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More water = less kidney stones

MedicalNewsToday - 8 hours 14 min ago
Staying well hydrated is an effective way to reduce your chances of forming kidney stones, according to new research presented at the National Kidney Foundation's 2015 Spring Clinical Meetings.
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Genetic discovery may offer new avenue of attack against schistosomiasis

MedicalNewsToday - 10 hours 14 min ago
Researchers at Oregon State University have discovered a group of genes in one species of snail that provide a natural resistance to the flatworm parasite that causes schistosomiasis, and opens the...
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Rapid testing for gene variants in kidney donors may optimize transplant outcomes

MedicalNewsToday - 10 hours 14 min ago
Kidney transplantation outcomes from deceased African-American donors may improve through rapid testing for apolipoprotein L1 gene (APOL1) renal risk variants at the time of organ recovery, according...
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New data supporting Arno Therapeutics' HDAC inhibitor AR-42 published

MedicalNewsToday - Thu, 2015-03-26 05:00
Arno Therapeutics, Inc., a clinical stage biopharmaceutical company primarily focused on the development of oncology therapeutics, has announced that data from a preclinical study demonstrate its...
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Precision Medicine in Active Surveillance for Prostate Cancer: Development of the Canary–Early Detection Research Network Active Surveillance Biopsy Risk Calculator

Abstract Background

Men on active surveillance (AS) face repeated biopsies. Most biopsy specimens will not show disease progression or change management. Such biopsies do not contribute to patient management and are potentially morbid and costly.

Objective

To use a contemporary AS prospective trial to develop a tool to predict AS biopsy outcomes.

Design, setting, and participants

Biopsy samples (median: 2; range: 2–9 per patient) from 859 men participating in the Canary Prostate Active Surveillance Study and with Gleason 6 prostate cancer (median follow-up: 35.8 mo; range: 3.0–148.7 mo) were analyzed.

Outcome measurements and statistical analysis

Logistic regression was used to predict progression, defined as an increase in Gleason score from ≤6 to ≥7 or increase in percentage of cores positive for cancer from <34% to ≥34%. Fivefold internal cross-validation was performed to evaluate the area under the receiver operating characteristic curve (AUC).

Results and limitations

Statistically significant risk factors for progression on biopsy were prostate-specific antigen (odds ratio [OR]: 1.045; 95% confidence interval [CI], 1.028–1.063), percentage of cores positive for cancer on most recent biopsy (OR: 1.401; 95% CI, 1.301–1.508), and history of at least one prior negative biopsy (OR: 0.524; 95% CI, 0.417–0.659). A multivariable predictive model incorporating these factors plus age and number of months since last biopsy achieved an AUC of 72.4%.

Conclusions

A combination of readily available clinical measures can stratify patients considering AS prostate biopsy. Risk of progression or upgrade can be estimated and incorporated into clinical practice.

Patient summary

The Canary–Early Detection Research Network Active Surveillance Biopsy Risk Calculator, an online tool, can be used to guide patient decision making regarding follow-up prostate biopsy.

Take Home Message

Urologists can now use the active surveillance biopsy risk calculator to individualize patients’ surveillance biopsy schedules. This approach may be attractive to many patients and may increase their participation in joint decision making during follow-up.

Keywords: Active surveillance, Biopsy, Progression, Prostate-specific antigen.

Footnotes

a Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

b Life Sciences Mathematics Unit, Technische Universitaet Muenchen, Munich, Germany

c Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

d Department of Urology, University of Washington, Seattle, WA, USA

e Department of Urology, Stanford University School of Medicine, Stanford, CA, USA

f Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, USA

g Department of Urologic Sciences, The Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada

h Departments of Microbiology and Molecular Cell Biology and Urology, Eastern Virginia Medical School, Norfolk, VA, USA

i Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

j Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

k Department of Urology, University of Michigan, Ann Arbor, MI, USA

Corresponding author. Zentrum Mathematik, M12, Technische Universitaet Muenchen, Boltzmannstr 3, 85747 Garching, Germany. Tel. +49 89 289 18388; Fax: +49 89 289 18435.

Article information

PII: S0302-2838(15)00242-0
DOI: 10.1016/j.eururo.2015.03.023
© 2015 European Association of Urology, Published by Elsevier B.V.

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Centralization and Quality Control of Elective Surgery Improve Outcome: Aren’t We Ethically Obliged to Force the Pace of Creating High-volume Centers?

Refers to article:

Achieving Quality Assurance of Prostate Cancer Surgery During Reorganisation of Cancer Services

Paul Cathcart, Ashwin Sridhara, Navin Ramachandran, Timothy Briggs, Senthil Nathan and John Kelly

Accepted 25 February 2015

Footnotes

Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany

Corresponding author. Martini-Clinic Prostate Cancer Center, Martinistrasse 52, 20246 Hamburg, Germany.

Article information

PII: S0302-2838(15)00251-1
DOI: 10.1016/j.eururo.2015.03.032
© 2015 European Association of Urology, Published by Elsevier B.V.

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Phosphodiesterase 5 Inhibitors for the Treatment of Erectile Dysfunction: A Trade-off Network Meta-analysis

Abstract Context

Erectile dysfunction (ED) is a major health care problem worldwide and phosphodiesterase 5 inhibitors (PDE5Is) are the pharmacological treatment of choice. However, the optimal PDE5I for ED treatment is not known.

Objective

To investigate trade-offs between efficacy and adverse events for various PDE5Is in treating ED.

Evidence acquisition

A review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Medline, Scopus, reference lists of relevant articles, and systematic reviews were searched. Eligible studies were randomized controlled trials comparing at least one PDE5I for treating ED with placebo or another PDE5I.

Evidence synthesis

We included 82 trials (47 626 patients) for efficacy analysis and 72 trials (20 325 patients) for adverse event analysis. In the trade-off analysis of starting dosages, sildenafil 50 mg had the greatest efficacy but also had the highest rate of overall adverse events. Tadalafil 10 mg had intermediate efficacy but had the lowest overall rate of all adverse events. Vardenafil 10 mg and avanafil 100 mg had similar overall adverse events than sildenafil 50 mg but a markedly lower global efficacy. Udenafil 100 mg had similar global efficacy to that of tadalafil 10 mg but its overall adverse event rates were higher.

Conclusions

This is the first trade-off analysis of the different PDE5Is currently available. For individuals who prioritize high efficacy, sildenafil 50 mg appears to be the treatment of choice. Men wishing to optimize tolerability should take tadalafil 10 mg or switch to udenafil 100 mg in the case of insufficient efficacy.

Patient summary

For patients with erectile dysfunction who wish to prioritize high efficacy, sildenafil 50 mg appears to be the treatment of choice. Men who wish to optimize tolerability should take tadalafil 10 mg or switch to udenafil 100 mg in the case of insufficient efficacy.

Take Home Message

For patients with erectile dysfunction who prioritize high efficacy, sildenafil 50 mg appears to be the treatment of choice. Men wishing to optimize tolerability should take tadalafil 10 mg or switch to udenafil 100 mg if the efficacy is insufficient.

Keywords: Phosphodiesterase 5 inhibitors, Erectile dysfunction, Network meta-analysis.

Footnotes

a Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland

b Brain Research Institute, University of Zürich, Zürich, Switzerland

c Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland

d Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands

e Medignition Research Consultants, Zürich, Switzerland

Corresponding author. Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, 8008 Zürich, Switzerland. Tel. +41 44 3863845; Fax: +41 44 3863909.

These authors contributed equally.

Article information

PII: S0302-2838(15)00250-X
DOI: 10.1016/j.eururo.2015.03.031
© 2015 European Association of Urology, Published by Elsevier B.V.

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Cryoablation for Small Renal Masses: Selection Criteria, Complications, and Functional and Oncologic Results

Abstract Context

Cryoablation (CA) is a minimally invasive modality with low complication rates, but its use in urology is relatively recent.

Objective

To summarize available evidence for CA for small renal masses (SRMs) and to assess the selection criteria, complications, and functional and oncologic results based on the latest CA literature.

Evidence acquisition

A systematic literature search of the Medline, Embase, and Scopus databases was performed in August 2014 using Medical Subject Headings and free-text protocol. The following search terms were included:kidney cryosurgery, renal cryosurgery, kidney cryoablation, renal cryoablation, kidney cryotherapy, andrenal cryotherapy.

Evidence synthesis

Due to the relatively recent mainstream utilization of CA and lack of long-term efficacy data from large prospective or randomized studies, most of the data available on CA are limited to treatment of SRMs in patients who are often older or are poor surgical candidates. The rates of major complications across the CA literature remain relatively low. Studies assessing renal function after CA suggest a degree of functional decline following CA because proper application includes freezing of a tumor margin; however, often this is not clinically significant. Specific oncologic outcomes should be evaluated in patients with biopsy-proven renal cell carcinoma; when SRM series include benign or unbiopsied tumors, the results of these outcomes are skewed. Although earlier series were suggestive of a higher recurrence rate after CA, some studies have challenged this view reporting recurrence rates comparable with extirpative nephron-sparing surgery.

Conclusions

CA represents an alternative approach to treatment for patients diagnosed with renal neoplasm. There is no consensus within the literature on the best patient selection criteria. Due to higher rates of treatment failure, it is often not offered to patients with minimal comorbidities and good life expectancy. In terms of functional outcomes, CA signifies a modality with minimum impact on renal function; however, well-designed studies precisely assessing this factor are lacking. CA is a minimally invasive modality with suitably low rates of complications, particularly if delivered via the percutaneous route.

Patient summary

Cryoablation (CA) represents an alternative approach for treating renal neoplasm. Excellent functional outcomes and low rates of complications make CA an ideal minimally invasive modality. Patient selection criteria and oncologic outcomes require further study.

Take Home Message

Cryoablation (CA) represents an alternative approach to treatment for renal neoplasm. Excellent functional outcomes and low rates of complications make CA an ideal minimally invasive modality for the treatment of small renal masses. Patient selection criteria and oncologic outcomes require further study.

Keywords: Renal cryoablation, Small renal masses, Cryotherapy, Selection criteria, Complications, Function, Oncology.

Footnotes

a Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

b Department of Radiology, Mayo Clinic, Rochester, MN, USA

c Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX

d Department of Urology, Academic Medical Center, Amsterdam, The Netherlands

e Department of Urology and Andrology, Paracelsus Medical University Salzburg, Salzburg, Austria

f Department of Urology, MD Anderson Cancer Center, Houston, TX, USA

g Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA

h Moffitt Cancer Center, Tampa, FL, USA

i Department of Urology, Mayo Clinic, Rochester, MN, USA

Corresponding author. Cleveland Clinic, Glickman Urology Institute Q 10, 9500 Euclid Avenue, Cleveland, OH 44106, USA. Tel. +1 216 526 6139.

Article information

PII: S0302-2838(15)00246-8
DOI: 10.1016/j.eururo.2015.03.027
© 2015 European Association of Urology, Published by Elsevier B.V.

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Predicting Life Expectancy in Men Diagnosed with Prostate Cancer

Abstract Context

The widespread use of prostate-specific antigen (PSA) screening has led to the detection of more indolent prostate cancer (PCa) in healthy men. PCa treatment and screening must therefore balance the potential for life gained against the potential for harm. Fundamental to this balance is physician awareness of a patient's estimated life expectancy (LE).

Objective

To review the evidence on LE differences between men diagnosed with PCa and the general population. To examine clinician- and model-predicted LE and publicly available LE calculators.

Evidence acquisition

A comprehensive search of the PubMed database between 1990 and September 2014 was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Free text protocols of the following search terms were used “life expectancy prostate cancer”, “life expectancy non-cancer”, “non-cancer mortality prostate”, and “comorbidity-adjusted life expectancy”. Two internet search engines were queried daily for 1 mo for the search term “life expectancy calculator”, and the top 20 results were examined.

Evidence synthesis

Of 992 articles and 32 websites screened, 17 articles and nine websites were selected for inclusion. Men with non–screening-detected PCa and distant disease at diagnosis were found to have shorter LE than age-matched peers, whereas men with localized PCa had prolonged LE. In general, clinician-predicted 10-yr LE was pessimistic and of limited accuracy; however, model-predicted LE provided only modest improvements in accuracy (c-index of models 0.65–0.84). Online LE calculators provide consistent LE estimates, but government life tables provide LE estimates near the mean for all calculators examined.

Conclusions

The accuracy of clinician-predicted survival is limited, and while available statistical models offer improvement in discrimination, it is unclear whether they provide advantages over freely available government life tables.

Patient summary

We examined differences in life expectancy between men diagnosed with prostate cancer and the general population, and ways of predicting life expectancy to help guide treatment decisions. We found that current models for predicting life expectancy specific to prostate cancer might not be any better than government life tables or simple rules of thumb.

Take Home Message

Important biases associated with screening-detected cancers necessitate the assessment of life expectancy when diagnosing or treating men with prostate cancer. This review summarizes the current literature on life expectancy estimation for men with prostate cancer. Even though the accuracy and utility of clinician-predicted survival rates are limited, available statistical models offer only a modest improvement in discrimination, and they may not provide advantages over freely available government life tables.

Keywords: Prostate cancer, Life expectancy, Survival, Prediction.

Footnotes

a VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA

b Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

c Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

d Department of Urology, Mayo Clinic, Rochester, MN, USA

e Department of Urology, University of Hamburg Eppendorf, Hamburg, Germany

f Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy

g Memorial Sloan Kettering Cancer Center, New York, NY, USA

h Division of Urologic Surgery, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA

Corresponding author. VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, 2799 W. Grand Boulevard, Detroit, MI 48202, USA. Tel. +1 207 6927167; Fax: +1 313 9164352.

Article information

PII: S0302-2838(15)00229-8
DOI: 10.1016/j.eururo.2015.03.020
© 2015 Published by Elsevier B.V.

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Polymorphisms of Genes Involved in Glucose and Energy Metabolic Pathways and Prostate Cancer: Interplay with Metformin

Abstract Background

Energy metabolism is important in cancer proliferation and progression, but its role in prostate cancer (PCa) remains unclear.

Objective

We explored whether single-nucleotide polymorphisms (SNPs) of genes involved in energy metabolic pathways are associated with PCa risk and prognosis, and whether antidiabetic treatment modifies any such association.

Design, setting, and participants

The PRACTICAL Consortium genotyped 397 SNPs among 3241 screened participants (including 801 PCa cases) in the Finnish Prostate Cancer Screening Trial and 1983 hospital-based PCa cases. Information on medication use was obtained from a national prescription database.

Outcome measurements and statistical analysis

Genetic risk scores were calculated in terms of SNPs associated with PCa incidence or survival at a significance level ofp< 5 × 10−3. Hazard ratios for PCa and disease-specific death were calculated via Cox regression modelling. The predictive value of the genetic risk score was evaluated using receiver operating characteristic and Harrell's c-index analyses.

Results and limitations

A total of 30 SNPs were associated with PCa risk and ten SNPs with survival. The genetic risk score was consistently associated with PCa survival. The risk association was non-significantly weaker in metformin users. The genetic risk score did not improve prediction of PCa risk, but slightly improved the ability to predict PCa survival when added to conventional predictors (c-index improved from 87.4 to 87.9;p < 0.001). A limitation is that information on diabetes apart from medication use was unavailable for the study population.

Conclusions

SNPs of genes involved in energy metabolic pathways are associated with PCa survival. This suggests an important role of glucose metabolism in PCa progression, which could point to new avenues for prevention of PCa death.

Patient summary

Genetic changes in glucose and energy metabolic pathways are associated with a higher risk of high-risk prostate cancer and adverse outcomes.

Take Home Message

Single-nucleotide polymorphisms in genes involved in the glucose and energy metabolic pathways, especiallyPDK1andPGM1genes, showed consistent associations with serum prostate-specific antigen, risk of high-grade and metastatic prostate cancer, and prostate cancer survival. This evidence supports an important role for glucose metabolism in prostate cancer progression, which could provide new avenues for prevention of prostate cancer death.

Keywords: Glucose metabolism, Prostate cancer, Risk, Survival.

Footnotes

a School of Medicine, University of Tampere, Tampere, Finland

b Department of Urology, Tampere University Hospital, Tampere, Finland

c Institute of Biosciences and Medical Technology / BioMediTech and Fimlab Laboratories, University of Tampere, Tampere, Finland

d Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

e Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland

f Institute of Biomedicine, Medical Biochemistry and Genetics, University of Turku, Turku, Finland

g School of Health Sciences, University of Tampere, Tampere, Finland

Corresponding author. School of Medicine, Building M, Room 313, University of Tampere, PL 2000, 33521 Tampere, Finland. Tel. +358 3 31165015; Fax: +358 3 31164358.

Members of the PRACTICAL Consortium are listed in Supplementary File 1.

Article information

PII: S0302-2838(15)00245-6
DOI: 10.1016/j.eururo.2015.03.026
© 2015 European Association of Urology, Published by Elsevier B.V.

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Prostate Cancer Risk Calculators Using ERSPC-derived Data Underestimate the Risk if the WHO IRP 96/670 Standard Is Used in Prostate-specific Antigen Analysis

Footnotes

a Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland

b Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK

Biomedical Sciences, Ulster University, Coleraine, BT 52 1SA, Northern Ireland, UK.

Article information

PII: S0302-2838(15)00247-X
DOI: 10.1016/j.eururo.2015.03.028
© 2015 European Association of Urology, Published by Elsevier B.V.

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Combining the old and new to kill cancer cells

MedicalNewsToday - Thu, 2015-03-26 02:00
A team of Singapore based scientists have found that pairing a new approach with an old drug may be an effective approach to treat common cancers. In a landmark study, Professor David Virshup and Dr.
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Catheter-associated Urinary Tract Infections in Children: Room for Improvement Commentary on: Reducing Catheter-associated Urinary Tract Infections: A Quality-improvement Initiative

Urology (Gold Journal) In Press - Wed, 2015-03-25 19:00
This article reports the results of a quality improvement project to reduce the incidence of catheter-associated urinary tract infections (CAUTIs) in a single, large, tertiary care children's hospital. An observational study was performed to determine the impact of implanting a quality improvement bundle on the incidence of CAUTIs in Children's Hospital of Philadelphia.
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A Case of Colon Cancer Metastasis to the Penis

Urology (Gold Journal) In Press - Wed, 2015-03-25 19:00
An 80-year-old male patient with a history of prostate cancer treated with brachytherapy 5 years ago at an outside institution with stable low prostate-specific antigen levels, history of pT2N1c colon adenocarcinoma involving the muscularis propria and pericolonic adipose tissue (Fig. 1) status post low anterior resection 2 years ago followed by adjuvant chemotherapy with 5-fluorouracil, leucovorin, and oxaliplatin presented with a 3-month history of an enlarging mass at the base of his circumcised penis.
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Reply

Urology (Gold Journal) In Press - Wed, 2015-03-25 19:00
During his professional life as a urologic surgeon, Prof. Sergio Cosciani Cunico (Fig. 1), who died in June 2013, not only always demonstrated his considerable technical expertise but also his care and devotion to his patients, above all, if they were children. He achieved many excellent clinical and scientific results and his charm and medical capability were both greatly appreciated by his patients and their families.
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Editorial Comment

Urology (Gold Journal) In Press - Wed, 2015-03-25 19:00
This brief case report1 is a memorial to the late Prof. Sergio Cosciani Cunico, a long-time Italian urologist. Born in Trieste in 1939, Prof. Cosciani Cunico studied medicine at Padova and was on the faculty at Brescia until his recent death in 2014. The case is that of a woman with classical bladder exstrophy, unclosed until she met with Prof. Cosciani Cunico when she was 20 years old. The case is of note for a number of reasons: (1) the unusual reconstruction of removing the bladder, mobilizing the ureters to the deep pelvis, and closing the abdominal and pelvic defects after creating ureteral stomas on the perineum; (2) the outcome nearly 40 years later of high-functioning upper tracts containing 2 good renal units; and (3) a psychosocially high-functioning woman in a happy marital relationship.
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Is Periurethral Calcification Associated With Urinary Flow Rate and Symptom Severity in Men With Lower Urinary Tract Symptoms-Benign Prostatic Hyperplasia? A Retrospective Review

Urology (Gold Journal) In Press - Wed, 2015-03-25 19:00
To evaluate the association of periurethral calcification (PUC) with urine flow rate and symptom severity in men with lower urinary tract symptoms-benign prostatic hyperplasia (LUTS-BPH).
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Body and Self-image in Individuals With Bladder Exstrophy: What Happens After … The Age of 60?

Urology (Gold Journal) In Press - Wed, 2015-03-25 19:00
An unusual case report to stress the complexity of development of identity and intimacy in people with bladder exstrophy. The psychosocial support seems to play a fundamental role to promote self-esteem of abdominal scarring and altered genital appearance.
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Laparoscopic Omentoplasty to Support Anastomotic Urethroplasty in Complex and Redo Pelvic Fracture Urethral Defects

Urology (Gold Journal) In Press - Wed, 2015-03-25 19:00
To test the hypothesis that a new surgical technique using elaborated perineal anastomotic urethroplasty combined with laparoscopic omentoplasty for patients with complex and prior failed pelvic fracture urethral defect repair was feasible, safe, and effective.
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Multimodal Management of a Pediatric Cervical Yolk Sac Tumor

Urology (Gold Journal) In Press - Wed, 2015-03-25 19:00
Even though vaginal bleeding is an unusual clinical presentation in infants and young children, thorough evaluation by the pediatric urologist requires the recognition and knowledge of less-common conditions, including malignancy. Extragonadal germ cell tumors are rare in children aged <15 years, representing approximately 1% of all cancers. Because of the close collaboration between pediatric oncologists and pediatric urologists, a multidisciplinary approach to the management and treatment of these tumors includes chemotherapy and surgical resection, aiming for fertility preservation when possible.
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