Justin T Matulay

Men with pathologic evidence of seminal vesicle invasion (SVI) at radical prostatectomy (RP) have higher rates of biochemical recurrence (BCR) and mortality. Adjuvant radiotherapy (XRT) has been shown to increase freedom from BCR, but its impact on overall survival is controversial and it may represent overtreatment for some. The present study, therefore, sought to identify men with SVI at higher risk for BCR after RP in the absence of adjuvant XRT. We identified 180 patients in our institutional database who underwent RP from 1990 to 2011 who had pT3bN0-1 disease. The Kaplan-Meier method was used to estimate freedom from BCR for the overall cohort and substratified by Gleason score, PSA, surgical margin status, and lymph node positivity. Cox Proportional Hazards models were used to determine demographic and histopathological factors predictive of BCR. Time-dependent ROC curve analysis was conducted to assess the ability of the UCSF-CAPRA score to predict BCR. Median age was 64 year...

We analyze the relationship between various patient, operative, and tumor characteristics to determine which factors correlate with renal parenchymal volume (RPV) loss after nephron sparing surgery (NSS) using a novel 3-dimensional (3-D) volume assessment. Retrospective review of institutional database from 1992-2014 of patients who underwent NSS for a localized renal mass. Tumors were classified according to the R.E.N.A.L. nephrometry system. Using 3-D reconstruction imaging software, preoperative and postoperative RPV was calculated for the ipsilateral and contralateral kidney. 158 patients were analyzed with mean age 58.7 years and mean follow-up of 40.1 months. The mean preoperative tumor volume was 34.0cc and mean tumor dimension was 3.4cm. The mean R.E.N.A.L. nephrometry score was 6.2, with 60.1%, 34.2%, and 5.7% of tumors classified as low, medium, and high complexity, respectively. The mean change in RPV after NSS was -15.3% for the ipsilateral kidney and -6.8% for the total...

Involvement of the prostatic urethra by bladder cancer directly impacts prognosis, risk of urethral recurrence, and timing of radical cystectomy (RC); it also affects the type of urinary diversion chosen. Both cold cup biopsies and transurethral (TUR) loop biopsies have been used to evaluate the status of the prostatic urethra. We report our 20 year experience with preoperative and intro-operative prostatic urethral biopsies in order to determine relative efficacy and associated treatment implications. The Columbia University urologic oncology database was reviewed and yielded 234 men who underwent preoperative endoscopic biopsies of the prostatic urethra before RC between 1990 and 2010. Two techniques were described: 1) cold cup biopsy, and 2) TUR loop biopsy. We evaluated the sensitivity, specificity, and predictive values for these respective techniques relative to the final pathological status of the prostatic urethra (PU) in the RC specimen. Of the 234 urethral biopsies 115 (49...

Urinary ascites results in pseudoazotemia due to urinary creatinine reabsorption across the peritoneum. We report a case of a pyeloplasty complicated by urine extravasation, in which the diagnosis was aided by discrepant findings of an elevated serum creatinine level but a stable cystatin C level. Cystatin C is a marker of renal function but is not typically excreted into the urine and therefore can be used to differentiate pseudoazotemia from true azotemia and is a better marker of renal function in the setting of known urinary ascites. These findings are relevant for patients with potential traumatic or nontraumatic sources of urine extravasation.