First 100 cases at a low volume prostate brachytherapy institution: learning curve and the importance of continuous quality improvement.

INTRODUCTION: We report the first 100 patients who underwent prostate brachytherapy as monotherapy with 125I at an institution with moderate volume radical prostatectomy but low volume brachytherapy (<2 cases per month). Learning curve and quality improvement was assessed by way of achieving prescription dose targets. MATERIALS AND METHODS: From May 2002 to August 2006, 100 patients underwent prostate 125I brachytherapy monotherapy via preplanned approach. Preoperative planned dose to 100% of prostate gland (D100) was 145 Gy and postoperative confirmed dose was assessed by computed tomography. The cohort was divided into quartiles and recurrence was assessed using Kaplan-Meier analysis. RESULTS: Patient quartiles were of similar age and Gleason grade, while PSA was slightly higher in the first group. Postoperative D90 increased after the first quartile (p = < 0.0001) reaching targeted values. Kaplan-Meier survival analysis revealed that 5 year recurrence-free survivals by Phoenix definition was 96%-100% in all groups while by ASTRO definition there was a decrease in recurrence for later cases. CONCLUSIONS: At our low volume institution during the first 100 brachytherapy cases, a learning curve for radiation dosimetry was evident, which improved after 25 patients. Preplanned dose-volume parameters were adjusted, enabling the achievement of post-implant goals emphasizing the importance of continuous quality improvement. Although recurrence data is limited by sample size and moderate follow up, there was a discrepancy between the Phoenix and ASTRO definition when evaluating recurrence.

Anti-interleukin-10R1 monoclonal antibody enhances bacillus Calmette-Guérin induced T-helper type 1 immune responses and antitumor immunity in a mouse orthotopic model of bladder cancer.

PURPOSE: Proper induction of the T-helper type 1 immune response is required for effective bacillus Calmette-Guérin immunotherapy for bladder cancer. Interleukin-10 down-regulates the T-helper 1 response and is associated with bacillus Calmette-Guérin failure. We investigated whether blocking interleukin-10 receptor 1 would enhance the bacillus Calmette-Guérin induced T-helper type 1 immune response and anti-bladder cancer immunity in a mouse model. MATERIALS AND METHODS: Splenocytes were incubated with bacillus Calmette-Guérin or bacillus Calmette-Guérin plus control IgG1, anti-interleukin-10 receptor 1 mAb or anti-interleukin-10 neutralizing mAb, followed by enzyme-linked immunosorbent assay of interferon-γ production. Bladder RNA was extracted after intravesical bacillus Calmette-Guérin plus intraperitoneal IgG1 or anti-interleukin-10 receptor 1 mAb and analyzed by reverse transcriptase and/or quantitative polymerase chain reaction. Urine was collected and analyzed by enzyme-linked immunosorbent assay. Mice bearing a luciferase expressing MB49 orthotopic tumor were treated with intravesical bacillus Calmette-Guérin plus intraperitoneal IgG1 or anti-interleukin-10 receptor 1 mAb. Tumor response was assessed by bioluminescent imaging and bladder weight measurement. RESULTS: Bacillus Calmette-Guérin plus anti-interleukin-10R1 mAb induced significantly higher interferon-γ production by splenocytes than bacillus Calmette-Guérin plus anti-interleukin-10 mAb. Bacillus Calmette-Guérin plus anti-interleukin-10 receptor 1 mAb also induced significantly higher interferon-γ mRNA and protein in bladder and urine, respectively, in a dose dependent manner. Treatment with phosphate buffered saline, bacillus Calmette-Guérin plus control IgG1 and bacillus Calmette-Guérin plus anti-interleukin-10 receptor 1 mAb showed a 0% tumor-free rate with a 20% death rate, a 20% tumor-free rate with a 20% death rate and a 40% tumor-free rate with a 0% death rate, respectively. Bladder weight also revealed the effect of anti-interleukin-10 receptor 1 mAb on the bacillus Calmette-Guérin induced bladder tumor response. CONCLUSIONS: Anti-interleukin-10 receptor 1 mAb enhanced the bacillus Calmette-Guérin induced T-helper type 1 immune response and anti-bladder cancer immunity. A humanized form of this mAb warrants future investigation for bacillus Calmette-Guérin treatment of bladder cancer.

Ureteric stent placement with extraction string: no strings attached?

UNLABELLED: Study Type--Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Of patients treated with an indwelling ureteric stent 80-90% experience lower urinary tract symptoms that are a hindrance to health-related quality of life. The prevalence of the extraction/retrieval string after ureteroscopy for stone disease and stent placement varies significantly between surgeons and published series, but the benefits of eliminating the need for a secondary procedure such as cystoscopy and stent removal, as well as the decrease in cost to the patient are well established. Published reports have not addressed the prevalence of post-procedure related events (PREs) in patients who have received an indwelling ureteric stent with the extraction/retrieval string still intact after ureteroscopy for stone disease. By analysing PREs (Emergency Room visits, unscheduled clinic visits, and telephone calls) related to their stent or procedure for patients with and without an extraction/retrieval string, the feasibility of the extraction string can be validated and the misconceptions about their use can be alleviated. OBJECTIVE: • To review a retrospective ureteric stent cohort with and without extraction string to compare post-procedure related events (PRE), as ureteric stent placement after endoscopic management of urolithiasis is common, but data regarding the potential benefits or disadvantages of ureteric stent placement with extraction string are sparse. PATIENTS AND METHODS: • Between June 2009 and June 2010, 293 patients underwent ureteroscopy with or without lithotripsy for stone disease. • In all, 181 patients had a unilateral procedure and underwent stent placement postoperatively. • Records were retrospectively reviewed for operative data and PRE occurring within the first 6 weeks after surgery, defined as unscheduled clinic or Emergency Room visits, or adverse event telephone calls. RESULTS: • Of 181 patients who underwent ureteric stent placement, 43 (23.8%) included an extraction string. • In all, 34.3% of all patients had a PRE, including 37.2% and 33.3% of patients with and without extraction string, respectively (P = 0.64). • PRE occurred in men with or without an extraction string (27.8 vs 32.4%, respectively; P = 0.71) and women with or without an extraction string (44.0 vs 34.3%, respectively, P = 0.39). • PRE occurred with relatively equal frequency between men and women (P = 0.28). • Only two women (4.7%) reported removing their stent prematurely, on postoperative days 2 and 6. CONCLUSIONS: • Ureteric stent placement with extraction string after ureteroscopy for stone disease does not seem to result in more PRE, regardless of gender. • Prospective randomised trials are needed to determine the benefits and disadvantages of ureteric stents with extraction string.

Traumatic urethral injury without pelvic fracture in an adult female.

A 23-year-old female was involved in a motor vehicle collision with multiple injuries, including a right acetabular fracture, but no pelvic fracture. Urology consultation was obtained due to difficulty placing a urethral catheter. Examination revealed a longitudinal urethral tear with vaginal laceration extending 2 cm from the urethral meatus proximally toward the bladder neck. The longitudinal urethral tear was repaired primarily. Traumatic female urethral injury in the absence of a pelvic fracture is an exceedingly rare occurrence.

Giant renal angiomyolipoma without fat density on CT scan: case report and review of the literature.

Giant renal angiomyolipomas have been reported, but typically have the pathognomonic finding of fat density on CT scan. We present the case of a 53-year-old male with a symptomatic, 35-cm, predominantly cystic renal mass without fat density on CT that on nephrectomy was found to be a fat-poor angiomyolipoma with predominantly epithelioid morphology weighing 17.9 kg. Giant renal angiomyolipoma without macroscopic fat density on CT scan is an exceedingly rare occurrence.

Basal cell carcinoma of the penis: a case report and review of the literature.

Basal cell carcinoma of the penis is an extremely rare entity, accounting for less than 0.03% of all basal cell carcinomas. Fortunately, wide local excision of such lesions is generally curative. Fewer than 25 cases have been reported in the literature describing penile basal cell carcinoma. Here we report a case of penile basal cell carcinoma cured with wide local excision.

Transitional Cell Carcinoma within a Portion of Inguinally Herniated Bladder.

Bladder herniation within the inguinal canal is a relatively uncommon finding. We report an even less-common occurrence of transitional cell carcinoma located within a portion of inguinally herniated bladder. Fewer than 20 reports exist in the literature describing this scenario.