Mesenchymal tumors of the genitourinary tract account for 5% percent of bladder malignancies and there are currently 35 documented cases of osteosarcoma type. Concomitant involvement of the prostate in mesenchymal genitourinary malignancies is even rarer. Herein we describe a case of a 72-year-old male with a history of radiation for prostate cancer who develops hematuria. A hematuria evaluation revealed osteosarcoma of the bladder and prostate. He underwent radical cystoprostatectomy with ileal conduit and adjuvant chemotherapy. His disease progressed despite treatment and he elected palliative care 10 months after initial resection. This case reviews a rare histological variant of genitourinary malignancy.

You have accessJournal of UrologyStone Disease: Surgical Therapy IV (PD54)1 Sep 2021PD54-04 THE MICHIGAN UROLOGICAL SURGERY IMPROVEMENT COLLABORATIVE APPROPRIATENESS CRITERIA FOR URETERAL STENT OMISSION FOLLOWING UNCOMPLICATED URETEROSCOPY FOR URINARY STONE DISEASE Spencer C. Hiller, Stephani Daignault-Newton, S. Mohammad Jafri, Ronald Rubenstein, Mazen Abdelhady, C. Peter Fischer, Elena Gimenez, Richard Sarle, William W. Roberts, Conrad Maitland, Rafid Yousif, Robert Elgin, Laris Galejs, Jeremy Konheim, David Leavitt, Eric Stockall, J. Rene Frontera, J. Stuart Wolf, John M. Hollingsworth, Casey A. Dauw, Khurshid R. Ghani, and for the Michigan Urological Surgery Improvement Collaborative Spencer C. HillerSpencer C. Hiller More articles by this author , Stephani Daignault-NewtonStephani Daignault-Newton More articles by this author , S. Mohammad JafriS. Mohammad Jafri More articles by this author , Ronald RubensteinRonald Rubenstein More articles by this author , Mazen AbdelhadyMazen Abdelhady More articles by this author , C. Peter FischerC. Peter Fischer More articles by this author , Elena GimenezElena Gimenez More articles by this author , Richard SarleRichard Sarle More articles by this author , William W. RobertsWilliam W. Roberts More articles by this author , Conrad MaitlandConrad Maitland More articles by this author , Rafid YousifRafid Yousif More articles by this author , Robert ElginRobert Elgin More articles by this author , Laris GalejsLaris Galejs More articles by this author , Jeremy KonheimJeremy Konheim More articles by this author , David LeavittDavid Leavitt More articles by this author , Eric StockallEric Stockall More articles by this author , J. Rene FronteraJ. Rene Frontera More articles by this author , J. Stuart WolfJ. Stuart Wolf More articles by this author , John M. HollingsworthJohn M. Hollingsworth More articles by this author , Casey A. DauwCasey A. Dauw More articles by this author , Khurshid R. GhaniKhurshid R. Ghani More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002081.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral stents are associated with pain and urinary symptoms. Despite guidelines recommending stent omission following uncomplicated ureteroscopy (URS), they are frequently placed. We sought to define clinical scenarios suitable for stent omission by use of the RAND/UCLA Appropriateness Methodology. METHODS: We convened a panel of 15 urologists representing diverse practices from the Michigan Urological Surgery Improvement Collaborative (MUSIC). Panelists defined uncomplicated URS and agreed on 7 variables that influence stent decision-making: stone size, location, pre-stenting, urinalysis/culture result, ureteral dilation, ureteral access sheath, fragment status. Over 2 rounds, panelists scored 144 clinical scenarios for stent omission appropriateness based on all combinations of variables, from 1 (highly inappropriate) to 9 (highly appropriate). Median scores 1 to 3 were inappropriate; 4 to 6, uncertain; and 7 to 9, appropriate. Multivariable analysis was used to determine the odds of each variable being scored appropriate for omission. Panel findings were then applied to prior stenting practices for uncomplicated URS within MUSIC. RESULTS: Of the 144 scenarios, 88 (61%) were inappropriate for omission and 26 (18%) were appropriate for omission (Fig. 1). All variables impacted stent omission decision-making (Fig. 2). Stenting rates in MUSIC correlated with panel results (Fig. 3). Among cases highly appropriate for omission, stents had been placed in 55%. CONCLUSIONS: We identified 26 clinical scenarios appropriate for stent omission. Implementation of these results into real-world practice will help reduce stenting rates, with the goal to decrease patient morbidity and improve the quality of care. Source of Funding: Blue Cross Blue Shield of Michigan © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e923-e924 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Spencer C. Hiller More articles by this author Stephani Daignault-Newton More articles by this author S. Mohammad Jafri More articles by this author Ronald Rubenstein More articles by this author Mazen Abdelhady More articles by this author C. Peter Fischer More articles by this author Elena Gimenez More articles by this author Richard Sarle More articles by this author William W. Roberts More articles by this author Conrad Maitland More articles by this author Rafid Yousif More articles by this author Robert Elgin More articles by this author Laris Galejs More articles by this author Jeremy Konheim More articles by this author David Leavitt More articles by this author Eric Stockall More articles by this author J. Rene Frontera More articles by this author J. Stuart Wolf More articles by this author John M. Hollingsworth More articles by this author Casey A. Dauw More articles by this author Khurshid R. Ghani More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement Loading ...

INTRODUCTION:We determined the efficacy, safety and tolerability of photovaporization of the prostate in the office setting for benign prostatic hyperplasia.METHODS:Between 2009 and 2011, 139 men with moderate to severe benign prostatic hyperplasia based on I-PSS (International Prostate Symptom Score) underwent photovaporization of the prostate using a 980 nm diode laser under local anesthesia. We compared preoperative and postoperative post-void residual urine volume, maximum urine flow and I-PSS/quality of life questionnaire responses. We also evaluated postoperative complications and patient satisfaction survey responses.RESULTS:An average ± SD of 782.5 ± 811.1 seconds of laser exposure at maximum power (180 W) resulted in a significant change in median post-void residual urine volume (-126 ml or -81.3%), maximum urine flow (4 ml per second or 40.0%) and I-PSS (-19 or -79.2%, each p <0.001). In men with a prostate greater than 70 ml the median change in post-void residual volume was considerably more pronounced at -232.5 ml (-97.9%, p <0.001) while changes in maximum urine flow (3.0 ml per second or 25%, p = 0.027) and I-PSS (-16.5 or -71.7%, p = 0.003) were also significant. The most common complications were vesicular neck contracture in 7% of cases and urinary retention in 6.4%.CONCLUSIONS:Office based photovaporization of the prostate can be a safe, effective and well tolerated approach to benign prostatic hyperplasia in office settings using local anesthesia. We believe that it can become an attractive low cost treatment option for the rapidly expanding population at risk for benign prostatic hyperplasia.

Background and Purpose: Placement of the fourth arm (4th arm) in the lower quadrant (LQ) is commonly described for robot-assisted renal surgiocal procedures but has anatomic restrictions and limited ergonomics. An alternative, upper quadrant (UQ) location is desirable, but patient habitus and spacing may restrict robotic attachment. We investigate current trends in 4th arm port placement and propose an alternative method at attaching the robot-the "Floating Arm'' (FLA).Methods: Robotic surgeons from the Endourological Society were surveyed. A 20-cm extra-long (XL Protype) da Vinci instrument was developed for the FLA technique. A dry lab allowed quantitative comparison of spacing and ranges of motion for standard da Vinci ports (dVP), bariatric dVP, telescoping dVP, and FLA.Results: There were 108 respondents who participated. Half of the respondents avoid using the 4th arm (30% lack of need and 20% because of interference). The majority (90%) typically positions the 4th arm in the LQ, but many reported limitations in this location. Few (5%) place 4th arm in the UQ, while most (73%) have never heard of UQ placement. Existing techniques may increase shoulder height clearance but inversely shorten the working length of the instrument intracorporeally. Alternatively, the XL Protype significantly increased the shoulder length and maintained available working distances intracorporeally. Adjacent arm interference angle was essentially identical (27 degrees) for all ports except a greater range of movement for the XL Protype (35 degrees).Conclusion: Few surgeons are using an UQ positioning or use techniques to improve attachment of the 4th arm. The greatest freedom may be obtained by implementing the FLA, but this necessitates production of a longer instrument.

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology III1 Apr 20122169 FEASIBILITY, OUTCOMES, AND SATISFACTION IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA UNDERGOING OFFICE PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE UNDER LOCAL ANESTHESIA Tarek Pacha, Valal George, Robert DiLoreto, and Robert Elgin Tarek PachaTarek Pacha Detroit, MI More articles by this author , Valal GeorgeValal George Detroit, MI More articles by this author , Robert DiLoretoRobert DiLoreto Detroit, MI More articles by this author , and Robert ElginRobert Elgin Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2342AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Demonstrate feasibility, report initial outcomes and patient satisfaction regarding office-based photo-selective vaporization of the prostate (PVP) under local anesthesia. Also, economic savings to health care were assessed. To our knowledge there has been no similarly published study to date. METHODS We describe our protocol and technique for PVP in the office under local anesthesia which includes a specific peri and intra prostatic block. Chart review was done on 109 patients who underwent office PVP for Benign Prostatic Hyperplasia (BPH) refractory to medical management. All prostatic sizes (including median lobe) were included. Pts with active prostate cancer and/or an atonic bladder were excluded. Maximal flow rate (Qmax), post void residuals (PVR), International Prostate Symptom Score (IPSS) were evaluated before and after the procedure. Patients were asked about procedure satisfaction. Financial information was obtained from local hospital billing and office collections regarding total cost of PVP if done in the Operating room versus the office. RESULTS All patients tolerated the entire procedure. Mean age was 71. Average prostate size in 54.2 (r: 50 to 115)Gs. Twelve pts had a prostate size > 100Gs. Average laser time and joules per procedure were 745.2 (r: 600 to 6085) sec and 99,856 (r: 17,800 to 452,722) J respectively. Preop IPSS scores and PVRs were significantly higher than postop (21 vs 10 and 158ml vs 63ml, respectively, p <0.001). Uroflow were significantly lower preop vs postop (10 vs 14ml/sec, p< .001). Average follow up was 8 mo (r: 2-26 mo). Complication rate was 11.3%. Satisfaction was 91% (n=77). Health care savings per case was 11,000 dollars. CONCLUSIONS Office PVP under local anesthesia is feasible and highly effective with excellent patient satisfaction. This study alone reduced the economical burden on health care by over 1 million dollars. The complication rate is comparable to a PVP done in the OR. Longer follow-up is required to assess for durability. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e875 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tarek Pacha Detroit, MI More articles by this author Valal George Detroit, MI More articles by this author Robert DiLoreto Detroit, MI More articles by this author Robert Elgin Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...