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  • Functional oncologic and technical outcomes after endoscopic groin dissection for penile carcinoma

    Canter J. Daniel, Dobbs W. Ryan, Jafri Mohammed A. S., Herrel A. Lindsey, Ogan Kenneth, Delman A. Keith, Master A. Viraj, MD Department of Urology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA

    Penile cancer is a rare cutaneous malignancy that frequently spreads to the regional inguinal lymph nodes with a prolonged locoregional phase. An inguinal lymph node dissection may be both diagnostic and therapeutic, even in the setting of advanced disease. Despite its proven oncologic importance and efficacy, an inguinal lymphadenectomy remains underutilized, even with the publication of guidelines advocating its use. Failure to apply this modality is most likely due to the significant morbidity associated with a traditional open approach, including flap necrosis, wound infection and debilitating lymphedema. The risks and complications associated with an open inguinal lymph node dissection have driven several investigators to develop techniques for performing a minimally invasive endoscopic inguinal lymph node dissection that is oncologically equivalent to the ?gold standard? open approach, while potentially minimizing the complications traditionally seen with the open technique. In this report, we detail our technique for performing a minimally invasive endoscopic groin dissection with inguinal lymphadenectomy for penile carcinoma. We also present preliminary complication and short term oncologic data employing this surgical technique in an initial cohort of patients.

    Keywords: penile carcinoma, laparoscopy,

    Aug 2012 (Vol. 19, Issue 4 , Page 6395)
  • A critical appraisal of accuracy and cost of laboratory methodologies for the diagnosis of hypogonadism: the role of free testosterone assays

    Morales Alvaro, Collier P. Christine, Clark F. Albert, MD Queen's University, Kingston, Ontario, Canada

    The biochemical diagnosis of male hypogonadism remains a controversial issue. The problem is compounded by the variety of laboratory assays available to measure serum testosterone (T) and the limited understanding, among clinicians, of their relative diagnostic validity. It is widely accepted that only the testosterone not bound to sex hormone-bounding globulin is metabolically active. Therefore, for diagnostic purposes it is frequent practice to order the measurement of free T (FT) or bioavailable T (BAT). Our objective is to describe the methods available for measuring FT and to review the literature to determine the relevance of ordering FT as a diagnostic laboratory tool in cases of suspected hypogonadism. We also provide our biochemical approach in evaluating men with T deficiency. The limited information available in this regard is frequently confined to the biochemistry literature. The few reliable studies indicate that analog-based measurement of FT offers no diagnostic or financial advantage over automated assay for total T. The manuscript also describes 'How we do it.' For optimal diagnostic accuracy and financial responsibility, total T and calculated FT (cFT) should be the tests employed for initial and confirmatory diagnosis respectively. Measurement of bioavailable T is an alternative option but not germane to the points to which we are calling attention in this paper. While clinicians should be discouraged from ordering FT assays, laboratories performing it should indicate what method was used and warned about possible reliability concerns. FT assays should no longer be a reimbursable test

    Keywords: free testosterone, superficial bladder cancer, non-muscle invasive bladder cancer, fluorescence cystoscopy,

    Jun 2012 (Vol. 19, Issue 3 , Page 6314)
  • Blue light cystoscopy for detection and treatment of non-muscle invasive bladder cancer

    Mark Ryan J. , Gelpi-Hammerschm Francisco, Trabulsi J. Edouard , Gomella G. Leonard, MD Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

    In patients with non-muscle invasive bladder cancer, fluorescence cystoscopy can improve the detection and ablation of bladder tumors. In this paper we describe the technique and practical aspects of hexaminolevulinate (HAL) fluorescence cystoscopy, also known as "blue light cystoscopy"

    Keywords: blue light cystoscopy, bladder cancer, transurethral resection of the bladder tumor, Olympus Button Electrode,

    Apr 2012 (Vol. 19, Issue 2 , Page 6227)
  • Photoselective vaporization of the prostate in office and outpatient settings

    Rosenthal D. Brian , DiTrolio V. Joseph, MD Urological Associates of Montgomery County, East Norriton, Pennsylvania, USA

    The 980 nm/1470 nm diode laser represents the latest in laser technology for photovaporization of the prostate. Surgeons have already used this device in both inpatient and outpatient (office and ASC) setting to produce transurethral resection of the prostate (TURP) like lesions-albeit with fewer complications than traditional methods. The objective of this article is to report the techniques we used to demonstrate its efficacy and safety of the Evolve Dual (biolitec Inc., East Longmeadow, MA, USA) system in an outpatient surgery type setting.

    Keywords: photovaporization, in office, holmium laser prostatectomy, holmium laser enucleation of the prostate (HoLEP), intravesical tissue morcellation,

    Apr 2012 (Vol. 19, Issue 2 , Page 6223)
  • UroLift system for relief of prostate obstruction under local anesthesia

    Barkin Jack , Giddens Jonathan , Incze Peter , Casey Richard , Richardson Stephen , Gange Steven, MD Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada

    Many men with benign prostatic hyperplasia (BPH) forego therapy because they are dissatisfied with current treatment options. While surgical resection and ablation using many different forms of energy remain the reference standard for BPH treatment, many men seek a less invasive technique that will improve symptoms but not risk the complications associated with tissue removal. The Prostatic Urethral Lift opens the prostatic urethra with UroLift (NeoTract Inc., Pleasanton, CA, USA) permanent implants that are delivered under cystoscopic visualization. The implants literally 'hold open' the lateral prostatic lobes creating a passage through the obstructed prostatic urethra. Voiding and symptoms are significantly improved without the morbidity or possible complications following prostate resection. The entire procedure can be readily performed using local anesthesia. As with all new implant procedures, the technique has evolved with experience. The objective of this article is to describe the most current technique for the delivery of the UroLift implant in order to achieve maximal impact on symptom relief.

    Keywords: prostate, LUTS, photovaporization, outpatient, 980-nm/1470-nm diode laser,

    Apr 2012 (Vol. 19, Issue 2 , Page 6217)
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