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INTRODUCTION AND OBJECTIVE:Extended pelvic lymph node dissection (eLND) at the time of radical prostatectomy has a staging benefit over limited pelvic lymph node dissection (LLND) but an unclear th...

INTRODUCTION AND OBJECTIVES:Benign ureteroenteric strictures (UES) may occur after radical cystectomy with urinary diversion. Timely treatment is instrumental in preventing renal insufficiency. The...

INTRODUCTION AND OBJECTIVES:Radical cystectomy during multi-visceral resection for locally advanced pelvic malignancy requires urinary diversion. Outcomes with incontinent and continent urinary div...

INTRODUCTION AND OBJECTIVES:A minority of patients undergoing trimodality therapy for bladder cancer will go on to require salvage cystectomy. We report the outcomes in a small cohort of open and m...

Minimally invasive surgical treatment for bladder cancer has gained popularity but standardized data on complications are lacking. Urinary diversion type contributes to complications and to our knowledge diversion types after minimally invasive cystectomy have not yet been compared. We evaluated perioperative complications stratified by urinary diversion type in patients treated with robot-assisted radical cystectomy.We analyzed the records of 209 consecutive patients who underwent robot-assisted radical cystectomy at our institution from 2003 to 2012 with respect to perioperative complications, including severity, time period (early and late) and diversion type. All complications were reviewed by academic urologists. Urinary diversion was also done. As outcome measurements and statistical analysis, univariate and multivariate logistic regression models were used to determine predictors of various complications.The American Society of Anesthesiologists(®) (ASA) score was 3 or greater in 80% of patients and continent diversion was performed in 68%. Median followup was 35 months. Within 90 days 77.5% of patients experienced any complication and 32% experienced a major complication. The 90-day mortality rate was 5.3%. Most complications were gastrointestinal, infectious and hematological. On multivariate analysis patients with ileal conduit diversion had a decreased likelihood of complications compared to patients with Indiana pouch and orthotopic bladder substitute diversion despite the selection of a more comorbid population for conduit diversion. Continent diversion was associated with a higher likelihood of urinary tract infection. Our results are comparable to those of previously reported open and minimally invasive cystectomy series.Open or minimally invasive cystectomy is a complex, morbid procedure. Urinary diversion is a significant contributor to complications, as is patient comorbidity. Although patients with an ileal conduit had more comorbidities, they experienced fewer complications than those with an orthotopic bladder substitute or Indiana pouch diversion.

was followed by an inverse change of equal or greater magnitude. To determine clinically meaningful variation, we used an increase of 1ng/ mL that was followed by a decrease of equal magnitude across measurements. The association between each measure of variation and number of PSA measurements was assessed using linear regression. RESULTS: In 541 men studied, the cumulative incidence of discontinuing AS for definitive treatment within 5 years was 13%. Among 251(46%) patients who reached a PSA of 7ng/mL, 186(74%) decreased from this threshold at least once. 417 (77%) patients reached a PSA of 4ng/mL but their PSA measurements fluctuated around this threshold less often. In patients who reached a PSA of 4ng/ mL or 7ng/mL, the number of PSA measurements was significantly associated with the frequency of variation across each threshold (p

INTRODUCTION AND OBJECTIVES: The National Comprehensive Cancer Network prostate cancer guidelines of 2011 recommend active surveillance for patients with under 20 year life expectancy with very low risk prostate cancer, defined as T1c, Gleason score less than or equal to 6, PSA 10 ng/ml, fewer than 3 biopsy cores positive, less than or equal to 50% cancer in any one core, and PSA density 0.15ng/mL/g. The aim was to determine if these patients harbored higher risk prostate cancer after complete pathologic examination made possible after radical prostatectomy. METHODS: An IRB approved database, which contains over 6000 patients who underwent robotic assisted radical prostatectomy, was queried for patients meeting the NCCN clinical criteria for Very Low Risk Prostate Cancer. Pathologic data, biochemical recurrence-free survival (BCRFS), cancer-specific survival (CSS), and use of secondary therapy were evaluated. RESULTS: Of 1279 patients meeting the NCCN clinical criteria for very low-risk prostate cancer, 36.1% had a final Gleason sum 7, and 0.5% had a Gleason sum greater than or equal to 8 . Final pathologic staging revealed 21.3%, 74%, 3.8%, and 1.0% had pT2ab, pT2c, pT3a, pT3b disease respectively. Node dissection was performed in 302 (23.6%), and 3 patients were found to have positive nodes. Positive margins occurred in 15.3%. At a median follow up of 15 months, 3-and 5-year biochemical recurrence-free survival was 95.1% and 92.8% respectively. On multivariate analysis, predicting factors for pathologic upgrading included prostate size under 55 grams (p 0.0001), seminal vesicle invasion (p 0.0001), age (p 0.0001), and body mass index (p 0.0001). Cancer specific survival was 100%. Secondary therapy was used in 12 patients for biochemical recurrence, radiotherapy in 11 and androgen deprivation in 1 patient. CONCLUSIONS: A substantial amount of very low risk patients experience pathologic upgrading. Nevertheless, these patients experienced good BCRFS and CSS after surgery. It is unknown whether such outcomes would hold true in the absence of intervention in these patients, which could only be determined with a randomized trial. Despite a categorization as Very Low Risk Prostate Cancer by NCCN, 4.9% of patients did experience a biochemical recurrence within 3 years, and 7.2% within 5 years. With longer follow up, disease specific and overall survival data will be determined.

RESULTS: Based on qPCR analysis, RA treatment (10μM) elicited significant downregulation of the pluripotency factor OCT-4, but marked upregulation of UP1A, UP1B, UP2, UP3A, and UP3B mRNA levels in comparison to naive ESCs and spontaneously differentiating controls in both 2-D and 3-D systems. Immunohistochemistry revealed robust expression of UPs 1A, 1B, 2, and 3A in RA-treated cultures, with FACS analysis showing ~60% of the population expressing UP3A. Transient induction of early endoderm markers, SOX17, FOXA1 and FOXA2, was also observed in RA-treated ESCs at 3 and 6 d, respectively, while GATA6 expression was sustained from 6 to 9 d corresponding to maximal UP expression. GATA6-/ESCs failed to undergo RA-induced UP 1A, 1B, 2, and 3A expression while GATA6+/ESCs showed partial recovery of UP1B and UP3A expression compared to WT cells. CONCLUSIONS: We show for the first time that UE differentiation of ESCs is mediated by RA signaling mechanisms and demonstrate that GATA6 is essential in this process. In addition, the development of ESC-derived UE cells from both 2-D and 3-D cell culture systems offers a prospective cell source and delivery system for bladder tissue engineering applications.

and identified by N-terminal sequencing. MAL cDNAs were cloned and sequenced, antibodies to MAL were used to localize it in bladder urothelium by LM and EM techniques. Mice lacking the MAL gene, and those over-expressing the MAL gene, were generated by transgenic techniques. RESULTS: N-terminal sequencing of the bovine p18 identified it as the ‘myelin-and-lymphocyte-protein’ (MAL). This protein has four transmembrane domains interconnected by short hydrophilic domains. It is expressed in bladder urothelium in a differentiation-dependent manner. EM localization studies showed that it is associated with the uroplakin-delivering vesicles of all stages in urothelial umbrella cells, including the small discoidal vesicles, the mature fusiform vesicles, and the apical urothelial surface. In the latter two cases, the MAL is selectively associated with the ‘hinge areas’ that interconnect the urothelial plaques. Genetic ablation of the mouse MAL gene results in the accumulation of fusiform vesicles. Conversely, over-expression of MAL in transgenic mouse urothelium results in a reduction of the fusiform vesicles and, concurrently, the accumulation of multivesicular bodies that are involved in the endocytic degradation of uroplakins. CONCLUSIONS: Our results indicate that (i) MAL is highly expressed in bladder urothelium as a major urothelial differentiation marker, (ii) MAL knockout blocks the fusion of the fusiform vesicles with the urothelial apical surface, and (iii) MAL over-expression increases the delivery of uroplakins to apical surface and their endocytic degradation. Therefore, MAL is a key component in regulating the targeting and degradation of the uroplakin complexes, which serve as the receptor for the uropathogenic E. coli, and contribute to the bladder permeability barrier function.