Faculty Bibliography

Urinary ascites results in pseudoazotemia due to urinary creatinine reabsorption across the peritoneum. We report a case of a pyeloplasty complicated by urine extravasation, in which the diagnosis was aided by discrepant findings of an elevated serum creatinine level but a stable cystatin C level. Cystatin C is a marker of renal function but is not typically excreted into the urine and therefore can be used to differentiate pseudoazotemia from true azotemia and is a better marker of renal function in the setting of known urinary ascites. These findings are relevant for patients with potential traumatic or nontraumatic sources of urine extravasation.

INTRODUCTION/BACKGROUND:Nephroureterectomy (NUx) with full bladder cuff excision is the gold-standard treatment for upper urinary tract urothelial cancer. Although minimally invasive techniques for NUx have demonstrated comparable outcomes to those of the open technique, the robotic technique is limited by the need for intraoperative patient repositioning and robot redocking to manage the distal ureter and bladder cuff. We describe our novel technique of robotic NUx that allows for complete access to the kidney and full bladder cuff excision. PATIENTS AND METHODS/METHODS:This modified technique was performed on a consecutive series of patients undergoing robotic NUx for upper urinary tract urothelial cancer from August 2012 to January 2014. Operative parameters and pathologic data were recorded, and patients were followed up for surveillance. After insufflation, the robotic trocars are placed in a standardized fashion, allowing for a one-time switch of instruments to facilitate distal ureteral dissection and a wide bladder cuff excision without patient repositioning or robot redocking. RESULTS:Twenty-six patients have undergone NUx using our modified technique. Mean blood loss and operative time were 66 mL and 230 minutes, respectively. There were no intraoperative complications or open conversions, and there were no positive surgical margins. The average follow-up time was 7.8 months (range, 2-17 months), and 4 cases of cancer recurrence in the bladder were identified. CONCLUSIONS:This novel technique for robotic NUx offers a standardized and easy-to-implement approach for NUx that requires a minimal learning curve for an experienced robotic surgeon, while affording a comparable oncologic control without the need for patient repositioning or additional port placement.

OBJECTIVE:To present the largest experience on the ureteroscopic management of ureteral obstruction secondary to intraluminal endometrial implantation. MATERIALS AND METHODS/METHODS:We retrospectively evaluated patients who underwent ureteroscopic management of intraluminal endometriosis from 1996 to 2012. All patients were diagnosed with ureteroscopic biopsy and underwent at least 1 ureteroscopic ablation with a holmium YAG (Ho:Yag) laser. Patients were monitored for evidence of disease persistence, recurrence, or progression with computed tomography, sonography, renal scan, ureteroscopy, and retrograde urography. Success was defined as the complete eradication of ureteral endometriosis, resolution of symptoms, and maintenance of renal function. RESULTS:Five patients were identified. Mean age was 37.5 years. All patients had hydroureteronephrosis at presentation whereas 2 had severely impaired renal function. Three patients were successfully treated with a single ablative procedure, whereas 2 had persistent symptomatic hydroureteronephrosis and underwent repeat ablation. Of those requiring repeat ablation, 1 became disease-free after the second ablation, whereas the other had persistence of disease, requiring nephroureterectomy. Three patients developed ureteral strictures, requiring balloon dilation and serial stent exchanges. At a median follow-up of 35 months (16-84), overall success rate was observed in 4 of 5 patients (80%). CONCLUSION/CONCLUSIONS:Endometriosis affects approximately 15% of premenopausal women and can present anywhere along the urinary tract including the ureters, which might result in urinary obstruction and impaired renal function. Although surgical resection is the conventional treatment option for intraluminal endometriosis, ureteroscopic management is a viable nephron-sparing alternative. Follow-up imaging, including ureteroscopic surveillance and retrograde urography is recommended to detect disease recurrence or progression, or both.

A series of substituted pyridines, ether linked to a phenylpiperidine core were optimized for dual NK(1)/SERT affinity. Optimization based on NK(1)/SERT binding affinities, and minimization of off-target ion channel activity lead to the discovery of compound 44. In vivo evaluation of 44 in the gerbil forced swim test (a depression model), and ex-vivo NK(1)/SERT receptor occupancy data support the potential of a dual acting compound for the treatment of depression.

PURPOSE/OBJECTIVE:We determined the total amount of diagnostic radiation that a patient with testicular cancer receives during the course of treatment and the associated risk of secondary malignancy. MATERIALS AND METHODS/METHODS:At a single institution 119 men with seminomatous and nonseminomatous germ cell tumors of the testis were retrospectively identified. Annual and lifetime exposure to radiation was determined for each histological subtype. Values were assessed for compliance with International Commission of Radiological Protection guidelines. RESULTS:The cohorts included 55 patients with seminomatous and 64 with nonseminomatous germ cell tumor. Between the groups no difference was found in the lifetime (215.5 and 214.1 mSV, p = 0.96) or the annual (104.6 and 104.6 mSV, respectively, p = 1.0) radiation dose. Of the 41 patients with more than 5-year followup 32 (78%) were in violation of guidelines by exceeding 20 mSV per year of radiation. Also, 74 patients (61.7%) received 50 mSV or greater of radiation during a 1-year period. Using the previously calculated excess relative risk for solid cancer and leukemia, excluding chronic lymphocytic leukemia, the RR was 1.06 and 1.33, [corrected] respectively, with a 2.1% lifetime risk of fatal cancer over the baseline risk. CONCLUSIONS:At a tertiary care center with experience with managing testicular cancer 78% of patients with more than 5 years of followup exceeded current national and standard safety limits for radiation exposure. Imaging should be done judiciously in this population at high risk for radiation overexposure.

1,4-Diamino-2-butyne was prepared from 1,4-dichloro-2-butyne via 1,4-diazido-2-butyne. Bis(amino acid) derivatives of 1,4-diamino-2-butyne having the general structure (Boc-Xxx-NHCH2C[triple bond])2 (Xxx = Ala, Phe and Met) were prepared and examined by 1H NMR spectroscopy. Using chemical shift, coupling constant and DMSO titration data it is found that these compounds adopt a C2-symmetric turn conformation featuring two intramolecular hydrogen bonds.