Bladder regeneration in a canine model using hyaluronic acid-poly(lactic-co-glycolic-acid) nanoparticle modified porcine small intestinal submucosa.

OBJECTIVE: • To determine if hyaluronic acid (HA) can be incorporated into porcine small intestinal submucosa (SIS) through poly (lactide-co-glycolide-acid) (PLGA) nanoparticles to improve the consistency of the naturally derived biomaterial and promote bladder tissue regeneration. METHODS: • Beagle dogs were subjected to 40% partial cystectomy followed by bladder augmentation with commercial SIS or HA-PLGA-modified SIS. • Urodynamic testing was performed before and after augmentation to assess bladder volume. • A scoring system was created to evaluate gross and histological presentations of regenerative bladders. RESULTS: • All dogs showed full-thickness bladder regeneration. • Histological assessment showed improved smooth muscle regeneration in the HA-PLGA-modified SIS group. • For both groups of dogs, urodynamics and graft measurements showed an approximate 40% reduction in bladder capacity and graft size from pre-augmentation to post-regeneration measurements. • Application of the scoring system and statistical analysis failed to show a significant difference between the groups. CONCLUSIONS: • SIS can be modified through the addition of HA-PLGA nanoparticles. The modified grafts showed evidence of improved smooth muscle regeneration on histological assessment, although this difference was not evident on a novel grading scale. • The volume loss and graft shrinkage experienced are consistent with previous models of SIS bladder regeneration at the 10-week time point. • Additional research into the delivery of HA and the long-term benefits of HA on bladder regeneration is needed to determine the full benefit of HA-PLGA-modified SIS. In addition, a more objective biochemical characterization will be needed to evaluate the quality of regeneration.

Predicting renal outcomes in children with anterior urethral valves: a systematic review.

PURPOSE: Prognostic information is limited on children with congenital anterior urethral valves or a diverticulum. We reviewed the literature and examined our clinical database to identify clinical features predicting a poor renal outcome, defined as azotemia, renal failure or death. MATERIALS AND METHODS: We reviewed 97 English language studies of patients 18 years old or younger. Seven patients from our institutions were also included in analysis. After data abstraction we used multivariate models to define factors associated with outcomes of interest. RESULTS: We identified 239 male patients with anterior urethral valves, of whom 139 had adequate data available for study inclusion. Of these patients 108 (78%) had normal renal function after treatment. On bivariate analysis vesicoureteral reflux (OR 22.4, p <0.0001), pretreatment azotemia (OR 17.1, p <0.0001), urinary tract infection (OR 3.3, p = 0.006), hydronephrosis (OR 10.0, p = 0.0004) and bladder trabeculation (OR 7.3, p = 0.01) were associated with renal failure or death while treatment method (p = 0.9), obstruction type (valve vs diverticulum, p = 0.4) and valve location (p = 0.6) were not. After adjusting for other factors only pretreatment azotemia (p = 0.0005) and vesicoureteral reflux (p = 0.01) remained associated with renal failure and/or death with a trend toward significance for urinary tract infection (p = 0.06). When all 3 factors were present, the odds of a poor renal outcome increased 25-fold (p = 0.005). CONCLUSIONS: Congenital anterior urethral obstruction in children has a generally good prognosis but may occasionally result in a poor renal outcome. The combination of pretreatment azotemia, vesicoureteral reflux and urinary tract infection is highly predictive of a poor renal outcome.

Regional variations in small intestinal submucosa evoke differences in inflammation with subsequent impact on tissue regeneration in the rat bladder augmentation model.

OBJECTIVE: To examine the histological differences in the inflammatory response and regenerative outcomes of distal vs proximal porcine small intestinal submucosa (SIS) grafts in the rat bladder, as SIS from distal small intestine yields reliable and reproducible bladder regeneration, while SIS from proximal portions of small intestine does not provide similar results. MATERIALS AND METHODS: In all, 30 Sprague-Dawley rats underwent hemi-cystectomy followed by anastomosis of a bladder patch of SIS prepared from either distal or proximal small intestine. After bladder harvest, immunohistochemistry was used to quantify mast cells, eosinophils, macrophages, and neutrophils (PMNs). Total cell count per unit area was compared across the time course in univariate and logistic regression modelling. RESULTS: There were more eosinophils and mast cells in proximal SIS grafts, while there were more macrophages and PMNs in distal SIS grafts (all P < 0.05). Trichrome analysis showed increased collagen deposition in proximal SIS grafts and little smooth muscle regeneration. There was also significant graft contracture in proximal SIS grafts compared with distal SIS grafts (P < 0.05). CONCLUSIONS: We conclude that the location of SIS origin may evoke different inflammatory responses, which results in altered bladder tissue regeneration.

Increasing prevalence and associated risk factors for methicillin resistant Staphylococcus aureus bacteriuria.

PURPOSE: Infections due to methicillin resistant Staphylococcus aureus are becoming increasingly prevalent in hospitals and in the community. We reviewed our institutional experience to determine whether methicillin resistant S. aureus is becoming a more common cause of bacteriuria and to determine if there are specific risk factors that may predict the development of methicillin resistant S. aureus bacteriuria. MATERIALS AND METHODS: We reviewed all urine cultures with a pure growth of a single organism obtained at our institution from 1997 and 2007. Patients with urine cultures positive for methicillin resistant S. aureus were compared to a cohort with cultures positive for methicillin sensitive S. aureus, and to a third cohort with cultures positive for Escherichia coli to determine patient characteristics and associated risk factors. RESULTS: We identified 7,100 and 9,985 positive urine cultures performed in 1997 and 2007, respectively. The most common urinary organism was E. coli. The number of patients with methicillin resistant S. aureus bacteriuria increased from 18 (0.3%) to 74 (0.8%) (p <0.001). On multivariate analysis older age (p = 0.004), catheter use (p = 0.004), hospital exposure (p <0.001) and patient comorbidity (p <0.001) were associated with methicillin resistant S. aureus bacteriuria compared with E. coli bacteriuria. CONCLUSIONS: Methicillin resistant S. aureus remains rare as a cause of bacteriuria but its incidence has increased during the last decade. Risk factors for methicillin resistant S. aureus bacteriuria include increased age, patient comorbidity, hospital exposure and catheter use. For patients with these risk factors and new onset urinary symptoms, methicillin resistant S. aureus should be considered a possible cause of urinary tract infection.

Frankincense oil derived from Boswellia carteri induces tumor cell specific cytotoxicity.

BACKGROUND: Originating from Africa, India, and the Middle East, frankincense oil has been important both socially and economically as an ingredient in incense and perfumes for thousands of years. Frankincense oil is prepared from aromatic hardened gum resins obtained by tapping Boswellia trees. One of the main components of frankincense oil is boswellic acid, a component known to have anti-neoplastic properties. The goal of this study was to evaluate frankincense oil for its anti-tumor activity and signaling pathways in bladder cancer cells. METHODS: Frankincense oil-induced cell viability was investigated in human bladder cancer J82 cells and immortalized normal bladder urothelial UROtsa cells. Temporal regulation of frankincense oil-activated gene expression in bladder cancer cells was identified by microarray and bioinformatics analysis. RESULTS: Within a range of concentration, frankincense oil suppressed cell viability in bladder transitional carcinoma J82 cells but not in UROtsa cells. Comprehensive gene expression analysis confirmed that frankincense oil activates genes that are responsible for cell cycle arrest, cell growth suppression, and apoptosis in J82 cells. However, frankincense oil-induced cell death in J82 cells did not result in DNA fragmentation, a hallmark of apoptosis. CONCLUSION: Frankincense oil appears to distinguish cancerous from normal bladder cells and suppress cancer cell viability. Microarray and bioinformatics analysis proposed multiple pathways that can be activated by frankincense oil to induce bladder cancer cell death. Frankincense oil might represent an alternative intravesical agent for bladder cancer treatment.

Marching to the beat of your own drum?: A proof-of-concept study assessing physiological linkage in Autism Spectrum Disorder.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by difficulty in dynamically adjusting behavior to interact effectively with others, or social reciprocity. Synchronization of physiological responses between interacting partners, or physiological linkage (PL), is thought to provide a foundation for social reciprocity. In previous work we developed a new technique to measure PL using dynamic linear time series modeling to assess cardiac interbeat interval (IBI) linkage in typically developing same-sex unacquainted dyads (Scarpa et al., 2017). The current article describes a proof-of-concept study with three dyads of young adults with ASD interacting with same-sex unacquainted typically developing (TD) partners. This pilot data is applied to propose potential benefits of using this technique to quantify and assess PL in individuals with ASD, both for basic research and for intervention science. Discussion focuses on applications of this measure to potentially advance knowledge of the biology-behavior link in ASD.

Superficial genitourinary abscesses in children: emergence of methicillin resistant Staphylococcus aureus.

PURPOSE: The prevalence of methicillin resistant Staphylococcus aureus is increasing. However, little is known about methicillin resistant S. aureus in the genitourinary tract, particularly in children. We assessed the incidence of pediatric genitourinary methicillin resistant S. aureus superficial abscess requiring surgical intervention. MATERIALS AND METHODS: We reviewed the records of all children undergoing surgical debridement of superficial abscess at a single institution between 1995 and 2007. We assessed surgical site, organism identity, patient comorbidity, methicillin resistant S. aureus risk factors, number of procedures and patient outcome. RESULTS: Surgical debridement of a superficial genitourinary abscess was performed in 60 children. Patient age ranged from 29 days to 17 years (median 3 years). A single debridement was generally curative, with only 5 patients (8.3%) requiring more than 1 procedure. One patient (1.7%) died of sepsis postoperatively due to Pseudomonas infection. One patient had myelomeningocele, 1 had undergone renal transplant and 2 were undergoing chemotherapy at the time of debridement. None of these 3 patients had a methicillin resistant S. aureus infection. Methicillin resistant S. aureus was more common in the groin/genitalia and less common in the perineum (p = 0.007). The incidence of methicillin resistant S. aureus increased during the study period, accounting for none of 40 infections between 1995 and 2003, and 8 of 20 (40%) from 2004 to 2007 (p <0.001). CONCLUSIONS: Methicillin resistant S. aureus has become the predominant organism causing pediatric superficial genitourinary abscesses at our institution, accounting for three-quarters of all surgically managed infections in the last 2 years. Methicillin resistant S. aureus was more common at the groin and genitalia. One debridement was generally curative, and patient morbidity was low with aggressive treatment.

B7-H1 expression in Wilms tumor: correlation with tumor biology and disease recurrence.

PURPOSE: Despite tremendous gains in improving prognosis, 10% of patients with Wilms tumor will ultimately experience disease recurrence. The identification of novel prognostic markers and tumor associated targets for patients at risk could enable clinicians to treat recurrences more aggressively and, thus, optimize outcomes. We have previously shown that tumor expression of the T cell coregulatory ligand B7-H1 portends a poor prognosis for adults with renal cell carcinoma and represents a promising target to improve therapy. We hypothesize that this finding may be true for Wilms tumor. MATERIALS AND METHODS: We identified 81 patients with Wilms tumor treated at 1 institution between 1968 and 2004. Histopathological features, including Wilms tumor B7-H1 expression, were correlated with clinical observations and outcome. RESULTS: Tumor recurrences were noted in 22% of patients with Wilms tumor and 14% died. B7-H1 was expressed in 11 tumors (14%) and was more likely to occur in anaplastic Wilms tumor (p = 0.03). Tumor B7-H1 expression was associated with a 2.7-fold increased risk of recurrence, although this difference did not achieve statistical significance (p = 0.06). However, in favorable histology tumors B7-H1 expression was associated with a 3.7-fold increased risk of recurrence (p = 0.03). CONCLUSIONS: B7-H1 is expressed by Wilms tumor, correlates with tumor biology and is associated with an increased risk of recurrence in patients with favorable histology tumors. B7-H1 may prove useful in identifying high risk patients who could benefit from more aggressive initial treatment regimens, and may represent a promising therapeutic target. Multi-institutional studies to elucidate the role of B7-H1 in the treatment of Wilms tumor are warranted.

Side by side: Modeling dyadic physiological linkage in strangers.

Physiological linkage (PL) refers to coordinated physiological responses among interacting partners (Feldman, 2012a), thought to offer mammals evolutionary advantages by promoting survival through social groups. Although PL has been observed in dyads who are familiar or have close relationships (e.g., parent-infant interactions, romantic couples), less is known with regard to PL in stranger dyads. The current study used dynamic linear time series modeling to assess cardiac interbeat interval linkage in 26 same-gender stranger dyads (17 female and 9 male dyads; 18-22 years old) while they spoke or wrote about emotional or neutral life events. The estimated coefficients in bivariate regression models indicated small but statistically significant PL effects for both male and female dyads. The PL effect was stronger for female dyads, extending to a lag of 4 seconds. For male dyads, the effect was statistically significant but weaker than for female dyads, extending only to a lag of 1 second. No statistically significant differences in PL were noted for type of task (i.e., baseline, writing, speaking, listening) or with differing task emotional content. Frequency domain analysis based on the estimated dynamic models yielded similar results. Our results suggest that PL can be detected among strangers in this setting and appears to be stronger and longer-lasting in women. Our findings are discussed in terms of the importance of biological synchrony in humans, gender differences, and possible implications for objective measurement of social reciprocity at a physiological level. (PsycINFO Database Record

Timing of posterior urethral valve diagnosis and its impact on clinical outcome.

OBJECTIVE: Our goals were to assess long-term outcome for patients with posterior urethral valves (PUV) and determine the impact of the timing of diagnosis. PATIENTS AND METHODS: We reviewed the hospital records for patients with PUV treated in 1994-2008. Only those patients diagnosed, treated surgically, and followed clinically at our center were included. RESULTS: There were 52 patients with PUV. Thirty-nine were diagnosed by 1 year of age (early diagnosis cohort), while 13 were diagnosed after 1 year (late diagnosis cohort). Mean follow up after valve operation was 7.2 years (range 15 months-14 years). Chronic renal failure rates were not statistically different between the early and late diagnosis groups after surgical intervention: 48% (14/29) vs 25% (3/12), P = 0.30. Among the early diagnosis cases, 10% (3/29) eventually required renal transplant, while no child in the late diagnosis group has developed end-stage renal disease to date (P = 0.55). CONCLUSIONS: Gestational age at diagnosis is an important predictor of postnatal renal outcome. Our results suggest that diagnosis after 1 year of age is associated with a lower risk of developing renal insufficiency on long-term follow up.

Vesicoureteral reflux in children with urachal anomalies.

OBJECTIVE: We report the largest known series of vesicoureteral reflux (VUR) in children with urachal anomalies (UA). METHODS: Two institutions' records were reviewed for children with UA (1951‒2007). RESULTS: Of 30 girls and 36 boys with UA (34 urachal cysts, 14 patent urachus, 10 urachal diverticula, 7 urachal sinuses, and 1 unknown), 57 (86%) underwent surgical resection or drainage. A voiding cystourethrogram was obtained in 22 (33%). VUR was demonstrated in 14 of the 22 children (64%), and rates were similar among the various types of UA. The median age with versus without VUR was not different (1.3 vs 1.7 years, P=0.97). Of 24 refluxing renal units, classification was grade≤3 in 71%, 4‒5 in 12%, and unspecified in 17%. Four children (26%) underwent ureteroneocystostomy and 10 observed patients resolved spontaneously. CONCLUSION: To our knowledge, this is the first series of VUR associated with UA. The increased incidence of VUR (64%) in this small subset of patients warrants prospective studies to determine if there is a positive correlation with UA. We believe thorough genitourinary and family histories are important when evaluating children with UA to help detect clinically significant VUR.

Gross hematuria in a 3-year-old girl caused by a large isolated bladder hemangioma.

Hemangiomas of the urinary tract can arise anywhere along the system. Although rare, these lesions can result in significant hematuria, with potential for patient morbidity. We report a case of an isolated bladder hemangioma identified in a 3-year-old girl presenting with recurrent high-volume gross hematuria. The lesion was not amenable to endoscopic resection because of its size. We present our operative management strategy as a potential method for other urologists who may be presented with similar scenarios.

Cryptorchidism: pathogenesis, diagnosis, treatment and prognosis.

Cryptorchidism is a common genital anomaly diagnosed at birth or during childhood. Genetic and/or environmental factors that alter expression or function of hormones crucial for testicular descent, insulin-like 3, and testosterone, may contribute to cryptorchidism. When identified at birth, surgical treatment is indicated by 6 months of age if testes fail to descend, or at the time of diagnosis in older children. A laparoscopic approach is preferred for abdominal testes. Early surgical therapy may reduce the risk of subfertility and/or malignancy.

Evaluation of need for salvage continence procedures after failed modern staged repair.

OBJECTIVES: To assess our experience with salvage continence procedures in patients with bladder exstrophy. METHODS: We retrospectively reviewed our surgical records of patients with bladder exstrophy who had undergone failed modern staged repair elsewhere and underwent salvage continence operations at our institute from 1996 to 2008. RESULTS: A total of 16 patients had undergone salvage continence operations. Bladder augmentation was performed in 11 patients (68.8%); 14 children (87.5%) received a continent, catheterizable stoma. In 6 children (37.5%) bladder neck injections were done. Three patients (18.8%) underwent bladder neck closure combined with other reconstructive procedures. A total of 49 continence procedures were performed, with an average of 3.06 per patient. We included all 16 children >5 years. After these operations, 13 of 16 (81.3%) became continent. Two children were able to void spontaneously and were dry day and night (12.5%). Of the remaining 14 patients, all of whom used clean intermittent catheterization, 11 (68.7%) were continent during the day and night with augmentation and/or a catheterizable stoma. Three patients were incontinent (18.7%). CONCLUSIONS: Although the need to perform salvage continence procedures after failed bladder modern staged repair is high, when patients are appropriately selected, continence can be achieved eventually.

Developmental evaluation of aldo-keto reductase 1C3 expression in the cryptorchid testis.

OBJECTIVES: To characterize aldo-keto reductase 1C3 (AKR1C3) expression in surgically-removed cryptorchid testes. Human AKR1C3 is a monomeric, cytoplasmic, multifunctional enzyme that reduces ketosteroids, ketoprostaglandins, and lipid aldehydes. AKR1C3 expression has been demonstrated in normal adult Leydig cells and peritubular fibromyocytes. No prior studies have evaluated AKR1C3 expression patterns across different age groups. METHODS: Surgically excised cryptorchid testes were subjected to hematoxylin-eosin evaluation to review overall testicular pathology. These samples were then evaluated for AKR1C3 distribution via immunohistochemical staining with a monospecific AKR1C3 monoclonal antibody. Single-pathologist grading of AKR1C3 expression was correlated with clinical presentations. RESULTS: A total of 16 cryptorchid testes were identified from the 2000 to present. Median age at the time of surgery was 9 years (range, 1-17). The testes were excised due to atrophy, poor tissue consistency, and short spermatic cord length. AKR1C3 expression was identified at all ages in fibromyocytes surrounding the testicular tubules. Leydig cell expression was absent at Tanner stages 1 and 2, while strong expression was found at Tanner stage 3 and beyond. No AKR1C3 expression was seen in germ cells at any stage. AKR1C3 expression was identified in 18%-26% of Sertoli cells in patients at Tanner stages 2 and beyond. CONCLUSIONS: AKR1C3 expression occurs in a Tanner stage dependent-fashion. Pre- and peri-pubertal changes appear to promote expression of the enzyme in Leydig cells. In contrast to the normal adult testis, the pediatric cryptorchid testis reveals AKR1C3 expression in Sertoli cells. Additional studies are warranted to determine the involvement of AKR1C3 in testicular descent and development.

Enhanced angiogenesis of modified porcine small intestinal submucosa with hyaluronic acid-poly(lactide-co-glycolide) nanoparticles: from fabrication to preclinical validation.

Hyaluronic acid-poly(de-co-glycolide) nanoparticles (HA-PLGA NPs) were synthesized to stabilize the porous structure of porcine small intestinal submucosa (SIS), to improve surface biocompatibility and to enhance performance in tissue regeneration. HA-PLGA NPs were characterized for size, zeta potential, surface morphology, and HA loading. Human microvascular endothelial cells responded to HA-PLGA NPs and HA-PLGA modified SIS (HA-PLGA-SIS) with elevated cell proliferation. HA-PLGA-SIS significantly enhanced neo-vascularization in an in ovo chorioallantoic membrane angiogenesis model. The angiogenic capability of the newly fabricated HA-PLGA-SIS was tested in a canine bladder augmentation model. Urinary bladder augmentation was performed in beagle dogs following hemi-cystectomy using HA-PLGA-SIS. The regenerated bladder was harvested at 10 weeks post augmentation and vascularization was evaluated using CD31 immunohistochemical staining. Bladder regenerated with HA-PLGA-SIS had significantly higher vascular ingrowth compared to unmodified SIS. This study shows that HA-PLGA NPs may represent a new approach for modifying naturally derived SIS biomaterials in regenerative medicine.

Iatrogenic ureteral injury: can adult repair techniques be used on children?

OBJECTIVE: Iatrogenic ureteral injury in children is a rare occurrence, with sparse literature available regarding optimal repair techniques. We reviewed our experience in the management of iatrogenic pediatric ureteral injuries, particularly with respect to initial versus delayed diagnoses. METHODS: All pediatric iatrogenic ureteral injuries repaired by a single surgeon during 1986-2007 were reviewed. RESULTS: Ten injuries were repaired over 20 years. Median patient age was 12 years. Injuries occurred during five open tumor resections, three laparoscopic procedures and two ureteroscopies. Diagnosis was immediate in four patients. Median ureteral defect length was 4 cm (range 2-5). All underwent ureteral reimplantation and psoas hitch Boari flap. Median follow up was 1 year, with no obstruction noted. Diagnosis was delayed in six patients by a median of 21 days. Five children (83%) were managed by temporary percutaneous nephrostomy tube and one (17%) by ureteral stent. Delayed repair was performed 1-3 months later. In the patients with laparoscopic or ureteroscopic injuries the median ureteral defect length was 4 cm (range 3-6). All underwent ureteral reimplantation and psoas hitch Boari flap. Median follow up was 1 year, with no obstruction noted. One child had a proximal ureteral defect 8 cm long; delayed ileal ureter was performed with good results 4 years postoperatively. CONCLUSIONS: Pediatric iatrogenic ureteral injuries are rare and may be repaired by both immediate and delayed techniques as circumstances demand. Standard techniques used in the adult population may be employed in children with the expectation of good long-term results.

Leukocyte inflammatory response in a rat urinary bladder regeneration model using porcine small intestinal submucosa scaffold.

Small intestinal submucosa (SIS) is a biodegradable scaffold that supports bladder regeneration after partial cystectomy. We sought to define the inflammatory response present in a rat bladder augmentation model using distal ileal SIS. Fifteen Sprague-Dawley rats underwent hemi-cystectomy followed by anastomosis of a bladder patch of SIS. Bladders were excised after days 2, 7, 14, 28, and 56. Tissue regeneration was evaluated by standard hematoxylin and eosin. Immunohistochemical staining was used to quantify neutrophils, macrophages, eosinophils, and mast cells. Total cell counts per unit area were compared between native and graft portions of the bladder for each cell type across the entire time course. Statistical analyses were conducted with the Wilcoxon Rank-Sum and Kruskal-Wallis tests. All tests were two-sided with significance set at p < 0.05. These inflammatory responses evolved consistently across all bladders over time. Neutrophil and eosinophil numbers were highest at day 2 and decreased over the 56-day period. In contrast, macrophage and mast cell numbers were low at days 2, 7, and 14; peaked at day 28; and decreased once again at day 56. Cell counts at native and graft sites were equivalent for all cell types, except neutrophils, which were more commonly found in the graft (124 vs. 24 cells/mm(2), p = 0.009). Thus, the inflammatory processes change over time during SIS-mediated bladder regeneration. Similar cell densities are present between the native and SIS portions of the bladder, but neutrophils predominate in the graft areas.

Reassessing the diagnostic yield of saturation biopsy of the prostate.

OBJECTIVE: Prostate biopsy remains the gold standard for detection of prostate cancer (PCa). This study was performed to determine whether saturation biopsy (>or= 24 cores) detects more prostate cancer than a standard 12-18 core office biopsy technique. METHODS: We conducted a nonrandomized cohort study of a consecutive series of prostate biopsies. The primary outcome assessed by both univariate and multivariate analysis was the detection of PCa, whereas the secondary outcomes of HGPIN (high-grade prostatic intraepithelial neoplasia) and ASAP (atypical small acinar proliferation) were also analyzed. RESULTS: From September 2005 to June 2006, a total of 469 patients undergoing prostate biopsy were included in this study. A standard office prostate biopsy was performed in 301 men, whereas 168 underwent a saturation biopsy. Age, body mass index (BMI), prostate volume, and family history of PCa were similar. However, patients in the saturation biopsy cohort were more likely to have had prior biopsies, higher prebiopsy PSA, longer PSA doubling times, and to carry more frequent diagnoses of HGPIN or ASAP (all p<0.05). After adjusting for covariates, saturation biopsy did not detect more abnormal pathology than standard office prostate biopsy, including PCa (OR, 1.2; p=0.339), HGPIN (OR, 1.4; p=0.368), or ASAP (OR, 2.2; p=0.201). CONCLUSIONS: Saturation biopsy does not appear to detect more abnormal prostate pathology than standard office biopsy of the prostate. This procedure may be associated with increased cost and patient morbidity.

Utility of dextranomer/hyaluronic acid injection in setting of bladder and ureteral anomalies.

OBJECTIVES: Previous studies have shown that the cure rates after dextranomer/hyaluronic acid (Dx/HA) injection can be decreased in patients with neurogenic bladder, previous ureteroneocystostomy, duplicated ureters, or periureteral diverticula. We attempted to determine whether these factors reduce the efficacy of Dx/HA injection compared with that in otherwise normal patients. METHODS: All children with vesicoureteral reflux (VUR) undergoing Dx/HA injection from April 2002 to March 2006 at two institutions were eligible for this study. Multivariate logistic regression models were built to assess the effect of bladder/ureteral anomalies on the success of Dx/HA injection. We adjusted for previously described predictors of injection success, including VUR grade, sex, age, surgeon experience, and injection technique. RESULTS: A total of 543 refluxing ureters (373 patients) were included, of which 145 (27%) had persistent VUR on postoperative voiding cystourethrography; 86 ureters (16%) had anatomic anomalies. On univariate analysis, the most important predictors of injection failure were increasing VUR grade, male sex, younger age, subureteral injection, ureteral duplication anomaly, increasing Dx/HA volume, and surgeon experience. On multivariate analysis, however, the only significant predictors of injection failure were increasing VUR grade, subureteral injection technique, and surgeon experience. No anatomic or functional abnormalities, considered individually or grouped, significantly affected the probability of injection failure. CONCLUSIONS: In our experience, children with functional and anatomic bladder/ureteral anomalies were no more likely to have Dx/HA injection fail than were children with uncomplicated VUR. The most important predictors of Dx/HA success remained VUR grade, injection technique, and surgeon experience. Dx/HA injection in patients with complex bladders could be a reasonable therapeutic option.