Objectives: Clinical and epidemiological studies have shown low testosterone (TST) is associated with increased risk of vascular disease, yet the molecular mechanisms remain unclear. Matrix metalloproteinases (MMPs) are implicated in dysfunctional remodeling. Our group has previously demonstrated an inverse relationship between TST levels and MMP activity in vitro. We have also demonstrated androgen deficiency (AD)-modulated inflammatory signaling does not influence systemic MMPs in vivo. Here we investigated the role of AD and TST replacement in MMP-modulated remodeling in response to injury. Methods: Sub-physiological and physiological TST replacement was administered via implanted pellets in aged orchiectomized rats (0.5-5mg, Table 1). Serum TST was determined by ELISA. At 14d TST replacement rats underwent balloon angioplasty of the left common carotid. Young intact (YI), aged intact (AI), and orchiectomized placebo (Plac) animals served as controls. Carotids were collected 14d post-injury for intima:media (I:M) and MMP quantification. Results: I:M was increased in Plac, sub-, and low-physiological TST animals compared to AI controls, and decreased with higher physiological TST (Fig 1). Injury-induced expression of MMPs involved in vascular remodeling was not significantly affected by TST status (Table 2). Conclusions: AD is associated with hyperplasia development in response to vascular injury while physiological TST replacement attenuated this effect. This attenuation occurs independent of MMP mechanisms known to be heavily involved in vascular remodeling. Future in vivo studies will examine molecular targets involved in AD and the effect of TST replacement in the acute inflammatory response to vascular injury. These studies are needed in determining if TST replacement therapy in AD men should be evaluated for attenuation of vascular pathogenesis.

Background: Androgen deficiency (AD) is associated with increased risk of atherosclerosis, cardiovascular, and peripheral arterial disease. Although the biochemical and molecular mechanisms underlying this risk remain unclear, higher testosterone (TST) levels correlate to significant immunoprotective molecular and cellular responses. Our group has previously demonstrated that female sex hormones influence vascular pathogenesis via inflammatory-modulated matrix metalloproteinase (MMP) regulation. Here we investigated the role of AD and androgen replacement therapy in the modulation of these hormonally responsive pathways that could be playing a role in the development of vascular pathogenesis.Methods: Aged orchiectomized male rats underwent TST supplementation per controlled release pellet implantation (0-150 mg). Young and aged intact groups served as controls. Serum was collected at 0-4 wk and analyzed by enzyme-linked immunosorbent assays, qualitative cytokine screening, and quantitative multiplex analyses. Human aortic smooth muscle cells were treated with 4,5 alpha-dihydrotestosterone (DHT; 0-3000 nM) before or after interleukin 1 beta (IL-1 beta; 5 ng/mL) stimulation. Quantitative polymerase chain reaction and ingel zymography was used to assay the effect on MMP expression and activity.Results: Subphysiological, physiological, and supraphysiological levels of TST were achieved with 0.5, 2.5, and 35 mg TST pellet implants in vivo, respectively. Inflammatory arrays indicated that interleukin cytokines, specifically IL-2, IL-6, IL-10, IL-12, and IL-13, were elevated at subphysiological level of TST, whereas TST supplementation decreased interleukins. Supraphysiological TST resulted in a significant increase in MMP-9 and tissue inhibitor of metalloproteinase-1 (TIMP-1) in vivo. Pretreatment with IL-1b slightly increased membrane type 1-MMP (MT1-MMP) and MMP-2 expression at low to mid-level DHT exposure in vitro, although these trends were not statistically significant.Conclusions: Here we demonstrate AD is a proinflammatory modulator and indicate that MMP-independent mechanisms may play a role downstream of AD-induced inflammatory signaling in dysfunctional vascular remodeling. Future in vivo studies will examine AD and TST supplementation in acute inflammatory response to vascular injury and in MMP-modulated vascular disease. (C) 2014 Elsevier Inc. All rights reserved.

A 55-year-old man presents with a 10-cm condylomatous penoscrotal mass. Final pathology after surgical removal reveals a rare vegetative lesion with underlying herpes simplex virus infection. Along with neoplasia, infectious causes must remain in the differential diagnosis in the immunocompromised patient who presents with an atypical lesion. (C) 2014 Elsevier Inc.

You have accessJournal of UrologyKidney Cancer: Evaluation/Staging II1 Apr 2014MP30-15 ELIMINATION OF PELVIC COMPUTED TOMOGRAPHY FOR RENAL CELL CARCINOMA FOLLOW-UP: A CLINICAL, SAFETY AND COST ANALYSIS Kyle Basham, James Bienvenu, Wesley White, Ryan Pickens, and Frederick Klein Kyle BashamKyle Basham More articles by this author , James BienvenuJames Bienvenu More articles by this author , Wesley WhiteWesley White More articles by this author , Ryan PickensRyan Pickens More articles by this author , and Frederick KleinFrederick Klein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.823AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The guidelines for follow-up imaging after treatment for Stage I-III renal cell carcinoma (RCC) vary between organizations. Current AUA guidelines recommend only periodic abdominal computed tomography (CT) imaging and CXR. NCCN guidelines suggest abdominal +/- pelvic CT and CXR. We look at the utility of the pelvic CT and analyze the potential cost and radiation exposure savings by eliminating the pelvic CT in RCC follow-up without sacrificing cancer surveillance. METHODS A retrospective review of charts from patients that underwent surgical resection for RCC between 2008 and 2012 at our institution from a single practice were analyzed. Follow-up imaging exams and results were analyzed for management-changing findings from pelvic CT. Cost and radiation exposure differences between the two imaging studies were ascertained from the University of Tennessee Medical Center Department of Radiology. RESULTS 245 patients (54% male, 46% female; mean age 59, range 17-88) underwent radical or partial nephrectomy for RCC (43% pT1a, 22% pT1b, 10% pT2, 25% pT3) from 2008 to 2012. A total of 146 patients had follow-up data. 139 had follow-up abdominal and pelvic CT, 6 had abdominal CT, and 1 had renal ultrasounds for follow-up. Sixteen patients had metastatic disease known at initial diagnosis. None of the 120 patients having routine follow-up abdominal + pelvic CT scans had new, positive findings on the pelvic CT. One patient developed a contralateral primary tumor, and another had a new L2 lesion seen on abdominal CT. Ninety-nine had no follow-up data due to various factors. At the time of this publication, performing only abdominal CT results in a savings of $1,652 per patient per imaging encounter at our institution. The average effective radiation dose is cut from 14 mSv to 8 mSv for eliminating the pelvic CT. CONCLUSIONS Abdominal CT alone is sufficient for continued follow-up of patients status-post partial or radical nephrectomy for Stage I-III RCC in the routine setting. Oncologic surveillance would not have been affected in our series. Eliminating the pelvic CT results in significant cost and radiation savings and benefits the patient and our healthcare system. We, therefore, recommend that routine RCC follow-up imaging exclude pelvic CT scans. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e319 Advertisement Copyright & Permissions© 2014Metrics Author Information Kyle Basham More articles by this author James Bienvenu More articles by this author Wesley White More articles by this author Ryan Pickens More articles by this author Frederick Klein More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Low testosterone levels have been associated with increased risk for vascular disease. Previous studies have shown a significant decrease in intimal hyperplasia (IH) development in the presence of testosterone. Matrix metalloproteinases (MMPs) play a major role in vascular remodeling due to their ability to selectively degrade components of the extracellular matrix, allowing pathological vascular smooth muscle cell (VSMC) migration and proliferation to the intimal layer. Our group has previously shown a positive correlation between estrogen/progesterone and IH development via increased MMP activity in vitro and in vivo. Here we hypothesized that testosterone attenuates the cellular processes of IH by inhibiting MMP expression and activity.

You have accessJournal of UrologyProstate Cancer: Detection & Screening (III)1 Apr 20131930 ROLE OF COMMUNITY-BASED PROSTATE SCREENING IN THE MODERN ERA Jared Moss, Eric Heidel, Erin Dittrich, Paul Terry, Mitchell Goldman, Frederick Klein, Bedford Waters, and Wesley White Jared MossJared Moss Knoxville, TN More articles by this author , Eric HeidelEric Heidel Knoxville, TN More articles by this author , Erin DittrichErin Dittrich Knoxville, TN More articles by this author , Paul TerryPaul Terry Knoxville, TN More articles by this author , Mitchell GoldmanMitchell Goldman Knoxville, TN More articles by this author , Frederick KleinFrederick Klein Knoxville, TN More articles by this author , Bedford WatersBedford Waters Knoxville, TN More articles by this author , and Wesley WhiteWesley White Knoxville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2349AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The recent and controversial recommendation by the USPSTF to eliminate PSA-based screening for prostate cancer has forced the urologic community as a whole to not only defend but also sharpen our current screening strategies. Mass community-based screenings represent one existing paradigm in need of evaluation. We examined our institution's longitudinal experience with community-based screenings with the explicit goal of defining its appropriateness as a preventative screening tool. METHODS A retrospective study was performed to evaluate all men who participated in our cancer center's mass community screenings between May 2009 and September 2010. There were no exclusion criteria for screening and study participation. Salient demographic and urologic data was self-reported and recorded prospectively at the time of screening. All men subsequently underwent digital rectal examination (DRE) by a board-certified urologist and prostate specific antigen (PSA) testing. The data reviewed contained information regarding patient demographics, family history of prostate cancer, lower urinary tract symptoms (LUTS), prior history of prostate cancer, most recent DRE, and the presence of an established relationship with a urologist. RESULTS A total of 500 men underwent screening. Mean age of the cohort was 63 years (range 32 − 87 years). Ninety-three percent of screened men were Caucasian, 5% were African American, and 2% were Hispanic. This cohort was consistent with regional demographics. Twenty-five percent of men reported a known family history of prostate cancer within a first-degree relative. Among patients 40?75 years of age, 78% reported no screening within the last year, and among patients with a family history of prostate cancer, 71% reported no screening within the last year. Additionally, only 29% of African American men had undergone annual screening in the past. Three percent of men reported having a prior history of prostate cancer. CONCLUSIONS Based on our experience, mass community-based prostate cancer screening appears to identify and screen at-risk men. Judicious and refined screening criteria are needed to avoid unnecessary and/or inappropriate screening. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189 Issue 4S April 2013 Page: e791 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Metrics Author Information Jared Moss Knoxville, TN More articles by this author Eric Heidel Knoxville, TN More articles by this author Erin Dittrich Knoxville, TN More articles by this author Paul Terry Knoxville, TN More articles by this author Mitchell Goldman Knoxville, TN More articles by this author Frederick Klein Knoxville, TN More articles by this author Bedford Waters Knoxville, TN More articles by this author Wesley White Knoxville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Basic Research I1 Apr 2012812 TESTOSERONE MODULATES VASCULAR SMOOTH MUSCLE CELL MEDIATED MATRIX METALLOPROTEINASE EXPRESSION AND FUNCTION, IN VITRO John Beddies, James Bienvenu, Deidra Mountain, Stacy Kirkpatrick, Oscar Grandas, and Frederick Klein John BeddiesJohn Beddies Knoxville, TN More articles by this author , James BienvenuJames Bienvenu Knoxville, TN More articles by this author , Deidra MountainDeidra Mountain Knoxville, TN More articles by this author , Stacy KirkpatrickStacy Kirkpatrick Knoxville, TN More articles by this author , Oscar GrandasOscar Grandas Knoxville, TN More articles by this author , and Frederick KleinFrederick Klein Knoxville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.901AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A strong association between serum testosterone levels and cardiovascular disease has been established. However, this relationship is complex, and the exact mechanism by which testosterone affects the vasculature system remains to be elucidated. Intimal hyperplasia (IH), the general response of a vessel to injury, is a well-established hallmark of atherosclerosis. An important component of this pathway involves matrix metalloproteinases (MMPs), implicated in vascular remodeling due to their ability to degrade components of the extracellular matrix. Previous studies have demonstrated a significant reduction of IH in the presence of testosterone, and our group has shown a positive correlation between female sex hormones and MMP activity. Therefore, we hypothesize testosterone reduces IH through modulation of MMP expression and function in male vascular smooth muscle cells (VSMCs). METHODS Male human aortic VSMCs were treated with low to high physiological concentrations of testosterone (TST; 0.3nM-3μM) or Dihydrotestosterone (DHT; 0.3nM-3μM) for 24hr. Control cells were incubated with delivery vehicle only. Total RNA was isolated and subjected to quantitative polymerase chain reaction (qPCR). Cell lysates were collected and subjected to Western blot analysis. MMP activities were measured in conditioned media using in-gel protease analysis. A modified MTT proliferation assay was used to investigate the role of TST and DHT on VSMC proliferation. Finally, VSMC migration was evaluated using a modified collagen type IV coated Boyden chamber assay. RESULTS qPCR revealed no significant change in the gene expression of MMPs. Western blot analysis and in-gel zymography demonstrated a significant change (P<0.05) in MMP-2 protein levels and enzymatic activity at higher physiological TST and DHT concentrations. Androgen stimulation at high physiological levels inhibited VSMC proliferation and migration through a collagen type IV lattice. CONCLUSIONS Dysfunctional remodeling underlies the pathogenesis of major vascular diseases, such as atherosclerosis. A key group of enzymes involved in these processes are MMPs. Testosterone affects the MMP pathway in a concentration-dependent manner. With increasing physiological levels of testosterone, MMP activity and VSMC migration are significantly inhibited, in vitro. Our data suggests the risk of developing IH may decrease with higher physiological testosterone concentrations via the downregulation of MMP activity. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187 Issue 4S April 2012 Page: e332 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Metrics Author Information John Beddies Knoxville, TN More articles by this author James Bienvenu Knoxville, TN More articles by this author Deidra Mountain Knoxville, TN More articles by this author Stacy Kirkpatrick Knoxville, TN More articles by this author Oscar Grandas Knoxville, TN More articles by this author Frederick Klein Knoxville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence) & Infection1 Apr 2012V1028 ROBOTIC SUPRAPUBIC PROSTATECTOMY FOR SEVERE BENIGN PROSTATIC HYPERPLASIA Wesley White, James Bienvenu, Eric Brewer, W. Bedford Waters, and Frederick Klein Wesley WhiteWesley White Knoxville, TN More articles by this author , James BienvenuJames Bienvenu Knoxville, TN More articles by this author , Eric BrewerEric Brewer Birmingham, AL More articles by this author , W. Bedford WatersW. Bedford Waters Knoxville, TN More articles by this author , and Frederick KleinFrederick Klein Knoxville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1132AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Conventional treatment of BPH includes α-1 adrenergic antagonists, 5 α reductase inhibitors, and minimally invasive procedures including TUMT and TUNA. Men with urinary retention, recurrent UTIs, prostate hemorrhage, bladder calculi, renal insufficiency, and/or symptoms unresponsive to medical therapy may be appropriate candidates for TURP or open prostatectomy. Compared to TURP, open prostatectomy offers a lower retreatment rate, more complete removal of the prostatic adenoma under direct vision, and avoids the potential for TURP syndrome. However, open prostatectomy is associated with an increased risk of perioperative hemorrhage and the need for a longer hospitalization and convalescence. Many of the aforementioned disadvantages with open prostatectomy were likewise common with radical retropubic prostatectomy before the advent of robotics. We present our experience with robotic suprapubic prostatectomy for the treatment of severe BPH. METHODS A 66 year old male presented with BPH refractory to medical therapy. Preoperative AUA symptom score was 26 and postvoid residual volume was 375cc. Maximum voiding flow rate preoperatively was 7.2mL/sec. The patient underwent transrectal ultrasound with a calculated volume of 175g. Treatment options were discussed with the patient in detail. Following informed consent, robotic suprapubic prostatectomy was performed. With the patient in the lithotomy position, a conventional 5 port configuration was employed. The bladder was dropped and the space of Retzius developed. The bladder was filled and a cystotomy created. The adenoma was circumferentially enucleated using blunt and sharp dissection. The enucleation bed was rendered hemostatic with pinpoint cautery. The incised mucosa of the posterior bladder neck was tacked to the prostate capsule using a running 3-0 Vicryl suture. The cystotomy was closed in multiple layers using absorbable suture. RESULTS Operative time was 123 minutes. Estimated blood loss was 50cc. There were no acute intraoperative or postoperative complications. Postoperative postvoid residual volume was 23cc. Postoperative AUA symptom score was 3. CONCLUSIONS Based on our experience, robotic simple prostatectomy is safe, effective, and minimizes many of the disadvantages traditionally associated with the open approach. The decision to approach the prostate through a suprapubic or retropubic approach is predicated on patient factors and the discretion of the operating surgeon. Further study is needed to determine the appropriate patient selection, efficacy and/or superiority as compared to TURP. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e418 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wesley White Knoxville, TN More articles by this author James Bienvenu Knoxville, TN More articles by this author Eric Brewer Birmingham, AL More articles by this author W. Bedford Waters Knoxville, TN More articles by this author Frederick Klein Knoxville, TN More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2012V1716 ROBOTIC PARTIAL NEPHRECTOMY AND PYELOLITHOTOMY IN A HORSESHOE KIDNEY Wesley White, Adam Stewart, W. Bedford Waters, and Frederick Klein Wesley WhiteWesley White Knoxville, TN More articles by this author , Adam StewartAdam Stewart Knoxville, TN More articles by this author , W. Bedford WatersW. Bedford Waters Knoxville, TN More articles by this author , and Frederick KleinFrederick Klein Knoxville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1675AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Horseshoe kidney represents the most common of all renal fusion anomalies with a reported incidence of 1 in 400. Myriad configurations of horseshoe kidney have been reported with the degree of ascent limited by the Inferior Mesenteric Artery (IMA). The majority of horseshoe kidneys demonstrate anteriorly oriented renal pelves and ureters and a highly variable and complex blood supply. Patients with horseshoe kidney are at a comparably higher risk of stone formation given their anomalous anatomy. In addition, renal tumors have been reported in patients with horseshoe kidneys but at a rate comparable to the general population. We present our experience with robotic partial nephrectomy and concomitant pyelolithtotomy in a horseshoe kidney. METHODS A 54 year old male presented with radiographic evidence of an approximate 7cm complex cystic renal mass involving the leftward moiety of his horseshoe kidney. In addition, an approximate 4cm partial staghorn calculus was identified involving his left renal pelvis. Following informed consent, the patient was positioned in the flank position and ports were placed in a somewhat more caudad location. The colon was reflected and the aorta identified. The anomalous arterial branches were identified and dissected out in preparation for hilar clamping. The tumor was exposed and intraoperative ultrasound performed. The tumor was excised with a margin of normal renal parenchyma. Reconstruction was performed using 2-0 Vicryl and 0-Vicryl sutures for the parenchyma and capsule, respectively. Next, the left ureter was identified and followed cephalad towards the renal pelvis. The renal pelvis was opened, the stone extracted, and the pyelotomy closed using running 4-0 Vicryl suture. RESULTS Operative time was 160 minutes. Estimated blood loss was 100cc. Warm ischemia time was 22 minutes. There were no acute intraoperative complications. The patient did develop a DVT postoperatively and was treated accordingly. Pathology demonstrated a pT1b renal cell cancer with negative margins as well as a 4cm x 2.5cm calcium oxalate stone. CONCLUSIONS Based on our experience, robotic partial nephrectomy in a horseshoe kidney is feasible and safe. Meticulous attention to the patient's arterial anatomy is paramount to avoid hemorrhagic complications. An individualized approach to port placement is necessary to avoid instrument clashing and to facilitate optimal access to the kidney. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e692 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Metrics Author Information Wesley White Knoxville, TN More articles by this author Adam Stewart Knoxville, TN More articles by this author W. Bedford Waters Knoxville, TN More articles by this author Frederick Klein Knoxville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyOncology, Bladder Oncology1 Apr 2012V1882 TRANSURETHRAL VAPORIZATION OF BLADDER TUMORS WITH THE ACMI PLASMAKINETIC “BUTTON” ELECTRODE Brent Hardin, Wesley White, Bedford Waters, and Frederick Klein Brent HardinBrent Hardin Knoxville, TN More articles by this author , Wesley WhiteWesley White Knoxville, TN More articles by this author , Bedford WatersBedford Waters Knoxville, TN More articles by this author , and Frederick KleinFrederick Klein Knoxville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2037AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transurethral resection of bladder tumors (TURBT) is widely recognized as the standard of care in the evaluation and treatment of urothelial carcinoma of the bladder. We investigate the use of the ACMI “button” electrode and provide tips on the use of this new modality in the transurethral treatment of bladder cancer. METHODS At our institution, patients diagnosed with urothelial carcinoma of the urinary bladder are given the option of transurethral resection of bladder tumor (TURBT) with the standard monopolar loop or to undergo treatment with the bipolar button electrode. The initial two cases performed at our institution were evaluated. RESULTS In our initial two cases, the operative times were 23 minutes and 50 minutes. Specimens obtained by cold cup biopsy included muscularis propria which was uninvolved by malignant cells in both cases. Pathologic grade and stage for the first case was low grade Ta and for the second case was low grade T1. There was minimal blood loss in each case. There was simple destruction of satellite lesions in both cases. There was a small bladder perforation in each case due to an obturator reflex. CONCLUSIONS Bladder tumors can be effectively analyzed and detroyed by transurethral vaporization with the ACMI plasmakinetic button electrode. Care must be taken to avoid perforation due to an obturator reflex. This technique is especially useful in very large tumors and in tumors located within or adjacent to bladder diverticulae. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e760 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brent Hardin Knoxville, TN More articles by this author Wesley White Knoxville, TN More articles by this author Bedford Waters Knoxville, TN More articles by this author Frederick Klein Knoxville, TN More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation I1 Apr 20121137 SCREENING FOR PRECLINICAL CORONARY ARTERY DISEASE USING CORONARY ARTERY CALCIUM SCORES IN MEN PRESENTING WITH ERECTILE DYSFUNCTION Brent Hardin, Deviprasad Venugopal, Edward Kim, Bret Rogers, Wesley White, Eric Heidel, Dale Wortham, and Frederick Klein Brent HardinBrent Hardin Knoxville, TN More articles by this author , Deviprasad VenugopalDeviprasad Venugopal Knoxville, TN More articles by this author , Edward KimEdward Kim Knoxville, TN More articles by this author , Bret RogersBret Rogers Knoxville, TN More articles by this author , Wesley WhiteWesley White Knoxville, TN More articles by this author , Eric HeidelEric Heidel Knoxville, TN More articles by this author , Dale WorthamDale Wortham Knoxville, TN More articles by this author , and Frederick KleinFrederick Klein Knoxville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1247AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Erectile dysfunction (ED) has proven to be a precursor in the development of symptomatic coronary artery disease (CAD). In an effort to identify men with preclinical CAD we designed a prospective study to screen men for asymptomatic CAD when they present with ED using computed tomography coronary artery calcium scores (CACS). METHODS Institutional review board approval was granted and research funding for each CACS was obtained. Men with ED and without a history of CAD were recruited and basic demographic data and comorbidities were captured. Control patients were men with neither a history of ED nor CAD. Erectile function was evaluated using the validated ED questionnaire: International Index of Erectile Function− Erectile Function Domain (IIEF−EF). Men with obvious causes of ED including surgery, trauma, medications, or psychiatric conditions were excluded. CACS were obtained on all ED patients and controls. Statistical analyses were performed. RESULTS From February 2010 through July 2011, 52 ED patients and 50 control patients were accrued. There was a statistically significant inverse correlation with regards to CACS and IIEF−EF score (Pearson r =-0.194, p = 0.05). Additionally, after dividing men into quartiles there was a significant correlation between severity of ED [IIEF > 26 (none), 17−25 (mild), 11−16 (moderate), 0−10 (severe)] and severity of CAD [CACS = 0 (none), 1−100 (mild), 101−400 (moderate), > 400 (severe)], with Spearman r =-0.248 and p = 0.012. Men with ED (IIEF <26) were 2.984 times more likely to have severe CAD (CACS >400), 95% CI = 1.11-8.0. CONCLUSIONS This is the first evenly matched prospective trial evaluating men for CAD with CACS as they present with ED. We found a statistically significant difference in CACS in men with ED compared to those without ED. Further, as the severity of ED increased the raw score of the CACS also increased. Men with ED were three times more likely to have severe CACS than men without ED. These findings strengthen the existing evidence that ED is a predictor of CAD. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e461 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Metrics Author Information Brent Hardin Knoxville, TN More articles by this author Deviprasad Venugopal Knoxville, TN More articles by this author Edward Kim Knoxville, TN More articles by this author Bret Rogers Knoxville, TN More articles by this author Wesley White Knoxville, TN More articles by this author Eric Heidel Knoxville, TN More articles by this author Dale Wortham Knoxville, TN More articles by this author Frederick Klein Knoxville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney & Ureter Oncology1 Apr 2011V1026 ROBOTIC PARTIAL NEPHRECTOMY WITH SELECTIVE SEGMENTAL ARTERIAL CLAMPING Wesley White, John Beddies, W. Bedford Waters, and Frederick Klein Wesley WhiteWesley White Knoxville, TN More articles by this author , John BeddiesJohn Beddies Knoxville, TN More articles by this author , W. Bedford WatersW. Bedford Waters Knoxville, TN More articles by this author , and Frederick KleinFrederick Klein Knoxville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1061AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Open Partial Nephrectomy (OPN) is considered the gold standard treatment for small, enhancing renal masses. Laparoscopic and Robotic partial nephrectomy offer compatible outcomes to OPN with markedly improved convalescence. These minimally invasive approaches require hilar clamping with the potential for irreversible ischemic injury to the kidney. Selective segmental hilar clamping has been proposed as a method of minimizing warm ischemia time. METHODS A 52 year old male presented with radiographic evidence of a 3.1cm enhancing mass in the lower pole of the right kidney. R.E.N.A.L. nephrometry score was 8p. CT Angiography was performed prior to robotic partial nephrectomy to determine if selective segmental clamping could be performed. Following reflection of the colon and duodenum, the entire renal hilum was skeletonized in preparation for cross-clamping. The lower pole segmental branch was isolated. The kidney was mobilized within Gerota's fascia and intraoperative ultrasound was performed. The segmental artery was clamped and the tumor was excised with a margin of normal parenchyma. Reconstruction was performed using a 2-0 and 0 Vicryl suture. RESULTS Operative time was 150 minutes. Estimated blood loss was 350mL. Segmental clamp time was 26 minutes. Length of hospitalization was 2 days. There were no intraoperative or postoperative complications. Pathology demonstrated a 3.9cm clear cell RCC with negative margins. Estimated GFR was unchanged at 6 months. CONCLUSIONS Based on our experience, selective segmental arterial clamping may be safely performed in appropriate patients. Preoperative CT Angiography is needed to safely guide patient selection. The entire renal hilum should be prepared for cross-clamping should selective clamping prove inadequate. A randomized, controlled trial is needed to determine the nature and degree of renal preservation with this approach. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e414 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wesley White Knoxville, TN More articles by this author John Beddies Knoxville, TN More articles by this author W. Bedford Waters Knoxville, TN More articles by this author Frederick Klein Knoxville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Oncology1 Apr 2011V1229 ROBOTIC INTERPOSITION NERVE GRAFTING USING AN ACELLULAR ALLOGRAFT NERVE Wesley White, Adam Stewart, Paul Hatcher, Frederick Klein, and Edward Kim Wesley WhiteWesley White Knoxville, TN More articles by this author , Adam StewartAdam Stewart Knoxville, TN More articles by this author , Paul HatcherPaul Hatcher Knoxville, TN More articles by this author , Frederick KleinFrederick Klein Knoxville, TN More articles by this author , and Edward KimEdward Kim Knoxville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.887AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In the setting of unfavorable prostate pathology, some men may require resection of one or both cavernous nerves at the time of prostatectomy. Potency rates in this subset of men are expectedly dismal and led to interposition nerve grafting. Interposition nerve grafting offers a scaffold for orderly nerve regeneration and may elaborate neurotrophic agents that foster the restorative process. Traditionally, autologous sural nerve has been the graft of choice and has been employed primarily during open radical prostatectomy. However, sural nerve harvest is often associated with donor site morbidity and may be time inefficient. Recently, decellularized allograft nerves have become commercially available that obviate the need for sural nerve harvest. We present our experience employing an acellular allograft nerve during robotic prostatectomy. METHODS Men with normal erections and pre-operative staging (digital rectal examination findings, PSA value, and biopsy findings) that suggests that neurovascular bundle resection may be necessary may be counseled on the possible benefits and risks of nerve grafting. Following dissection of the endopelvic fascia and bladder neck, one or both neurovascular bundles are resected and the ends tagged. The operative field is rendered hemostatic to ensure precise identification of the transected ends. An allograft nerve is prepared on the back table and tagged using a 7-0 PDS. The nerve is transposed to the defect and affixed to the cut ends of the neurovascular bundle. A graft that is approximately 10–20% longer than necessary is ideal to compensate for subsequent contracture. Upon completion of the graft, a standard vesico-urethral anastomosis is performed with care taken to ensure that the graft is not disrupted during knot-tying. RESULTS To date, our group has performed interposition nerve grafting on 72 patients, 5 of which underwent unilateral or bilateral grafting using an acellular allograft. Mean operative time per nerve graft was 14 minutes. The potency rate following open and robotic nerve grafting is between 43 and 65%. CONCLUSIONS The true benefit of interposition nerve grafting has yet to be determined. Based on our experience, the robotic operating platform offers filtration of tremor and outstanding optics that lends itself to microsurgical reconstruction such as interposition grafting. Likewise, new acellular allografts are more robust than autologous nerves and confer surgical efficiency. Prospective, multi-center trials of robotic-assisted interposition grafting and nerve reconstruction using acellular grafts are needed. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e492 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wesley White Knoxville, TN More articles by this author Adam Stewart Knoxville, TN More articles by this author Paul Hatcher Knoxville, TN More articles by this author Frederick Klein Knoxville, TN More articles by this author Edward Kim Knoxville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal1 Apr 20111832 OUTCOMES FOLLOWING SECONDARY TREATMENT USING EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY Adam Stewart, Wesley White, and Frederick Klein Adam StewartAdam Stewart Knoxville, TN More articles by this author , Wesley WhiteWesley White Knoxville, TN More articles by this author , and Frederick KleinFrederick Klein Knoxville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1851AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Conventional treatment of renal and upper ureteral calculi includes ureteroscopy (URS) and Extracorporeal Shock Wave Lithotripsy (ESWL). Although initial treatment success rates with ESWL approach 90%, select patients will require a second treatment. URS is often employed in this scenario despite limited data regarding treatment success following repeat ESWL. We present outcomes following re-treatment of stones using ESWL in a large observational cohort of patients. METHODS A retrospective review was performed to determine the efficacy and perioperative outcomes following secondary treatment of renal and ureteral calculi using ESWL. Following initial treatment with ESWL, patients who were defined as treatment failures were offered repeat ESWL or URS. Patients who underwent secondary treatment with ESWL were followed postoperatively and routine aftercare was performed. Post-treatment imaging included KUB or non-contrast CT at 30 days. Aftercare reports were completed and catalogued in a prospectively maintained database. Success was defined as the absence of stones or the presence of fragments less than 4mm. RESULTS Between 1/1/2000 and 12/31/2009, 14,313 patients underwent 22,463 treatments for renal or ureteral calculi by ESWL. Mean stone size was 9.04mm. Success rate with initial treatment was 91%. A total of 617 patients underwent secondary treatment with ESWL. Mean stone size was 1.24cm. Success was achieved in 75% of patients. Among patients that underwent repeat treatment, success rates were highest among patients with a stone size less than 1cm. Stone location did not appear to impact secondary treatment outcomes. CONCLUSIONS Based on our large, single-center experience, secondary treatment with ESWL continues to offer a high overall success rate. Although URS should be strongly considered following initial treatment failure, patients who request or are better suited for ESWL can be offered repeat treatment with a high level of confidence. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e734-e735 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adam Stewart Knoxville, TN More articles by this author Wesley White Knoxville, TN More articles by this author Frederick Klein Knoxville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal1 Apr 20111555 COMPARATIVE ANALYSIS OF ANTERIOR AND POSTERIOR TREATMENT PLANES UTILIZING THE DORNIER DELTA COMPACT ELECTROMAGNETIC LITHOTRIPTER Brent Hardin, Adam Stewart, John Beddies, Ryan Pickens, Wesley White, W. Bedford Waters, and Frederick Klein Brent HardinBrent Hardin Knoxville, TN More articles by this author , Adam StewartAdam Stewart Knoxville, TN More articles by this author , John BeddiesJohn Beddies Knoxville, TN More articles by this author , Ryan PickensRyan Pickens Knoxville, TN More articles by this author , Wesley WhiteWesley White Knoxville, TN More articles by this author , W. Bedford WatersW. Bedford Waters Knoxville, TN More articles by this author , and Frederick KleinFrederick Klein Knoxville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1563AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Extracorporeal shockwave lithotripsy (ESWL) has been shown to be a safe and effective modality for the treatment of renal and upper ureteral calculi. Proper treatment of calculi requires visualization and localization of stones via two-dimensional fluoroscopy. In certain cases, stone position and patient body habitus prohibit stone localization in the posterior plane. In these circumstances, the patient must be repositioned prone or an alternate treatment modality must be investigated. A few lithotripters allow for rotation of the treatment head for localization of the calculus in the anterior plane. Limited data exists concerning efficacy and complications of the anterior treatment approach. We present longitudinal data comparing the safety and efficacy of these two approaches from a large cohort of patients treated by our regional stone center. METHODS Data was obtained by a retrospective review of all after care reports from the database of patients treated on a Dornier delta compact lithotripter with rotating treatment head. Parameters such as stone location, stone size, and treatment approach were reviewed. Outcomes were determined and compared for each treatment group including rates of success and post-treatment adverse events. RESULTS Between 1/1/2000 and 12/31/2009, 14,313 patients underwent 22,463 treatments for renal or ureteral calculi by ESWL. Mean stone size was 9.04 mm. A total of 20,810 stones (79.5%) were treated with a posterior approach and 5,363 stones (20.5%) were treated via an anterior approach. Success rates were 91% and 89% from the posterior and anterior approaches, respectively. Rates of hematoma formation were 0.3% and 0.1% for posterior and anterior approaches, respectively. The rate of post-operative obstruction was 1.0% and the hospital admission rate post-operatively was 0.68% for the entire cohort. Four Clavien grade 4–5 complications occurred in the entire cohort, all of which were treated in the posterior position. CONCLUSIONS Based on observational, non-randomized data, the anterior approach appears to offer comparable results to posterior treatments in terms of efficacy and safety. Lithotripters with a rotational head offer safety and convenience to the patient and staff by facilitating anterior treatment positions without changing patient position. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e624 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brent Hardin Knoxville, TN More articles by this author Adam Stewart Knoxville, TN More articles by this author John Beddies Knoxville, TN More articles by this author Ryan Pickens Knoxville, TN More articles by this author Wesley White Knoxville, TN More articles by this author W. Bedford Waters Knoxville, TN More articles by this author Frederick Klein Knoxville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2011V496 ROBOTIC UPPER POLE HEMINEPHRECTOMY FOR A CHRONICALLY OBSTRUCTED DUPLICATED COLLECTING SYSTEM IN A SOLITARY KIDNEY Wesley White, Brent Hardin, Ryan Pickens, and Frederick Klein Wesley WhiteWesley White Knoxville, TN More articles by this author , Brent HardinBrent Hardin Knoxville, TN More articles by this author , Ryan PickensRyan Pickens Knoxville, TN More articles by this author , and Frederick KleinFrederick Klein Knoxville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.592AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Complete or incomplete duplication of the ureter is one of the most common congenital malformations of the urinary tract. In some cases of complete ureteral duplication, the upper pole moiety is obstructed and non-functional while the lower pole moiety demonstrates reflux. Management of the upper pole moiety includes either upper pole heminephrectomy or reimplantation. Failure to address the upper pole ureter during lower pole reimplant can lead to recurrent obstruction and infection. METHODS A 49 year old female presented with recurrent right flank pain, fevers, and nausea. The patient had previously undergone bilateral ureteral reimplantation for vesicoureteral reflux at an outside hospital 5 years prior. Follow-up VCUG demonstrated no recurrent reflux. Cross-sectional imaging demonstrated an atrophic left kidney as well as a duplicated right kidney. A dilated right upper pole moiety was apparent. MAG3 renal scan confirmed the poorly functioning nature of the left kidney. The patient was subsequently taken to the operating room for planned robotic upper pole heminephrectomy. Following cystoscopy with retrograde pyelogram and JJ stent placement of the lower pole ureter, the colon and duodenum were reflected medially. The large upper pole ureter was immediately apparent. The obstructed ureter was dissected from the lower pole of the ureter cephalad towards the renal hilum. The obstructed system was dissected away from the lower pole collecting system and parenchyma of the kidney. The upper pole moiety was next opened and excised. The operative bed was rendered hemostatic with use of the argon beam and a topical hemostatic agent. A drain was placed and the kidney retroperitonealized. RESULTS Operative time was 134 minutes. Estimated blood loss was 25mL. There were no intraoperative or postoperative complications. Length of hospitalization was 3 days. The J-P drain and stent were removed at one week following surgery. At 8 months following surgery, the patient denies any pain or fevers. Renal function is within normal limits. CONCLUSIONS Complex upper pole heminephrectomy may be safely and efficiently addressed in a minimally invasive fashion. Use of the robotic operating platform affords improved visualization and articulation when performing hilar dissection and excision of the non-functioning moiety. Care must be taken to preserve the lower pole ureter including preoperative ureteral catheter or stent placement. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e202 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wesley White Knoxville, TN More articles by this author Brent Hardin Knoxville, TN More articles by this author Ryan Pickens Knoxville, TN More articles by this author Frederick Klein Knoxville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence—Evaluation & Therapy1 Apr 20111336 LONG TERM FOLLOW-UP DATA ON THE MINIARC™ SINGLE INCISION SLING SYSTEM FOR THE TREATMENT OF STRESS URINARY INCONTINENCE Ryan Pickens, Brent Hardin, John Beddies, Wesley White, W. Bedford Waters, and Frederick Klein Ryan PickensRyan Pickens Knoxville, TN More articles by this author , Brent HardinBrent Hardin Knoxville, TN More articles by this author , John BeddiesJohn Beddies Knoxville, TN More articles by this author , Wesley WhiteWesley White Knoxville, TN More articles by this author , W. Bedford WatersW. Bedford Waters Knoxville, TN More articles by this author , and Frederick KleinFrederick Klein Knoxville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1157AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is a paucity of long-term outcomes data on single incision slings for the treatment of stress urinary incontinence (SUI). We present surgical and quality of life outcomes at two years in an observational cohort of patients undergoing surgery for SUI with the MiniArc™ Single Incision Sling System. METHODS A prospective analysis of patients who underwent surgical intervention with the MiniArc™ Single Incision Sling System for SUI was performed. Patients completed a quality of life questionnaire, a female sexual function index (FSFI), an IIQ-7 form, and an UDI-6 form. We compared IIQ-7 and UDI-6 scores at one month to those at two years post-op. Quality of life questionnaires were used to determine treatment failures. The FSFI was used to determine how the procedure affected their sexual activity. Statistical analysis was performed. RESULTS From September 2007 to August 2008, a total of 120 patients underwent placement of the MiniArc™ Single Incision Sling System for SUI at our institution . One hundred five patients (88%) completed two year follow-up. Mean patient age at surgery was 58.4 years (range 26-87). Forty-two (35%) patients had concomitant urge incontinence pre-operatively. Mean body mass index (BMI) was 27.2. Preoperative pad usage was 2.40 pads per day per patient. Mean IIQ-7 and UDI-6 scores pre-op were 2.6 and 2.5 per question, respectively. At a minimum follow-up of 24 months, 98 of the 105 responders (93%) denied having any symptoms of SUI, 5 reported occasional leakage (5%) and 2 reported full return of symptoms of SUI (2%). The average pads per day per patient post-op was 0.2 (p<0.005). At two years post-op, mean IIQ-7 and UDI-6 scores were 0.3 (p<0.005) and 0.3 (p<0.005) per question, respectively. Twenty (19%) patients reported urge incontinence on a daily basis, five of whom have de novo urgency (5%). Average quality of life scores improved from 4.2 pre-operatively to 9.1 at two years. Based on FSFI results, 53 of our patients never have discomfort with intercourse (50%), 4 sometimes have discomfort (4%), and 2 always have discomfort (2%). Forty-six of our patients are currently sexually inactive (44%). CONCLUSIONS Based on our experience, successful treatment of SUI with the MiniArc™ Single Incision Sling System is durable with long term follow-up. Quality of life is significantly improved with minimal impact on sexual function. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e534 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Pickens Knoxville, TN More articles by this author Brent Hardin Knoxville, TN More articles by this author John Beddies Knoxville, TN More articles by this author Wesley White Knoxville, TN More articles by this author W. Bedford Waters Knoxville, TN More articles by this author Frederick Klein Knoxville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction & Incontinence)1 Apr 2011V674 ROBOTIC SACRAL COLPOPEXY WITH CONCOMITANT SUPRACERVICAL HYSTERECTOMY Wesley White, Ryan Pickens, Robert Elder, and Frederick Klein Wesley WhiteWesley White Knoxville, TN More articles by this author , Ryan PickensRyan Pickens Knoxville, TN More articles by this author , Robert ElderRobert Elder Knoxville, TN More articles by this author , and Frederick KleinFrederick Klein Knoxville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1626AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Conventionally, the treatment of female pelvic organ prolapse (POP) has come in the form of myriad vaginal repairs and/or abdominal sacral colpopexy (SCP). Although abdominal SCP offers superior and more durable outcomes, patients are often resistant to undergo an open repair that can be painful and cosmetically unpleasing. In response to these issues, laparoscopic and robotic abdominal approaches have been described that offer equivalent efficacy, expedited recovery, less discomfort, and are more esthetically pleasing compared to classic open repairs. Uterine preservation at the time of prolapse reduction is controversial and often dependent on patient preference. In appropriately selected candidates, robotic supracervical hysterectomy may be performed at the time of SCP and may facilitate and hasten reconstruction. We present our series of patients who underwent robotic SCP with concomitant supracervical hysterectomy. METHODS A prospective analysis was performed to evaluate perioperative and quality of life outcomes following robotic SCP for the treatment of symptomatic POP. All patients underwent multi-disciplinary history and physical including pelvic examination. Appropriate candidates underwent robotic SCP with concomitant supracervical hysterectomy and/or mid-urethral sling. Salient demographic and perioperative data was recorded. Patients were followed post-operatively for evidence of immediate and delayed adverse events as well as durability of the repair. RESULTS Between 01/01/2010 and 11/01/2010, 10 patients underwent robotic SCP with concomitant supracervical hysterectomy. Mean operative time was 114 minutes. Estimated blood loss was 40mL. There were no intraoperative complications or conversions. Mean length of hospitalization was 22 hours. There were no remote adverse events. At a mean duration of follow-up of 6 months, no patients have demonstrated objective evidence of recurrent prolapse. CONCLUSIONS Based on our experience, appropriately selected patients may undergo concomitant robotic supracervical hysterectomy at the time of SCP. Use of the cervical stump offers a robust platform for mesh fixation. A randomized, controlled trial is needed to determine the equivalence or superiority of robotic SCP with or without uterine preservation and/or SCP following prior hysterectomy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e272-e273 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Metrics Author Information Wesley White Knoxville, TN More articles by this author Ryan Pickens Knoxville, TN More articles by this author Robert Elder Knoxville, TN More articles by this author Frederick Klein Knoxville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Interstitial Cystitis1 Apr 2011816 PHENOTYPING MEN WITH INTERSTITIAL CYSTITIS/PAINFUL BLADDER Adam Stewart, Edward Kim, Ragi Doggweiler, and Frederick Klein Adam StewartAdam Stewart Knoxville, TN More articles by this author , Edward KimEdward Kim Knoxville, TN More articles by this author , Ragi DoggweilerRagi Doggweiler Knoxville, TN More articles by this author , and Frederick KleinFrederick Klein Knoxville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.634AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) is most commonly characterized by urgency and frequency of urination, painful urination, and chronic pelvic pain. IC/PBS is less commonly diagnosed in men. Men with refractory pelvic pain and lower urinary tract symptoms who are ultimately found to have IC/PBS frequently demonstrate a common constellation of non-genitourinary symptoms. The purpose of this study was to review the signs, symptoms, and co-morbidities of men with pelvic pain and voiding dysfunction in order to make an earlier diagnosis and institute treatment in men with IC/PBS. METHODS A retrospective analysis of male patients who underwent cystoscopy and hydrodistension for pelvic pain and lower urinary tract symptoms in the last 6 years was performed. Most patients' workup included a detailed history and physical, urine and semen cultures, and multiple courses of antibiotics. The diagnosis of IC/PBS was based on glomerulations found in the bladder mucosa after cystoscopic hydrodistension under general anesthesia. Demographic and treatment related outcomes were reviewed. RESULTS From January 2005 to July 2010, 166 men underwent cystoscopy with hydrodistension under general anesthesia for clinical symptoms of IC/PBS. A total of 96 men demonstrated National Institute of Diabetes and Digestive and Kidney Diseases objective criteria for IC/PBS. In addition to their chronic pelvic pain, 84% of these men had common associated co-morbidities including chronic gastrointestinal complaints (45%), anxiety/depression (41%), chronic back pain (38%), chronic joint pain/neuropathy (26%), and/or migraines (11%). Also, 35% of patients have a history of narcotic and/or benzodiazepine dependence. CONCLUSIONS Based on our experience, men with IC/PBS demonstrate characteristic psycho-social, chronic pain, and gastrointestinal problems that concomitantly and adversely affect quality of life which are similar to those found in women. These clinical findings support the role of a multi-disciplinary approach for males with IC/PBS and should alert the urologist to have a low threshold for cystoscopy with hydrodistension. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e328 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adam Stewart Knoxville, TN More articles by this author Edward Kim Knoxville, TN More articles by this author Ragi Doggweiler Knoxville, TN More articles by this author Frederick Klein Knoxville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...