Management of urethral recurrence after orthotopic urinary diversion

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To evaluate our experience with urethral recurrences in patients treated by radical cystectomy(RC) and orthotopic neobladder urinary diversion for carcinoma of the bladder.

PATIENTS AND METHODS

We retrospectively reviewed the records of patients treated with RC and orthotopic urinary diversion between January 1980 and July 2004.

RESULTS

In all, 260 patients underwent RC with a Studer or Hautmann orthotopic urinary diversion; the median (range) follow‐up was 5.1 (0–15.6) years. Six patients (2.3%) developed local recurrence of urothelial cancer (UC) within the urethra after this treatment. The median (range) time to presentation with recurrence after RC was 2.4 (0.7–3.6) years for pT1‐4 UC. Recurrences were treated with various methods, including transurethral resection, urethrectomy with conversion of neobladder to continent catheterizable diversion, and chemotherapy. At the last follow‐up, four of these six patients were alive without disease, one was alive with disease, and one had died from disease.

CONCLUSIONS

In our experience, local recurrences involving the urethra are infrequent. Complete surgical excision can provide a good outcome. Neoadjuvant chemotherapy should be considered for recurrences with adverse clinicopathological features.     

Characterizing the contribution of stem/progenitor cells to tumorigenesis in the Pten-/-TP53-/- prostate cancer model

Loss of PTEN is one of the most common mutations in prostate cancer, and loss of wild-type TP53 is associated with prostate cancer progression and castrate resistance. Modeling prostate cancer in the mouse has shown that while Pten deletion in prostate epithelial cells leads to adenocarcinoma, combined loss of Pten and TP53 results in rapidly developing disease with greater tumor burden and early death. TP53 contributes significantly to the regulation of stem cell self-renewal, and we hypothesized that loss of Pten/TP53 would result in measurable changes in prostate cancer stem/progenitor cell properties. Clonogenic assays that isolate progenitor function in primary prostate epithelial cells were used to measure self-renewal, differentiation, and tumorigenic potential. Pten/TP53 null as compared with wild-type protospheres showed increased self-renewal activity and modified lineage commitment. Orthotopic transplantation of Pten/TP53 null cells derived from protospheres produced invasive Prostatic Intraepithelial Neoplasia (PIN)/adenocarcinoma, recapitulating the pathology seen in primary tumors. Pten/TP53 null progenitors relative to wild type also demonstrated increased dependence on the AKT/mammalian target of rapamycin complex 1 (mTORC1) and androgen receptor (AR) pathways for clonogenic and tumorigenic growth. These data demonstrate roles for Pten/TP53 in prostate epithelial stem/progenitor cell function, and moreover, as seen in patients with castrate-resistant prostate cancer, suggest for the involvement of an AR-dependent axis in the clonogenic expansion of prostate cancer stem cells.     

Diagnosis and treatment of midline prostatic cysts

We report three patients with midline prostatic cysts (simple, n=1; complex, n=2) that presented with low ejaculate volume and hematospermia. Transrectal ultrasound (TRUS) revealed a midline prostatic cystic structure that could represent either an ejaculatory duct cyst or a Müllerian duct cyst. In one patient, the ejaculatory duct cyst was confirmed by identification of spermatozoa at microscopic analysis of fluid obtained by TRUS-guided needle aspiration. The two other patients underwent transurethral incision of the cyst with complete resolution of symptoms.     

How well is the outcome of patch testing remembered by the patients? A 10‐year follow‐up of testing with the Swedish baseline series at the Department of Dermatology in Örebro,Sweden

Background. Patch testing is beneficial for patients with contact dermatitis. However, it is not known how well the outcome of patch testing is remembered after a prolonged period. Objectives. To study how well patients remember the outcome of their tests after 1–10 years. Patients/materials/methods. In 2010, a questionnaire was sent to all patients tested with the Swedish baseline series in 2009, 2005, and 2000. Results. The response rate was 53.3% (252/473), and 96% (241/252) of patients reported that they had been submitted for allergy testing. Among those with positive patch test results, 79% (111/141) remembered a positive result and 29% (41/141) reported the correct name of the allergen. We found a wide variation (0–80%) in how well the patients remembered positive test results for different allergens. The ability to recall allergens had no relationship with the localization or extension of eczema lesions, but was negatively correlated with the number of diagnosed allergies, the number of years after patch testing, and being male. Conclusions. Our results indicate that improved information for patients following patch testing is required, in order to improve the prognosis of contact dermatitis.