Salvage Therapy for Non-muscle-invasive Bladder Cancer: Novel Intravesical Agents.

Bacillus Calmette-Guerin (BCG)-refractory high-grade non-muscle-invasive bladder cancer remains a challenging problem. Radical cystectomy is standard of care, but carries significant morbidity. Therefore, there is a need for effective treatments. Previous salvage intravesical therapies have had disappointing results with long-term follow-up; however, a wide array of novel agents is currently under investigation. These include novel combinations of existing intravesical agents, novel modes of delivery such as hyperthermia, viral mediated therapies, and immunotherapy. We review the need for novel treatment with existing agents and their long-term results, and discuss novel intravesical therapies and the data currently available on these therapies.

Effect of the Need for Preoperative Dialysis on Perioperative Outcomes on Patients Undergoing Laparoscopic Nephrectomy: An Analysis of the National Surgical Quality Improvement Program Database.

OBJECTIVE: To investigate whether patients requiring dialysis are a higher risk surgical population and would experience more perioperative adverse events even when undergoing a perceived less invasive operation as a laparoscopic radical nephrectomy (LRN). LRN is generally a well-tolerated surgical procedure with minimal morbidity and mortality. Prior to transplantation, dialysis patients will often have to undergo a LRN to remove a native kidney with a suspicious mass. MATERIALS AND METHODS: Patients in the American College of Surgeons National Surgical Quality Improvement Program who underwent a LRN between 2011 and 2016 were included. Patients were stratified by the need for preoperative dialysis 2 weeks prior to surgery, and perioperative outcomes were compared. A multivariable logistic regression analysis was performed to test the association between the need for preoperative dialysis and perioperative risk. RESULTS: There were 8315 patients included in this analysis of which 445 (5.4%) patients required preoperative dialysis. Patients who required preoperative dialysis had more minor (P <.0001) and major (P = .0025) complications, a higher rate of return to the operating room (P = .002), and a longer length of stay (P <.0001) than those patients not requiring preoperative dialysis. In a multivariate analysis, the need for preoperative dialysis was independently associated with adverse perioperative outcomes (OR= 1.45, CI = 1.08-1.95, P = .015). CONCLUSION: Patients requiring preoperative dialysis were more likely to experience a perioperative complication and have a longer length of stay. For LRNs performed prior to transplantation, further risk stratification is needed, and treatment sequencing may need to be reconsidered.

Ileocalicostomy Ureteral Substitution for Complex Ureteropelvic Junction Stricture: Technique and Initial Experience.

OBJECTIVE: To present our novel surgical technique, ileocalicostomy ureteral substitution, for the management of long upper ureteral strictures in patients without a dilated extra-renal pelvis. MATERIALS AND METHODS: Two patients were identified with long, complex proximal ureteral strictures who were treated with our novel surgical technique by a single surgeon at a single institution. Perioperative data for these two patients are presented along with a detailed description of the surgical technique. RESULTS: Ileocalicostomy ureteral substitution was successfully performed in two cases. The total operative time for these cases was 436 minutes and 246 minutes, with estimated blood loss of 300 mL and 200 mL. Length of stay for the two patients was 8 days and 6 days, respectively. There were no major (Clavien-Dindo Classification ≥ grade 3) complications. Both patients are entirely free of urinary tubes with unobstructed kidneys since reconstruction. CONCLUSION: Ileocalicostomy ureteral substitution is a feasible reconstructive option for select patients. To our knowledge this report is the initial experience in the literature presented.

Factors Affecting the Completion of Genitourinary Physical Examinations Prior to Urologic Consultation.

BACKGROUND: Proper instruction during medical training regarding performing adequate physical examinations prior to urologic consultations greatly improves patient care. We evaluated the frequency of genitourinary (GU) physical examinations performed prior to urologic consultation to determine the influence of factors affecting the completion of these examinations. METHODS: Between January 2013 and December 2014, 1,596 consultations were requested by primary providers and completed by the urology department at a major tertiary care teaching institution. We reviewed patient medical records retrospectively and recorded the number of GU examinations performed prior to consultation. Patient demographics were evaluated for trends in the rates of examination. A total of 9 available urology residents saw at least one consult each. RESULTS: We identified a total of 1,596 urologic consultations during the study period, of which 233 of 407 (57.2%) (51 female and 182 male patients) received GU examinations prior to the urologic consult in the emergency department (ED) and 394 of 1,189 (33.1%) (118 female and 276 male patients) received GU examinations by the inpatient care team. Staff in the ED were 3.11 times more likely to perform a GU examination on a male patient than a female patient, and the inpatient teams were 1.48 times more likely to perform a GU examination on a male patient than a female patient. The likelihood of examination by either team was low in patients aged ≥65 years. CONCLUSION: Prior to urologic consultation, GU examinations are inconsistently performed. This variability may affect patient care and could be the subject of a future study.

Collateral urethral duplication in an adult with adult polycystic kidney disease.

Duplications of the lower urinary tract are rare congenital anomalies that are usually accompanied by concomitant nonurologic anomalies; they are typically diagnosed in early childhood. In more rare cases these are isolated, leading to diagnosis later. We describe a 50-year-old man who remained asymptomatic and therefore undiagnosed for five decades. His is one of fewer than 20 cases in the literature describing urethral duplication in the coronal (collateral) plane, the more common variant being sagittal (dorsal-ventral) duplication. He is one of only four cases reported without concomitant midline anomaly. Furthermore, he is the sole case associated with adult polycystic kidney disease.