The efficacy of gated versus nongated shockwave lithotripsy using the Medstone STS lithotriptor.

PURPOSE: To determine the efficacy of a gated and slower shockwave lithotripsy (SWL) vs a nongated and faster SWL delivery with regard to stone fragmentation and clearance using the Medstone STS lithotriptor. PATIENTS AND METHODS: We performed a retrospective chart review of 300 consecutive patients who underwent SWL for renal stones at our institution from 2001 to 2007. One hundred and five patients underwent SWL with shocks gated to the electrocardiographic signal and 195 patients underwent nongated SWL with an externally fixed signal. Subset analysis was performed between stones <1 cm and > or =1 cm. Main outcome was stone-free rates. RESULTS: The gated procedure was performed 35% of the time. Gated and nongated patients underwent treatment at average rates of 76 shocks/minute and 120 shocks/minute, respectively. Operative time for the gated group was significantly longer at 50 minutes vs 34 minutes. A significantly higher percentage of men underwent a gated procedure. Other variables for age, body mass index, American Society of Anesthesiologists class, percent lower pole, percent stented, preoperative stone burden, and mean follow-up were comparable between groups. Overall stone-free rates were comparable for gated and nongated at 33.3% and 35.4%, respectively (P = 0.819). For stones <1 cm, stone-free rates were 41.2% vs 39.7% (P = 0.957) for gated and nongated groups, respectively. For stones > or =1 cm, stone-free rates were 18.9% vs 26% (P = 0.520) for gated and nongated groups, respectively. CONCLUSIONS: Gated SWL requires a significantly longer time to perform and does not appear to have an affect on stone-free rates, regardless of stone size.

Radical cystectomy with extended lymphadenectomy in the presence of a pelvic kidney.

The pelvic kidney represents the most common form of congenital renal ectopia. Because of its location, variable vasculature, and short ureteral length, the presence of a pelvic kidney in a patient undergoing radical cystectomy and pelvic lymphadenectomy creates unique technical challenges for the urologic surgeon. We describe a patient with a right pelvic kidney and invasive bladder cancer for whom radical cystectomy with extended pelvic iliac lymph node dissection and ileal conduit was performed.

DU-145 and PC-3 human prostate cancer cell lines express androgen receptor: implications for the androgen receptor functions and regulation.

The majority of human prostate cancer cell lines, including the two "classical" cell lines DU-145 and PC-3, are reported to be androgen receptor (AR)-negative. However, other studies have provided evidence that the DU-145 and PC-3 cell lines express AR mRNA. These contradictory observations prompted us to investigate whether DU-145 and PC-3 cell lines express the androgen receptor. Using antipeptide antibodies directed against three distinct regions of the human AR protein and an improved method to detect AR protein in immunoblotting, we report that DU-145 and PC-3 cell lines express AR protein. We found that the relative levels of the AR mRNA and protein that were detected in DU-145 and PC-3 cell lines were lower than the LNCaP, an AR-positive cell line. Moreover, the antibody directed against the non-variant region (amino acids 299-315), but not the variant N- or C-terminal region (amino acids 1-20 and 900-919, respectively) of the human AR protein, detected the expression of AR in all prostate cancer cell lines. Notably, treatment of these cell lines with dihydrotestosterone (DHT) resulted in measurable increases in the AR protein levels and considerable nuclear accumulation. Although, treatment of DU-145 and PC-3 cells with DHT did not result in stimulation of the activity of an AR-responsive reporter, knockdown of AR expression in PC-3 cells resulted in decreases in p21(CIP1) protein levels, and a measurable decrease in the activity of the p21-luc-reporter. Our observations demonstrate the expression of AR protein in DU-145 and PC-3 prostate cancer cell lines.

Extramammary Paget disease of the scrotum with features of Bowen disease.

The scrotum is an uncommon site for the presentation of extramammary Paget disease (EMPD). We describe a case of EMPD that was discovered in a patient who had been previously diagnosed and treated for squamous cell carcinoma in situ of the scrotum 3 years earlier. Pathologic examination of the current scrotectomy specimen revealed an erythematous patch with areas of pale induration. Microscopic examination revealed areas with the characteristic histology of Paget disease adjacent to areas characteristic of Bowen disease. Immunohistochemical findings demonstrated a strong expression of carcinoembryonic antigen, cytokeratin 7, and low-molecular-weight cytokeratins (CAM 5.2) in both of these areas, giving support to the overall diagnosis of EMPD. High-molecular-weight cytokeratins (34betaE12) were uncharacteristically expressed in the cytoplasm of the Paget cells with equal or greater strength than in the surrounding keratinocytes, suggesting some degree of squamous differentiation. Very few publications have reported the coexistence of EMPD with squamous cell carcinoma in situ, occurring mostly in the vulva. To our knowledge, our case is the first report of scrotal EMPD with features of Bowen disease. Our findings support the theory that primary EMPD arises multifocally from multipotential epidermal cells.