analyzers, and also by an experienced technician using both the Makler chamber and the hemocytometer. The results obtained from the two automated analyzers were compared with those obtained by subjective evaluation. Variation in sperm count and motility were analyzed according to the sperm density. Four groups, less than 30 million/ml with debris, less than 30 million/ml, 30-50 million/ml, and greater than 50 million/ml were studied. The majority of patients fit into the first two groups. We observed that the HTM 2000 is superior to the Cell Soft in evaluating sperm count within the patient population group. For our donor population with an average sperm count of greater than 85 million/ml both systems provide extremely accurate counts.(ABSTRACT TRUNCATED AT 250 WORDS)
View details for Web of Science ID A1988Q940400010
View details for PubMedID 3207202
DEFECTIVE ANTIADHERENCE ACTIVITY OF BLADDER EXTRACTS FROM PATIENTS WITH RECURRENT URINARY-TRACT INFECTION
JOURNAL OF UROLOGY
1988; 140 (1): 157-159
A substantial body of animal work indicates that the initial first line defense against invading microorganisms in the urinary tract is the antiadherence activity of the surface mucin layer. Previous work has demonstrated that bacterial adherence to anion exchange resin can be used as a model for adherence to the mucin deficient rabbit bladder. This anion exchange resin adherence model can also be used as a rapid screen for potential antiadherence agents. In vitro saline extracts of bladder mucosa from various mammalian species including man have been shown to inhibit bacterial adherence to both anion exchange resin and the mucin deficient rabbit bladder. The present report investigates the ability of in vivo saline bladder washes from several groups of patients to inhibit bacterial adherence to anion exchange resin. This has an advantage over other methods of quantitation or visualization of mucin since it is the ability of the bladder extract to prevent bacterial adherence, and not merely the quantity of mucin, that determines the effectiveness of the mucin lining in preventing bacterial attachment. Bladder washes from patients with recurrent urinary tract infection were significantly less potent at inhibiting bacterial adherence than extracts from other groups of patients. This decreased functional antiadherence activity of bladder extracts may help explain the frequency of urinary tract infection in this group of patients.
View details for Web of Science ID A1988P085400049
View details for PubMedID 3379683
THE EFFECTS OF SHORT-TERM INVIVO ISCHEMIA ON THE CONTRACTILE FUNCTION OF THE RABBIT URINARY-BLADDER
JOURNAL OF UROLOGY
1988; 139 (6): 1350-1354
The proper functioning of any smooth muscle requires adequate perfusion with oxygen and nutrients. Ischemia compromises both these factors and results in dysfunction, the extent depending on the degree and duration of ischemia. This study determined the effects of one, two and four weeks in vivo ischemia on the capacity, compliance and contractile function of the rabbit urinary bladder. Morphological changes were also studied with light microscopy. Different degrees of ischemia were achieved as follows. In the unilateral group the vesical artery was tied on one side and the animals were sacrificed at one week or two weeks. In the bilateral group the vesical arteries on both sides were tied and the animals were sacrificed one week later. In the bilateral staged group the vesical artery was tied on one side and after one week the contralateral artery was ligated, and the animals sacrificed one week after the second procedure. Muscle strips were studied for contractile response, with a distinction being made between the ipsilateral and contralateral side of vessel ligation in the unilateral group. The results were as follows. 1) In the unilateral group there was a 72% reduction in the contractile response of the dome of the bladder to bethanecol on the side of vessel ligation and a 32% reduction on the contralateral side. The response to methoxamine on the base was reduced by 44%, with no difference between the ipsilateral and contralateral side. 2) Bilateral vessel ligation resulted in a 97% reduction in contractile response to bethanechol on the dome and a 75% in the response of the base to methoxamine. 3) Staged bilateral ligation resulted in a 69% reduction in the contractile response of the dome to bethanechol and a 18% reduction in the response of the base to methoxamine. Ischemia caused a marked reduction in the compliance and capacity of the bladder in all the three groups, with the most marked changes in the bilateral group. Multiple spontaneous contractions were noted in the three groups during the filling phase of the cystometrograms. Histological features correlated well with the functional changes in the different groups.
View details for Web of Science ID A1988N638900059
View details for PubMedID 3373613
EFFECT OF BETHANECHOL ON GLYCOLYSIS AND HIGH-ENERGY PHOSPHATE-METABOLISM OF THE RABBIT URINARY-BLADDER
JOURNAL OF UROLOGY
1988; 139 (3): 646-649
The urinary bladder, similar to other smooth muscles, utilizes glucose as one of its primary sources of metabolic energy. We have studied the effect of bethanechol on both glycolysis and high energy phosphate metabolism. The results can be summarized as follows: bethanechol administration in vitro stimulates a 30% decrease in intracellular glycogen, a 100% increase in lactic acid production, and an 80% increase in CO2 generation. Although there was a rapid and sustained decrease in the intracellular concentration of creatine phosphate, there was only a minor decrease in the intracellular concentration of ATP. There were no changes in adenine uptake or de novo ATP synthesis.
View details for Web of Science ID A1988M285400058
View details for PubMedID 2893843
EFFECT OF ILEOCYSTOPLASTY ON CONTRACTILE RESPONSE OF THE BLADDER, ILEUM, AND CYSTOPLASTIC ILEAL SEGMENT
NEUROUROLOGY AND URODYNAMICS
1988; 6 (5): 363-369
View details for Web of Science ID A1988M803300001
FUNCTIONAL EFFECT OF CHRONIC ISCHEMIA ON THE RABBIT URINARY-BLADDER
NEUROUROLOGY AND URODYNAMICS
1988; 7 (1): 1-12
View details for Web of Science ID A1988N548400001
STUDIES ON THE BIPHASIC NATURE OF URINARY-BLADDER CONTRACTION AND FUNCTION
NEUROUROLOGY AND URODYNAMICS
1987; 6 (4): 339-350
View details for Web of Science ID A1987L105600008
MILD METABOLIC HYPEROXALURIA AND ITS RESPONSE TO PYRIDOXINE
1986; 41 (5): 393-396
Three cases of mild metabolic hyperoxaluria (with glycollaturia) are described. They showed different types of response to pyridoxine. One responded to low dose, one responded at first to low dose but became resistant, and the third showed temporary response to high dose. One case also had primary hyperparathyroidism and one had medullary sponge kidneys and hypercalciuria. It is important to measure urinary oxalate (and glycollate) in all cases of calcium oxalate urolithiasis.
View details for Web of Science ID A1986F506600012
View details for PubMedID 3811039
- OCCURRENCE OF TOXOPLASMA-GONDII ANTIBODIES IN TANZANIAN BLOOD-DONORS EAST AFRICAN MEDICAL JOURNAL 1985; 62 (8): 585-588
IDIOPATHIC HYPERCALCIURIA - URATE AND OTHER IONS IN URINE BEFORE AND ON VARIOUS LONG-TERM TREATMENTS
1985; 13 (6): 271-275
24 h urine compositions of male stone formers with idiopathic hypercalciuria prior to treatment were compared with those of male general practitioners without urolithiasis. Urinary urate was slightly higher in the stone formers than in the normals but this was not statistically significant. Furthermore, when results were corrected for the higher creatinine excretions of the stone formers then the reverse was true and statistically significant. All subjects with urinary urate over 7.0 mmol/24 h were separately studied. In these groups the normals had higher urate and creatinine excretions than the stone formers but when results were corrected for creatinine the difference in the urate excretions disappeared. In long term follow up studies urinary calcium was lowered by diet and more so by diet supplemented with either Bendrofluazide or cellulose phosphate. Each drug raised urinary oxalate slightly and this was statistically significant, while both drugs together caused an even bigger rise in oxalate excretion. An unexpected finding was a rise in urinary urate with cellulose phosphate.
View details for Web of Science ID A1985AWM6800002
View details for PubMedID 4095826
Prevalence of Toxoplasma antibodies in pregnant African women in Tanzania.
African journal of medicine and medical sciences
1982; 11 (4): 167-170
Three hundred and fifty-seven serum samples from pregnant African women were examined for Toxoplasma gondii antibodies with indirect haemagglutination test in Dar es Salaam. Out of these 222 women were normal, sixty-nine had anaemia and sixty-six were suffering from hypertension. Infection rate in normal pregnant women was 41.9%, in anaemic women 52.5%, and in those suffering from hypertension 66.7%. Highly significant relationship was observed between Toxoplasma infection and anaemia, and hypertension. Infection rate was significantly high in women who had histories of abortion. The results suggested associations of Toxoplasma gondii infection with hypertension and anaemia in African women.
View details for PubMedID 6308981
- CHLOROQUINE-RESISTANT FALCIPARUM-MALARIA IN SEMI-IMMUNE NATIVE AFRICAN TANZANIANS LANCET 1982; 2 (8288): 43-43