Prognostic value of CA 125 in transitional cell carcinoma of the bladder.

Recent studies have reported that serum cancer antigen (CA) 125 levels may be associated with pathological and survival outcomes in patients with bladder cancer to an extent that may support further investigation of clinical utility as a prognostic biomarker. The limitations of conventional bladder cancer staging prompted our institution to evaluate the association of CA 125 with pathological stage and tumor recurrence after radical cystectomy. Conventionally utilized for the management of ovarian cancer, the ability to detect CA 125 in transitional cell carcinoma tissue and urine of patients with transitional cell carcinoma raises the possibility that bladder cancer may be another indication for such testing. This article evaluates the current literature supporting the role of CA 125 as a biomarker with potential applications in patients with transitional cell carcinoma of the bladder undergoing radical cystectomy and urinary diversion. This article demonstrates that preoperative serum CA 125 levels may serve as a useful predictor of pathological outcomes above grade and stage in patients undergoing cystectomy for urothelial carcinoma of the bladder. The findings also show the potential use of preoperative CA 125 levels to predict unresectable tumors and clarify which candidates should receive neoadjuvant therapy.

Holmium laser ablation and enucleation of the prostate: a pilot study of the hybrid technique.

OBJECTIVES: To report the initial clinical experience using a hybrid technique combining holmium laser ablation of the prostate (HoLAP) and holmium laser enucleation of the prostate (HoLEP) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). METHODS: A total of 18 patients with documented moderate to severe LUTS underwent the hybrid technique. Baseline characteristics were documented for all patients. Operative and resection times, as well as intra and perioperative complications, were recorded. Additionally, changes in American Urological Association symptom index (AUA-SI) and quality of life (QoL) scores and serum prostate-specific antigen (PSA) values were recorded both pre and postoperatively. RESULTS: All patients experienced significant improvements in their AUA-SI and QoL scores, with a mean decrease in PSA of 74.6% postoperatively. There were no reported complications with this technique and the average resection time (48.2 min) was decreased in comparison to those reported for HoLAP or HoLEP monotherapies. CONCLUSIONS: This is the first report of surgical therapy for BPH involving two different holmium laser therapies. This hybrid technique offers tissue for pathologic analysis in comparison to HoLAP, and an improved learning curve and decreased complication rate in comparison to HoLEP. Additional studies are warranted to validate this data.

Determining the utility of recalled lower urinary tract symptoms.

OBJECTIVES: To assess the utility of recalled American Urological Association Symptom Index (AUA-SI) scores 6 months after an initial outpatient clinic visit. The AUA-SI is a validated questionnaire used to assess a patient's lower urinary tract symptoms (LUTS) over a 4-week period. However, patient recall of their LUTS at greater time points is currently unknown. METHODS: Between May 2007 and August 2008, 98 patients completed the AUA-SI questionnaire at their initial visit ("Past"). At 6-month follow-up, patients recalled their AUA-SI and quality of life (QoL) scores ("Recall"). As a reference, patients also reported their current symptom scores ("Present"). Descriptive statistics, correlations, regression models, and kappa statistics were performed to assess the associations between the "Past" and "Recall" symptom scores as either categorical (mild, moderate, severe) or continuous (0-35 points) variables. Similar analyses were performed for QoL scores. RESULTS: Analyses indicated significant correlations between the "Recall" and "Past" AUA-SI and QoL scores. Although 70% of patients remained in the same categorical groupings, 62% of patients had clinically significant differences (>or= 3 points) between "Recall" and "Past" scores. Approximately, 80% of patients recalled their QoL score accurately (

Clinical significance of intramuscular cysts in the rotator cuff and their relationship to full- and partial-thickness rotator cuff tears.

OBJECTIVE: Secondary signs have been sought to help in the MR diagnosis of rotator cuff tears, especially partial-thickness tears. We sought to determine whether intramuscular cysts are always present with rotator cuff tears and the types of rotator cuff tears with which they present, and to establish the clinical significance of finding intramuscular cysts. MATERIALS AND METHODS: Retrospective analysis of our institution's database of 5,101 MRI examinations of the shoulder during an 8-year period resulted in 187 examinations in 185 patients who were thought to have intramuscular cysts. Of the 187 examinations, 134 shoulders in 132 patients (62 women, 70 men) met our criteria for an intramuscular cyst. RESULTS: Of the 134 shoulders with intramuscular cysts, 102 (76.1%) showed imaging findings of both intramuscular cysts and rotator cuff tears. Thirty-two of the 134 (23.9%) shoulders were diagnosed with only an intramuscular cyst and were not associated with a rotator cuff tear. Fifty-five of 102 (53.9%) shoulders consisted of an intramuscular cyst associated with a full-thickness rotator cuff tear, and 47 of 102 (46.1%) shoulders presented with a partial-thickness rotator cuff tear. Forty-eight of 102 (47.1%) shoulders with both an intramuscular cyst and a rotator cuff tear also underwent the reference standard arthroscopy examination to confirm the MRI findings. In 46 of 48 (95.8%) shoulders that underwent arthroscopy, the findings confirmed the imaging evidence; the other two cases were shown to have an intact rotator cuff at arthroscopy. CONCLUSION: Our study echoes the findings of previous studies that suggest a relationship between intramuscular cysts and full- and partial-thickness rotator cuff tears but illustrates that the incidence of an isolated intramuscular cyst is higher than previously expected. When intramuscular cysts present with rotator cuff tears, they present with full- and partial-thickness rotator cuff tears in relatively equal proportions. The presence of an intramuscular cyst on MRI, although it may be an isolated finding, should prompt a thorough search of all the rotator cuff tendons for tears so that the patient may receive appropriate follow-up.