Management of Left Staghorn Calculus With Colorenal Fistula.

Fistula formation between the kidney and the colon is a rare occurrence. Colorenal fistulas have been reported after renal cryoablation, calculous pyonephrosis, and renal cell carcinoma. Fistula formation is reported in as many as 35% of patients with Crohn's disease. Crohn's-related urinary fistulas may include enterovesical, enteroureteral, rectourethral, urethrocutaneous, and entero-urachal fistulas. Here, we report a rare case of a patient who was found to have a left colorenal fistula in the setting of a left staghorn calculus and recurrent urinary tract infections with a question about the eventual definitive management of the patient.

Prostate cancer stem cell-targeted efficacy of a new-generation taxoid, SBT-1214 and novel polyenolic zinc-binding curcuminoid, CMC2.24.

BACKGROUND: Prostate cancer is the second leading cause of cancer death among men. Multiple evidence suggests that a population of tumor-initiating, or cancer stem cells (CSCs) is responsible for cancer development and exceptional drug resistance, representing a highly important therapeutic target. The present study evaluated CSC-specific alterations induced by new-generation taxoid SBT-1214 and a novel polyenolic zinc-binding curcuminoid, CMC2.24, in prostate CSCs. PRINCIPAL FINDINGS: The CD133(high)/CD44(high) phenotype was isolated from spontaneously immortalized patient-derived PPT2 cells and highly metastatic PC3MM2 cells. Weekly treatment of the NOD/SCID mice bearing PPT2- and PC3MM3-induced tumors with the SBT-1214 led to dramatic suppression of tumor growth. Four of six PPT2 and 3 of 6 PC3MM2 tumors have shown the absence of viable cells in residual tumors. In vitro, SBT-1214 (100 nM-1 µM; for 72 hr) induced about 60% cell death in CD133(high)/CD44(+/high) cells cultured on collagen I in stem cell medium (in contrast, the same doses of paclitaxel increased proliferation of these cells). The cytotoxic effects were increased when SBT-1214 was combined with the CMC2.24. A stem cell-specific PCR array assay revealed that this drug combination mediated massive inhibition of multiple constitutively up-regulated stem cell-related genes, including key pluripotency transcription factors. Importantly, this drug combination induced expression of p21 and p53, which were absent in CD133(high)/CD44(high) cells. Viable cells that survived this treatment regimen were no longer able to induce secondary spheroids, exhibited significant morphological abnormalities and died in 2-5 days. CONCLUSIONS: We report here that the SBT-1214 alone, or in combination with CMC2.24, possesses significant activity against prostate CD133(high)/CD44(+/high) tumor-initiating cells. This drug combination efficiently inhibits expression of the majority of stem cell-related genes and pluripotency transcription factors. In addition, it induces a previously absent expression of p21 and p53 ("gene wake-up"), which can potentially reverse drug resistance by increasing sensitivity to anti-cancer drugs.

Diagnosis of bladder cancer with microelectromechanical systems-based cystoscopic optical coherence tomography.

OBJECTIVES: To examine the utility and potential limitations of microelectromechanical systems-based spectral-domain cystoscopic optical coherence tomography (COCT) so as to improve the diagnosis of early bladder cancer. METHODS: An optical coherence tomography catheter was integrated into the single instrument channel of a 22F cystoscope to permit white-light-guided COCT over a large field of view (4.6 mm wide and 2.1 mm deep per scan at 8 frames/s) and 10-microm resolution. Intraoperative COCT diagnosis was performed in 56 patients, with a total of 110 lesions examined and compared with biopsied histology. RESULTS: The overall sensitivity of COCT (94%) was significantly higher than cystoscopy (75%, P = .02) and voided cytology (59%, P = .005); the major enhancement over cystoscopy was for low-grade pTa-1 cancer and carcinoma in situ (P < .018). The overall specificity of COCT (81%) was comparable to voided cytology (88.9%, P = .49), but significantly higher than cystoscopy (62.5%, P = .02). CONCLUSIONS: The microelectromechanical systems-based COCT, owing to its high resolution and detection sensitivity and large field of view, offers great potential for "optical biopsy" to enhance the diagnosis of nonpapillary bladder tumors and their recurrences and to guide bladder tumor resection.

Effects of resectoscope loop manipulation.

BACKGROUND AND PURPOSE: Urologic resectoscope loops often are manipulated to reposition the angle. The effects of these maneuvers on the efficiency and functionality of the loop have never been tested. Our goal was to evaluate the changes in tensile strength, conductivity, and dispersion of cautery effect resulting from such manipulation. MATERIALS AND METHODS: Resectoscope loops manufactured by Karl Storz, Olympus, Boston Scientific, and ACMI were tested for tensile strength and unevenness of cautery effect before and after one manipulation from an angel of 15 degrees posterior to 15 degrees anterior deviation. RESULTS: Prior to manipulation, the loops demonstrated a tensile strength of approximately 40 lb to failure. After one manipulation, the tensile strength was reduced by 90.1% (P < 0.001), with 46.7% of the loops failing to meet minimum industry standards. Manipulation of the loops increased the resistance to current flow within the wire. Microscopic evaluation showed longitudinal fracture lines at the manipulated sites. CONCLUSION: Physician-manipulated resectoscope loop angles have a dramatic effect on the strength of the loop as well as the dispersion of energy. A bend of 30 degrees results in 46.7% of the loops failing to meet minimum tensile-strength standards and alters the effectiveness and dispersion of electrical current. Infrared photography confirms the defect to be generated at the point of manipulation, thereby reducing the anticipated capabilities at a constant setting of the loop energizer. Ultimately, the quality of surgical resection suffers from even one manipulation of a resectoscope loop.

Carcinosarcoma of the ureter: report of a case with unusual histology and review of the literature.

Carcinosarcomas of the ureter are rare biphasic neoplasms, with distinct malignant epithelial and mesenchymal components. To the authors' knowledge there have been only 12 cases reported in the literature. Primary cartilaginous tumors of the ureter are also rare tumors. Thus far there has been a single case report of an extraskeletal mesenchymal chondrosarcoma of the ureter in the German literature. Herein a unique case is reported of ureteral carcinosarcoma in an 81-year-old woman presenting with gross hematuria in which the sarcomatous component had extraskeletal mesenchymal chondrosarcomatous differentiation. This is thought to be the first reported case of a carcinosarcoma with such a differentiation in the sarcomatous component.

Case report: urinary retention secondary to a foreign body in the male urethra.

We report the case of a male patient who presented to the Emergency Department with urinary retention secondary to a suspected foreign object in his urethra. We review the diagnosis and management of self-inserted urethral foreign objects in men. Emergent treatment is necessary in patients with urethral foreign objects. Prompt radiologic studies should be obtained because immediate bladder access and drainage is mandatory, especially in patients presenting with urosepsis or urinary retention. Endoscopic removal is the management of choice.

Multiple bilateral perivascular epithelioid cell tumor (PEComa) of the kidneys.

Perivascular Epithelial Cell (PEComa) Tumors are extremely rare. These tumors are often regarded as low grade Sarcomas and treated as such. We report a case of a 70 year old female with a history of nonspecific complaints and on routine CT scan had bilateral multiple renal masses with no other extra renal disease. The largest mass on the right was 11 cm x 7 cm x 11 cm and the left there were multiple smaller masses. She underwent a right radical nephrectomy that showed a PEComa and an adjacent renal cell carcinoma. Her contralateral kidney was followed for 3 years with no evidence of growth or metastasis.

Treatment of bilateral fibroepithelial polyps in a child.

Ureteral fibroepithelial polyps are extremely rare benign lesions composed of stroma with a surface of normal transitional epithelium. Traditionally, symptomatic polyps were treated with open exploration and segmental resection. We describe the first case of bilateral polyps in a child. One was removed by segmental resection and the other by ureteroscopic laser surgery.