Valproic acid decreases urothelial cancer cell proliferation and induces thrombospondin-1 expression.

BACKGROUND: Prevention of bladder cancer recurrence is a central challenge in the management of this highly prevalent disease. The histone deacetylase inhibitor valproic acid (sodium valproate) has anti-angiogenic properties and has been shown to decrease bladder cancer growth in model systems. We have previously shown reduced expression of thrombospondin-1 in a mouse model and in human bladder cancer relative to normal urothelium. We speculated that inhibition of angiogenesis by valproate might be mediated by this anti-angiogenic protein. METHODS: Bladder cancer cell lines UMUC3 and T24 were treated with valproate or another histone deacetylase inhibitor, vorinostat, in culture for a period of three days. Proliferation was assessed by alamar blue reduction. Gene expression was evaluated by reverse transcription of RNA and quantitative PCR. RESULTS: Proliferation assays showed treatment with valproate or vorinostat decreased proliferation in both cell lines. Histone deacetylase inhibition also increased relative expression of thrombospondin-1 up to 8 fold at 5 mM valproate. CONCLUSIONS: Histone deacetylase inhibitors warrant further study for the prevention or treatment of bladder cancer.

Anatomical and histological equivalence of the human, canine, and bull vas deferens.

INTRODUCTION: Several animal models have been utilized for in-vitro experimentation and surgical training exercises of the vas deferens. The canine model is currently the standard for both in-vivo and ex-vivo study. Due to increasing costs associated with experimentation on canines, and in keeping with the principles of refine, reduce, and replace, a novel model that is cost-effective and easily obtained is desired. We compared morphology of the bull vas deferens to that of the human and the canine. MATERIALS AND METHODS: Bilateral vas deferens tissue from the human (n = 6), canine (n = 6), and bull (n = 5) were compared. Outer diameter (OD), inner diameter (ID), and microscopic measurements of the luminal mucosa and muscularis were then determined from each of these tissues. Histological comparisons were performed by a single pathologist. Data was analyzed using Two One-sided Tests (TOST) Analysis of Equivalence. RESULTS: According to the TOST statistical analysis, the vassal ID was equivalent for all three species. Similarly, equivalent microscopic measurements were noted for both vassal mucosal (human-canine and human-bull) and muscularis thicknesses (canine-bull). Lastly, all three species had similar histological characteristics. CONCLUSIONS: The vas deferens' of the human, canine, and bull are equivalent in many ways, including histological similarities. It is reasonable to conclude that the bull vas could be substituted for the human vas for both in-vitro testing and microscopic vasovasostomy simulation exercises. Specimens are cost-effective, provide ample tissue length, and are easy to obtain.

An unusual clinical presentation of rhabdomyomatous Wilms' tumor.

Wilms' tumor (WT) is the most common primary malignant renal tumor in children and usually presents as an abdominal mass. Rhabdomyomatous nephroblastoma is a rare histologic variant of WT. Herein we report an unusual case of WT with rhabdomyomatous differentiation presenting with hematuria and the passage of tissue via the urethra in a 2-year-old male.

Hematospermia: etiological and management considerations.

BACKGROUND: Hematospermia, or blood in the ejaculate, usually follows a benign self-limiting course. However, it can be a source of considerable anxiety in patients. The purpose of this article is to provide the primary care physician an algorithm for the evaluation and management of hematospermia based on frequency of occurrence and patient age. METHODS: We performed an English language MEDLINE (1966 to present) search for the terms hematospermia, hemospermia, management, prostate biopsy and combinations thereof. We then constructed a management algorithm based on available evidence. RESULTS: Typically, patients present to their primary care physician after a single episode of hematospermia out of concern for malignancy or venereal disease. In men 40 years old or younger, it is most often due to inflammatory or infectious processes. In men over 40 years of age, however, an association exists between hematospermia and more serious underlying pathology. A significant number of cases remain idiopathic even after extensive investigation. CONCLUSIONS: Hematospermia is an anxiety-provoking sign that is usually due to inflammatory or infectious causes. Recurrent or symptomatic hematospermia may herald more serious underlying pathology, especially in those patients over 40 years old. A thorough evaluation is warranted to both rule out more serious pathology and to adequately address patient anxiety. With modern imaging techniques, the number of "idiopathic" cases should be much lower than historically reported.

A case of synchronous bilateral spermatocytic seminoma.

Bilateral testis tumors are rare and the majority of cases are classic seminoma presenting metachronously. We present the only reported case of synchronous bilateral spermatocytic seminoma.

Office based transurethral needle ablation of the prostate with analgesia and local anesthesia.

PURPOSE: We evaluated the efficacy and feasibility of performing office based transurethral needle ablation of the prostate with analgesia and local anesthesia. MATERIALS AND METHODS: A total of 56 consecutive patients underwent transurethral needle ablation of the prostate for symptomatic benign prostatic hyperplasia. Oral rofecoxib (50 mg) and ciprofloxacin (250 mg) were administered before the procedure with 25 mg hydroxyzine and 50 to 100 mg meperidine intramuscularly. A combination of 2% lidocaine solution and jelly was used for anesthesia. Patients rated discomfort during anesthesia administration and the procedure using a 10-point scale of 0--no discomfort to 10--the worst pain/discomfort ever experienced in the patient life. Overall satisfaction with the procedure was assessed with a 4-point scale of 1--very satisfactory to 4--very unsatisfactory. Followup was 12 months for uroflow and 36 months for International Prostate Symptom Score. RESULTS: The mean age of 47 patients was 65.4 years. Mean discomfort ratings were 3.6 and 4.9 for anesthesia administration and the procedure, respectively. Average operative time was 34.4 minutes, excluding anesthesia administration. The mean overall satisfaction score was 1.5. The mean preoperative International Prostate Symptom Score was 23.1, which improved to 10.9, 11.2, 12.3, 13.8 and 11.3 at 3, 6, 12, 24 and 36 months, respectively. Mean maximum uroflow improved from 8.2 ml/sec at baseline to 12.8, 13.9 and 13.3 ml/sec at 3, 6 and 12 months, respectively. CONCLUSIONS: Administration of an intramuscular narcotic combined with oral analgesic and topical lidocaine provided adequate pain control for transurethral needle ablation of the prostate, making it a feasible office procedure.

Ureteral obstruction by uterine artery aneurysm in third trimester of pregnancy.

Uterine artery aneurysm (UAA) is an uncommon complication of pregnancy. Its diagnosis before postpartum hemorrhage is rare. We report on a patient who presented with symptomatic ureteral obstruction secondary to UAA. The hydronephrosis was managed by ureteral stenting. The UAA was successfully embolized after a planned cesarean section delivery. UAA is a rare and clinically significant cause of hydronephrosis during pregnancy.