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Permanent Urology Job in Shelbyville Tennessee with Community Health Systems
IDEAL UROLOGY PRACTICE OPPORTUNITY IN NASHVILLE AREA Heart of Tenn's Walking Horse Country within an hour's drive from Nashville This is your opportunity to live in a lovely, growing, hometown nestled
Permanent Urology Job in Selmer Tennessee with Community Health Systems
UROLOGY Opportunity near Pickwick Lake - TENNESSEE McNairy Regional Hospital is seeking a BC/BE Urologist for this lovely community east of Memphis and north of Corinth, Mississippi. Nearby Pickwick
Permanent Urology Job in Morristown Tennessee with Community Health Systems
Establish a thriving solo practice; Just Outside Knoxville, TN! If you're looking to establish your own solo practice in a mid-sized community conveniently located near mountain lakes, the Great Smoky

Urology / Nephrology News From Medical News Today

Antibiotic Prophylaxis For Children With Primary Vesicoureteral Reflux: Where Do We Stand Today?
Mon, 01 Dec 2008 00:00:00 -0800
UroToday.com - A systematic review, performed by Michiel Costers, et al., evaluated the cessation of antibiotic prophylaxis in children with primary vesicoureteral reflux. The main goal of this study was to see whether antibiotics could be safely discontinued in children with reflux and whether prophylaxis was truly effective in the prevention of recurrent UTI's and renal damage in those patients.
Pediatric Robotic-assisted Laparoscopic Augmentation Ileocystoplasty And Mitrofanoff Appendicovesicostomy: Complete Intracorporeal - Initial Case
Mon, 01 Dec 2008 00:00:00 -0800
UroToday.com - In this article, Dr. Mohan S. Gundeti, et al., from the University of Chicago reported on an initial experience with a pediatric robotic assisted laparoscopic augmentation in the execution of a Mitrofanoff appendicovesicostomy. They utilized five transperitoneal laparoscopic ports before docking the daVinci S robotic system. Their mobilization was done laparoscopically before using robotic assistance.
The Minimally Invasive Treatment Of Ureteropelvic Junction Obstruction: A Review Of Our Experience During The Last Decade
Mon, 01 Dec 2008 00:00:00 -0800
UroToday.com - This companion article to the prior large series on robotic pyeloplasty is of great importance as the authors have evaluated retrograde endopyelotomy (128 patients), laparoscopic dismembered pyeloplasty (116 patients), and robotic pyeloplasty (29 patients) with renal scans, over time. Notable is that with 19-20 months mean follow-up in all 3 groups, the success rate is 60%, 89% and 100%.

BMC Urology - Latest articles

The trends in prostate specific antigen usage amongst United Kingdom urologists, a questionnaire based study.
Helena P Burden, Chris R Davis, Sophie Tate, Raj Persad, Chris H Holmes and Kate Whittington Thu, 20 Nov 2008 00:00:00 -0000
Background: Worldwide, the use of prostate specific antigen (PSA) testing as a screen for prostate cancer is contentious. Whilst there is no National UK Screening programme, many men undergo opportunistic screening. This study investigates UK urologist's usage of PSA and the awareness surrounding the Department of Health (DoH) PSA guidelines. Methods: Urologists were sent a questionnaire regarding PSA cut-off values. Results: Of the 733 urologists eligible to participate in this study 346 returned completed questionnaires giving a response rate of 47%. The most commonly generally used age-related PSA cut-off values (36% of respondents) are - 3.5 ng/ml for 50 - 59 year olds, 4.5 ng/ml for 60 - 69 year olds and 6.5 ng/ml for over 70 year olds. Two-thirds (58%, 200/346) of respondents were aware of the DoH PSA guidelines but only 20% (n=69/346) follow these guidelines. The majority of respondents (68%, n=234/346) used higher PSA cut-offs than recommended by the DoH. The level of compliance showed marked regional variation with a range from 7% to 44% (median 19%). In addition, it was apparent that lower PSA cut-off values were used in private practice as opposed to the National Health Service. Conclusion: A nationwide lack of agreement on PSA cut-off values may generate a variable standard of care both regionally and in NHS versus private practice. Generally, higher PSA cut-off values are being used than recommended by the DoH guidance.
The influence of high and low levels of estrogen on diurnal urine regulation in young women
Charlotte Graugaard-Jensen, Gitte M. Hvistendahl, Jorgen Frokiaer, Peter Bie and Jens Christian Djurhuus Wed, 19 Nov 2008 00:00:00 -0000
Background: Sex hormones have a pronounced effect on arginine vasopressin (AVP), and therefore on the diurnal water homeostasis. Low and high levels of plasma-estradiol as seen in the follicular phase of the menstrual cycle may therefore alter the diurnal regulation of urine production. Furthermore the structural resemblance of oxytocin to vasopressin has led to speculations about the possible antidiuretic properties of oxytocin under normal physiological conditions. To elucidate the influence of high and low p-estradiol on the regulation of the diurnal urine production, 15 normal menstruating women (21-33 y) underwent two circadian in-patient investigations, both situated in follicular phase. Methods: Admitting the participants solely in the follicular phase resulted in high and low plasma-estradiol whereas plasma-progesterone was similar. Urine and blood samples were taken at predetermined time points to determine plasma AVP, plasma oxytocin, plasma aldosterone, plasma natriuretic peptide (ANP), urinary solute excretions, and urinary excretions of prostaglandin E2 (PGE-2) and aquaporin-2 (AQP-2). Blood pressure was measured every hour. Results: Plasma AVP, plasma aldosterone and plasma ANP were unaffected by the different levels of estradiol. All had marked circadian variations whereas oxytocin did not display any circadian rhythm. High estradiol resulted in lower p-osmolality and p-sodium reflecting a downward resetting of the osmoreceptors. Oxytocin did not correlate with either diuresis or urine osmolality. The diurnal urine production was similar in the two groups as were urine osmolality, excretion of PGE-2 and AQP-2. AQP-2 does not have a circadian rhythm and is not significantly correlated to either AVP or oxytocin under normal physiological conditions. Conclusion: High and low level of estradiol has no influence on the circadian rhythm of AVP or the subsequent urine production. High p-estradiol resets the osmoreceptors for AVP release. Furthermore it appears that oxytocin under normal physiological conditions do not contribute to the overall antidiuretic effect.
GOLPH2 expression in renal cell cancer
Florian R Fritzsche, Mark-Oliver Riener, Manfred Dietel, Holger Moch, Klaus Jung and Glen Kristiansen Tue, 11 Nov 2008 00:00:00 -0000
Background: Renal cell carcinomas (RCC) are among the most common and most lethal genitourinary malignancies. GOLPH2 (golgi phosphoprotein 2, GOLM1) has recently been proposed as a biomarker for hepatocellular and prostate cancer. In this study we analysed the expression patterns and the prognostic and diagnostic value of GOLPH2 in RCC. Methods: GOLPH2 protein expression was analysed by immunohistochemistry in 104 clinically well characterized RCC cases in comparison with matched normal kidney tissue and in association with clinico-pathological parameters. Statistical analyses including Kaplan Meier analyses were performed with SPSS version 15.0. Results: GOLPH2 was highly expressed in normal renal tubules and in almost half of RCC with a statistically significant predominance in the papillary and chromophobe histological subtypes. No other associations with clinico-pathological parameters were detectable. The Kaplan-Meier curves showed a weak trend for unfavourable prognosis of tumours with high GOLPH2 expression, but failed significance. Conclusions: GOLPH2 protein is expressed in normal renal tissue (especially in distal tubular epithelia) and is down-regulated in the majority of clear cell RCC. In papillary and chromophobe RCC GOLPH2 expression is consistently present. In contrast to its diagnostic value in hepatocellular and prostatic carcinomas, a prognostic or diagnostic value of GOLPH2 in RCC appears to be unlikely.
Characterization of prostate cancer detected at repeat biopsy
Takeshi Yuasa, Norihiko Tsuchiya, Teruaki Kumazawa, Takamitsu Inoue, Shintaro Narita, Mitsuru Saito, Yohei Horikawa, Shigeru Satoh and Tomonori Habuchi Mon, 10 Nov 2008 00:00:00 -0000
Background: The aim of this study was to investigate the characteristics of prostate cancer patients who were diagnosed at repeat biopsy and compare them to non-cancerous patients or patients who were diagnosed at initial biopsy. Methods: We carried out a retrospective analysis of clinical and pathological data from 576 patients, which included data on the period of time from radical prostatectomy to biochemical failure. Results: Cancer was diagnosed in 191 (33%) of 576 patients at initial biopsy and in 23 (18%) of 127 patients who underwent a repeat biopsy. Cut-off values of 0.80 and 0.30 for prostate specific antigen velocity (PSAV) and prostate specific antigen density (PSAD), respectively, were determined using ROC curve analysis. Based on these values, PSAV and PSAD were able to predict 94% (46 of 49) of negative repeat biopsies, indicating that these patients had undergone unnecessary repeat biopsies. Although the patients who were diagnosed at repeat biopsy had a higher rate of organ-confined tumor than those who were diagnosed at initial biopsy (73% and 44%, respectively; P = 0.041), there were no differences in the recurrence rate or the duration of biochemical failure-free survival between the two groups. Conclusions: PSAV and PSAD may be useful indicators of the results of repeat biopsies. Although prostate cancer that was diagnosed at repeat biopsy was associated with a more favorable pathological profile, it was not associated with a better outcome after radical prostatectomy.
Implications of computer tomography measurement in the management of renal tumours
Rahul Mistry, Ramaswamy Manikandan, Penny Williams, Joe Philip, Peter Littler, Christopher S Foster and Keith F Parsons Tue, 04 Nov 2008 00:00:00 -0000
Background: To compare radiographic measurement and pathological measurement of renal tumours to see if there was a significant difference between the two as this may have implications in the management. Methods: We retrospectively analyzed CT measurements of 106 consecutive patients who underwent either radical or nephron sparing surgery in our institution and compared this to the actual measurement of the surgical specimen. The largest axial measurement was compared as this is the primary consideration before offering either treatment modality. Results: The mean age of the patients was 64 years (range 31–92). There were 76 males and 30 females. The median tumour size was 70 mm (range 16–175) on CT and 65 mm (range 15–90) on pathological measurement. 25 patients had a CT size ≤ 40 mm. CT tended to overestimate the size of tumours in 41 patients, underestimate in 45 and agree with surgical size in 20 patients. Statistically there was no significant difference between the two measurements (p = 0.7, Wilcoxon sign ranked test). When subdivided into tumours less than 40 mm (p = 0.7) and more than 40 mm (p = 0.09) again there was no statistically significant difference between the two measurements. However in 5(5%) patients who were not offered nephron sparing surgery based on CT findings (size > 40 mm) the pathological size was ≤ 40 mm (p = < 0.001, Fishers Exact test). Pathologically the tumours were classified as renal cell carcinoma (n = 98), angiomyolipoma (3), and oncocytoma (5). Conclusion: CT measurement of renal tumour size correlates well with the actual size of the tumour. However CT does tend to overestimate the size in a small number of patients which may have a bearing on the modality of treatment offered.
RASSF1A protein expression and correlation with clinicopathological parameters in renal cell carcinoma
Hossein Tezval, Axel S Merseburger, Ira Matuschek, Stefan Machtens, Markus A Kuczyk and Jürgen Serth Fri, 26 Sep 2008 00:00:00 -0000
Background: Epigenetic silencing of RAS association family 1A (RASSF1A) tumor suppressor gene occurs in various histological subtypes of renal cell carcinoma (RCC) but RASSF1A protein expression in clear cell RCC as well as a possible correlation with clinicopathological parameters of patients has not been analyzed at yet. Methods: 318 primary clear cell carcinomas were analyzed using tissue microarray analysis and immunohistochemistry. Survival analysis was carried out for 187 patients considering a follow-up period of 2–240 month. Results: Expression of RASSF1A was found to be significantly decreased in tumoral cells when compared to normal tubular epithelial cells. RASSF1A immunopositivity was significantly associated with pT stage, group stage and histological grade of tumors and showed a tendency for impaired survival in Kaplan-Meier analysis. Conclusion: While most tumors demonstrate a loss of RASSF1A protein, a subset of tumors was identified to exhibit substantial RASSF1A protein expression and show increased tumor progression. Thus RCC tumorigenesis without depletion of RASSF1A may be associated with an adverse clinical outcome.

Current Opinion in Urology - Current Table Of Contents

Editorial introductions.
Page: viiDOI: 10.1097/MOU.0b013e328317cb2d
Reconstructive urology.
Page: 555DOI: 10.1097/MOU.0b013e328311c9f1Authors: Woodhouse, Christopher
Robotic renal and upper tract reconstruction.
Page: 557DOI: 10.1097/MOU.0b013e32830fe43dAuthors: Hyams, Elias S; Mufarrij, Patrick W; Stifelman, Michael D
Current status of tissue engineering in urology.
Page: 564DOI: 10.1097/MOU.0b013e32830f9402Authors: Wood, Dan a; Southgate, Jennifer b
Salvage surgery for bladder outlet obstruction after prostatectomy or cystectomy.
Page: 570DOI: 10.1097/MOU.0b013e328311c9deAuthors: Westney, Ouida L
The prepuce: preservation and reconstruction.
Page: 575DOI: 10.1097/MOU.0b013e328311c9c2Authors: Haseebuddin, Mohammed; Brandes, Steven B

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