The Open Approach to Severe Stent Encrustation: A Consecutive Case Series.

Urologists rely heavily on indwelling ureteral stents to manage urinary tract obstruction secondary to calculi, malignancy, stricture, congenital anomalies, or edematous response to operative procedures (Borboroglu and Kane, 2000). The use of a ureteral stent is a temporary intervention and requires removal to prevent potential complications. However, patient noncompliance with follow-up may lead to encrustation of the ureteral stent. Given the widespread use of indwelling ureteral stents in urologic practice, the issue of encrustation secondary to a retained stent is a significant clinical challenge.

A review for clinicians: Prostate cancer and the antineoplastic properties of metformin.

OBJECTIVES: Metformin has numerous antineoplastic effects including an AMP-activated protein kinase-dependent mechanism, AMP-activated protein kinase-independent mechanisms, alteration of insulin and insulin-like growth factor signaling pathways, and suppression of androgen signaling pathways that trigger prostate cancer growth and proliferation. In contrast to other malignancies that are associated with increased incidence among patients with obesity and type II diabetes mellitus (T2DM), epidemiological studies suggest that obesity and T2DM may impart a protective effect on prostate cancer incidence by creating a set of metabolic conditions that lower androgen levels. METHODS AND MATERIALS: The PubMed and Web of Science databases were searched using the terms "prostate cancer," "metformin," "antineoplastic," "antitumorigenic," and "diabetes" up to the first week of August 2016. Articles regarding metformin's antineoplastic properties on prostate cancer were reviewed. RESULTS: Treating T2DM with metformin may reverse the metabolic conditions that suppress androgen levels, thereby enabling higher levels of androgens to stimulate prostate growth, proliferation, and tumorigenesis. Thus, the antineoplastic properties of metformin may not be appreciable in the early stages of prostate cancer development because metformin corrects for the metabolic conditions of T2DM that impart a protective effect on prostate cancer. These findings, although inconclusive, do not support the use of metformin as a preventive agent for prostate cancer. However, the future appears bright for metformin as either a monotherapy or an adjunct to androgen deprivation therapy, external-beam radiation therapy, prostatectomy, or chemotherapy. Support for this includes meta-analyses that suggest a mortality benefit to patients with prostate cancer on metformin, a clinical trial that demonstrates metformin leads to significant improvement in metabolic syndrome parameters for patients with prostate cancer on androgen deprivation therapy, and a clinical trial that shows metformin has modest activity in the treatment of some patients with asymptomatic or minimally symptomatic metastatic castration-resistant prostate cancer. CONCLUSIONS: This review summarizes the literature regarding the antineoplastic mechanisms, clinical implications, and future trajectory of clinical research for metformin in prostate cancer.

Penile incarceration secondary to an S-shaped lead pipe: removal with Dremel Moto-Tool.

BACKGROUND: Penile incarceration or strangulation is a urologic emergency. OBJECTIVES: Several techniques to remove metallic objects strangulating the penis are described in the literature. The method utilized depends on the severity of the incarceration and the tools that are readily accessible. Prompt action and resourcefulness, with expeditious removal, prevents organ ischemia and vascular or mechanical sequelae. CASE REPORT: We describe a case in which a Dremel Moto-Tool was used to remove a lead pipe strangulating a penile shaft, after failure of the string technique. CONCLUSION: A hospital-based Emergency Medical Services and Rescue program is a valuable resource to provide the tools needed for management of penile strangulation. Features of safe removal, including protecting the tissues from heat damage and mechanical injury from the cutting blade, are described.