Patients with posterior urethral valves and severe bladder dysfunction in whom nadir creatinine remains increased are at risk for upper urinary tract deterioration, requiring renal replacement therapy. It is unclear whether high grade vesicoureteral reflux at diagnosis may also be a poor prognostic sign. Further analysis is necessary to evaluate the effects of early aggressive bladder management on renal outcomes.

PURPOSE We performed a population-based study comparing trends in perioperative outcomes and cost for open (OP), laparoscopic (LP), and robotic (RP) pediatric pyeloplasty. Specific billing items contributing to cost were also investigated. MATERIALS AND METHODS Using the Premier Perspective database, we identified 12,662 pediatric patients who underwent open, laparoscopic and robotic pyeloplasty (ICD-9 55.87) in the United States from 2003 – 2010. Univariate and multivariate statistics were used to evaluate perioperative outcomes, complications, and costs for the competing surgical approaches. Propensity weighting was employed to minimize selection bias. Sampling weights were used to yield a nationally representative sample. RESULTS A decrease in OP and a rise in minimally invasive pyeloplasty (MIP) was observed. All procedures had low complication rates. Compared to OP, LP and RP had longer median operating room (OR) times (240 minutes, p<0.0001 and 270 minutes, p<0.0001, respectively). There was no difference in median length of stay (LOS). The median total cost was lower among patients undergoing OP versus RP ($7,221 vs $10,780, p<0.001). This cost difference was largely attributable to robotic supply costs. CONCLUSIONS During the study period, OP made up a declining majority of cases. LP utilization plateaued, while RP increased. OR time was longer for MIP, while LOS was equivalent across all procedures. A higher cost associated with RP was driven by OR use and robotic equipment costs, which abrogated low room and board cost. This study reflects an adoption period for RP. With time, perioperative outcomes and cost may improve.

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Intraoperative breakdown of the Da Vinci robot is uncommon, but patients should be counseled preoperatively and a plan devised on how breakdown will be managed. Intracorporeal suturing skills allow conversion to a pure laparoscopic approach, if necessary. Consequently, standard laparoscopic suturing skills should remain in the residency curriculum.

BackgroundAberrant expression of HGF/SF and its receptor, c-Met, often correlates with advanced prostate cancer. Our previous study showed that expression of c-Met in prostate cancer cells was increased after attenuation of androgen receptor (AR) signalling. This suggested that current androgen ablation therapy for prostate cancer activates c-Met expression and may contribute to development of more aggressive, castration resistant prostate cancer (CRPC). Therefore, we directly assessed the efficacy of c-Met inhibition during androgen ablation on the growth and progression of prostate cancer.MethodsWe tested two c-Met small molecule inhibitors, PHA-665752 and PF-2341066, for anti-proliferative activity by MTS assay and cell proliferation assay on human prostate cancer cell lines with different levels of androgen sensitivity. We also used renal subcapsular and castrated orthotopic xenograft mouse models to assess the effect of the inhibitors on prostate tumor formation and progression.ResultsWe demonstrated a dose-dependent inhibitory effect of PHA-665752 and PF-2341066 on the proliferation of human prostate cancer cells and the phosphorylation of c-Met. The effect on cell proliferation was stronger in androgen insensitive cells. The c-Met inhibitor, PF-2341066, significantly reduced growth of prostate tumor cells in the renal subcapsular mouse model and the castrated orthotopic mouse model. The effect on cell proliferation was greater following castration.ConclusionsThe c-Met inhibitors demonstrated anti-proliferative efficacy when combined with androgen ablation therapy for advanced prostate cancer.

There are significant differences in 24-hour urinary calcium levels between solitary and recurrent calcium stone forming children. A patient with increased urinary calcium indices on a 24-hour specimen may benefit from more aggressive initial dietary and pharmacological treatment to prevent stone recurrence.

Background:The LZTS2 is a novel ␤-catenin-interacting protein, and its role in development and tumorigenesis is unknown. Results: Lzts2 KO mice show severe kidney and urinary tract developmental defects, including renal/ureteral duplication, hydroureter, and hydronephrosis. Conclusion: LZTS2 plays a critical role in kidney and urinary tract development. Significance: A novel mechanism by which LZTS2 regulates ␤-catenin mediated nephrogenesis is implicated.

This study showed improved performance using three-dimensional optics on some tasks, but not a significant improvement in overall results. Three-dimensional vision does appear beneficial during performance of some complex tasks. The wrist-like action of the robot improved performance on some tasks, while the lack of tactile feedback likely was a source of errors on other tasks.