Faculty Bibliography

BACKGROUND:Considering the relatively high 5-yr survival rate (76.9%) for bladder cancer (BC), its overall prevalence will probably continue to increase. Therefore, it is important to understand the effects of BC diagnosis and management, including psychological sequelae. OBJECTIVE:To determine the prevalence of depression among elderly patients with BC and identify patient characteristics associated with depression. DESIGN SETTING AND PARTICIPANTS/METHODS:Survey responses from a population-based sample of 5787 patients older than 65 yr with a history of BC were retrieved from the Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey registry, spanning 1999-2014. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS/METHODS:The primary outcome measured is the prevalence of a positive depression screen. Cancer characteristics and demographic, socioeconomic, health-related, and activities of daily living (ADL)-related data were reviewed. Univariate analysis was conducted to identify correlation between a positive depression screen and patient characteristics. Multivariate analysis was performed to identify independent predictors of depression. RESULTS AND LIMITATIONS/CONCLUSIONS: <  0.0001) were protective against the development of depression. Limitations include the lack of consideration of treatment outcomes and whether patients have active disease or only a history of cancer. CONCLUSIONS:Depression affects a substantial percentage (14%) of elderly patients with BC. Poor general health and impaired ability to complete ADL were the greatest risk factors for depression. Acknowledgment of sociodemographic factors may improve awareness of depression in patients with BC and a potential need for psychosocial support. PATIENT SUMMARY/RESULTS:Depression affects a significant proportion of patients with bladder cancer. Social and demographic factors influence a patient's risk of depression. Acknowledgment of these factors may improve the detection of depression and a possible need for intervention.

OBJECTIVE:To demonstrate placement of bedside double-j ureteral stents in an Emergency Department or hospital floor setting. BACKGROUND:. We demonstrate a safe and efficacious method for bedside ureteral stent placement without fluoroscopic guidance. MATERIALS AND METHODS:In the setting of the Emergency Department we use ketamine for conscious sedation and local anesthesia while on the wards, we utilize just local anesthesia. After the patient has been sterilely prepped and draped, the operator passes the flexible cystoscope into the bladder in the standard fashion. The obstructed ureteral orifice is identified, and an extra-long guidewire is used to place a 4.8-French ureteral stent through the scope and beyond the obstruction. A post-operative plain film x-ray of the abdomen confirms proper placement. If significant issues are encountered, the procedure is abandoned, and standard operating room stent placement is undertaken. RESULTS:The technique is simple and reproducible for placing double-j ureteral stents outside of the operating room environment without general anesthesia. CONCLUSION:In select patients, bedside double-j ureteral stent placement using our method is a safe and reproducible way to avoid the costs and risks associated with general anesthesia and to optimize utilization of scarce operating room resources.

Despite innovations in surgical technology and advancements in radiation therapy, radical treatments for clinically localized prostate cancer are associated with significant patient morbidity, including both urinary and sexual dysfunction. This has created a vital need for therapies and management strategies that provide an acceptable degree of oncologic efficacy while mitigating these undesirable side effects. Successful developments in screening approaches and advances in prostate imaging have allowed clinicians to identify, localize, and more precisely target early cancers. This has afforded urologists with an important opportunity to develop and employ focal ablation techniques that selectively destroy tumors while preserving the remainder of the gland, thus avoiding detrimental treatment effects to surrounding sensitive structures. A lack of high-level evidence supporting such an approach had previously hindered widespread adoption of focal treatments, but there are now numerous published clinical trials which have sought to establish benchmarks for safety and efficacy. As the clinical evidence supporting a potential role in prostate cancer treatment begins to accumulate, there has been a growing acceptance of focal therapy in the urologic oncology community. In this narrative review article, we describe the techniques, advantages, and side effect profiles of the most commonly utilized focal ablative techniques and analyze published clinical trial data supporting their evolving role in the prostate cancer treatment paradigm.