Deficits in urological knowledge among medical students and primary care providers: potential for impact on urological care.

PURPOSE: Recent data indicate a decline in the urological education of third and fourth year medical students. To determine if this decline has an impact on the treatment of patients we performed a survey to evaluate the general level of knowledge, attitudes and practices with regard to common urological issues seen in a general medical practice among medical students and faculty involved in primary care at an academic institution. MATERIALS AND METHODS: A confidential questionnaire was distributed to attendings, residents and fellows, and the clinical medical students at our academic institution to ascertain how they evaluate and treat patients with common urological complaints. All responses were entered into SPSS statistical software. RESULTS: A total of 300 surveys were distributed, 150 of which were returned with complete information for data analysis. Knowledge with regard to various conditions including hematuria, recognition of an age specific abnormality in serum prostate specific antigen and overactive bladder was low for all groups. Furthermore, respondents demonstrated a low likelihood of requesting formal urological evaluation for these conditions. Exposure to a urology elective in medical school had a positive impact on some areas of urological evaluation. CONCLUSIONS: General urological knowledge with regard to the primary care setting is insufficient. The potential for impact on patient care is enormous. These data highlight the need for a definitive urological curriculum in medical school as well as continued education at the resident and faculty level with regard to evaluation, management and recognition of when to request formal urological evaluation in the primary care setting.

Partial nephrectomy for a large renal lymphatic malformation in a child presenting with hypertension.

A 9-year-old girl had hypertension (systolic blood pressure of 125 mm Hg) noted at an annual well child visit. An ultrasound study demonstrated a large right renal cystic mass. A partial nephrectomy was performed. The surgical specimen was 9.7 × 9.4 × 6.4 cm and weighed 413.2 g. The tumor stained diffusely positive for smooth muscle actin and focally positive for factor VIII. Final histologic diagnosis was primary intrarenal lymphatic malformation. The case is unusual because of the presentation, size of the mass, as well as the therapeutic approach of partial nephrectomy.

The green tea compound, (-)-epigallocatechin-3-gallate downregulates N-cadherin and suppresses migration of bladder carcinoma cells.

Green tea has been reported as potential dietary protection against numerous cancers and has been shown to have activity in bladder tumor inhibition in different animal models. The goal of this study was to examine the effects of (-)-epigallocatechin gallate (EGCG-the major phytochemical in green tea) on growth inhibition and behavior of human bladder carcinoma cells and to identify the altered signaling pathway(s) underlying the response to EGCG exposure. EGCG inhibited the in vitro growth of invasive bladder carcinoma cells with an IC(50) range of 70-87 microM. At a concentration of 20 microM, EGCG decreased the migratory potential of bladder carcinoma cells with concomitant activation of p42/44 MAPK and STAT3 and inactivation of Akt. Using biochemical inhibitors of MAPK/ERK, and siRNA to knockdown STAT3 and Akt, inhibition of migration was recorded associated with Akt but not MAPK/ERK or STAT3 signaling in bladder cells. In addition, EGCG downregulated N-cadherin in a dose-dependent manner where reduction in N-cadherin expression paralleled declining migratory potential. Continuous feeding of EGCG to mice prior to and during the establishment of bladder carcinoma xenografts in vivo revealed >50% reduction in mean final tumor volume (P