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  • Adjunctive use of Narrow Band Imaging during transurethral resection/vaporization of bladder tumors to aid In identifying mucosal and sub-mucosal hypervascularity

    Diorio J. Gregory, Canter J. Daniel, MD Einstein Healthcare Network, Philadelphia, Pennsylvania, USA

    For patients with non-muscle invasive bladder cancer, cystoscopy and transurethral resection/vaporization of the bladder tumor plays an integral role in the treatment of a given patient's bladder cancer. Although considered the current gold standard for tumor detection, traditional or white light cystoscopy has been shown to have its limitations visualizing both small papillary tumors and/or carcinoma in-situ. Current efforts have been directed to closing this gap with data demonstrating that by identifying these previously missed lesions, tumor recurrence and progression rates are reduced, thereby improving patient outcomes. Narrow Band Imaging, which can be used during cystoscopy and transurethral resection/vaporization of bladder tumors, can aid in visualizing mucosal and sub-mucosal hypervascularity--a probable surrogate for malignant lesions--potentially visualizing the boundaries of lesions that may have been missed during white light cystoscopy alone. This technique may produce equivalent visual markers with fewer logistical hurdles than currently available methods. In this article, we detail our technique for the adjunctive use of Narrow Band Imaging during cystoscopy and transurethral resection/vaporization of bladder tumors to aid in visualizing mucosal and sub-mucosal hypervascularity. Although not yet readily adopted, Narrow Band Imaging may be a practical and easy to use adjunct to existing methods in visualizing occult bladder lesions.

    Keywords: bladder cancer, transurethral resection/vaporization of a bladder tumor, Narrow Band Imaging,

    Apr 2015 (Vol. 22, Issue 2, Page 7763)
  • The prone ureteroscopic technique for managing large stone burdens

    Sternberg M. Kevan, Jacobs L. Bruce, King J. Benjamin, Wachterman B. Jared, Shahrour Khaled, Theisen M. Katherine, Sprauer E. Sarah, Ohmann Erin, Averch D. Timothy, MD University of Vermont, Burlington, Vermont, USA

    Percutaneous nephrolithotomy (PCNL) is the standard treatment for patients with large stone burdens, but can be associated with significant complications. Flexible ureteroscopy is an alternative approach that is less invasive, but often requires multiple procedures. Typically, many factors play a role in the decision to perform PCNL or ureteroscopy. The challenge is that it is difficult to predict which stone burdens will be able to be cleared ureteroscopically. We describe our approach using initial prone ureteroscopy with the transition to standard prone PCNL if required.

    Keywords: percutaneous nephrolithotomy (PCNL), prone ureteroscopy, ureteroscopy, renal calculi, shock wave lithotripsy (SWL),

    Apr 2015 (Vol. 22, Issue 2, Page 7758)
  • Urologic and endovascular repair of a uretero-iliac artery fistula

    Hirsch M. Lior, Amirian J. Michael, Hubosky G. Scott, Das K. Akhil, Abai Babak, Lallas D. Costas, MD Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA

    Patients with a uretero-iliac artery fistula (UIAF) are at an elevated risk of life-threatening hemorrhage. Identification and treatment of the fistula may be challenging, and requires the combined expertise of a urologist and endovascular specialist. This manuscript provides a list of equipment needed and describes our technique for diagnosing and treating a UIAF.

    Keywords: uretero-iliac artery fistula (UIAF), ureteroarterial fistula (UAF),

    Feb 2015 (Vol. 22, Issue 1, Page 7661)
  • How I do it: laparoscopic renal cryoablation (LRC)

    da Silva Donalisi Rodrigo, Jaworski Paulo, Gustafson Diedra, Nogueira Leticia, Kang Francis, Molina Wilson, Kim J. Fernando, MD Division of Urology, Denver Health Medical Center, Denver, Colorado, USA

    Recently, diagnoses of small renal masses and renal cell carcinoma (RCC) have increased due to the widespread use of radiographic imaging studies (computerized tomography, magnetic resonance imaging). It appears that biological factors such as obesity and tobacco use increase the risk for RCC. In general, small malignant renal masses are low stage and low grade. The management of asymptomatic renal masses is a surgical challenge since overtreatment of benign masses is not desired, especially for patients with complex medical comorbidities, elderly patients, and those with impaired renal function. Partial nephrectomy has been considered the gold standard when treating small renal masses. However, technical challenges and possible irreversible ischemia-reperfusion injury should be considered when treating these lesions. Preservation of renal function without compromising oncological control is the foundation for nephron-sparing surgery. Laparoscopic renal cryoablation (LRC) emerges as an option to treat small renal masses due to the less invasive procedure with low intraoperative complications rates, with no renal ischemia-reperfusion injury and comparable medium term follow up. It is our objective to demonstrate our technique to perform an effective small renal tumor cryoablation using the laparoscopic approach.

    Keywords: renal cancer, renal cryoablation, laparoscopic cryoablation,

    Dec 2014 (Vol. 21, Issue 6, Page 7574)
  • How I Do It: Managing bone health in patients with prostate cancer

    Barkin Jack, MD Humber River Hospital, Toronto, Ontario, Canada

    Urologists have two scenarios where they have to address bone loss or increased risk of fractures in men with prostate cancer. In the first setting, a patient who has been started on androgen deprivation therapy may develop cancer-treatment-induced bone loss. In the second setting, a patient’s prostate cancer may have metastasized to the bone. This article describes six steps to manage bone health in patients diagnosed with prostate cancer in a community practice.

    Keywords: prostate cancer, managing bone health,

    Aug 2014 (Vol. 21, Issue 4, Page 7399)
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