Resume fraud: unverifiable publications of urology training program applicants.

PURPOSE: We examined the incidence of resume fraud among urology residency applicants by determining the rate of misrepresented publications listed in applications to a urology residency program. MATERIALS AND METHODS: Applications from all 147 urology residency applicants to a program from the 2007 application cycle were analyzed. Verification of listed publications was attempted by querying PubMed, Google Scholar and MEDLINE. Univariate analysis was conducted to assess associations between unverifiable publications and applicant demographics. RESULTS: Of the applicants who submitted publications 19% (14 of 71) had at least 1 unverifiable publication, which represented 9% (14 of 147) of the entire applicant pool. There were no statistically significant associations between misrepresented publications and applicant demographics. CONCLUSIONS: Applicants had a low but still unacceptable rate of misrepresented publications and this trend in academic medicine is of great concern.

Malignant cystic nephroma.

AIM: To describe a malignant cystic nephroma in an asymptomatic man. METHODS: Case report and review of the literature. RESULTS: A 60 year old white male presented with an incidentally discovered right perirenal mass. An MRI demonstrated a large perinephric encapsulated mass with diffuse heterogeneity. Patient underwent a radical nephrectomy and retroperitoneal node dissection. Histopathological analyses of the resected specimen revealed malignant cystic nephroma. CONCLUSION: This represents the first published report of this rare tumor in an adult patient.

Short-term cancer control after primary cryosurgical ablation for clinically localized prostate cancer using third-generation cryotechnology.

OBJECTIVES: Percutaneous perineal cryoablation of the prostate is a promising technique in the treatment armamentarium for clinically localized prostate carcinoma. We report our initial experience using a transrectal ultrasound-guided, third-generation, argon/helium cryosurgical system. METHODS: From January 2002 to July 2005, 50 men underwent primary cryosurgery for clinically localized prostate carcinoma. The median patient age was 68 years (range 50 to 83), and the median follow-up period was 18 months (range 3 to 43). According to the D'Amico risk stratification system, 36 patients (72%) had low-risk, 9 (18%) had intermediate-risk, and 5 (10%) had high-risk prostate cancer. All patients underwent a dual freeze-thaw cycle using third-generation cryotechnology with ultrathin 17-gauge cryoneedles. RESULTS: The prostate-specific antigen (PSA) level for all patients at the last follow-up visit was less than 0.5 ng/mL in 45 patients (90%) and 0.5 ng/mL or more in 5 (10%). Two patients had persistent prostate cancer confirmed by prostate biopsy and were treated with salvage cryotherapy or external beam radiotherapy. Three other patients had an elevated PSA level after cryotherapy despite negative posttreatment biopsies and a metastatic evaluation. Of these 3 patients, 2 had their postcryotherapy PSA level normalize, and 1 patient, with intermediate-risk disease preoperatively, had a consistent increase in PSA up to 1.2 ng/mL. The overall survival rate was 100%. CONCLUSIONS: Cryoablation of the prostate is a feasible and safe treatment option in patients with organ-confined prostate cancer. Additional studies with longer follow-up are necessary to determine the sustained efficacy of this procedure.

Open radical retropubic prostatectomy 2007: the true minimally invasive surgery for localized prostate cancer?

The introduction of robotic laparoscopic assisted prostatectomy at our institution and nationwide has been a great advancement and has caused us to focus and fine-tune our goal for improvements in prostate cancer outcomes whether the patient elects for robotic laparoscopic assisted prostatectomy or open minimally invasive radical retropubic prostatectomy. While these authors favor the open technique performed by highly skilled urologic surgical oncologists, the lessons we have learned to date suggest that it is the skill of the surgeon that determines outcome, regardless of whether or not the operation is performed by an open or robotic laparoscopic technique. The concepts we have articulated here are related to resection and avoidance of positive margins, limited intraoperative blood loss and pain control, which allow equivalence in these outcome areas, regardless of technique.

Comparative financial analysis of minimally invasive surgery to open surgery for small renal tumours < or =3.5 cm: a single institutional experience.

OBJECTIVE: We analysed total hospital costs by comparing minimally invasive surgery (MIS) procedures, such as laparoscopic cryoablation (LCA), laparoscopic partial nephrectomy (LPN), and hand-assisted laparoscopic nephrectomy (HALN), with conventional surgery. METHODS: Between March 2000 and July 2005, 184 consecutive patients underwent surgery for a small, organ-confined renal tumour < or =3.5 cm in diameter. The distribution of patients among the surgical procedures was: HALN (n=53); LPN (n=20); open radical nephrectomy (ORN; n=20); open partial nephrectomy (OPN; n=71); and LCA (n=20). Total hospital costs were analysed for each procedure. RESULTS: Patients undergoing OPN at a mean age of 58+/-13 yr were significantly younger those undergoing HALN, ORN, and LCA. The mean hospital length of stay in the LCA group (2.0+/-1.2 d) was shorter than all other groups (p<0.05). Higher surgical costs occurred with LCA, LPN, and HALN compared (p<0.05) with ORN and OPN. However, total financial costs were lower for LCA and HALN with more obvious differences between LCA and the other four groups. CONCLUSIONS: The costs of MIS remain competitive with traditional surgery. Although the surgical costs were higher, LCA had the lowest total hospital costs for the renal tumour < or =3.5 cm at our institution. Long-term oncologic efficacy studies will be needed to fully appreciate the cost-efficacy ratio of MIS.

Financial comparative analysis of minimally invasive surgery to open surgery for localized prostate cancer: a single-institution experience.

OBJECTIVES: To evaluate the financial implications of how the costs of new minimally invasive surgery such as laparoscopic robotic prostatectomy (LRP) and cryosurgical ablation of the prostate (CAP) technologies compare with those of conventional surgery. METHODS: From January 2002 to July 2005, 452 consecutive patients underwent surgical treatment for clinically localized (Stage T1-T2) prostate cancer. The distribution of patients among the surgical procedures was as follows: group 1, radical retropubic prostatectomy (RRP) (n = 197); group 2, radical perineal prostatectomy (RPP) (n = 60); group 3, LRP (n = 137); and group 4, CAP (n = 58). The total direct hospital costs and grand total hospital costs were analyzed for each type of surgery. RESULTS: The mean length of stay in the CAP group was significantly lower (0.16 +/- 0.14 days) than that for RRP (2.79 +/- 1.46 days), RPP (2.87 +/- 1.43 days), and LRP (2.15 +/- 1.48 days; P <0.0005). The direct surgical costs were less for the RRP (2471 dollars +/- 636 dollars) and RPP (2788 dollars +/- 762 dollars) groups than for the technology-dependent procedures: LRP (3441 dollars +/- 545 dollars) and CAP (5702 dollars +/- 1606 dollars; P <0.0005). The total hospital cost differences, including pathologic assessment costs, were less for LRP (10,047 dollars +/- 107 dollars, median 9343 dollars) and CAP (9195 dollars +/- 1511 dollars, median 8796 dollars) than for RRP (10,704 dollars +/- 3468 dollars, median 9724 dollars) or RPP (10,536 dollars +/- 3088 dollars, median 9251 dollars), with significant differences (P <0.05) between the minimally invasive technique and open surgery groups. CONCLUSIONS: In our study, despite the relatively increased surgical expense of CAP compared with conventional surgical prostatectomy (RRP or RPP) and LRP, the overall direct costs were offset by the significantly lower nonoperative hospital costs. The cost advantages associated with CAP included a shorter length of stay in the hospital and the absence of pathologic costs and the need for blood transfusion.

Multiple nephron-sparing procedures in solitary kidney with recurrent, metachronous, nonfamilial renal cell carcinoma.

Patients with metachronous bilateral renal cell carcinoma pose a significant challenge given the high mortality of renal cell carcinoma and the poor quality of life should dialysis become necessary. In addition, patients may be subject to morbidity due to potential multiple treatments of the multifocal renal tumors. We present the case of a 71-year-old woman with multifocal, bilateral clear cell carcinoma who maintained a minimal change in serum creatinine after undergoing unilateral radical nephrectomy, subsequent percutaneous radiofrequency ablation, percutaneous cryoablation, laparoscopic cryoablation, and open partial nephrectomy for recurrent renal cell carcinoma in a solitary kidney.