Intravesical therapy use in the high risk patient: practice patterns in an equal access healthcare institution before and after national guidelines.

PURPOSE: We examined patterns of intravesical therapy use in nonmuscle invasive bladder cancer over the last 10 years at our institution where there is equal access to healthcare. We further examined any affect that the introduction of national guidelines may have had on the utilization of intravesical therapy in these patients. MATERIALS AND METHODS: An Institutional Review Board (IRB) approved retrospective chart review was performed between the years 1997 and 2007. Only those with premalignant or malignant pathology, as identified using intradepartmental surgical logs and pathology reports, were included. RESULTS: Four hundred seventeen procedures, representing 228 patients, were identified that met the above criteria. A total of 170 high risk, nonmuscle invasive bladder tumors (HG, CIS and T1) were identified, or 41% of cases in whom intravesical therapy was indicated according to the 1999 American Urological Association (AUA) guidelines. One hundred nine (64.2%) received intravesical therapy and 61 (35.8%) did not. This corresponds to an underutilization rate of 19.4% (33/170 high risk tumors did not receive intravesical therapy for unknown reasons). CONCLUSIONS: We have determined that the utilization of intravesical therapy in patients with high risk nonmuscle invasive bladder cancer has improved since the introduction of the 1999 AUA guidelines in an equal access healthcare institution and that patients are compliant with this therapy.

Lichen sclerosus: review of the literature and current recommendations for management.

PURPOSE: We reviewed the literature regarding the clinical presentation, etiology, natural history, and medical and surgical management of lichen sclerosus in men. MATERIALS AND METHODS: We performed a comprehensive search of the literature in PubMed, MEDLINE and other electronic databases between 1950 and 2006 using the key words lichen sclerosis, balanitis xerotica obliterans and urethral stricture. Our search resulted in 1,268 sources containing the words lichen sclerosus or balanitis xerotica obliterans. We reviewed 68 articles in the peer reviewed journals and 2 chapters on this subject. RESULTS: Lichen sclerosus is a chronic, lymphocyte mediated skin disease that was first described in 1887. It shows a predilection for the anogenital area in men and women. Much has been discovered regarding the epidemiology, natural history and histological features of this disease process during the last century, including the discovery of a strong association between lichen sclerosus and squamous cell carcinoma. The techniques of medical and surgical management of this disorder are still being elucidated. Biopsy of the initial lesion for definitive diagnosis and long-term followup of affected patients are well established, critical elements in the management of lichen sclerosus. CONCLUSIONS: Lichen sclerosus is a chronic, debilitating condition that may progress to cause significant voiding complications. Biopsy is recommended in all patients suspected of having lichen sclerosus to rule out squamous cell carcinoma. Further research is needed to improve the prevention, understanding and treatment of this challenging condition.

Epidemiology of nephrolithiasis in personnel returning from Operation Iraqi Freedom.

OBJECTIVES: To examine the epidemiology of urolithiasis in personnel returning from deployment to Southwest Asia. METHODS: A survey-based study of personnel returning from deployment to Southwest Asia was performed. The demographics were compared between the personnel reporting a history of urolithiasis during or within the first 90 days of returning from deployment and the personnel without a history of reported urolithiasis. RESULTS: A total of 10,180 personnel were demobilized and 6153 surveys were received during a 9-month period, for a survey response rate of 60%. Of the personnel returning survey, 1% reported urolithiasis during their deployment. The personnel who reported urolithiasis were slightly older than those who did not (32.6 vs 29 years old, P < .00038). The odds of reporting urolithiasis during deployment were 30.9 times greater for personnel with a history of stone disease and 2.4 times greater for those with a family history of stone disease. No difference was found in the rates of urolithiasis with regard to sex or race. Also, no strong evidence for an association between the rates of reported urolithiasis and seasonal variations in temperature in Southwest Asia was found. CONCLUSIONS: The rate of reported urolithiasis among deployed personnel was lower than that in the general population. The personnel who reported urolithiasis during deployment were slightly older. A personal history or family history of stone disease was significant predictors of urolithiasis in this deployed population.

Benign fibrous pseudotumor of tunica vaginalis testis.

We discuss the rare benign paratesticular mass identified as fibrous pseudotumor. We performed a published data search to review the etiology, incidence, gross and microscopic examinations, and pathologic diagnostic considerations. Fibrous pseudotumor is a rare, benign lesion. Histologic examinations, as well as concerted efforts between the pathologist and surgeon, are necessary for appropriate diagnosis and treatment.

Ureteral endometriosis in patients after total abdominal hysterectomy: presentation and diagnosis: a case series.

Although ureteral endometriosis is uncommon, it is a significant disease process that can cause irreversible renal damage because of delays in diagnosis. It is even more uncommon and therefore more likely to be left out of the differential diagnosis in postmenopausal women. This case series reviewed the clinical presentation and treatment of ureteral endometriosis, as well as the history and treatment of 3 postmenopausal women who presented with ureteral obstruction secondary to ureteral endometriomas.