Clinical Validation of a Size-Based Microfluidic Device for Circulating Tumor Cell Isolation and Analysis in Renal Cell Carcinoma.

Renal cell carcinoma (RCC) presents as metastatic disease in one third of cases. Research on circulating tumor cells (CTCs) and liquid biopsies is improving the understanding of RCC biology and metastases formation. However, a standardized, sensitive, specific, and cost-effective CTC detection technique is lacking. The use of platforms solely relying on epithelial markers is inappropriate in RCC due to the frequent epithelial-mesenchymal transition that CTCs undergo. This study aimed to test and clinically validate RUBYchip™, a microfluidic label-free CTC detection platform, in RCC patients. The average CTC capture efficiency of the device was 74.9% in spiking experiments using three different RCC cell lines. Clinical validation was performed in a cohort of 18 patients, eight non-metastatic (M0), five metastatic treatment-naïve (M1TN), and five metastatic progressing-under-treatment (M1TP). An average CTC detection rate of 77.8% was found and the average (range) total CTC count was 6.4 (0-27), 101.8 (0-255), and 3.2 (0-10), and the average mesenchymal CTC count (both single and clustered cells) was zero, 97.6 (0-255), and 0.2 (0-1) for M0, M1TN, and M1TP, respectively. CTC clusters were detected in 25% and 60% of M0 and M1TN patients, respectively. These results show that RUBYchip™ is an effective CTC detection platform in RCC.

Laparoscopic Psoas Hitch Double Ureteral Re-implantation in the Duplex Urinary System for Treatment of Ureterovaginal Fistula.

INTRODUCTION: Although laparoscopy is widely established for ablative urologic procedures, pelvic reconstructive procedures are still mostly performed by open-surgery. As urologists continue to introduce advanced laparoscopic skills to reconstructive urologic procedures, we present our experience with a laparoscopic psoas hitch double ureteral re-implantation in a patient with an ureterovaginal fistula and an ipsilateral duplex urinary system. MATERIALS AND METHODS: A 42-year-old patient presented with continuous involuntary urine loss from the vagina after an abdominal hysterectomy. A double modified Lich-Gregoir ureteral re-implantation with a psoas hitch was performed, using a 4-port laparoscopic approach. RESULTS: There were no post-operative complications and the cystography at post-operative day 14 revealed good positioning of the psoas hitch, with no leak or reflux. At three-months follow-up, the patient is completely dry and asymptomatic. CONCLUSION: Laparoscopic ureteroneocystostomy with psoas hitch for the treatment of lesions of the distal ureter is a possible, safe, and effective way to resolve a complex urologic situation with minimally invasive surgery. Laparoscopy is becoming the standard approach to urologic pelvic reconstructive procedures, even in the most complex cases.

Prostate Ewing Sarcoma/PNET: A case of long survival in a highly aggressive malignancy.

Prostate Ewing sarcoma/peripheral primitive neuroectodermal tumor (ES/PNET) is extremely rare. Currently, a multimodal approach is recommended, although there is no standard treatment. Nevertheless, this tumor has a very poor prognosis, with the longest reported survival of 24 months. We present a case of locally advanced prostate ES/PNET in a 29-year-old male who was treated with a multimodal approach. The patient is alive and disease free, with a seven year follow-up, with very good quality of life. This exceptionally long survival may be the result of the very aggressive multimodal treatment chosen and described herein.

A Prospective Randomized Trial Comparing the Vienna Nomogram and a Ten-Core Prostate Biopsy Protocol: Effect on Cancer Detection Rate.

BACKGROUND: We evaluated whether the Vienna nomogram increases the detection rate of transrectal ultrasound-guided prostate biopsy compared with a 10-core biopsy protocol. PATIENTS AND METHODS: In the present prospective randomized study, men eligible for prostate biopsy were randomized to a Vienna nomogram protocol (group A) or a 10-core protocol (group B). They were further stratified according to age (≤ 65, > 65 but ≤ 70, and > 70 years) and prostate volume (≤ 30, > 30 but ≤ 50, > 50 but ≤ 70, and > 70 cm3). The cancer detection rate (CDR) was compared between the groups by logistic regression analysis, with adjustment for age as necessary, overall and with age and prostate volume stratification. Additional statistical analysis was performed with Fisher's exact test for contingency tables and the Mann-Whitney U test for 2 independent samples. P < .05 was considered statistically significant. A subgroup analysis was performed for patients with serum prostate-specific antigen levels of 2 to 10 ng/mL. RESULTS: From January 2009 to July 2010, 456 patients were enrolled, 237 to the Vienna nomogram group and 219 to the 10-core group. No significant differences were found in serum prostate-specific antigen or prostate volume between the 2 groups. Multivariate analysis with adjustment for age revealed no significant differences in CDR, with 42.6% in group A and 38.4% in group B (P = .705). When stratified by age and prostate volume, no statistically significant differences were found in the CDR between the groups in all subclasses. Also, in the subgroup analysis, CDR was not significantly different, 37.9% versus 34.7% for groups A and B, respectively (P = .891). CONCLUSION: These results study suggest that the use of the Vienna nomogram does not significantly increase the overall CDR compared with a 10-core biopsy scheme. Further prospective randomized studies, with adequate sample sizes, are needed to definitively determine the best prostate biopsy protocol.

Extraperitoneal laparoscopic radical prostatectomy: A prospective 2-year single-surgeon experience with 171 cases.

OBJECTIVE: To assess the safety and the oncological and functional efficacy of a prospective series of extraperitoneal laparoscopic radical prostatectomy (ELRP). PATIENTS AND METHODS: This prospective study included 171 consecutive patients (mean age 62.9 years, SD 6.5) who underwent ELRP by one surgeon between January 2008 and December 2009. The variables analysed were operative duration, blood loss, conversion rate, complications, hospital stay, duration of catheterisation, and the oncological results. We also assessed the rates of continence and erectile function. RESULTS: There were no conversions to open surgery. The mean (SD) operative duration was 112.7 (19.4) min, the blood loss was 372.1 (219.1) mL, the hospital stay was 6.8 (2.0) days, and the duration of catheterisation 6.7 (1.5) days. Collectively, 23.4% (40/171) of patients had positive surgical margins. Urinary continence at 1, 3, 6 and 12 months was achieved in 63.3% (95/150), 88.6% (78/88), in 90.3% (121/134) and 92.1% (117/127) of patients, respectively. The respective percentages for physiological erections after nerve-sparing ELRP at the same times were 11.8% (13/110), 11.8% (13/110), 18.2% (20/110) and 25.5% (28/110). The overall potency recovery rates (including patients on pharmacotherapy) were, respectively, 26.4% (29/110), 35.5% (39/110), 52.7% (58/110) and 69.1% (76/110), for the nerve-sparing procedure. CONCLUSION: ELRP gave good oncological and functional results, especially in terms of urinary continence.