Granulocytic sarcoma of the adrenal gland.

We report a case of primary granulocytic sarcoma (GS) of the left adrenal gland, with no evidence of hematologic involvement. To our knowledge, this is the first case of granulocytic sarcoma of the adrenal gland.

Periurethral mass formations following bulking agent injection for the treatment of urinary incontinence.

PURPOSE: Durasphere is gaining popularity as a bulking agent for treating women with stress urinary incontinence. We present a series of patients with periurethral mass formation following Durasphere injection. MATERIALS AND METHODS: The charts of 135 women with a mean age of 69.4 years (range 46 to 83) who underwent Durasphere periurethral injections were retrospectively reviewed. Patients who had a periurethral mass were identified and their clinical data were collected and analyzed. RESULTS: Four patients (2.9%) were diagnosed with periurethral mass formation 12 to 18 months (average 14.7) following a Durasphere injection. Clinical presentation varied, including irritative voiding symptoms, pelvic pain and urinary incontinence. All patients were found to have a tender and tense periurethral mass. A radiopaque mass was revealed during videourodynamic study in 1 patient. Incision, and transvaginal and endoscopic drainage or transvaginal excision were used to treat these masses. Intraoperative and pathological findings as well as operative outcomes are presented. CONCLUSIONS: Irritative or obstructing voiding symptoms, pelvic pain or a periurethral mass in patients with a history of Durasphere or other periurethral bulking agent injection should alert the physician to the possibility of periurethral mass formation. The true incidence of this late complication remains to be determined.

Bladder wall abscess following midurethral sling procedure.

Midurethal sling procedures are gaining popularity as the treatment of choice for stress urinary incontinence. Complications that were described include bladder perforation, urinary retention, pelvic hematoma and suprapubic wound infection. Sling erosion and pelvic abscess are rare complications of midurethral slings. We report the first case of an abscess formed within the wall of the urinary bladder, 7 months following a midurethral sling procedure.

Noninvasive detection of prostate cancer by quantitative analysis of telomerase activity.

PURPOSE: Prostate cancer is the most common male malignancy and the second leading cause of male cancer death; therefore, there is urgent necessity for noninvasive assays for early detection of prostate cancer. Obtaining prostate tumor samples surgically is problematic because the malignancy is heterogeneous and multifocal and early-stage tumors are nonpalpable. In contrast, exfoliated cells represent the cancer status of the entire gland better due to the general tendency of cancer cells to exfoliate into biological fluids. The purpose of this study was to clarify whether quantitative analysis of telomerase activity in exfoliated cells in urine could serve as a reliable molecular marker of prostate malignancy. EXPERIMENTAL DESIGN: We analyzed prospectively post-prostatic examination-exfoliated cells from the urine of 56 patients undergoing routine prostate screening. Epithelial cells were isolated and enriched by immunomagnetic separation. Telomerase activity was analyzed by quantitative real-time PCR telomeric-repeat amplification protocol assay using Opticon MJ research instrument. RESULTS: We report now that all prostate cancer patients revealed high levels of telomerase activity thereby showing 100% of the assay sensitivity. In contrast, the majority of patients with clinically confirmed benign prostatic hyperplasia (BPH) did not express any telomerase activity (70% of all BPH patients), most likely presenting cancer-free cases, or expressed low levels of activity (18%). However, about 12% of BPH patients revealed high levels of telomerase activity that potentially can reflect hidden prostate cancer. CONCLUSIONS: We suggest that the quantitative analysis of telomerase activity can be useful for the selection of prostate cancer and cancer-free cases.

Endoscopic treatment of bladder calculi in post-renal transplant patients: a 10-year experience.

BACKGROUND AND PURPOSE: Urinary calculus formation following renal transplantation is an uncommon phenomenon. As a result of the growing number of renal transplants performed and the greater graft survival, there has been increased awareness of transplant-related complications, one of which is calculus formation. We report our experience in the management of bladder calculi after renal transplantation. PATIENTS AND METHODS: We retrospectively reviewed the charts of 500 consecutive renal transplant patients from 1992 through 2002 and encountered 7 who had bladder calculi postoperatively. Ureteroneocystostomy had been performed using polyglactic acid suture. Bladder calculi were treated endoscopically by litholapaxy, electrohydraulic lithotripsy (EHL), or holmium:YAG laser lithotripsy. RESULTS: Three calculi were found incidentally at the time of stent removal, and the others were associated with hematuria (43%), urinary tract infection (14%), or irritative voiding symptoms (14%). Eighty-six percent of the calculi were close to the allograft ureteral orifice. CONCLUSION: While various forms of lithotripsy were employed in treating bladder calculi, Hol:YAG laser lithotripsy appeared to be both efficacious and safe. Both EHL and litholapaxy were complicated by mucosal bleeding necessitating Bugbee fulguration. Holmium:YAG laser lithotripsy was not associated with mucosal bleeding, and fulguration was not required near the allograft ureteral orifice. In addition, ureteral stenting is not required. Bladder calculi may form over both absorbable and nonabsorbable suture material, and the ideal suture for the ureteroneocystostomy has yet to be found. Until then, the Hol:YAG laser should be the lithotrite of choice for bladder calculi following renal transplantation.