Joshua S. Jue

Focal therapy aims to provide a durable oncological treatment option for men with prostate cancer (PCa), while preserving their quality of life. Most focal therapy modalities rely on the direct tissue effect, resulting in a possible nontargeted approach to ablation. Here, we report the results of the first human feasibility trial utilizing nanoparticle-directed focal photothermal ablation for PCa. A prospective open-label, single-arm multicenter study of men with localized PCa in the Gleason Grade Group (GGG) 1 to 3 was conducted. Men received a single infusion of gold nanoparticles (AuroShells), followed by MR/US fusion-guided laser excitation of the target tissue to induce photothermal ablation. MRI was used to assess the effectiveness of prostate tissue ablation at 48 to 96 hours, 3-months, and 12-months post-treatment. At 3 months, a targeted fusion biopsy of the lesion(s) was conducted. At 12 months a targeted fusion biopsy and standard templated biopsy were performed. Treatment success was determined based on a negative MR/US fusion biopsy outcome within the treated area. Forty-six men were enrolled in the study, and 44 men with 45 lesions completed nanoparticles infusion and laser treatment. The mean PSA level at baseline was 9.5 ng/mL, which decreased 5.9 ng/mL at 3-months and 4.7 ng/mL at 12-months (P < .0001). The oncologic success rates at 3- and 12-months resulted in 29 (66%) and 32 (73%) of 44 patients, respectively, being successfully treated confirmed with negative MR/US fusion biopsies within the ablation zone. Among GGG, maximum-lesion-diameter (MLD) on MRI, prostate volume, and PI-RADS scoring, the MLD was significantly associated with the odds of treatment failure at 12-months (P = .046). Nanoparticle-directed focal laser ablation of neoplastic prostate tissue resulted in 73% patients with successful treatment at 12-months post-treatment, confirmed by negative MR/US fusion biopsy of the treated lesion and a systematic biopsy.

Background: Extra-adrenal pheochromocytoma (paraganglioma) of the urinary bladder is a rare tumor, accounting for 0.05% of bladder tumors and less than 1% of all paragangliomas. In the genitourinary tract, paragangliomas are most commonly found in the bladder. These tumors have aggressive malignant potential, so complete surgical resection for localized disease is important. Paragangliomas may be non-functional or functional with catecholamine secretions. Although these tumors are rare and difficult to distinguish from urothelial carcinoma (UC), intraoperative manipulation of these tumors may lead to a catecholamine surge and intraoperative complications. Preoperative or early intraoperative recognition of this tumor would facilitate appropriate alpha blockade to minimize morbidity. Case Description: Herein we report a rare non-functional paraganglioma arising from the bladder of a 46-year-old male. This case is notable for the location of the mass, requiring a 70-degree cystoscopic lens for complete visualization near the bladder neck, and for the identification of a golden-yellow sessile mass during the resection. Upon visualization of this mass, the operation should be paused for close hemodynamic monitoring and assess for signs of hypertensive crisis prior to continuing without alpha blockade. Conclusions: Suspected localized bladder paraganglioma cases should be optimized hemodynamically and managed surgically. Visualization of a sessile bladder mass on gross examination with golden-yellow tumor during the resection should prompt suspicion for a paraganglioma. Biochemical evaluation with serum or urine catecholamines, metanephrines, and normetanephrines should be performed to assess for tumor functionality.

Kidney-sparing management for upper tract urothelial carcinoma (UTUC) has become more common but is still most limited by inaccurate histopathologic diagnosis

Background: Penile prosthesis (PP)-induced impending erosion is a rare complication that has not been well characterized.Aim: This study evaluates the role of prosthesis sizing and of the safety of xenograft windsock repair (AlloDerm, Tutoplast, ArthroFLEX) of impending erosion.Methods: This was a retrospective review of xenograft use during inflatable penile prosthesis (IPP) replacement. Patient demographics, prior PP characteristics, and xenograft-augmented IPP characteristics were obtained. Paired-samples t tests were used to compare the PP cylinder size, rear tip extender size, and calculated PP length between the most recent prior PP and the xenograft-augmented IPP. Complications and follow-up data were obtained.Outcomes: The primary outcome was comparing the corporal body and device measurements between the PP presenting with impending erosion and the implanted xenograft-augmented IPP. The secondary outcome was evaluating the incidence of subsequent explantation.Results: A total of 24 patients underwent xenograft repair with simultaneous IPP replacement from 2012 to 2022. The median number of prior PP was 1 (interquartile range, 1-2.75). The median time between the most recent prior PP and xenograft-augmented IPP placement was 21 (interquartile range, 14-79) months. The prior PP was significantly longer at the time of explantation compared with the measured corporal body length in both the left (21.4 cm vs 20.1 cm; P < .01) and right (21.4 cm vs 20.1 cm; P < .01) sides. However, there was no significant difference in length between the xenograft-augmented IPP length at the time of implantation and measured corporal body length in both the left (20.1 cm vs 20.0 cm; P = .67) and right (20.2 cm vs 20.1 cm; P = .56) sides. A total of 16 (66.7%) cases required bilateral xenograft corporal body use. Only 1 (4.2%) patient had an IPP infection requiring explantation within 90 days of xenograft-augmented IPP placement. A total of 2 (8.3%) patients had device malfunction and 1 (4.2%) patient had impending erosion recurrence requiring removal/replacement of their initial xenograft-augmented IPP in a median time of 56 months from placement.Clinical Implications: PP oversizing may increase risk of PP-induced impending erosion, which is a delayed process.Strengths and Limitations: This is the largest retrospective study of xenograft use during IPP replacement for impending erosion but does not have a control cohort. This study is limited by its retrospective nature, limited follow-up, and absence of a treatment comparison.Conclusion: PP-induced impending erosion may be due to PP oversizing but can be successfully repaired with xenograft windsock during simultaneous IPP replacement.

Prostate-specific antigen (PSA) has been utilized as a prostate cancer screening test for its high sensitivity for prostate cancer but is often criticized for its low specificity

We detail the instruments required to perform a single-port robotic transvesical simple prostatectomy, as well as the surgical technique to perform this operation using the single-port robot. A 3-cm transverse incision is made three fingerbreadths above the pubic symphysis and a longitudinal cystotomy is made. The roll wound retractor rolling ring is inserted into the bladder lumen, with the access port, SP Short Entry Guide, and AirSeal trocar within it. The robot is then docked to the SP cannula, and the bladder is insufflated to 8 mm Hg. A semilunar incision is made through the bladder mucosa using the monopolar scissors along the posterior aspect of the bladder neck or median lobe. The forceps can be used to retract the prostatic adenoma, while using the monopolar scissors to further bluntly dissect the adenoma from the capsule. The prostatic adenoma can be removed en bloc , but is usually removed en lobe . A vesicourethral mucosal advancement flap is performed with 3-0 V-Loc suture from apex to base at 3-o-clock and 9-o-clock; a double-arm 3-0 V-Loc suture is then used to approximate the bladder and urethral mucosa, by running from 6-o-clock to 12-o-clock. Prostatic adenoma specimens can be removed from the SP Access Port directly or removed from the bladder using the robotic camera for observation. The cystotomy is closed in two layers with 3-0 Vicryl suture. The patient is observed for 2 hours on continuous bladder irrigation to determine ambulatory discharge eligibility. Follow-up is in 3 to 7 days for trial of void. Disclosure: Portions of this video and title were presented at the AUA 2023 in the form of a video abstract and as an AUA Core Curriculum video. https://www.auajournals.org/doi/pdf/10.1097/JU.0000000000003288.06 Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. There are no commercial associations during the past 3 years that might create a conflict of interest in connection with the video. Runtime of video: 7 mins 37 secs