Acute and Chronic Effects of Static Stretching on Intramuscular Hamstring Stiffness.

Passive hamstring stiffness varies proximo-distally, resulting in inhomogeneous tissue strain during stretching that may affect localized adaptations and risk of muscle injuries. The purpose of the present study was to determine the acute and chronic effects of static stretching (SS) on intramuscular hamstring stiffness. Thirty healthy active participants had acute changes in passive biceps femoris (BF), semimembranosus (SM), and semitendinosus (ST) stiffness measured at 25% (proximal), 50% (middle), and 75% (distal) muscle length, using shear-wave elastography, immediately after SS. Participants then completed 4 weeks of either a SS intervention (n = 15) or no intervention (CON, n = 15) with stiffness measured before and after the interventions. The acute and chronic effects of SS were compared between anatomical regions and between regions on the basis of their relative stiffness pre-intervention. Acutely, SS decreased stiffness throughout the BF and SM (p ≤ 0.05) but not the ST (p = 0.326). However, a regional effect of stretching was observed for SM and ST with greater reduction in stiffness occurring in stiffer muscular regions (p = 0.001-0.013). Chronically, SS increased BF and ST (p < 0.05), but not SM (p = 0.422) stiffness compared with CON, but no regional effect of stretching was observed in any muscle (p = 0.361-0.833). SS resulted in contrasting acute and chronic effects, acutely decreasing stiffness in stiffer regions while chronically increasing stiffness. These results indicate that the acute effects of SS vary along the muscle's length on the basis of the relative stiffness of the muscle and that acute changes in stiffness from SS are unrelated to chronic adaptations.

A Urinary Drug-Disposing Approach as an Alternative to Intravesical Chemotherapy for Treating Nonmuscle Invasive Bladder Cancer.

The standard treatment of nonmuscle invasive bladder cancer (NMIBC) is transurethral resection of the tumors, followed by intravesical therapy (IT), which comprises a direct instillation of a solution of Bacillus Calmette-Guérin vaccine or chemotherapy into the bladder. However, the recurrence rate in this disease remains unacceptably high. IT is a local treatment that fails to reach tumors developed in the upper urinary tract (ureter and renal pelvis). The catheterization procedure required for IT is invasive, painful, and poses an increased infection risk, resulting in poor patient quality of life and compliance. There is an unmet need for a potent, comprehensive, and noninvasive option. Without chemical modifications, peptides are rapidly removed by renal clearance. This "shortcoming" can be advantageous when used as a drug carrier for directing therapy to NMIBC. Here we develop a urinary drug-disposing (UDD) approach to improve NMIBC treatment. A 12-amino acid bio-inert peptide (Bdd) that can be exclusively eliminated via renal filtration was generated for delivering the microtubule inhibitor DM1 to NMIBC with minimal nonspecific accumulation in other organs. The UDD approach prolonged survival of mice bearing human bladder tumors. Unlike IT, the treatment was given noninvasively (intravenously). Furthermore, it was more effective at suppressing tumor growth than clinically used IT (mitomycin) and safer than free DM1. The application of this UDD approach to treat kidney tumors and deliver other drugs such as doxorubicin was also demonstrated. Overall, the rapid renal clearance of peptides can be exploited to direct cancer therapies to the urinary system. SIGNIFICANCE: A noninvasive drug delivery approach that targets the urinary system overcomes the current barriers facing effective treatment of bladder cancer.

ChemPix: automated recognition of hand-drawn hydrocarbon structures using deep learning.

Inputting molecules into chemistry software, such as quantum chemistry packages, currently requires domain expertise, expensive software and/or cumbersome procedures. Leveraging recent breakthroughs in machine learning, we develop ChemPix: an offline, hand-drawn hydrocarbon structure recognition tool designed to remove these barriers. A neural image captioning approach consisting of a convolutional neural network (CNN) encoder and a long short-term memory (LSTM) decoder learned a mapping from photographs of hand-drawn hydrocarbon structures to machine-readable SMILES representations. We generated a large auxiliary training dataset, based on RDKit molecular images, by combining image augmentation, image degradation and background addition. Additionally, a small dataset of ∼600 hand-drawn hydrocarbon chemical structures was crowd-sourced using a phone web application. These datasets were used to train the image-to-SMILES neural network with the goal of maximizing the hand-drawn hydrocarbon recognition accuracy. By forming a committee of the trained neural networks where each network casts one vote for the predicted molecule, we achieved a nearly 10 percentage point improvement of the molecule recognition accuracy and were able to assign a confidence value for the prediction based on the number of agreeing votes. The ensemble model achieved an accuracy of 76% on hand-drawn hydrocarbons, increasing to 86% if the top 3 predictions were considered.

Neurofibroma originating from a urachal mass.

Urachal anomalies are rare in the adult population and when diagnosed, are typically malignant. Herein, we report a case of a 61-year-old male who underwent an excision of a urachal mass for a presumed malignancy. Pathologic evaluation demonstrated a neurofibroma. Neurofibromas are benign peripheral nerve sheath tumors that mostly appear as localized skin tumors and rarely involve the genitourinary system. Neoplastic transformation of neurofibromas is rare but not unheard. To our knowledge, this is the first description of a neurofibroma originating from the urachus.

Review of Power Electronics Components at Cryogenic Temperatures.

In order to apply power electronics systems to applications such as superconducting systems under cryogenic temperatures, it is necessary to investigate the characteristics of different parts in the power electronics systems. This paper reviews the influence of cryogenic temperature on power semiconductor devices including Si and wide bandgap switches, integrated circuits, passive components, interconnection and dielectric materials, and some typical cryogenic converter systems. Also, the basic theories and principles are given to explain the trends for different aspects of cryogenically cooled converters. Based on the review, Si active power devices, bulk CMOS based integrated circuits, nanocrystalline and amorphous magnetic cores, NP0 ceramic and film capacitors, thin/metal film and wirewound resistors are the components suitable for cryogenic operation. Pb-rich PbSn solder or In solder, classic PCB material, most insulation papers and epoxy encapsulant are good interconnection and dielectric parts for cryogenic temperatures.

Dependence of laser-induced tissue ablation on optical fiber movements for laser prostatectomy.

PURPOSE: The aim of the current study was to identify the efficient fiber movements for 532-nm laser prostatectomy. MATERIALS AND METHODS: 532-nm Lithium triborate (LBO) laser light was tested on 120 kidney tissues at three different translational speeds (TS 1, 2, and 4 mm/s) and four different rotational speeds (RS 0.5, 1.0, 1.6, and 2.1 rad/s). The applied power was 120 W at a 2-mm working distance and 60° sweeping angle. Ablation rate and dimensions of resulting ablation craters were measured. RESULTS: Slower TSs and RSs created deeper and wider ablation craters with thinner coagulation, leading to more efficient ablation performance. Maximal ablation rate was achieved at a TS of 2 mm/s and RSs of 0.5 and 1.0 rad/s. An RS of 0.5 rad/s accompanied surface carbonization for all the TSs. Irrespective of TS, ablation rate became saturated at faster RSs than 1.0 rad/s. Faster TSs or RSs reduced tissue ablation, but increased thermal coagulation due to a shorter interaction time. CONCLUSIONS: Optimal ablation efficiency occurred at a TS of 2 mm/s and a RS of 1.0 rad/s with a thin coagulation of around 1.0 mm and no or minimal carbonization. Further studies will validate the current findings with prostate tissue and high-power levels for laser prostatectomy.

Factors influencing drainage setting and cost for cutaneous abscesses among pediatric patients.

OBJECTIVE: To evaluate the clinical and microbiological factors associated with skin and soft tissue infections drained in the emergency department (ED) vs operative drainage (OD) in a tertiary care children's hospital. METHODS: This was a cross-sectional study among children aged 2 months to 17 years who required incision and drainage (I&D). Demographic information, signs and symptoms, abscess size and location, and wound culture/susceptibility were recorded. Patient-specific charges were collected from the billing database. Multivariate regression analysis was used to determine factors determining setting for I&D and the effect of abscess drainage location on cost. RESULTS: Of 335 abscesses, 241 (71.9%) were drained in the ED. OD for abscesses was favored in children with prior history of abscess (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.36-7.44; P = .01) and labial location (OR, 37.81; 95% CI, 8.12-176.03; P < .001). For every 1-cm increase in size, there was approximately a 26% increase in the odds of having OD (OR, 1.26; 95% CI, 1.11-1.44, P < .001). Methicillin-resistant Staphylococcus aureus was identified in 72% of the 300 abscesses cultured and 12.3% were clindamycin resistant. OD was more expensive than I&D in the ED. Per abscess that underwent I&D, OD is $3804.29 more expensive than I&D in the ED while controlling for length of stay. DISCUSSION: Clinical factors associated with OD rather than I&D in the ED included history of abscess, increased abscess length, and labial location. Microbiological factors did not differ based on I&D setting. For smaller, nonlabial abscesses, ED drainage may result in significant cost savings.

A retrospective review of office-based 532-nm GreenLight laser prostatectomy in men with symptomatic benign prostatic hyperplasia.

OBJECTIVE: To evaluate the feasibility, safety, and outcomes of men with symptomatic benign prostatic hyperplasia undergoing 532-nm GreenLight laser prostatectomy in the office-based setting. MATERIALS AND METHODS: From September 2007 to October 2011, 47 patients underwent office-based 532-nm GreenLight laser prostatectomy by a single surgeon. Patients were enrolled prospectively and preoperative, intraoperative, and postoperative parameters were then reviewed retrospectively. Statistical analysis was performed with Wilcoxon rank sum test with a P value ≤.05 being considered statistically significant. RESULTS: The mean patient age was 66 (range, 49-89); 91% of men were on an alpha-blocker preoperatively; mean (standard deviation; SD) prostate volume by transrectal ultrasound was 35.8 mL (14.5); mean (SD) American Society of Anesthesiologists score was 2.33 (0.77); mean (SD) operative time was 36.73 minutes (18); mean (SD) lasing time was 19.1 minutes (8.31); mean (SD) total laser kiloJoules used was 85,387 kJ (38,885); and mean (SD) follow-up time was 8.48 months (8.24). The 1-year decrease in mean (SD) American Urologic Association Symptom Score and quality of life were 17.7 (8.3)-7 (7.3) and 4.1 (1.4)-2.27 (2) respectively. The maximal urinary flow increased from 8.1 (3.8) to 10.7 (6). Patients' postvoid residual improved from 130 mL (147) to 27 mL (55) over a 1-year period. (P <.01 for all). There were no reoperations for refractory lower urinary tract symptoms or hospital admissions. CONCLUSION: For men with small but symptomatic benign prostatic enlargement, office-based GreenLight laser prostatectomy is safe and feasible.

Evaluation of continence following 532 nm laser prostatectomy for patients previously treated with radiation therapy or brachytherapy.

INTRODUCTION/OBJECTIVE: Urinary complications such as bladder outlet obstruction or urinary retention following radiation therapy or brachytherapy have been reported in up to 15% of men. When conservative therapy has failed, surgical intervention with transurethral resection of the prostate (TURP) may be performed, but carries a significant risk of incontinence, ranging from 18% to 70% in reported literature. We reviewed a cohort of men previously treated with radiation or brachytherapy, who underwent laser prostatectomy. METHODS: From February 2004 to October 2011, 12 patients (Six = brachytherapy and Six = external beam radiation) underwent 532 nm GreenLight™ laser prostatectomy by a single surgeon (BBC) for chronic retention or debilitating obstructive symptoms. Preoperative, intraoperative, and postoperative parameters were collected prospectively and reviewed retrospectively. Statistical analysis was performed with a Wilcox Rank sum test with significance defined as P < 0.05. RESULTS: The median patient age was 77.4 (Interquartile range (IQR) 73.9, 79.1). Prior to surgery, five patients were catheter dependent. Intraopertively, the median operative time was 48 minutes (IQR 35, 67); median lasing time was 28 minutes (IQR 23, 44); median Joules used was 126,873 (IQR 95,030, 222,336) J. Postoperative median follow up was 22.9 (IQR 13.4, 41.7) months. Significant improvements were noted in IPSS, QoL scores, PVR, and Qmax after PVP treatment. At 12 months, the median decrease in IPSS, QoL scores, and PVR was 15 (IQR 14.5, 22) to 10 (IQR 5.5, 13.5), 5 (IQR 3.5, 5) to 2 (IQR 1, 3.5), 200 (IQR 171, 327.5) to 5 (IQR 1.25, 8), respectively (P < 0.05 for all). Similarly, at 12 months, the median increase in Qmax (ml/second) was 4 (IQR 3, 10) to 15.9 (IQR 11, 16) (P = 0.04). There were no reportable complications at 12 months. None of the 12 patients that underwent 532 nm GreenLight™ laser prostatectomy developed stress urinary incontinence. One patient developed metastatic prostate cancer and the remaining patients had no evidence of biochemical recurrence. CONCLUSION: In this pilot study, 532 nm GreenLight™ laser prostatectomy is feasible and safe in patients who have undergone prior radiotherapy for prostate cancer. Laser prostatectomy provides a durable response while maintaining continence in this cohort suffering from severe lower urinary tract symptoms (LUTS) or retention. Larger, randomized trials comparing GreenLight™ laser prostatectomy to traditional TURP are necessary to confirm non-inferiority.

Review of current laser therapies for the treatment of benign prostatic hyperplasia.

The gold standard for symptomatic relief of bladder outlet obstruction secondary to benign prostatic hyperplasia has traditionally been a transurethral resection of the prostate (TURP). Over the past decade, however, novel laser technologies that rival the conventional TURP have multiplied. As part of the ongoing quest to minimize complications, shorten hospitalization, improve resection time, and most importantly reduce mortality, laser prostatectomy has continually evolved. Today, there are more variations of laser prostatectomy, each with several differing surgical techniques. Although abundant data are available confirming the safety and feasibility of the various laser systems, future randomized-controlled trials will be necessary to verify which technique is superior. In this review, we describe the most common modalities used to perform a laser prostatectomy, mainly, the holmium laser and the potassium-titanyl-phosphate lasers. We also highlight the physical and clinical characteristics of each technology with a review of the most current and highest-quality literature.

Defining optimal laser-fiber sweeping angle for effective tissue vaporization using 180 W 532 nm lithium triborate laser.

PURPOSE: The goal of this study is to identify the most efficient sweeping angle (SA) during photoselective vaporization of the prostate (PVP). MATERIALS AND METHODS: Experiments were conducted with GreenLight XPS™ laser at 120 and 180 W. Ten blocks of porcine kidney were used for each SA (0, 15, 30, 45, 60, 90, and 120 degrees). Vaporization efficiency was assessed by the amount of tissue removed per time. The coagulation zone (CZ) thickness was also measured. RESULTS: Maximal vaporization rate (VR) was achieved at SA 15 and 30 degrees. Irrespective of power, VR increased and CZ decreased linearly with decreasing SA from 120 to 30 degrees. The CZ was the thinnest at SA 30 degrees. CONCLUSIONS: Optimal vaporization occurred at a SA of 15 degrees and 30 degrees with the lowest CZ at 30 degrees. Contrary to a previous recommendation for a wider SA (60 degrees or greater), a narrower SA (30 degrees) achieved the maximal tissue vaporization efficiency.

180-W XPS GreenLight laser therapy for benign prostate hyperplasia: early safety, efficacy, and perioperative outcome after 201 procedures.

BACKGROUND: Photoselective vaporisation of the prostate has evolved from the GreenLight 80-W KTP powered laser to the latest 180-W XPS laser involving a MoXy fibre. OBJECTIVE: Evaluate the prevalence of perioperative complications and short-term outcome for the first time with the XPS laser in men with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE). DESIGN, SETTING, AND PARTICIPANTS: Prospective data were collected from consecutive patients at seven centres worldwide during June 2010 and March 2011. Indication for surgery was based on the European Association of Urology and the American Urological Association guidelines. Patients receiving anticoagulants or those with retention were included and analysed separately. INTERVENTION: 180-W XPS GreenLight laser prostatectomy using the MoXy fibre. MEASUREMENTS: Standard parameters associated with transurethral prostate surgery and perioperative prevalence of surgery-associated problems or complications were documented. RESULTS AND LIMITATIONS: A total of 201 patients were included in the study. Mean follow-up was 5.8 mo (standard deviation [SD]: 2.8; range: 1-12 mo). A quarter of the patients had a prostate volume≥80 ml. For prostates between 51 and 60 ml, a mean of 300 kJ (SD: 112) of energy was applied (lasing time: 35.0 min; SD: 15). Statistically significant improvements were noted in all key parameters postoperatively. The prevalence of perioperative complications was low. Limitations of the study are short duration of follow-up and limited number of available patients for the functional follow-up. CONCLUSIONS: The 180-W GreenLight XPS laser is a new effective treatment option with a low prevalence of perioperative complications for patients suffering from LUTS due to BPE.

Optimal laser fiber rotational movement during photoselective vaporization of the prostate in a bovine ex-vivo animal model.

BACKGROUND AND PURPOSE: Photoselective vaporization of the prostate (PVP) has emerged as an effective debulking procedure for prostatic urinary obstruction. Surgical technique for the most efficient vaporization has, however, received little scientific investigation. We used an ex-vivo bovine prostate model to investigate how variation in the angle of laser fiber rotational movement ("sweeping") affects prostate tissue vaporization efficiency. MATERIALS AND METHODS: Experiments were conducted using the GreenLight™ HPS 120W laser system. A single surgeon performed a clinical PVP video analysis, forming the basis of our study design. Sixty bovine prostate specimens were vaporized using an ex-vivo chamber equipped with computer-assisted axial movements. Specimens were vaporized at a fixed sweeping speed (0.5 sweeps/sec) and variable sweeping angles (0, 15, 30, 60, 90, and 120 degrees). The volume of tissue vaporized was calculated from cross sections and compared by a two-sample t test. RESULTS: Clinical PVP video analysis of a single experienced surgeon showed a mean angle of 47.7 degrees with 25% of vaporization between 0 and 30 degrees. Ex-vivo analysis showed larger sweeping angles generated wider but more superficial vaporization defects, leading to smaller vaporized volumes. Specifically, vaporization volumes with angles of 0, 15, or 30 degrees were significantly greater than those with rotational angles of 45, 60, and 90 degrees (1.5-3.0 X; P<0.05). The depth of tissue coagulation significantly increased with greater rotational angles. CONCLUSIONS: Optimal PVP occurred at narrower angles of laser fiber sweeping in our ex-vivo model. Our findings highlight that PVP laser fiber movement can be tested in a scientific manner, identifying parameters to maximize vaporization efficiency.

The effect of laser-fiber sweeping speed on the efficiency of photoselective vaporization of the prostate in an ex vivo bovine model.

INTRODUCTION: Recommendations for efficient photoselective vaporization of the prostate (PVP) include a side-to-side rotational laser-fiber "sweeping" motion, yet scientific study of this technique is lacking. We investigated whether the speed of laser-fiber sweeping affects tissue vaporization efficiency. METHODS: PVP was performed using the 120-W GreenLight high-performance system. Video analysis of a surgeon performing PVP was carried out to identify sweeping speeds used clinically. PVP efficiency was subsequently tested at four different sweeping speeds using two manipulations of an ex vivo bovine prostate model, including (1) excised prostate tissues (n = 40) in a vaporization chamber equipped with motorized laser-fiber movements; (2) retrograde endoscopic vaporization (n = 80) within whole lower urinary tracts. Vaporized cavity sizes and coagulative margins were measured by liquid-paraffin molding and histologic cross-sectioning approaches. RESULTS: Video analysis of clinical PVP showed wide variability in sweeping speed, mostly ranging between 0.5 and 2.0 (mean 1.50) sweeps/second. Using either manipulation of the ex vivo bovine prostate model described above, PVP at lower sweeping speeds (0.5 and 1.0 sweeps/second) removed significantly more tissue (up to twofold) compared with higher sweeping speeds (1.5 and 2.0 sweeps/second), with significant albeit minimal reductions in coagulation margins. CONCLUSION: In this ex vivo prostate model, our results suggest that vaporization efficiency is compromised with faster laser-fiber sweeping. This finding counters principles of traditional transurethral resection of the prostate, in which faster axial movement toward the surgeon removes tissue more efficiently. This study highlights that PVP technique can be tested in a scientific manner, identifying optimal parameters for achieving maximal tissue vaporization efficiency.

Evaluation of a new multi-basket load-release ureteral stent.

INTRODUCTION: A multi-basket ureteral stent was tested and modified to assess feasibility of load-release features intended to release stone(s) if resistance is encountered during stent removal. METHODS: Three versions of the stent were evaluated: (1) unaltered stent, (2) one strand of each basket partially cut to 50%, or 75% (3) tube between baskets longitudinally slit. One of the baskets was filled with multiple 3-4-mm stones or a single large 6-mm stone to 20Fr diameter. The force required to release the device through a tube with an 8Fr narrowing was determined. In a separate assessment, urologists used a string attached to the force gauge to exert the maximum force they would be comfortable using in ureteral stent removal. RESULTS: The unaltered stent was associated with higher release forces or inability to remove the stent: 18.67 +/- 8.35 N when a single large stone was present, compared to 8.46 +/- 2.75 N for multiple small stones. Modified devices with 50% and 75% cut basket strands released at 15.19 +/- 1.54 N, and 10.65 +/- 2.09 N, respectively. The longitudinal slit device released at 3.11 +/- 1.57 N. The maximum force exerted by urologists in simulated stent removal was 7.3 +/- 0.4 N. CONCLUSION: Modifications to the multi-basket ureteral stent allow for stent removal in an in vitro model with a narrowing present with stone(s) in the stent baskets. The longitudinal slit modification appears to allow for stent removal with forces low enough to prevent significant ureteral injury, even if ureteral strictures are present.

Births using sperm retrieved via immediate microdissection of a solitary testis with cancer.

OBJECTIVE: To determine the feasibility of achieving births using sperm retrieved from a solitary testis with cancer. DESIGN: Prospective clinical study of azoospermic men with testis cancer in a solitary testis. SETTING: Infertility patients in an academic environment. PATIENT(S): Azoospermic men with previous history of orchiectomy and testis cancer in a remaining solitary testis. INTERVENTION(S): Viable sperm were retrieved by immediate microdissection of paratumor testicular tissue from orchiectomy specimen. MAIN OUTCOME MEASURE(S): Live births were achieved using sperm from immediate microdissection of orchiectomy specimen with testis cancer. CONCLUSION(S): Azoospermic men with cancer in a solitary testis have potential for fertility.

Enhanced adenoviral-vector mediated gene transfer using human albumin solder.

BACKGROUND AND OBJECTIVE: Laser tissue welding with human albumin solder (HAS) has been used as an alternative method of wound closure. Adenoviral vectors have been used to introduce various cytokine genes into wounds to accelerate wound closure. In the present study, we were interested in the effect of HAS on adenoviral vector transfer of the beta-galactosidase (beta-gal) gene in vitro and in vivo. STUDY DESIGN/MATERIALS AND METHODS: 3T3 fibroblasts were used to study the effect of HAS on beta-gal gene transfer in vitro. The presence of beta-gal was determined by Western blot, and its activity by a colorimetric assay. A punch biopsy model of wound healing in pigs was used for in vivo experiments. RESULTS: HAS increased the efficiency of adenoviral-mediated beta-gal transduction and stabilized the adenovirus at room temperature. HAS protected adenovirus from inactivation by laser, both in vitro and in vivo. CONCLUSIONS: HAS may stabilize adenoviral vectors to deliver cytokine genes in future wound healing experiments.

Pulmonary embolus related to PC-SPES use in a patient with PSA recurrence after radical prostatectomy.

Patients diagnosed with a rising prostate-specific antigen level after radical prostatectomy represent a therapeutic dilemma. Herbal therapies including PC-SPES have gained popularity as alternatives to conventional hormonal ablation in such patients as a result of the perceived benefits of using natural products and proven clinical response in decreasing prostate-specific antigen levels. PC-SPES is one of the most popular herbs with known estrogenic activity in vitro and in vivo. Estrogenic compounds increase the risk of thromboembolic events. However, no specific guidelines are available with regard to the risk of thromboembolic events for patients using PC-SPES. We report a case of a patient treated with PC-SPES for prostate-specific antigen recurrence after radical prostatectomy who presented with pulmonary embolus and a right common femoral deep venous thrombus.

A rare case of painless gross hematuria: primary localized AA-type amyloidosis of the urinary bladder.

A 60-year-old Asian woman presented with a 1-year history of painless gross hematuria. She had no prior urologic history and no other medical problems. Her physical examination, urine cytology, and computed tomography scan were normal. Cystoscopy demonstrated several punctate areas of erythema within the bladder. Biopsies revealed amyloidosis, and immunohistochemical staining of the specimens defined the process as amyloid AA (often called secondary amyloidosis). The workup for systemic conditions associated with amyloid AA was negative. This represents an unusual case of primary localized AA-type amyloidosis of the bladder.