Faculty Bibliography

PURPOSE: We present our initial experience in 40 patients undergoing laparoendoscopic single site donor nephrectomy. MATERIALS AND METHODS: We prospectively collected data on 40 consecutive patients. A single access GelPOINT device was inserted into the abdomen through a 4 to 5 cm periumbilical incision. We used a bariatric camera with a right angle attachment for the light cord to maximize triangulation. Parameters analyzed included warm ischemia time, operative time, estimated blood loss, visual analog pain score, time to recipient creatinine less than 3 mg/dl, and recipient creatinine at discharge home, and 3 and 6 months. RESULTS: A total of 38 left and 2 right donor nephrectomies were performed. Complete laparoendoscopic single site donor nephrectomy was successful in 38 cases. One left and 1 right case were converted to a hand assisted approach. Average +/- SD body mass index was 26.1 +/- 5.2 kg/m(2). Mean operative time to allograft extraction was 93.5 +/- 27.5 minutes and mean total operative time was 166.7 +/- 33.8 minutes. Average estimated blood loss was 106.7 +/- 93.5 cc. Mean warm ischemia time was 3.96 +/- 0.72 minutes. Mean hospital stay was 1.77 +/- 0.43 days and median time to recipient creatinine less than 3.0 mg/dl was 54.2 +/- 110.3 hours. Mean recipient creatinine at discharge home, and at 3 and 6 months was 1.48 +/- 0.67, 1.29 +/- 0.38 and 1.19 +/- 0.34 mg/dl, respectively. Complications included hyponatremia in 1 patient, wound infection in 1, and a grade III laceration in an allograft that was sustained during extraction. CONCLUSIONS: Our initial experience with laparoendoscopic single site donor nephrectomy is encouraging. This approach to kidney donation without an extra-umbilical incision could become particularly relevant to minimize morbidity in young, healthy organ donors.

At the time of diagnosis, approximately 75% of bladder cancers are non-muscle invasive. Appropriate diagnosis and surgical resection at this stage improves prognosis dramatically. However, these lesions, being small and/or flat, are often missed by conventional white-light cystoscopes. Furthermore, it is difficult to assess the surgical margin for negativity using conventional cystoscopes. Resultantly, the recurrence rates in patients with early bladder cancer are very high. This is currently addressed by repeat cystoscopies and biopsies, which can last throughout the life of a patient, increasing cost and patient morbidity. Multiphoton endoscopes offer a potential solution, allowing real time, non-invasive biopsies of the human bladder, as well as an up-close assessment of the resection margin. While miniaturization of the Multiphoton microscope into an endoscopic format is currently in progress, we present results here indicating that Multiphoton imaging (using a bench-top Multiphoton microscope) can indeed identify cancers in fresh, unfixed human bladder biopsies. Multiphoton images are acquired in two channels: (1) broadband autofluorescence from cells, and (2) second harmonic generation (SHG), mostly by tissue collagen. These images are then compared with gold standard hematoxylin/eosin (H&E) stained histopathology slides from the same specimen. Based on a "training set" and a very small "blinded set" of samples, we have found excellent correlation between the Multiphoton and histopathological diagnoses. A larger blinded analysis by two independent uropathologists is currently in progress. We expect that the conclusion of this phase will provide us with diagnostic accuracy estimates, as well as the degree of inter-observer heterogeneity.

Angiosarcoma of the bladder is extremely rare and carries a dismal prognosis because of the uniformly high-grade and aggressive tumor biology of the neoplasm. We report the long-term disease-free survival of 1 patient, treated with multimodal therapy, whom we have previously reported on. Six years after the initial presentation, the patient died, and the postmortem analysis revealed no evidence of residual disease. Our case represents the longest reported survival of a patient with angiosarcoma of the bladder.

OBJECTIVE: To evaluate the effect of urethral reconstructive surgery on sexual drive, erectile function and ejaculation. PATIENTS AND METHODS: The study group consisted of 52 men with a median (range) age of 44 (18-79) years who underwent 59 urethral reconstructive procedures for anterior urethral stricture disease between 2001 and 2004. We evaluated sexual functioning using the O'Leary Brief Male Sexual Function Inventory (BMSFI) before and after surgery. RESULTS: The mean (sd) follow-up was 22.3 (14.8) months. The mean BMSFI scores were only statistically significantly different for an improvement in ejaculation after surgery (P = 0.04). When separated by age, only the men aged 50-59 years reported decreased erectile function after surgery (P < 0.001) and only those aged <40-49 years reported an improvement in ejaculatory function (P = 0.05). Men at <1 year after surgery reported lower sexual drive (P = 0.025) and erectile function (P = 0.05) than men with longer periods of recovery. CONCLUSIONS: The BMFSI is useful for evaluating sexual function after urethroplasty. Overall, the men did not report a decline in erectile function or sexual drive after surgery; however, older men might have a higher incidence of erectile dysfunction after surgery. Erectile function might recover with time. Younger men had the most pronounced improvement in ejaculatory function, but further studies are necessary to evaluate the clinical significance of this.