Data show high stone-free rates with URS LL in all locations of the urinary tract and with all stone types and sizes. Recent data comparing LL with dusting versus basketing suggest higher rates of residual fragments with dusting but less utilization of ureteral access sheaths and potentially shorter operative times. Differences in postoperative complications, re-intervention rates, and other outcome parameters are not yet clear. Interpretation of published data is problematic due to variability in laser settings, follow-up intervals, and definitions for what constitutes stone-free status. URS has overtaken shock wave lithotripsy in the last decade as the most commonly utilized surgical approach for treating urolithiasis. Two primary strategies have emerged as the most common techniques for performing LL: dusting and basketing. There is a relative paucity of data examining the difference in these techniques as it pertains to peri-operative outcomes and overall success. We attempt to synthesize this data into evidence-based and experience-based recommendations.
The study objective was to evaluate the efficacy of changing testosterone gel preparations among suboptimally responsive hypogonadal men. The records of all hypogonadal men on gel (Testim or Androgel) testosterone replacement therapy (TRT) were reviewed to identify men who underwent a brand substitution in gel TRT due to initial suboptimal response. Total and free serum testosterone levels and the presence of hypogonadal symptoms (ADAM) were compared pre-and post-gel substitution. Of the 370 hypogonadal men on testosterone gel replacement therapy, 75 (20%) underwent a brand substitution. Prior to substitution, among patients initially treated with Androgel, the mean total and free testosterone levels were 311 ng dl À1 and 10.4 pg ml À1 , respectively. Total testosterone levels were below 300 ng dl À1 in 58% of these patients. Following a change to Testim, mean total and free testosterone levels increased to 484 ng dl À1 (Po0.001) and 14.6 pg ml À1 (P ¼ 0.01), respectively. Total testosterone levels remained below 300 ng dl À1 in only 17% of these patients. Among patients initially treated with Testim, the mean total and free testosterone levels were 544 ng dl À1 and 18.0 pg ml À1 , respectively. Total testosterone levels were below 300 ng dl À1 in 15% of men. Following testosterone gel change to Androgel, mean total and free testosterone levels were 522 ng dl À1 (P ¼ 0.7) and 16.1 pg ml À1 (P ¼ 0.6), respectively. Total testosterone levels remained below 300 ng dl À1 in 27% of these patients. Hypogonadal symptoms improved in a significant proportion of men who underwent a brand substitution following an initial suboptimal biochemical or symptomatic response. A change in testosterone gel preparation among initially unresponsive hypogonadal men is justified prior to abandoning or considering more invasive TRT. Changing from Androgel to Testim offers hypogonadal men the potential for improved clinical and biochemical responsiveness. Changing from Testim to Androgel is indicated to eliminate or minimize unwanted side effects.
BackgroundTraditional beliefs of androgen’s stimulating effects on the growth of prostate cancer (PCa) have been challenged in recent years. Our previous in vitro study indicated that physiological normal levels of androgens inhibited the proliferation of PCa cells. In this in vivo study, the ability of testosterone (T) to inhibit PCa growth was assessed by testing the tumor incidence rate and tumor growth rate of PCa xenografts on nude mice.MethodsDifferent serum testosterone levels were manipulated in male nude/nude athymic mice by orchiectomy or inserting different dosages of T pellets subcutaneously. PCa cells were injected subcutaneously to nude mice and tumor incidence rate and tumor growth rate of PCa xenografts were tested.ResultsThe data demonstrated that low levels of serum T resulted in the highest PCa incidence rate (50%). This PCa incidence rate in mice with low T levels was significantly higher than that in mice treated with higher doses of T (24%, P < 0.01) and mice that underwent orchiectomy (8%, P < 0.001). Mice that had low serum T levels had the shortest tumor volume doubling time (112 h). This doubling time was significantly shorter than that in the high dose 5 mg T arm (158 h, P < 0.001) and in the orchiectomy arm (468 h, P < 0.001).ConclusionThese results indicated that low T levels are optimal for PCa cell growth. Castrate T levels, as seen after orchiectomy, are not sufficient to support PCa cell growth. Higher levels of serum T inhibited PCa cell growth.
There have been no previous reports of post-chemotherapy robotic bilateral retroperitoneal lymph node dissection (RPLND) using a single-dock technique. One deterrent of robotic RPLND is that accessing bilateral retroperitoneal spaces requires patient reposition and surgical robot redocking, therefore increasing operative time. Herein we provide the first step-by-step description of a single-dock technique for robotic bilateral RPLND in the post-chemotherapy setting. We describe port placement and technique for robot positioning to optimize access to bilateral retroperitoneal spaces with a single dock. We also demonstrate the feasibility of sparing the inferior mesenteric artery when utilizing this approach. This single-dock approach was used on two patients at our institution who had residual paracaval masses following chemotherapy for metastatic testicular cancer. Mean operative time was 6 h, and neither patient had significant blood loss or suffered from any peri-operative complications.
We evaluated the potential use of intraoperative gelatin matrix hemostatic sealant (GMHS; FloSeal; Baxter Healthcare) embedded with macrophages (M/) transduced with murine interleukin (IL)-12 recombinant adenoviral vector (G/M//AdmIL-12) for prevention of recurrence of prostate cancer following radical prostatectomy. Application of G/M//AdmIL-12 resulted in significant suppression of tumor growth and spontaneous lung metastases, a statistically significant survival advantage of the G/M//AdmIL-12-treated animals, more efficient trafficking of M/ to lymph nodes draining from the prostate and generation of systemic natural killer cell activity and tumor-specific cytolytic T lymphocyte responses compared to the controls in a preclinical mouse model of residual prostate cancer. Our data recommend this treatment as a novel adjuvant for prevention of local recurrence of prostate cancer following radical prostatectomy.
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