Mullerianosis of the urinary bladder: a case report.

Mullerianosis is a rare, complex, benign tumor most commonly found in the bladder and often mistaken for a neoplastic lesion.  Herein, we report a case of mullerianosis in a 65-year-old woman who presented with an incidental 2 cm bladder mass found on cross-sectional imaging.  A mixed cystic and solid tumor was identified on cystoscopy and a transurethral resection of the suspected tumor was performed with histopathology confirming a final diagnosis of mullerianosis.  While an unusual diagnosis, mullerianosis of the urinary bladder needs to be correctly identified to provide appropriate treatment and avoid misdiagnosis.

In vitro and in vivo calibration of low affinity genetic Ca2+ indicators.

Calcium is a universal intracellular messenger and proper Ca2+concentrations ([Ca2+]) both in the cytosol and in the lumen of cytoplasmic organelles are essential for cell functions. Ca2+ homeostasis is achieved by a delicate pump/leak balance both at the plasma membrane and at the endomembranes, and improper Ca2+ levels result in malfunction and disease. Selective intraorganellar Ca2+measurements are best achieved by using targeted genetically encoded Ca2+ indicators (GECIs) but to calibrate the luminal fluorescent signals into accurate [Ca2+] is challenging, especially in vivo, due to the difficulty to normalize and calibrate the fluorescent signal in various tissues or conditions. We report here a procedure to calibrate the ratiometric signal of GAP (GFP-Aequorin Protein) targeted to the endo-sarcoplasmic reticulum (ER/SR) into [Ca2+]ER/SR based on imaging of fluorescence after heating the tissue at 50-52 °C, since this value coincides with that obtained in the absence of Ca2+ (Rmin). Knowledge of the dynamic range (Rmax/Rmin) and the Ca2+-affinity (KD) of the indicator permits calculation of [Ca2+] by applying a simple algorithm. We have validated this procedure in vitro using several cell types (HeLa, HEK 293T and mouse astrocytes), as well as in vivo in Drosophila. Moreover, this methodology is applicable to other low Ca2+ affinity green and red GECIs.

Impact of genomic testing on urologists' treatment preference in favorable risk prostate cancer: A randomized trial.

INTRODUCTION: The Oncotype Dx Genomic Prostate Score (GPS) is a 17-gene relative expression assay that predicts adverse pathology at prostatectomy. We conducted a novel randomized controlled trial to assess the impact of GPS on urologist's treatment preference for favorable risk prostate cancer (PCa): active surveillance versus active treatment (i.e., prostatectomy/radiation). This is a secondary endpoint from the ENACT trial which recruited from three Chicago hospitals from 2016 to 2019. METHODS: Ten urologists along with men with very low to favorable-intermediate risk PCa were included in the study. Participants were randomly assigned to standardized counseling with or without GPS assay. The main outcome was urologists' preference for active treatment at Visit 2 by study arm (GPS versus Control). Multivariable best-fit binary logistic regressions were constructed to identify factors independently associated with urologists' treatment preference. RESULTS: Two hundred men (70% Black) were randomly assigned to either the Control (96) or GPS arm (104). At Visit 2, urologists' preference for prostatectomy/radiation almost doubled in the GPS arm to 29.3% (29) compared to 14.1% (13) in the Control arm (p = 0.01). Randomization to the GPS arm, intermediate NCCN risk level, and lower patient health literacy were predictors for urologists' preference for active treatment. DISCUSSION: Limitations included sample size and number of urologists. In this study, we found that GPS testing reduced urologists' likelihood to prefer active surveillance. CONCLUSIONS: These findings demonstrate how obtaining prognostic biomarkers that predict negative outcomes before treatment decision-making might influence urologists' preference for recommending aggressive therapy in men eligible for active surveillance.

Genitourinary Mpox: A case report & primer for urologists.

Since May 2022, there has been a worldwide outbreak of Mpox infection, a zoonotic viral disease caused by the monkeypox virus, outside of central and west Africa where it is endemic. In this report, we describe a case of a 23-year-old African American male patient with HIV infection and normal CD4 counts who presented with painful, evolving skin lesions at the base of his penis which were found to be a manifestation of Mpox. Early recognition of the symptomatology caused by Mpox is important for urologists as cases of this virus continue to rise in the United States.

Use of chin sling for conservative treatment of mandibular fracture in a guinea pig (Cavia porcellus).

OBJECTIVE: To describe a treatment for a mandibular fracture in a guinea pig (Cavia porcellus). ANIMAL: A 6-month-old sexually intact male guinea pig referred for a 24-hour history of hyporexia. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: Physical examination showed lateral displacement of the incisors and inflammation and crepitation during mandible lateralization. Imaging tests revealed a minimally displaced complete oblique fracture of the left mandible with fracture of the left mandibular first premolar tooth and incisor tooth. TREATMENT AND OUTCOME: Conservative treatment was established by placing a chin sling (CS) to immobilize the jaw and a nasogastric tube for nutritional support. Imaging tests repeated 3 weeks later showed initial callus formation, and the conservative treatment was discontinued. Follow-up examinations showed appetite and progressive weight gain. Five months later, the clinical crown of the left mandibular incisor was absent and a resorptive lesion on the left mandibular first premolar tooth was detected. Complete ossification of the fracture without premolar and moler teeth elongation was observed on control imaging tests. Ten months after initial examination, the patient was reportedly healthy with no signs of pain or dental disease. CLINICAL RELEVANCE: Jaw fracture treatments in guinea pigs are poorly described in the literature. Surgical treatment can be challenging in this species due to its skull and dental anatomy. Although CS was originally employed to increase the congruency of premolar and molar teeth after coronal reduction, this device yielded satisfactory results as a noninvasive, inexpensive treatment of a mandibular fracture in this guinea pig. Alopecia on the back of the head was the only undesired adverse effect associated with the CS.

Scrotal abscess as an unusual presentation of blastomycosis.

Blastomyces dermatitidis is an environmental fungus endemic to parts of Eastern North America that notably causes pulmonary infection in humans and other animals with the potential for extrapulmonary spread, particularly in immunocompromised hosts. However, it rarely presents with genitourinary (GU) tract involvement. Herein, we present a unique case of a 37-year-old immunocompetent male with genitourinary blastomycosis with the initial presentation of a scrotal abscess.

Computed Tomography-Guided Fine Needle Biopsies of Vertebral and Paravertebral Lesions in Small Animals.

Fine needle biopsy (FNB) is an effective, minimally invasive and inexpensive diagnostic technique. Under computed tomography (CT)-guidance, lesions that have a difficult approach can be sampled to reach a diagnosis. The aim of this study is to describe the use of CT-guidance to obtain FNB from vertebral and paravertebral lesions in small animals. Ten dogs and one ferret that had undergone CT-guided FNB of vertebral and paravertebral lesions and had a cytological or a histological diagnosis were included in this retrospective study. The FNB samples were taken in four cases from the vertebra, in two cases from the intervertebral disc and in five cases from the intervertebral foramen. Two infectious and nine neoplastic lesions were diagnosed. The percentage of successful FNB was 91%. The percentage of samples with a cytological diagnosis was 80%. The percentage of complications was 9%. Limitations were the small number of animals in the study, the lacking complementary percutaneous biopsies for comparison, the lacking final histological diagnoses in some cases and the intervention of multiple operators. Computed tomography-guided FNB is a useful and safe technique for the diagnosis of vertebral and paravertebral lesions in small animals. However, a degree of expertise is important.

Adrenal cortex stimulation with hCG in spayed female dogs with Cushing's syndrome: Is the LH-dependent variant possible?

Background: The expression and overexpression of luteinizing hormone (LH) receptors in the canine adrenal gland cortex have been reported. Therefore, it was hypothesized that a LH-dependent form of Cushing's syndrome (CS) could exist in dogs. Aim: To assess whether the adrenal gland post-ovariectomy (OVx) exhibits a greater response to adrenocorticotrophin (ACTH) stimulation; to evaluate whether the adrenal gland responds to human chorionic gonadotropin (hCG) stimulation by increasing the release of cortisol; and to consider whether hCG stimulus testing would be useful as a diagnosis for possible cases of LH-dependent CS. Methods: Cortisol concentrations were measured from healthy female dogs (n=16) at baseline and following ACTH stimulation before and 2 months after gonadectomy (OVx). Cortisol concentrations were also measured for female dogs with CS (n = 14) following administration of hCG (5000 IU). A post-hCG cortisol concentration greater than 140 nmol/l was used to define dogs with LH-dependent Cushing's syndrome. Results: In normal female dogs, both pre- and post-stimulation cortisol concentrations increased following OVx (p = 0.002 and p = 0.0003, respectively). In female dogs with CS, cortisol concentrations increased following stimulation with hCG in 57% (8/14; p = 0.002). Age at the time of OVx was associated (p = 0.015) with the cortisol response to hCG [8 (5-9) years vs. 3.5 (2-6) years, p = 0.0013). Conclusion: Based on these results, an LH-dependent form of CS occurs in spayed female dogs, and that it is more likely to occur when female dogs are spayed later in life.

Diabetes mellitus remission in three cats with hypersomatotropism after cabergoline treatment.

CASE SUMMARY: Three diabetic cats presented with polyuria, polydipsia, polyphagia and poor glycemic control. Cat 1 displayed prognathia inferior and had a body condition score (BCS) of 4/5; cat 2 had a BCS of 5/5; and cat 3 had broad facial features. Serum insulin-like growth factor 1 concentrations were compatible with hypersomatotropism in cat 1 and cat 2 (>1500 ng/ml and 1200 ng/ml, respectively) and just below the cut-off of 1000 ng/ml (947 ng/ml) in cat 3; in this last cat diagnosis was further supported by the presence of pituitary enlargement on MRI. Oral cabergoline (10 µg/kg q48h) was initiated. Insulin requirements progressively reduced, as evidenced by daily blood glucose monitoring and weekly blood glucose curves. Diabetic remission occurred in all three cats between the second and third months of cabergoline treatment. At the time of writing, remission has persisted thus far (cat 1: 23 months; cat 2: 14 months; cat 3: 38 months). RELEVANCE AND NOVEL INFORMATION: To our knowledge, these are the first reported cases of diabetic remission in cats with hypersomatotropism after cabergoline treatment, despite previous reports of this being an ineffective treatment. Further work is indicated to determine why some cats do, and others do not, respond to this treatment.

Impact of a Genomic Test on Treatment Decision in a Predominantly African American Population With Favorable-Risk Prostate Cancer: A Randomized Trial.

PURPOSE: The Genomic Prostate Score (GPS), performed on biopsy tissue, predicts adverse outcome in prostate cancer (PCa) and has shown promise for improving patient selection for active surveillance (AS). However, its impact on treatment choice in high-risk populations of African Americans is largely unknown and, in general, the effect of the GPS on this difficult decision has not been evaluated in randomized trials. METHODS: Two hundred men with National Comprehensive Cancer Network very low to low-intermediate PCa from three Chicago hospitals (70% Black, 16% college graduates) were randomly assigned at diagnosis to standard counseling with or without a 12-gene GPS assay. The primary end point was treatment choice at a second postdiagnosis visit. The proportion of patients choosing AS was compared, and multivariable modeling was used to estimate the effects of various factors on AS acceptance. RESULTS: AS acceptance was high overall, although marginally lower in the intervention group (77% v 88%; P = .067), and lower still when men with inadequate specimens were excluded (P = .029). Men with lower health literacy who received a GPS were seven-fold less likely to choose AS compared with controls, whereas no difference was seen in men with higher health literacy (Pinteraction = .022). Among men with low-intermediate risk, 69% had GPS values consistent with unfavorable intermediate or high-risk cancer. AS choice was also independently associated with a family history of PCa and having health insurance. CONCLUSION: In contrast to other studies, the net effect of the GPS was to move patients away from AS, primarily among men with low health literacy. These findings have implications for our understanding of how prognostic molecular assays that generate probabilities of poor outcome can affect treatment decisions in diverse clinical populations.

Prostate cancer presentation, treatment selection, and outcomes among men with HIV/AIDS: A clinical stage, race, and age-matched contemporary analysis.

PURPOSE: To compare the clinical presentation, treatment receipt, and oncologic outcomes between human immunodeficiency virus-seropositive (HIV+) and seronegative (HIV-) men with prostate cancer (CaP) matched by age, clinical stage, and race. MATERIALS AND METHODS: A retrospective review of 3,135 men treated for CaP from 2000 to 2016 was performed. HIV+ patients (N = 46) were matched 1:2 to 3 to HIV- men (N = 137) by age, race, and clinical stage. Clinicopathologic features and primary treatment received were compared between cohorts. Associations between HIV status and progression-free, cancer-specific, and overall survival were compared by HIV status using the Kaplan-Meier method and Cox proportional hazards analysis. RESULTS: After matching, men with and without HIV were similar with respect initial prostate-specific antigen, Gleason Sum, and Eastern Cooperative Oncology Group (ECOG) performance status. Among HIV+ men, 67.4% had a history of acquired immune deficiency syndrome, and 91.3% were on highly active antiretroviral therapy at CaP diagnosis. Among men with localized disease, HIV+ men were more likely to receive radiation (59.5% vs. 44.8%) or no therapy (13.5% vs. 4.3%) and less likely to receive surgery (16.2% vs. 30.2%), or to initiate active surveillance (10.8% vs. 16.4%; P = 0.04 overall). There were no differences in rates of clinical progression, development of castration resistance, or CaP death by HIV status. However, HIV+ status was associated with inferior overall survival (hazard ratio 2.89, P = 0.04). CONCLUSIONS: While most HIV+ patients had a history of acquired immune deficiency syndrome; HIV was well controlled in the majority of patients at the time of CaP diagnosis. While oncologic outcomes were similar between HIV+ and HIV- men, significant differences in treatment selection were observed. Further research is necessary to understand differences in treatment election by HIV status and to define optimal CaP treatment selection in men with HIV.

Predictive Risk Factors for Continued Smoking after the Diagnosis of a Genitourinary Malignancy.

OBJECTIVE: To determine risk factors for continued smoking following a diagnosis of a genitourinary (GU) malignancy. Smoking is a well established risk factor in the development of cancers involving the GU tract. Unfortunately, a large percentage of patients continue to smoke or relapse after cancer diagnosis; by doing so, there is an increased risk of recurrence, poor survival rates, treatment complications, secondary primary cancers, and other chronic smoking related illnesses. MATERIALS AND METHODS: Two hundred and five patients who presented to a Urologic Oncology clinic at a single tertiary treatment center were given smoking cessation counseling and pharmacotherapy, as well as a questionnaire which was used to identify smoking status, demographics, and behavioral/psychosocial characteristics. Patients were followed for a minimum of 1 year with a median length of follow up for 13 months. RESULTS: 91% of patients enrolled in the study continued smoking at survey completion. After accounting for age, ethnicity, education and cigarettes consumed/day, 5 variables were independently associated with an increased risk of continued smoking: smoking 20 or more cigarettes per day, less than 2 prior quit attempts, anxiety and/or depression, fear of cancer recurrence, and home secondhand smoke exposure. CONCLUSION: The role of the urologist is imperative for encouraging smoking cessation. While every patient should receive adequate counseling regarding smoking at the time of a GU malignancy diagnosis, identifying patients with the risk factors noted in this study and augmenting smoking cessation efforts may result in stronger efforts to quit and prevention of long-term complications.

Constrictive myelopathy secondary to caudal articular vertebral process dysplasia in West Highland white terrier dogs.

Clinical signs, imaging findings and long-term follow-up of 3 West Highland white terrier dogs with constrictive myelopathy secondary to caudal articular vertebral process dysplasia are described. Clinical signs were consistent with an acute or chronic T3-L3 myelopathy in all dogs. Diagnostic imaging revealed hypoplasia or aplasia of the caudal articular vertebral processes, extradural compressive myelographic pattern (hourglass-like pattern) with a reduced diameter of the spinal cord, and focal thickening of extradural soft tissues. Medical treatment initially improved the clinical signs in 2 dogs; however, mild proprioceptive deficits remained in all cases. Key clinical message: Constrictive myelopathy secondary to caudal articular vertebral process dysplasia in West Highland white terrier dogs should be considered as a differential diagnosis of an acute or chronic T3-L3 myelopathy in this breed.

Myélopathie constrictive secondaire à une dysplasie du processus articulaire caudal vertébral chez des chiens terriers West Highland white. Les signes cliniques, les trouvailles en imagerie et le suivi à longterme de trois chiens West Highland white avec myélopathie constrictive secondaire à une dysplasie du processus articulaire caudal vertébral sont décrits. Les signes cliniques étaient compatibles avec une myélopathie aiguë ou chronique au niveau T3­L3 chez tous les chiens. L'imagerie diagnostique a révélé une hypoplasie ou une aplasie des processus articulaires caudaux vertébraux, un patron myélographique de compression extra-dural (patron en sablier) avec un diamètre réduit de la moëlle épinière, et épaississement focal des tissus mous extra-duraux. Un traitement médical permis une amélioration des signes cliniques chez deux des chiens; toutefois, des déficits légers de proprioception ont persisté dans tous les cas.Message clinique clé:Une myélopathie constrictive secondaire à une dysplasie du processus articulaire caudal vertébral chez des chiens terriers West Highland white devrait être considérée comme un diagnostic différentiel d'une myélopathie aiguë ou chronique de T3­L3 chez cette race.(Traduit par Dr Serge Messier).

Low diagnostic sensitivity of cystoscopy and cystography of surgically confirmed vesicoenteric fistulae.

PURPOSE: The objective of this study was to assess the accuracy of cystoscopy and cystography, as compared to other diagnostic studies, in identifying vesicoenteric fistulae (VEF) in a contemporary series of patients with surgically confirmed VEF. METHODS: With institutional review board approval, we performed a single-center retrospective review of surgically confirmed VEF between 2002 and 2018. Demographic data, comorbidities, symptoms, and diagnostic evaluation were reviewed. The sensitivity, specificity, and accuracy of cystoscopy in diagnosis of VEF were compared to cross-sectional imaging. RESULTS: The study cohort consisted of 51 patients with surgically confirmed VEF secondary to diverticular disease. Diagnostic evaluation included cross-sectional imaging with CT (94%), colonoscopy (82%), cystoscopy (75%), cystography (53%), and barium enema (26%). Cystoscopic evaluation definitively demonstrated evidence of VEF in 34% of patients, while 55% of patients had nonspecific urothelial changes on cystoscopy without definitively demonstrating VEF. Comparatively, the sensitivity of VEF was 25% for cystography and 84% for CT. CONCLUSIONS: In clinical practice, the diagnostic work-up of VEF is variable. In the modern era of managed care, inclusion of cystoscopy and cystography in the evaluation of VEF does not contribute a substantial additive benefit over standard cross-sectional imaging. Cystoscopy and cystography could potentially be eliminated from the diagnostic evaluation of VEF, in the absence of a concern for malignancy, in an effort to minimize unnecessary invasive testing as well as health care expenditures.

Giant bladder stone in association with severe kidney injury.

Minimal data exist on the causes, incidence and management of giant bladder stones considering their rare occurrence. Only a handful of case reports have reported stones larger than 10 cm, and most of these cases are managed surgically. We present a case of a 56-year-old female who presented with vague, lower urinary tract symptoms who was later found to have severe post-renal acute kidney injury due to a giant bladder stone measuring 11 × 11 × 10.4 cm.

Pre-diagnostic carbohydrate intake and treatment failure after radical prostatectomy for early-stage prostate cancer.

PURPOSE: An association between dietary carbohydrate intake and prostate cancer (PCa) prognosis is biologically plausible, but data are scarce. This prospective cohort study examined the relation between pre-diagnostic carbohydrate intake and treatment failure following radical prostatectomy for clinically early-stage PCa. METHODS: We identified 205 men awaiting radical prostatectomy and assessed their usual dietary intake of carbohydrates using the 110-item Block food frequency questionnaire. We also evaluated carbohydrate intake quality using a score based on the consumption of sugars relative to fiber, fat, and protein. Logistic regression analyzed their associations with the odds of treatment failure, defined as a detectable and rising serum prostate-specific antigen (PSA) or receiving androgen deprivation therapy (ADT) within 2 years. RESULTS: Sucrose consumption was associated with a higher odds and fiber consumption with a lower odds of ADT after accounting for age, race/ethnicity, body mass index, and tumor characteristics (odds ratio [OR] (95% confidence interval [CI]) 5.68 (1.71, 18.9) for 3rd vs. 1st sucrose tertile and 0.88 (0.81, 0.96) per gram of fiber/day, respectively). Increasing carbohydrate intake quality also associated with a lower odds of ADT (OR (95% CI) 0.78 (0.66, 0.92) per unit increase in score, range 0-12). CONCLUSIONS: Pre-diagnostic dietary carbohydrate intake composition and quality influence the risk of primary treatment failure for early-stage PCa. Future studies incorporating molecular aspects of carbohydrate metabolism could clarify possible underlying mechanisms.

Validation of the Spanish version of the Pittsburgh Fatigability Scale for older adults.

BACKGROUND: The Pittsburgh Fatigability Scale (PFS) is the only validated scale for measuring perceived fatigability in older adults. AIMS: We validated the PFS Spanish version by assessing convergent validity with respect to several measures of physical performance, physical activity, physical function and disability. METHODS: A cross-sectional validation study of 79 community-dwelling older adults aged 70 and older from Barcelona, Spain was included. Translation-retrotranslation was performed. Convergent validity was assessed in relation to physical activity and performance measurements, and analyzed with Spearman correlation coefficients, a linear trend test and non-linear regression. We also assessed the discriminant validity of the PFS physical score between participants with different physical activity and performance levels. RESULTS: Higher PFS physical scores were inversely associated with the Short Physical Performance Battery (r = - 0.5, p < 0.001) and weak to moderately correlated with gait speed (r = 0.38, p = 0.001), and self-reported weekly walking time (r = 0.24, p = 0.035). CONCLUSION: The PFS is a novel, brief instrument to assess fatigability in Spanish-speaking older adults, with good convergent validity against physical performance measurements. Thus, the PFS can be used in Spanish-speaking populations.

Epithelioid angiomyolipoma metastasis to the rectus abdominis.

A 37-year-old female presented with abdominal pain. An abdominal computed tomography scan demonstrated a 10 cm x 13 cm left renal mass. An open adrenal-sparing radical nephrectomy was performed. The pathological diagnosis was epithelioid angiomyolipoma. Five-year surveillance did not demonstrate recurrence of disease. However, a 1.8 cm x 2.5 cm mass on the rectus abdominis muscle was identified after 5 years. Biopsy of the mass demonstrated histologic findings consistent with the primary tumor. Herein, we report a case of metastatic renal epithelioid angiomyolipoma to the rectus abdominis muscle more than 5 years after resection of primary renal tumor.

Metformin reduces insulin resistance and the tendency toward hyperglycaemia and dyslipidaemia in dogs with hyperadrenocorticism.

Hypercortisolism induces a state of insulin resistance that can occur concurrently with fasting hyperglycaemia, dyslipidaemia and diabetes mellitus. Metformin reduces hepatic glucose production and insulin resistance of the skeletal muscle and adipose tissue. The aim of this study was to evaluate the effects of metformin on the control of metabolic disorders of dogs with hyperadrenocorticism (HAC). Twenty-three dogs with HAC were randomly divided into two groups, consisting of a control group and a metformin group (10 mg metformin/kg/12 h). Both groups received the same treatment for HAC. At baseline and 3 months, blood glucose, total cholesterol, triglycerides and insulin concentrations, in addition to urinary cortisol:creatinine ratio, Homeostatic Model Assessment (HOMA) for insulin sensitivity and ß-cell function were measured. Dogs treated with metformin showed significantly reduced glycaemia, cholesterolaemia and triglyceridaemia. They also presented reduced hyperinsulinism and insulin resistance, as well as improved pancreatic ß-cell function. The implementation of metformin as an adjuvant therapy is effective for the normalisation of metabolic disorders of dogs with HAC.