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Background: Given the significant drawbacks of using human embryonic stem (hES) cells for regenerative medicine, the search for alternative sources of multipotent cells is ongoing. Studies in mice have shown that multipotent ES-like cells can be derived from neonatal and adult testis. Here we report the derivation of ES-like cells from adult human testis., Methods: Testis material was donated for research by four men undergoing bilateral castration as part of prostate cancer treatment. Testicular cells were cultured using StemPro medium. Colonies that appeared sharp edged and compact were collected and subcultured under hES-specific conditions. Molecular characterization of these colonies was performed using RT-PCR and immunohistochemistry. (Epi)genetic stability was tested using bisulphite sequencing and karyotype analysis. Directed differentiation protocols in vitro were performed to investigate the potency of these cells and the cells were injected into immunocompromised mice to investigate their tumorigenicity., Results: In testicular cell cultures from all four men, sharp-edged and compact colonies appeared between 3 and 8 weeks. Subcultured cells from these colonies showed alkaline phosphatase activity and expressed hES cell-specific genes (Pou5f1, Sox2, Cripto1, Dnmt3b), proteins and carbohydrate antigens (POU5F1, NANOG, SOX2 and TRA-1-60, TRA-1-81, SSEA4). These ES-like cells were able to differentiate in vitro into derivatives of all three germ layers including neural, epithelial, osteogenic, myogenic, adipocyte and pancreatic lineages. The pancreatic beta cells were able to produce insulin in response to glucose and osteogenic-differentiated cells showed deposition of phosphate and calcium, demonstrating their functional capacity. Although we observed small areas with differentiated cell types of human origin, we never observed extensive teratomas upon injection of testis-derived ES-like cells into immunocompromised mice., Conclusions: Multipotent cells can be established from adult human testis. Their easy accessibility and ethical acceptability as well as their non-tumorigenic and autogenic nature make these cells an attractive alternative to human ES cells for future stem cell therapies.

Purpose: To compare repeatability and agreement of conventional ultrasound bladder wall thickness (BWT) measurements with automatically obtained BWT measurements by the BVM 6500 device., Methods: Adult patients with lower urinary tract symptoms, urinary incontinence, or postvoid residual urine were urodynamically assessed. During two subsequent cystometry sessions the infusion pump was temporarily stopped at 150 and 250 ml bladder filling to measure BWT with conventional ultrasound and the BVM 6500 device. For each method and each bladder filling, repeatability and variation was assessed by the method of Bland and Altman., Results: Fifty unselected patients (30 men, 20 women) aged 21–86 years (median 62.5 years) were prospectively evaluated. Invalid BWT measurements were encountered in 2.1–14% of patients when using the BVM 6500 versus 0% with conventional ultrasound (significant only during the second measurement at 150 ml bladder filling). Mean difference in BWT values between the measurements of one technique was −0.1 to +0.01 mm. Measurement variation between replicate measurements was smaller for conventional ultrasound and the smallest for 250 ml bladder filling. Mean difference between the two techniques was 0.11–0.23 mm and did not differ significantly. The BVM 6500 device was not able to correctly measure BWTs above 4 mm., Conclusions: Both BWT measurements are repeatable and agree with each other. However, conventional ultrasound measurements have a smaller measurement variance, can measure BWT in all patients, and BWTs above 4 mm.

Context: Young boys treated with high-dose chemotherapy are often confronted with infertility once they reach adulthood. Cryopreserving testicular tissue before chemotherapy and autotransplantation of spermatogonial stem cells at a later stage could theoretically allow for restoration of fertility., Objective: To establish in vitro propagation of human spermatogonial stem cells from small testicular biopsies to obtain an adequate number of cells for successful transplantation., Design, Setting, and Participants: Study performed from April 2007 to July 2009 using testis material donated by 6 adult men who underwent orchidectomy as part of prostate cancer treatment. Testicular cells were isolated and cultured in supplemented StemPro medium; germline stem cell clusters that arose were subcultured on human placental laminin-coated dishes in the same medium. Presence of spermatogonia was determined by reverse transcriptase polymerase chain reaction and immunofluorescence for spermatogonial markers. To test for the presence of functional spermatogonial stem cells in culture, xenotransplantation to testes of immunodeficient mice was performed, and migrated human spermatogonial stem cells after transplantation were detected by COT-1 fluorescence in situ hybridization. The number of colonized spermatogonial stem cells transplanted at early and later points during culture were counted to determine propagation., Main Outcome Measures: Propagation of spermatogonial stem cells over time., Results: Testicular cells could be cultured and propagated up to 15 weeks. Germline stem cell clusters arose in the testicular cell cultures from all 6 men and could be subcultured and propagated up to 28 weeks. Expression of spermatogonial markers on both the RNA and protein level was maintained throughout the entire culture period. In 4 of 6 men, xenotransplantation to mice demonstrated the presence of functional spermatogonial stem cells, even after prolonged in vitro culture. Spermatogonial stem cell numbers increased 53-fold within 19 days in the testicular cell culture and increased 18,450-fold within 64 days in the germline stem cell subculture., Conclusion: Long-term culture and propagation of human spermatogonial stem cells in vitro is achievable.

Context: Incorporation of bipolar technology in transurethral resection (TUR) of the prostate (TURP) potentially offers advantages over monopolar TURP (M-TURP)., Objective: To evaluate the evidence by a meta-analysis, based on randomized controlled trials (RCTs) comparing bipolar TURP (B-TURP) with M-TURP for benign prostatic obstruction. Primary end points included efficacy (maximum flow rate [Q(max)], International Prostate Symptom Score) and safety (adverse events). Secondary end points included operation time and duration of irrigation, catheterization, and hospitalization., Evidence Acquisition: Based on a detailed, unrestricted strategy, the literature was searched up to February 19, 2009, using Medline, Embase, Science Citation Index, and the Cochrane Library to detect all relevant RCTs. Methodological quality assessment of the trials was based on the Dutch Cochrane Collaboration checklist. Meta-analysis was performed using Review Manager 5.0., Evidence Synthesis: Sixteen RCTs (1406 patients) were included. Overall trial quality was low (eg, allocation concealment and blinding of outcome assessors were poorly reported). No clinically relevant differences in short-term (12-mo) efficacy were detected (Q(max): weighted mean difference [WMD]: 0.72 ml/s; 95% confidence interval [CI], 0.08-1.35; p=0.03). Data on follow-up of >12 mo are scarce for B-TURP, precluding long-term efficacy evaluation. Treating 50 patients (95% CI, 33-111) and 20 patients (95% CI, 10-100) with B-TURP results in one fewer case of TUR syndrome (risk difference [RD]: 2.0%; 95% CI, 0.9-3.0%; p=0.01) and one fewer case of clot retention (RD: 5.0%; 95% CI, 1.0-10%; p=0.03), respectively. Operation times, transfusion rates, retention rates after catheter removal, and urethral complications did not differ significantly. Irrigation and catheterization duration was significantly longer with M-TURP (WMD: 8.75 h; 95% CI, 6.8-10.7 and WMD: 21.77 h; 95% CI, 19.22-24.32; p<0.00001, respectively). Inferences for hospitalization duration could not be made. PlasmaKinetic TURP showed an improved safety profile. Data on TUR in saline (TURis) are not yet mature to permit safe conclusions., Conclusions: No clinically relevant differences in short-term efficacy exist between the two techniques, but B-TURP is preferable due to a more favorable safety profile (lower TUR syndrome and clot retention rates) and shorter irrigation and catheterization duration. Well-designed multicentric/international RCTs with long-term follow-up and cost analysis are still needed.

Purpose of Review: Testicular microlithiasis becomes a greater interdisciplinary issue among urologists, andrologists, gynecologists dedicated to reproductive medicine, pediatricians, radiologists and pathologists. Proposed management ranges from benign neglect, instructing self-examination over follow-up once, regular biannual follow-up including ultrasonography to bilateral testicular biopsy to rule out possible concomitant unclassified intratubular germ cell neoplasia (ITGCN) or future development of testicular cancer. The aim of this review is to present an overview of the current dilemma and summarize management trends based on the most recent data., Recent Findings: Testicular microlithiasis is not a premalignant condition but may accompany ITGCN or testicular cancer. The importance of ruling out ITGCN with testicular biopsy in high-risk men, such as in those with bilateral testicular microlithiasis, infertility, cryptorchidism, atrophic testes or contralateral testicular cancer, has been recently advocated., Summary: Despite greater awareness of testicular microlithiasis, a clear definition is currently missing and the etiology is still obscure. This causes confusion in management and follow-up. Self-examination alone or in combination with testicular ultrasonography has been advised. Recently, a single set of biopsies in selected, high-risk groups has been proposed to rule out ITGCN without a need for further investigations apart from self-examination. However, the cost-effectiveness of such a strategy needs to be evaluated.

Life expectancy gradually increases in the Western part of the world. Older patients may present with small, localized tumours and/or advanced or metastatic disease and still, potentially, have a considerable life expectancy. The consequence of the increased life span is that in older patients all potential treatments have to be discussed. A critical review of the literature regarding the treatment of different stages of renal cell cancer (RCC) in the elderly patient group was conducted. Elderly people with small renal masses are up to 3.5 times more likely to have a benign lesion. The oncological outcome from nephron sparing surgery (NSS), whether by means of laparoscopy or by means of open surgery, seems not to be different between young and old patients. No relationship between local recurrence and metastatic progression rates and patient age has been demonstrated. The outcome from systemic treatments in advanced/metastatic disease has been studied, no differences were observed between age groups, although toxicity profiles might differ between the younger and older patient groups.

Purpose: We compared prostate cancer detection rates achieved using an 8 and 12-core biopsy protocol in a clinical population to determine the significance of additional transition zone sampling on repeat biopsy., Materials and Methods: Between September 2004 and September 2007, 269 eligible patients with a clinical suspicion of prostate cancer referred to our department were randomized to an 8-core lateral (group 1) or a 12-core lateral and parasagittal (group 2) transrectal ultrasound guided prostate biopsy protocol. Study inclusion criteria were age dependent increased serum prostate specific antigen (1.25 ng/ml or greater at ages less than 50 years, 1.75 or greater at ages 50 to less than 60 years, 2.25 or greater at ages 60 to less than 70 years and 3.25 or greater at ages 70 years or greater), positive digital rectal examination and/or suspicious transrectal ultrasound. After negative first round biopsy patients underwent 12-core biopsy, including 4 transition zone cores., Results: Nine patients were excluded from analysis because of protocol violation or they did not complete the whole biopsy procedure due to discomfort. The cancer detection rate in groups 1 and 2 did not differ significantly (34.1% or 45 of 132 patients and 38.3% or 49 of 128, respectively, p = 0.48). Detected cancer median Gleason scores were similar in the groups. Of 109 patients who underwent repeat biopsy prostate cancer was detected in 20 (14.4%), of whom 9 had positive cores from the transition zone and 6 had positive biopsies only from the transition zone., Conclusions: There are no statistically significant differences in the prostate cancer detection rate between 8 and 12-core prostate biopsy protocols. Transition zone biopsies contribute to prostate cancer detection in a repeat biopsy protocol.

Purpose of Review: To review the most recent literature concerning renal mass biopsy with special consideration to three points: variation in results related to the standard used as comparison, biopsy in small renal masses (up to 4 cm in diameter) and the case for nondiagnostic biopsy., Recent Findings: The overall rate of failed and indeterminate biopsies shows a trend for improvement. However, selection bias and the lack of a uniform index test for comparison preclude a definitive statement. Fine-needle aspiration may equal results of core biopsy, but its role in the diagnostic algorithm is not yet defined. In-vivo accuracy decreases in small renal masses with the same limitations exposed for the overall literature on renal mass biopsy. When nondiagnostic biopsies are considered, there is a need for standardization of the nomenclature in order to compare results. Re-biopsies or surgery after a nondiagnostic biopsy shows malignancy in up to 75% of the cases of renal cell carcinoma., Summary: There is a trend in increasing interest and accuracy on the subject of percutaneous biopsy of renal masses as well as a decreasing trend in the rate of nondiagnostic biopsies. In the small renal masses, most likely to be benign, a diagnostic percutaneous biopsy may have a definitive role. However, the higher rate of nondiagnostic results in this population calls for prospective studies with standard definitions and when possible homogenous index test to properly assess the diagnostic performance of the biopsy.

Purpose of Review: The high rate of early recurrences in nonmuscle invasive bladder cancer is considered to be strongly related to the effectiveness of transurethral resection (TUR). The aim of this article is to review methods, currently available or in development, that aim at improving TUR, with an emphasis on studies over the past year., Recent Findings: It has been shown that re-TUR diminishes staging error and improves local tumour control. However, instead of simply repeating the standard procedure, it makes more sense to improve the technique itself. Modifications in TUR equipment, such as bipolar resection and laser treatment, mainly have the potential to reduce complication rates and possibly thereby improve the effectiveness of TUR. New imaging techniques that can be used during TUR such as narrow-band imaging and optical coherence tomography seem promising, whereas photodynamic diagnosis has already proven its potential role in improving the effectiveness of TUR., Summary: The currently available techniques of re-TUR and photodynamic diagnosis have demonstrated potential to improve effectiveness of TUR and should be used in selected cases. New techniques such as narrow-band imaging and optical coherence tomography seem promising, but more evidence is needed before these methods can be implemented in daily practice.

Background: Low morbidity has been advocated for cryoablation of small renal masses., Objectives: To assess negative perioperative outcomes of laparoscopic renal cryoablation (LRC) with ultrathin cryoprobes and patient, tumour, and operative risk factors for their development., Design, Setting, and Participants: Prospective collection of data on LRC in five centres., Intervention: LRC., Measurements: Preoperative morbidity was assessed clinically and the American Society of Anaesthesiologists (ASA) score was assigned prospectively. Charlson Comorbidity Index (CCI) and Charlson-Age Comorbidity Index (CACI) scores were retrospectively assigned. Negative outcomes were prospectively recorded and defined as any undesired event during the perioperative period, including complications, with the latter classed according to the Clavien system. Patient, tumour, and operative variables were tested in univariate analysis as risk factors for occurrence of negative outcomes. Significant variables (p<0.05) were entered in a step-forward multivariate logistic regression model to identify independent risk factors for one or more perioperative negative outcomes. The confidence interval was settled at 95%., Results and Limitations: There were 148 procedures in 144 patients. Median age and tumour size were 70.5 yr (range: 32-87) and 2.6 cm (range: 1.0-5.6), respectively. A laparoscopic approach was used in 145 cases (98%). Median ASA, CCI, and CACI scores were 2 (range: 1-3), 2 (range: 0-7), and 4 (range: 0-11), respectively. Comorbidities were present in 79% of patients. Thirty negative outcomes and 28 complications occurred in 25 (17%) and 23 (15.5%) cases, respectively. Only 20% of all complications were Clavien grade > or = 3. Multivariate analysis showed that tumour size in centimetres, the presence of cardiac conditions, and female gender were independent predictors of negative perioperative outcomes occurrence. Receiver operator characteristic curve confirmed the tumour size cut-off of 3.4 cm as an adequate predictor of negative outcomes., Conclusions: Perioperative negative outcomes and complications occur in 17% and 15.5%, respectively, of cases treated by LRC with multiple ultrathin needles. Most of the complications are Clavien grade 1 or 2. The presence of cardiac conditions, female gender, and tumour size are independent prognostic factors for the occurrence of a perioperative negative outcome.

Context: New developments in optical diagnostics have a potential for less invasive and improved detection of bladder cancer., Objective: To provide an overview of the technology and diagnostic yield of recently developed optical diagnostics for bladder cancer and to outline their potential future applications., Evidence Acquisition: A PubMed literature search was performed, and papers on Raman spectroscopy (RS), optical coherence tomography (OCT), photodynamic diagnosis (PDD) and narrow-band imaging (NBI) regarding bladder cancer were reviewed. Technology, clinical evidence, and future applications of the techniques are discussed., Evidence Synthesis: With RS, the molecular components of tissue can be measured objectively in qualitative and quantitative ways. The first studies demonstrating human in vivo applicability are still awaited. OCT produces high-resolution, cross-sectional images of tissue, comparable with histopathology, and provides information about depth of tumour growth. The first in vivo studies of OCT demonstrated promising diagnostic accuracy. RS and OCT are not suitable for scanning the entire bladder. PDD is a technique using fluorescence to indicate pathologic tissue. Several studies have shown that PDD increases the detection rate of bladder tumours and improves resection, resulting in fewer early recurrences. The relatively low specificity of PDD remains a problem. NBI enhances contrast of mucosal surface and microvascular structures. The NBI technique has clear advantages over PDD, and the two studies published to date have shown promising preliminary results. PDD and NBI do not contribute to histopathologic diagnosis., Conclusions: RS and OCT aim at providing a real-time, minimally invasive, objective prediction of histopathologic diagnosis, while PDD and NBI aim at improving visualisation of bladder tumours. For RS, OCT, and NBI, more research has to be conducted before these techniques can be implemented in the management of bladder cancer. All techniques might be of value in specific clinical scenarios.

Aim: To evaluate the diagnostic feasibility and reproducibility of immediate postcryoablation biopsies of small renal masses., Materials and Methods: Between December 2006 and July 2007, 21 intraoperative pre- and postcryoablation (18-gauge core) biopsies of renal masses were obtained. Evaluation of the biopsies by the institutional uropathologist was followed by a blind assessment by two other uropathologists. Tumor subtype and Fuhrman grade were determined by the three pathologists, while biopsy timing (before or after cryoablation) was only assessed by the two blinded pathologists. The diagnostic yield of the pre- and postcryoablation biopsies and interobserver agreement were calculated., Results: The mean size of the 21 cryoablated tumors was 2.8 cm. No significant bleeding occurred after any biopsy. Of the precryoablation biopsies 75-81% was correctly labeled as precryo, and 48% of the postcryoablation biopsies as postcryo. The diagnostic yield of the three pathologists for precryo biopsies ranged between 67% and 71%, and for postcryo biopsies between 48% and 71% (not statistically different). When combining both types of biopsies, the overall diagnostic yield was 81% for all pathologists. The interobserver agreement was "almost perfect" (kappa = 0.902) for precryo biopsies and "substantial" (kappa = 0.514) for postcryo biopsies., Conclusion: This study shows that it is feasible to obtain histopathological diagnoses from postcryoablation biopsies with a diagnostic yield and interobserver agreement similar to precryoablation biopsies.

In current clinical practice, lidocaine gel is widely used as a local anesthetic lubricant before various forms of transurethral instrumentation. Over the past few years, the value of local anesthesia during urethral catheterization and flexible or rigid cystoscopy has been questioned. Strong data are lacking, and the results from the different studies are contradictory. As a result, the correct use of the intraurethral gels is, for the most part, left to individual preference. The purpose of this review is to provide an overview of the characteristics of the intraurethral gels, to assess the effectiveness, and to define evidence-based indications for their use.

Nocturia is a prevalent symptom that can adversely affect quality of sleep and overall quality of life leading to morbidity and even mortality. Nocturia can be due to a range of urological conditions and non-urological diseases. Nocturia can be due to an insufficient bladder capacity and/or (nocturnal) polyuria. Some of the possibly underlying non-urological diseases can be life-threatening, implying treatment priorities. Urological treatment options include alpha-adrenoceptor antagonists, muscarinic receptor antagonists and vasopressin receptor agonists. The former two have shown beneficial but small and inconsistent effects in patients assumed to have benign prostatic hyperplasia or overactive bladder, respectively. In contrast, the vasopressin analog desmopressin has consistently shown nocturia improvement in patients with proven polyuria. While supported by lower levels of evidence, lifestyle modifications are generally considered important for nocturia treatment. We conclude that nocturia is a urinary storage symptom with a major impact on patients' lives and a complex pathophysiology.

The expansion of laparoscopy and endoscopic surgery has promoted a change in surgical skills acquisition. This review aims to identify problems that modulate surgical skills acquisition and the role of simulation in the current training programs. Social, medical, and working time constraints, together with patient safety issues, lead to a decreased availability of operating room (OR) training opportunities. Systematic reviews show that there is a positive "model to model" transfer of skills more evident for virtual reality (VR) simulation, although transfer from video tower exists for naïve trainees, both of which supplement standard laparoscopic training. VR to OR positive transfer is proven for laparoscopic cholecystectomy and colonoscopy/sigmoidoscopy, although not for all parameters analyzed. A mixed model integrating both types of trainers into surgical curricula may strengthen their respective possibilities. To what extent simulation will be included in the surgical training programs depends on development of objective and finer assessment tools and proficiency-based criteria.

Many patients concomitantly receive multiple urological and nonurological medications. This practice can lead to drug-drug interactions (DDIs). These interactions can be pharmacodynamic (acting on the same body function) or pharmacokinetic (affecting each other's concentrations) and are a frequent cause of adverse drug reactions. Examples of pharmacodynamic DDIs include the use of overactive bladder drugs together with those prescribed for psychiatric or neurological indications that also have anticholinergic properties, or the use of PDE5 inhibitors together with vasodilating drugs, particularly nitrates. Pharmacokinetic DDIs are mainly due to effects on drug metabolism, specifically that involving CYP3A4 and 2D6, or on drug transporters. Drugs can both inhibit and induce the activity of many of these enzymes and transporters. CYP3A4 inducers can lower levels of cyclosporine or tacrolimus so much that transplant rejection occurs, and CYP3A4 inhibitors can increase their levels, leading to nephrotoxicity. Levels of the anticholinergic darifenacin can be increased so much by potent CYP3A4 inhibitors that this combination is contraindicated. These examples show that knowledge of DDI can help patients avoid undesirable side effects of drugs.

Although minimally invasive treatments for ureteral stones are efficacious, they are not free of complications and are associated with high cost. Medical expulsive therapy (MET) has recently emerged as an alternative strategy for the initial management of small distal ureteral stones. A MEDLINE search was undertaken to evaluate all currently available data on efficacy and safety of MET therapy in such patients. The specific mechanism of action on the ureteral smooth muscle and the emerging evidence of the efficacy (defined as either an increase in expulsion rate or a decrease in time to expulsion) and low-risk profile suggest that alpha-adrenergic receptor antagonists (alpha-blockers) and calcium channel antagonists should be the initial medical treatment in patients amenable to conservative therapy. NSAIDs and anticholinergics have not shown efficacy as single agents or in combination with alpha-blockers or nifedipine. Corticosteroids may provide a small additive effect when combined with either alpha-blockers or nifedipine.

Background: Fine needle aspiration (FNA) cytology is under consideration as an auxiliary preoperative diagnostic technique in the diagnosis of renal masses. However, reports for FNA are contradictory with regard to diagnostic accuracy and applicability., Objective: To evaluate the diagnostic accuracy and reproducibility of FNA from renal masses., Design: FNAs performed in-bench (hematoxylin and eosin [H&E] stains) from 66 consecutive renal tumours (58 malignant and 8 benign tumours) were presented twice with a 6-mo interval to five pathologists with little experience in renal cytology. Pathologists were blinded for the results of the first round as well for the surgical specimen. The FNAs were stained for Papanicolaou and Giemsa., Measurements: Diagnostic accuracy, concordance between smears and surgical specimens, and the generalized kappa for interobserver/intraobserver agreement were calculated., Results and Limitations: The number of nondiagnostic and nonconclusive cases ranged from 5-14% in the first and 3-8% in the second round. Overall accuracy varied between 73-89% and 71-91% for the first and second round, respectively. Sensitivity (72-97%) and positive predictive value (PPV) (93-100%) to classify a malignant tumour in both rounds was high. Sensitivity (25-100%) and PPV (28-100%) to classify a benign tumour was lower with a wide confidence interval. Overall concordance in subtyping ranged from 39-70% in the first, and from 52-74% in the second round. Interobserver agreement ranged from fair (kappa=0.039) to substantial (kappa=0.540) for the different subtypes. The intraobserver agreement (mean kappa=0.357, CI 95%=0.304-0.411) was moderate for all pathologists. The low number of benign tumours in this study precludes sound statements regarding the diagnostic accuracy of FNA to classify benignity., Conclusion: Despite the lack of experience in renal cytology, all pathologists showed a high diagnostic yield and good overall accuracy in distinguishing between malignant and benign tumours. Concordance in subtyping varied widely among pathologists and was reliable only for clear cell renal cell carcinoma (ccRCC). These results suggest that FNA may have a potential role in the diagnosis of renal tumours although its value in subtyping was limited in our setting.

Purpose of Review: To review evidence and regulatory dosing recommendations for muscarinic receptor antagonists used in the treatment of overactive bladder symptom complex (darifenacin, fesoterodine, oxybutynin, propiverine, solifenacin, tolterodine, trospium) in special patient populations., Recent Findings: Growing evidence demonstrates effects of renal impairment, hepatic impairment, genetics and/or comedications on the pharmacokinetics of muscarinic antagonists. They may cause greater exposure in the respective population, which may translate into greater risks for side effects. These possible risks lead to drug-specific regulatory dosing recommendations or even contraindications in certain patient populations., Summary: Physicians should be aware of pharmacokinetic alterations in special patient populations and possible associated risks. The evidence-based choice of a muscarinic antagonist in such patients should be guided by its specific pharmacokinetic profile.

Purpose: We stratified factors affecting treatment morbidity, compared the outcomes of percutaneous nephrolithotomy procedures from a single department and provided evidence of treatment benefits when percutaneous nephrolithotomy is performed in an expert setting., Materials and Methods: Since the department became a dedicated endourological center in 2002 we grouped all percutaneous nephrolithotomy procedures into those performed before 2002 (group 1) and after 2002 (group 2). The modified Clavien classification was used to score morbidity. Independent variables with an influence on complications were studied including stone size, operating time, operative complications, dilation device, urine culture, group allocation and lithotripsy device. Contingency and logistic regression were used for univariate and multivariate analysis., Results: Of the 244 percutaneous nephrolithotomy procedures 68 comprised group 1 and 176 formed group 2. Statistical preoperative differences were patient age, the use of anticoagulants and positive urinary cultures. Group 1 had a complication rate of 56.8% and group 2 had a complication rate of 37.2%. There were significant differences between the groups (p = 0.007). Almost all complications were grade 1 to 2. On univariate analysis the influence variables were urine culture (OR 1.69), group allocation (OR 2.20), stone size (OR 2.28), dilation device (OR 4.8), lithotripsy device (OR 1.22), perioperative complications (OR 2.83) and surgical time (OR 1.87). On multivariate analysis the independent factors in the complicated outcome were stone size (OR 1.25), type of lithotripsy device (OR 1.35) and incidence of perioperative complications (OR 3.71)., Conclusions: The dedicated setting for percutaneous nephrolithotomy at our center resulted in decreased operative time, more uneventful procedures and decreased hospitalization time. The modified Clavien morbidity score is a reliable tool for more objective outcome comparisons after renal stone treatment.

Context: Percutaneous nephrolithotomy (PNL) is traditionally performed with the patient in the prone position., Objective: To assess the efficacy and safety of the prone and supine positions, particularly in obese patients and in those with staghorn calculi., Evidence Acquisition: A Medline search was conducted for articles published during the last 10 yr related to PNL in the prone and supine positions., Evidence Synthesis: This search revealed 9 published studies for supine and 25 for prone PNL. None of the supine PNL studies reported visceral injuries, while transfusion rates were 0.0-9.4% and stone-free rates were 69.6-95.0%. One study of supine PNL evaluated a significant proportion of obese patients. Prone PNL studies in obese patients report transfusion rates of 3.2-8.8% and stone-free rates of 79.0-89.2%. In the only randomized study, excluding obese patients and staghorn calculi, operative time favors the supine position. A nonrandomized comparative study demonstrated similar complication rates with insignificant improvement in treatment success for supine PNL; however, when comparing series with similar proportions of staghorn calculi cases, there are slightly improved outcomes for prone PNL. Moreover, comparison of weighted means favors prone PNL., Conclusions: For obese patients and staghorn calculi, prone PNL appears to be associated with decreased operative times with similar bleeding rates and slightly better stone-free rates than supine PNL.

Bladder cancer is one of the most frequents pathologies in urology. The introduction of the laser among the technical tools supposed a great advance, but the initial results with the first model failed with the expectations. Nevertheless, nowadays we have at our disposal a great variety of laser for urological use, with different functions and applications. We perform a review and try to assess the actual indications for its employment in the treatment of bladder cancer, as well as future applications.

Aim: To study factors influencing training and maintaining skills in performing percutaneous nephrolithotomy (PCNL)., Methods: We matched key words, throughout Medline, MeSH, and Cochrane databases including: renal stone, percutaneous, nephrostomy, endourology, educational, training, learning curve, expertise, skill, residency, practice, survey, simulator, and robotics. For this topic we defined, if possible, levels of evidence based on International Consultation on Urological Diseases (ICUD) and World Health Organization recommendations., Results: Obtaining renal access is one of the most important factors in training for PCNL. A resident has to perform about 24 PCNL procedures to obtain a good proficiency during the residence period. Competence at performing PCNL is reached after 60 cases and excellence is obtained at >100 cases. Stone centers providing all the endoscopic treatment options seem to provide the best conditions to ensure a sufficient volume of patients recruited. Virtual reality simulators may have a potential in training for PCNL. To maintain one's expertise, participation in continuing educational programs is recommended., Conclusion: PCNL is currently the most complicated stone surgery technique to teach. The steep learning curve is mainly related to obtaining renal access. The traditional method of acquiring surgical skills is by apprenticeship in the absence of validated virtual simulators. Given the complexity of the treatment of renal stones, one may consider a centralized renal stone treatment in dedicated stone centers.

Background: Degarelix is a gonadotropin-releasing hormone antagonist (GnRH receptor blocker) with immediate onset of action, suppressing gonadotropins, testosterone, and prostate-specific antigen (PSA) in prostate cancer., Objective: To determine the efficacy and safety of initial doses of 200 mg or 240 mg of degarelix and thereafter monthly subcutaneous maintenance doses of 80 mg, 120 mg, or 160 mg of degarelix for the treatment of prostate cancer., Design, Setting, and Participants: The 1-yr study was of open-label, randomised design and involved 187 patients (range: 52-93 yr, median: 72 yr) with histologically confirmed adenocarcinoma of the prostate and a baseline PSA >2 ng/ml., Results and Limitations: At baseline, median serum testosterone was 4.13 ng/ml (range: P25-P75, 3.37-5.19 ng/ml) and PSA was 27.6 ng/ml (range: P25-P75, 11.9-55.0 ng/ml). On day 3, 88% and 92% of patients in the groups to whom 200-mg and 240-mg initial doses of degarelix were administered, respectively, had testosterone levels < or =0.5 ng/ml. For patients with testosterone levels < or =0.5 ng/ml at 1 mo, the testosterone levels remained < or =0.5 ng/ml until the end of the study in 100% of the patients treated with a monthly maintenance dosage of 160 mg of degarelix. No evidence of testosterone surge was detected. PSA decreased by 97-98% after 1 yr and the median time to 90% reduction in PSA was 8 wk in all but one patient (from the 80-mg dosage treatment group at the initial 200-mg dose of degarelix). Thirteen patients (6%) withdrew from the study due to adverse events, largely related to androgen deprivation., Conclusions: Degarelix treatment for 1 yr resulted in a fast, profound, and sustained suppression of testosterone and PSA, with no evidence of testosterone surge. Degarelix was well tolerated.

Purpose of Review: To review the most recent data on preoperative diagnostic methods in kidney cancer and in follow-up and monitoring after ablation therapy., Recent Findings: Although the role of the percutaneous biopsy in the diagnostics of renal masses has been limited, new data suggest a high accuracy of the percutaneous core biopsy in the diagnostics of malignancy and a fair to perfect interobserver and intraobserver variability. Accuracy in determining the subtype is also high but lower for Fuhrman grade determination. Data on fine needle aspiration remain controversial. Refinements in cross-sectional imaging might have a value in differentiation of low-fat content angiomyolipoma from renal cell carcinoma. Contrast cross-sectional imaging remains the reference standard in the assessment of ablation results. Contrast-enhanced ultrasound shows promising results in this field but further confirmation is needed., Summary: Although few changes are evident in the diagnostic imaging of kidney tumors, percutaneous core biopsy has gained attention and in the light of the current results might play an extended role in the preoperative workup of renal masses. New techniques should be investigated for monitoring after ablation therapies in order to reduce toxicity and costs.

Objective: To evaluate changes in the pathological characteristics, stage of primary renal tumours and their surgical management in the Netherlands during the period 1995-2005., Methods: Extracts from the records of all patients who had surgery for primary renal tumours in the Netherlands during the period 1995-2005 were reviewed. Data were collected from PALGA, the nationwide network and archive of histocytopathology. The 2002 Tumour-Node-Metastasis and the three-tier Fuhrman grade were used for staging and grading., Results: In all there were 12 471 operations for primary renal masses during the study period. The incidence of surgically removed renal cancers increased from 6.2 in 1995 to 7.5 cases per 100 000 inhabitants (P = 0.005) in 2005. The mean (sd, median) age of the patients was 63.3 (11.9, 65.0) years, with a male-to-female ratio of 3:2. The mean (sd) tumour size of malignant tumours decreased from 7.3 (3.6) to 6.9 (3.7) cm (P = 0.301). The percentage of benign removed tumours remained relatively stable (P = 0.056), with a mean of 5.4% of all resected tumours. There was an increase of grade 1 tumours; the incidence of T1 tumours increased from 36.6% to 44.2%, and advanced tumours decreased from 46.4% to 33.7%, respectively. The percentage of nephron-sparing surgery increased from 3.5% in 1995 to 10.1% (P = 0.003) in 2005, mainly in the T1a tumours., Conclusions: During the last decade there was an increase in the incidence of surgically treated renal tumours in the Netherlands. Tumours with favourable histopathological characteristics, low stage and grade, accounted for most of this increase. The percentage of surgically removed benign tumours remained stable. The use of nephron-sparing surgery increased during the last decade, especially in T1a tumours.

Background: Detrusor overactivity is one known cause of lower urinary tract symptoms and has been linked to bladder storage symptoms (urgency, frequency, or urge incontinence)., Objective: To determine clinical and urodynamic parameters associated with detrusor overactivity in patients with suspected benign prostatic hyperplasia., Design, Setting, and Participants: During 1993-2003, urodynamic investigations were performed in patients aged 40 yr or older and with lower urinary tract symptoms, benign prostatic enlargement, and/or suspicion of bladder outlet obstruction (maximum flow rate < 15 ml/s or postvoid residual urine > 50 ml)., Measurements: Detrusor overactivity was defined according to the new International Continence Society classification (2002) as involuntary detrusor contractions during cystometry, which may be spontaneous or provoked, regardless of amplitude. The Schäfer algorithm was used to determine bladder outlet obstruction., Results: In total, 1418 men were investigated (median age: 63 yr) of whom 864 men (60.9%) had detrusor overactivity. In univariate analysis, men with detrusor overactivity were significantly older, more obstructed, had larger prostates, higher irritative International Prostate Symptoms Score subscores, a lower voiding volume at free uroflowmetry, and a lower bladder capacity at cystometry. The prevalence of detrusor overactivity rose continuously with increasing bladder outlet obstruction grade. Multivariate analysis showed that only age and bladder outlet obstruction grade were independently associated with detrusor overactivity. After age adjustment, the odds ratios of detrusor overactivity compared to Schäfer class 0 were 1.2 for class I, 1.4 for class II, 1.9 for class III, 2.5 for class IV, 3.4 for class V, and 4.7 for class VI., Conclusions: In patients with clinical benign prostatic hyperplasia, detrusor overactivity is independently associated with age and bladder outlet obstruction. The probability of detrusor overactivity rises with increasing age and bladder outlet obstruction grade.

Objective: In light of recent interest in the use of muscarinic receptor antagonists for the treatment of male lower urinary tract symptoms, understanding how such drugs work not only on the bladder but also on the prostate is important., Methods: A literature review was conducted to identify studies on the cholinergic innervation and presence and function of muscarinic acetylcholine receptors in the human prostate., Results: The available studies demonstrate a dense cholinergic innervation within both stromal and epithelial compartments of the prostate. Concomitantly, the human prostate expresses muscarinic receptors at densities exceeding those of alpha(1)-adrenoceptors. They mainly belong to the M(1) subtype and are found on epithelial cells, but a smaller population of M(2) receptors is found on stromal cells. Both populations have been shown to be functional in signal transduction assays. However, in line with the sparse receptor density on stromal smooth muscle cells, contractile responses of the prostate are only small. Data from prostate cancer cell lines and from botulinum toxin injections into the benign prostate raise the possibility that muscarinic receptors may promote prostatic growth. Animal data suggest that muscarinic receptors may be of primary importance in the genesis of prostatic secretions, but this needs to be confirmed in humans., Conclusions: Taken together it appears that direct effects on the prostate need to be considered when using muscarinic receptor antagonists in men. They may primarily involve alterations of glandular secretion and prostatic growth.

In cryosurgery it is crucial that the performance of cryoprobes is predictable and constant. In this study we tested the intra- and interneedle variation between 17-gauge cryoprobes in two homogeneous mediums. Also, a multiprobe setup was tested. Cryoprobe performance was defined as the time it takes one cryoprobe to lower the temperature from 0 to -20 degrees C as measured by four thermosensors each at 3 mm distance from the cryoprobe. In agar eight cryoprobes were tested during six freeze cycles, and in gel four cryoprobes during four freeze cycles; each freeze cycle in a different cup of agar or gel. Using more accurate 'bare' thermosensors three cryoprobes were tested in gel during two freeze cycles. A multiprobe configuration with four cryoprobes was tested during two freeze cycles in both agar and gel. Statistical analyses were done using ANOVA for repeated measures. There was no significant intraneedle variation, whereas both in agar and gel there was a significant interneedle variation (p<0.05). Mean performance in gel was better than in agar (p<0.001). Also, there was a significant variation between the four thermosensors (p<0.001). Using bare thermosensors mean performance was 2.7 times faster compared to measurements by regular thermosensors (p<0.001). In a multiprobe configuration, overall performance seems less variable and more reproducible compared to a single cryoprobe. In conclusion, the performance of cryoprobes differs depending on the medium and measuring device used. Cryoprobes deliver reproducible freeze cycles, although there is variation between different cryoprobes. In a multiprobe configuration performance seems less variable.

During the past decade, increasing numbers of minimally invasive treatments for managing male lower urinary tract symptoms caused by urinary tract obstruction have been positioned. On one hand, transurethral needle ablation and transurethral microwave thermotherapy bridge the gap between medical management and surgery, while on the other hand, outcomes of holmium laser enucleation of the prostate and Greenlight laser equal outcomes following transurethral resection of the prostate (TURP). With the introduction of the bipolar technology, however, TURP has reinforced its position.

Photoselective vaporization of the prostate (PVP) with a potassium titanyl phosphate (KTP) laser may be the most promising new technology applied to the treatment of benign prostatic hyperplasia (BPH). The specific laser light characteristics and the ideal interactions between KTP lasers and prostatic tissue result in an even and efficient vaporization of the prostate and the formation of a clearly deobstructed prostate cavity. PVP can be a day-care procedure, with few hours of catheterization and minimal postoperative discomfort, offering outcomes at least equivalent to the reference standard transurethral resection of the prostate. Although larger studies are necessary to further define where PVP stands in the management of BPH, this review focuses on contemporary treatment techniques and their limitations, and comments on the outcomes of its current use.

Aims: To test the hypothesis that improvements of lower urinary tract symptoms (IPSS) upon treatment with an alpha-blocker are due to reduction of bladder outlet obstruction (assessed as the bladder outlet obstruction index, BOOI); relationships of either with free flow Q(max) were also explored., Methods: The database of a large placebo-controlled, randomized, double-blind study with the alpha-blocker tamsulosin was analyzed retrospectively. Patients were stratified into lower and upper halves according to baseline IPSS, Q(max) or BOOI and treatment-associated alterations thereof. In these strata differences between values for the other two parameters were analyzed, for example, improvement of IPSS and Q(max) were compared in patients with below and above median improvement of BOOI., Results: Patients with below and above median baseline for one parameter, for example, IPSS had rather similar values for the other two parameters, for example, Q(max) and BOOI. Likewise, patients based upon baseline strata for one parameter had rather similar improvements of the other two parameters. Most importantly, patients with below and above median treatment-associated improvements of one parameter, for example, BOOI exhibited only small if any difference for alterations of the other two parameters, for example, IPPS and Q(max)., Conclusions: We conclude that IPSS, free flow Q(max) and BOOI are only loosely related at baseline. More importantly, treatment-induced improvements of these parameters are also only loosely related. These data do question the hypothesis that alpha-blockers largely improve lower urinary tract symptoms by reducing bladder outlet obstruction and suggest that they may also act independent of prostatic smooth muscle tone., ((c) 2007 Wiley-Liss, Inc.)

Objective: Stress urinary incontinence (SUI) occurs in men and women. Pharmacologic treatment of female SUI has been beneficiary but the role of drug treatment in male SUI is controversial. This review evaluates the drug classes, the effects of these drugs in trials with male SUI, and the levels of evidence of the individual trials., Methods: A systematic literature review was conducted searching for studies on male SUI published between 1966 and 2007. In retrieved articles, reference lists were hand-searched to identify additional articles. The level of evidence was judged according to the Oxford classification., Results: This search found nine articles providing evidence that alpha-adrenoceptor agonists (ephedrine, phenylpropanolamine, midodrine), beta2-adrenoceptor agonists (clenbuterol), and serotonin-noradrenaline reuptake inhibitors (imipramine, duloxetine) have a potentially beneficial effect on male SUI. Most trials used only small numbers of patients and a mixed study population (men and women). The evidence level of most studies was low due to the lack of randomisation (case series or cohort studies, level 4). In contrast, the first high-level study to provide evidence in the treatment of male SUI was with duloxetine, a selective serotonin and noradrenaline reuptake inhibitor (randomised controlled study, level 1b). However, only one well-designed study has been published so far., Conclusions: One high-level study with duloxetine in combination with pelvic floor muscle training shows preliminary but promising results in the treatment of male SUI. These results have to be confirmed in larger and well-designed trials to allow definite recommendations for the pharmacologic treatment of male SUI.

Purpose: To review the literature on the definition and incidence of leakage after laparoscopic radical prostatectomy (LRP) as well as its relation to the surgeon's technical experience, the type of urethrovesical suture, and the approach (extraperitoneal or transperitoneal)., Materials and Methods: We conducted a systematic review of the subject, consulting MEDLINE, Embase, and Cochrane library (MeSH terms "radical prostatectomy," "laparoscopy," "anastomotic leakage," and "complications"). Languages were limited to English, Spanish, and French. Selection criteria were original papers with 30 or more patients and description of the leakage rate. Data on mean catheterization days, surgical approach, and type of suture were retrieved. Papers were included after approval by two independent reviewers. Statistical analysis was performed with SPSS V. 12. A P value <0.05 was considered significant., Results: A total of 24 articles were identified meeting the inclusion criteria. Most of them were observational. There were no randomized controlled trials. Meta-analysis was not performed because of clinical heterogeneity. Leakage was defined in 11 of the papers, and great variation in the definition was found. On average, the incidence of anastomotic leakage was 9.7% (396/4091 patients) and ranged from 3.2% to 33%. None of the risk factors studied showed statistical significance, although some individual series demonstrated a decrease in the leakage rate with increasing surgeon experience., Conclusions: The evidence in the studies on urine leakage after LRP is poor. There is a lack of a uniform definition of the condition. Time frame, diagnostic method, and significance need to be standardized. This lack of definition, together with the character of the studies and the heterogeneity of the series, makes comparison difficult, precluding a proper meta-analysis.

Objectives: The aim of this prospective study was to compare the diagnostic accuracy of detrusor wall thickness (DWT), free uroflowmetry, postvoid residual urine, and prostate volume (index tests) with pressure-flow studies (reference standard) to detect bladder outlet obstruction (BOO) in men., Methods: During a 2-yr period, men older than 40 yr with lower urinary tract symptoms and/or prostatic enlargement had the following tests: ultrasound measurements of DWT, free uroflowmetry (Q(max), Q(ave)), postvoid residual urine, and prostate volume. Pressure-flow studies were used to divide obstructed from nonobstructed bladders., Results: One hundred sixty men between 40-89 yr of age (median: 62 yr) were included in the study; 75 patients (46.9%) had BOO according to pressure-flow studies. The results of all investigated index tests differed significantly between obstructed and nonobstructed men. DWT was the most accurate test to determine BOO: the positive predictive value was 94%, specificity 95%, and the area under the curve of ROC analysis 0.93. There was an agreement of 89% between the results of DWT measurement and pressure-flow studies., Conclusions: Measurements of DWT can detect BOO better than free uroflowmetry, postvoid residual urine, or prostate volume. In clinical routine, DWT measurements can be used to judge BOO noninvasively., (European Association of Urology.)

Objectives: Laparoscopic partial nephrectomy (LPN) is a technically challenging procedure for the management of renal tumours. Major complications of LPN include bleeding and urine leakage. Haemostatic agents (HAs) and/or glues may reduce haemorrhage and urine leakage. We sought to examine the current practice patterns for urologists performing LPN with regard to HA use and its relationship with bleeding and urine leakage., Materials and Methods: A survey was sent via e-mail to urologists currently performing LPN in centres in the United States and Europe. We queried the indications for HA/glue usage, type of HAs/glues used, and whether concomitant suturing/bolstering was performed. In addition, the total number of LPNs performed, laparoscopic tools used to resect the tumour, tumour size, and tumour position were queried., Results: Surveys suitable for analysis were received from 18 centres (n=1347 cases). HAs and/or glues were used in 1042 (77.4%) cases. Mean tumour size was 2.8cm, with 79% of the tumours being defined as exophytic and 21% deep. The HAs and glues used included gelatin matrix thrombin (FloSeal), fibrin gel (Tisseel), bovine serum albumin (BioGlue), cyanoacrylate glue (Glubran), oxidized regenerated cellulose (Surgicel), or combinations of these. Sixteen centres performed concomitant suturing/bolstering. The overall postoperative bleeding requiring transfusion and urine leakage rates were 2.7% and 1.9%, respectively., Conclusions: The use of HAs and/or glues is routine in most centres performing LPN. The overall haemorrhage and urine leakage rates are low following LPN. More studies are needed to assess the potential role of HAs and/or glues in LPN., (European Association of Urology.)

Unlabelled: Authors from the Netherlands studied the use of a casting technique, cryomicrotome imaging and three-dimensional computer analysis to visualise and reconstruct the arterial anatomy in a porcine kidney model. They found that this could be done satisfactorily to a resolution of 50 microm., Objective: To assess the combined use of a casting technique, cryomicrotomy imaging, and three-dimensional (3D) computer analysis as a method for visualizing and reconstructing the arterial vascular tree in a porcine renal model., Material and Methods: The arterial branches of two porcine kidneys were filled with a fluorescent cast, after which they were cut into slices of 50 microm in an imaging cryomicrotome. From each section, digital images of the cutting plane of the sample were taken and stored in the computer, after which stacks of images were rendered in 3D., Results: A 3D computerized reconstruction of the arterial vascular tree was constructed and showed the complete arterial anatomy up to arterioles of 50 microm., Conclusion: With visualization by fluorescence imaging cryomicrotomy, the anatomical and 3D reconstruction of the renal arterial blood supply in a pig kidney is possible up to a resolution of 50 microm.

The diagnosis of prostate cancer is based on histology. Prostate biopsies are obtained based on the triad of prostate specific antigen (PSA), digital rectal examination (DRE) and transrectal ultrasound. Because prostate biopsies still have a large percentage of negative outcomes, patient selection and biopsy direction need improvement. This paper describes the recent improvements in prostate cancer imaging, especially contrast-enhanced transrectal ultrasound.

Background and Purpose: On the one hand, nephron-sparing surgery (NSS) in small renal tumors is a safe and effective alternative to radical nephrectomy. On the other hand, the role of preoperative percutaneous needle biopsies (PNB) remains controversial. The purpose of this study was to evaluate the global current use of NSS in the treatment of renal-cell carcinoma (RCC) and the use of PNB among endourologists., Materials and Methods: One thousand questionnaires were distributed during the 23rd World Congress of Endourology and SWL. Six questions regarding NSS and two questions regarding PNB were presented. Two hundred twenty-two questionnaires were returned., Results: Of the respondents, 86.6% perform NSS for small renal tumors, whereas 13.4% perform only radical nephrectomies; 7.5% will consider NSS only in patients with a solitary kidney, and 0.5% will never consider NSS. The techniques for NSS, in descending order of preference, are partial nephrectomy, enucleation, cryoablation, radiofrequency ablation, and high-intensity focused ultrasound. The mean and maximum diameter of the tumor in patients with a normal contralateral kidney for which the urologists perform NSS is 4.0 cm. For a centrally located tumor, NSS is an option for 27.2% of the respondents. Regarding PNB in patients with suspicion of RCC, 55.9% of respondents never obtain renal biopsies in the preoperative assessment and 41.8% obtain them only in rare cases. The majority (90%) prefer histologic over cytologic biopsies., Conclusions: Nephron-sparing surgery is evolving to a global worldwide standard treatment for small renal tumors. Percutaneous needle biopsy remains a highly debated procedure.

Objective: To determine whether evaluating perfusion patterns with contrast-enhanced ultrasonography using contrast-pulse sequence imaging (CPS; a new imaging method that enables selective visualization of perfusion) is possible at different times after cryoablation of renal tumours, and to describe the characteristics of CPS in a small group of patients., Patients and Methods: The efficacy of renal cryoablation is mainly judged using imaging. Seven randomly selected patients, each at a different time after laparoscopically assisted cryoablation of a renal tumour, were investigated with CPS and a microbubble-contrast agent. The perfusion characteristics in the lesions were scored by two investigators and described, and the lesions were measured., Results: In the seven patients treated with cryoablation for small renal tumours, eight CPS studies were performed. Five lesions showed no enhancement and one lesion, investigated 18 months after treatment was not recognized. In one patient, no enhancement was seen after 1 month but 7 months later, there were minimal contrast signals inside the treated area. The lesions could be measured with a mean standard deviation of 1.1 mm and a mean difference between the two investigators of 0.7 mm., Conclusion: Our first experiences with CPS imaging for the follow-up of renal cryoablation show that this technique can be used to characterize perfusion defects at different times after cryoablation.

Background and Purpose: The use of contrast-enhanced ultrasonography for imaging of renal masses was first described in 1994. Since then, many new techniques for visualization of the effect of microbubble contrast agents have been developed. In this pilot study, a small number of patients was investigated with contrast pulse sequence imaging (CPS), and the characteristics of this perfusion imaging technique were evaluated subjectively and judged against the clinical diagnosis and histology findings when available. The purpose of this pilot study was to describe CPS imaging in several cases., Patients and Methods: Eighteen patients with 20 previously identified renal masses were examined with CPS. Perfusion imaging was compared with clinical diagnosis and with histologic findings when available., Results: Nineteen masses were visible. Various enhancement patterns could be observed, and interpretations of CPS characteristics are described. In carcinomas, inhomogeneous enhancement patterns were observed, and areas without enhancement inside the inhomogeneous lesions corresponded to necrotic areas in histologic specimens. All simple cysts and complex benign cysts showed absence of enhancement inside or in the wall of the lesion and a regular shape., Conclusion: To our knowledge, this is the first study in which the characteristics of CPS imaging of renal masses have been related to clinical diagnoses and histologic features. From the results of this pilot project, we conclude that CPS is a promising technique to determine perfusion patterns in the kidney.

Objectives: To evaluate the durability of transurethral microwave therapy (TUMT) Prostasoft 3.5 for the treatment of patients with benign prostatic hyperplasia treated with the 30-minute protocol., Methods: A total of 213 patients (45 with urinary retention) were treated with TUMT Prostasoft 3.5. The International Prostate Symptom Score (IPSS), quality of life (QOL) score, and maximal flow rate (Qmax) were assessed at baseline and at 12, 24, 36, 48, and 60 months of follow-up., Results: The overall mean follow-up period was 33.9 months, with a maximum of 65 months. Patients without retention had significant improvement (P <0.0001) in the Qmax for up to 4 years (from 8.5 to 13.2 mL/s). The mean IPSS had decreased significantly from 20.3 to 12.2 at 5 years (P <0.0001). Similarly, the mean QOL score improved significantly during follow-up (P <0.0001). In the retention group, analysis showed that the clinical outcomes in terms of Qmax, IPSS, and QOL score remained stable during the follow-up period. Retreatment was required for 48 patients without urinary retention (28.6%) and 17 patients with retention (37.8%). The corresponding Kaplan-Meier cumulative retreatment risk at 5 years was estimated to be 42.3% and 58.8%., Conclusions: Our long-term data have indicated that the IPSS and QOL score remained improved in responders compared with their pretreatment scores 5 years after the 30-minute TUMT protocol and the Qmax remained significantly increased for up to 4 years. However, a significant number of patients required additional treatment, with those in retention before TUMT at a greater risk.

Open pyeloplasty is traditionally the recommended treatment for ureteropelvic junction obstruction. In the past decades, several less invasive procedures emerged with the advantages of lower morbidity and better patient tolerance. In 1993, an electrosurgical cutting balloon device called the Acucise (Applied Medical Resources Corp., Laguna Hills, CA) was introduced. It was presented as a straightforward, safe procedure that can be performed in a complete retrograde fashion under fluoroscopic guidance. Despite these advantages; however, it is not yet a generally excepted procedure. This is mainly due to the fact that specific patient selection is needed, and success rates are comparable with other already established endoscopic procedures. Considering the large variety of minimally invasive procedures available, treatment of choice must be based on several factors such as success rate, morbidity, cost, and surgeon's experience. Acucise is considered a good alternative for the treatment of ureteropelvic junction obstruction in selected patients. However, the efficacy is significantly lower than the reference standard.

Noninvasive tests for detecting genetic or molecular alterations in urine indicative of urothelial cancer are increasingly becoming the focus of urological cancer research. Since its approval by the US FDA in 2001, the fluorescence in situ hybridization test (Vysis UroVysion) has been widely evaluated. In general, published data demonstrate better sensitivity and equal or better specificity compared with routine cytology, which is still considered the 'gold standard' in diagnosing and monitoring bladder tumors. However, the fluorescence in situ hybridization test seems to provide not only a useful tool in bladder cancer detection, but also in the diagnosis of upper urinary tract tumors, surveillance and determining therapy effectiveness. This multitarget assay that detects four different chromosomal aberrations in tumor cells is a kind of objective molecular cytology and has proven advantages over routinely used cytology.