An unusual foreign body in the urinary bladder mimicking a parasitic worm.

We report an unusual case of a foreign body removed from the urinary bladder of a 63-year-old male which mimicked a parasitic worm. The foreign body was identified as an artificial fishing worm by morphological comparison to a similar commercially produced product and by infrared spectrum analysis.

Direct comparison of surgical and functional outcomes of robotic-assisted versus pure laparoscopic radical prostatectomy: single-surgeon experience.

OBJECTIVES: To compare the perioperative and functional outcomes of laparoscopic radical prostatectomy (LRP) and robotic-assisted laparoscopic prostatectomy (RALP) in a single-surgeon series. Robotic assistance aids the laparoscopically naive surgeon in performing minimally invasive prostate surgery by offering superior visualization and dexterity. METHODS: The initial 75 patients with >/=12 months of functional data who had undergone RALP by a single surgeon were selected. These were compared with 75 patients who had undergone LRP from a confidential database of the same surgeon experienced in LRP toward the end of his experience with this modality (>300 cases). RESULTS: The patients in both groups were similar with respect to age, preoperative prostate-specific antigen level, biopsy Gleason score, pathologic stage, and positive margin rate. Statistically significant differences were noted in favor of RALP vs LRP with regard to operative time (199 vs 232 minutes, P < .001), intraoperative blood loss (230 vs 311 mL, P = .004), and length of stay (1.95 vs 3.4 days, P < .0001). The 12-month continence rate was 89% after LRP and 93.3% after RALP (P = .56). The potency rate was 71.1% and 76.5% at 12 months after LRP and RALP (P = .64) for a bilateral nerve-sparing procedure, respectively. CONCLUSIONS: Our initial experience has revealed that RALP is an equivalent, if not a superior, minimally invasive surgical option for localized prostate cancer with less blood loss and a shorter operative time and length of stay. Although the potency and continence rates were comparable, a trend was noted toward a faster return of functional outcomes in our early RALP experience.

Predicting differential renal function using computerized tomography measurements of renal parenchymal area.

PURPOSE: We evaluated any correlation between measured renal parenchymal area on computerized tomography and differential function on (99m)technetium-mercaptoacetyltriglycine renal scan to ascertain whether computerized tomography measurements could predict differential renal function. MATERIALS AND METHODS: Between 2005 and 2007 we identified 111 patients who underwent computerized tomography and renal scan. Average renal parenchymal thickness was calculated by measurements made at the upper and lower poles of each kidney. The product of average renal parenchymal thickness and renal length was calculated bilaterally and the ratio of parenchymal area was compared to the differential shown on renal scan. RESULTS: The average difference between predicted and observed renal function was 4.73% (Pearson's correlation coefficient 0.959). Patients with positive urine cultures at renal scan were compared to the other 89. The average functional difference was 6.54% vs 4.28% (Pearson's correlation 0.955 vs 0.965, p = 0.0045). The 89 uninfected patients were then compared based on contrast vs noncontrast computerized tomography and obstructed vs unobstructed renal units. No statistical difference was found with contrast administration. When compared based on evidence of obstruction, unobstructed kidneys resulted in a lower Pearson correlation (0.743 vs 0.975) but they had a statistically significant average functional difference in favor of unobstructed units (3.28% vs 5.10%, p = 0.0036). No difference was found in the obstructed group with prior drain placement. CONCLUSIONS: Differential renal parenchymal area measured by computerized tomography strongly correlates with differential function on renal scintigraphy and it may obviate the need for nuclear renal scan in some circumstances.

Comparison of open and laparoscopic nephrectomy in obese and nonobese patients: outcomes stratified by body mass index.

PURPOSE: Laparoscopic radical nephrectomy has been accepted as the preferred management for low stage renal masses not amenable to partial nephrectomy. Early in the mid 1990s several studies suggested that obesity should be a relative contraindication to laparoscopy. We present our surgical outcomes and complications in patients undergoing open and laparoscopic nephrectomy, stratified by body mass index. MATERIALS AND METHODS: We retrospectively identified 88 patients, of whom 43 underwent open nephrectomy and 45 were treated laparoscopically. All patients were stratified by body mass index to compare multiple perioperative end points and pathological outcomes of laparoscopy. RESULTS: Overall our data showed that compared to open nephrectomy laparoscopic nephrectomy resulted in statistically significant lower estimated blood loss (147.95 vs 640.48 cc, p <0.0002), operative time (156.11 vs 198.95 minutes, p <0.003) and hospital stay (3.7 vs 5.9 days, p <0.004). When stratified by body mass index less than 25, 25 to 29.9 and 30 kg/m(2) or greater, there was a statistically significant difference in estimated blood loss and hospital stay that was in favor of the laparoscopic approach in each body mass index category. Operative time did not show a statistical difference in the subgroups but all laparoscopic procedure times were shorter than open procedure times in each body mass index category. When patients with a body mass index of greater than 30 kg/m(2) were further subgrouped into 35 kg/m(2) or greater and 40 kg/m(2) or greater, there was a statistically significant difference in estimated blood loss and hospital stay that was again in favor of the laparoscopic method. CONCLUSIONS: Laparoscopic radical nephrectomy is technically more challenging as body mass index increases due to many factors but our data show that it is feasible and safe in experienced hands. Laparoscopy appears to result in perioperative outcomes that are superior to those of open nephrectomy in this high risk population with a complication profile that is equivalent to that of the open method for each stratified body mass index category.

Minimally invasive approaches to prostate cancer: a review of the current literature.

INTRODUCTION: While radical retropubic prostatectomy has been the gold standard surgical approach, the explosion of minimally invasive methods has led to the search for less invasive treatment options. We offer an overview of the evolution of laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic prostatectomy (RALP) in terms of the landmark publications and recent head-to-head comparisons, and we review our own experience. MATERIALS AND METHODS: A Medline search was performed using the keywords prostate cancer, prostatectomy, laparoscopic, and robotic. All pertinent articles concerning localized prostate cancer were reviewed. The Montefiore experience consisted of a retrospective review of a prospectively maintained confidential database. RESULTS: Several laparoscopic and robotic series were identified including review articles of each modality as well as studies directly comparing the two. Both LRP and RALP compare very favorably with conventional open surgery in terms of safety and oncologic efficacy. Both minimally invasive approaches offer decreased blood loss, transfusion rate, and length of hospital stay when contrasted with open surgery. When compared directly, LRP and RALP offer similar surgical, oncologic, and functional outcomes. However, RALP likely requires a shorter learning curve. CONCLUSION: The use of minimally invasive techniques has revolutionized the surgical treatment of prostate cancer. Pure LRP has been shown to be feasible and reproducible. However, it has a steep learning curve and is difficult to learn. In contrast, RALP is easier to learn and is now the surgical treatment of choice in most centers of excellence in the United States. The superior optics with respect to visualization and magnification translates into a procedure that is equivalent, if not superior, with respect to perioperative parameters, oncologic outcomes, and functional outcomes to its open counterpart.

The genomic sequence of the accidental pathogen Legionella pneumophila.

We present the genomic sequence of Legionella pneumophila, the bacterial agent of Legionnaires' disease, a potentially fatal pneumonia acquired from aerosolized contaminated fresh water. The genome includes a 45-kilobase pair element that can exist in chromosomal and episomal forms, selective expansions of important gene families, genes for unexpected metabolic pathways, and previously unknown candidate virulence determinants. We highlight the genes that may account for Legionella's ability to survive in protozoa, mammalian macrophages, and inhospitable environmental niches and that may define new therapeutic targets.