Need For Urologists Research Articles

Estimated prospects of demand and supply of urologists in Korea over the next 10 years.

This study aimed to provide the basic data needed to estimate future urologist supply and demand by applying various statistical models related to healthcare utilization. Data from multiple sources, including the Yearbook of Health and Welfare Statistics, Korean Hospital Association, Korean Medical Association, and the Korean Urological Association, were used for supply estimation. Demand estimation incorporated data on both clinical and non-clinical urologists, along with future population estimates. In-and-out moves and demographic methods were employed for supply estimation, while the Bureau of Health Professions model was utilized for demand estimation. Supply estimation assumptions included fixed resident quotas, age-specific death rates, migration rates, and retirement age considerations. Demand estimation assumptions included combining clinical and nonclinical urologist demands, adjusting population size for age-related healthcare usage variations. Urologist productivity was determined by adjusting productivity levels to 100%, 90%, and 80% of the base year based on actual clinical practice volumes. Estimations of both demand and supply consistently indicate an oversupply of urologists until 2025, followed by an expected shortage by 2035 owing to increased deaths and retirements attributed to the aging urologist population. This shortage becomes more pronounced when employing more reliable models, such as logit or ARIMA (autoregressive integrated moving average), underscoring the growing need for urologists in the future. All estimation models estimated an oversupply of urologists until 2025, transitioning to a deficit due to reduced supply thereafter. However, considering potential unaccounted factors, greater effort is needed for accurate predictions and corresponding measures.

The Impact of PSMA PET/CT on Modern Prostate Cancer Management and Decision Making—The Urological Perspective

Prostate-specific membrane antigen (PSMA) PET use in prostate cancer treatment has recently become a routinely used imaging modality by urologists. New, established data regarding its performance in different stages of prostate cancer, as well as gaining clinical knowledge with new tracers, drives the need for urologists and other clinicians to improve the utilization of this tool. While the use of PSMA PET/CT is more common in metastatic disease, in which it outperforms classical imaging modalities and drives treatment decisions and adjustments, recently, it gained ground in localized prostate cancer as well, especially in high-risk disease. Still, PSMA PET/CT might reveal lesions within the prostate or possibly locoregional or metastatic disease, not always representing true cancer when utilized in earlier stages of the disease, potentially adding diagnostic burden and changing treatment decisions. As urological treatment options advance toward focal treatments in localized organ-confined prostate cancer, recent reports suggest the utilization of PSMA PET/CT in treatment planning and follow-up and even when choosing active surveillance. This review aims to reveal the current perspective of urologists regarding its daily use.

MP34-02 PUBLIC INTEREST IN ONLINE INFORMATION ON RECURRENT UTIS IS GREATEST FOR INFORMATION WITH THE POOREST PUBLICATION QUALITY

You have accessJournal of UrologyCME1 Apr 2023MP34-02 PUBLIC INTEREST IN ONLINE INFORMATION ON RECURRENT UTIS IS GREATEST FOR INFORMATION WITH THE POOREST PUBLICATION QUALITY Sapna Thaker, Justin Chan, Karan Thaker, Rebecca Takele, Abbi Newlands, Kayleigh Maxwell, Jessica Price, Melissa Kramer, and Kymora Scotland Sapna ThakerSapna Thaker More articles by this author , Justin ChanJustin Chan More articles by this author , Karan ThakerKaran Thaker More articles by this author , Rebecca TakeleRebecca Takele More articles by this author , Abbi NewlandsAbbi Newlands More articles by this author , Kayleigh MaxwellKayleigh Maxwell More articles by this author , Jessica PriceJessica Price More articles by this author , Melissa KramerMelissa Kramer More articles by this author , and Kymora ScotlandKymora Scotland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003268.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary tract infections (UTIs) are one of the most common bacterial infections, affecting 150 million people each year worldwide. Patients also increasingly seek answers to health-related questions online. This study aims to characterize the public’s interaction with online information on recurrent UTIs, and categorize recurrent UTI patient concerns. METHODS: A popular online community of recurrent UTI sufferers was queried to gauge common concerns about the disease. An Airtable database of questions was created containing interviews of recurrent UTI patients, to identify and categorize concerns. Patient concerns helped guide keywords for Google Trends analysis and social media analysis to identify areas of interest for recurrent UTI patients. Buzzsumo was used to calculate average online engagement (likes, shares, comments, views) with information on recurrent UTIs. The reliability of highly engaged articles was evaluated using the DISCERN questionnaire. RESULTS: Mean engagement and view count for articles and videos related to recurrent UTIs was 1654 and 6802, respectively. Buzzsumo analysis revealed four broad searches for recurrent UTIs: general information, treatment, causes, herbal remedies. “Herbal remedies” had the highest engagement and views. Overall DISCERN scores indicated moderate reliability, but the “herbal remedies” category had the lowest reliability scores. Google Trends analysis identified “causes” and “treatment” categories to be of high interest. The 10 most popular categories of concern observed after categorizing patient questions were antibiotics, microbiome, vaccine, inflammation/prevention, pelvic pain, sex, testing, symptoms, diet/lifestyle, and hormones. CONCLUSIONS: Recurrent UTIs are a highly engaged urologic disease online, with subcategories of poor reliability being the most engaged. This highlights the need for urologists to be aware of unreliable content that may be targeting patients and complicating their ability to treat recurrent UTIs effectively. Urologists should counteract misinformation by providing evidence-based information on recurrent UTIs online. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e459 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sapna Thaker More articles by this author Justin Chan More articles by this author Karan Thaker More articles by this author Rebecca Takele More articles by this author Abbi Newlands More articles by this author Kayleigh Maxwell More articles by this author Jessica Price More articles by this author Melissa Kramer More articles by this author Kymora Scotland More articles by this author Expand All Advertisement PDF downloadLoading ...

Promotion of next generation urologists-Construct urology of the future

In view of the growing demand for urological care and the simultaneous demographic change, the need for urologists in Germany is increasing. Therefore, young professionals are urgently needed to ensure urological care in the future. This objective can be achieved by fascinating medical students for urology and by implementing satisfactory residency programs in clinical departments and outpatient offices. Perspectives and possible career paths should be shown to junior colleagues at an early stage. Structured research funding is needed to reconcile academic with clinical work. The German Society for Residents in Urology (GeSRU) offers young urologists aplatform for networking, for representation of interests as well as for education and training.

A Glimpse Into Urology Medical School Education: A Multi-Institutional Medical Student Survey

Introduction: Urological education and exposure for medical students is imperative as we face a growing geriatric population with increased urological needs. Previous research has examined American Urological Association (AUA) program director opinions of student exposure, but no surveys have been directed at current medical students. The purpose of this study is to quantify student exposure to and opinions of urology to determine precipitating factors that lead students towards or away from urology as a specialty of choice. Methods: A 14 question (11 multiple choice and 3 fill-in-the blank) Google Survey was developed. Questions ranged from student exposure to urology, consideration of urology as a specialty, to opinions of positive/negative aspects of urology. After receiving IRB approval, the survey was distributed to the deans and student affair offices of 156 AAMC medical schools. Results: Twenty medical schools (13%) disseminated the survey, contributing to 147 student responses with an even gender split. The percentage of MS4s that applied to urology was 9%. Of all the respondents, 11% did not have a urology rotation, and 25% had no exposure throughout medical school. A large proportion of students (54%) felt the urology exposure to be inadequate. The majority of respondents had either a positive (43%) or neutral (48%) perception towards urology. The positive aspects of urology included perceptions of salary (87%), lifestyle (62%), focalized specialization (54%) and use of technology (49%). The negative aspects of urology included competitiveness (75%), resident workload (33%), and focalized specialization (29%). Conclusions: Urological education opportunities during medical school appear to be limited. Many students do not have any exposure to urology, let alone opportunities to experience a clinical rotation in the field. Although the specialization and lifestyle of urology are attractive, the competitiveness of the field seems to have dissuaded many possible applicants. However, with the increased need for urologists and the decreasing supply, future work should focus on increasing medical student exposure to urology.

MP36-19 PLATELET-RICH PLASMA AND STEM CELL THERAPY FOR ERECTILE DYSFUNCTION: CHARACTERIZATION OF MARKET FORCES IN MAJOR METROPOLITAN AREAS

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy II (MP36)1 Sep 2021MP36-19 PLATELET-RICH PLASMA AND STEM CELL THERAPY FOR ERECTILE DYSFUNCTION: CHARACTERIZATION OF MARKET FORCES IN MAJOR METROPOLITAN AREAS Gary Shahinyan, Robert Shahinyan, Shangyang Christopher Yang, James Weinberger, Jesse Mills, and Sriram Eleswarapu Gary ShahinyanGary Shahinyan More articles by this author , Robert ShahinyanRobert Shahinyan More articles by this author , Shangyang Christopher YangShangyang Christopher Yang More articles by this author , James WeinbergerJames Weinberger More articles by this author , Jesse MillsJesse Mills More articles by this author , and Sriram EleswarapuSriram Eleswarapu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002045.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A robust industry focusing on “regenerative” therapies has emerged to cater to men experiencing erectile dysfunction (ED). Independent providers have begun to market platelet-rich plasma (PRP) or stem cells directly to consumers, despite lack of scientific evidence. These treatments are not recommended beyond an investigational role by the AUA. We sought to characterize the landscape of PRP and stem cell treatments for ED by evaluating trends in marketing and deployment of these therapies in large metropolitan areas. We aim to describe costs of treatment, training and qualifications of providers, and level of standardization across treatment plans. METHODS: Using Google Search, we identified regenerative medicine treatment providers in seven large U.S. metropolitan areas. Search terms included: “PRP for ED in [city]”; “P shot in [city]”; “PRP for erectile dysfunction in [city]”; “Priapus shot in [city]”. Clinics were contacted by telephone; data regarding providers, prices, and durations of treatment were collected. RESULTS: A summary of results is shown in Table 1. Eighty-seven clinics provide PRP or stem cell treatments for ED in the metropolitan areas sampled. Comprehensive information was available for 68% of the clinics identified. 8% of providers had formal urology training. The average price of PRP injections was $1519 per injection (range $500-$2500). Stem cell therapy was offered by 10 providers, averaging $3620 per treatment (range $1000-$7000). Treatment courses ranged from one injection to indefinite injections based on patient circumstance. CONCLUSIONS: PRP and stem cell treatments suffer from substantial inconsistency and lack of standardization. Non-urologists predominate, and costs and frequency of therapy appear to be market-driven without evidence base. Advertised outcomes vary: some clinics suggest a single injection will be sufficient for cure, while others recommend repeat injections for indefinite time periods. The AUA and SMSNA classify these treatments as experimental and state explicitly that providers should not charge patients for these treatments. There is a critical need for urologists to take an active role in patient education and clinical research for these novel methodologies. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e643-e643 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gary Shahinyan More articles by this author Robert Shahinyan More articles by this author Shangyang Christopher Yang More articles by this author James Weinberger More articles by this author Jesse Mills More articles by this author Sriram Eleswarapu More articles by this author Expand All Advertisement Loading ...

Signet Ring Cell Carcinoma of the Prostate Gland: A Review and Update

Signet-ring cell carcinoma of the prostate gland (SRCCP) an uncommon and aggressive malignant tumour of the prostate gland which is characterized by histopathology examination features of compression of the nucleus into the form of a crescent by a large cytoplasmic vacuole. SRCCPs that have so far been reported have been either (a) primary tumours, metastatic tumours with the primary tumour elsewhere with the gastro-intestinal tract being the site of the primary tumour but the primary tumour could originate elsewhere, and additionally some reported SRCCPs have been classified as carcinoma of unknown primary. SRCCP could be a pure tumour or a tumour that is contemporaneously associated with other types of tumour including various variants of adenocarcinoma. SRCCP can manifest in various ways including: Incidental finding following prostatectomy that has been undertaken for a presumed benign prostatic hyperplasia, lower urinary tract symptoms, visible and non-visible haematuria, raised levels of serum PSA but some SRCCPs have been diagnosed with normal / low levels of serum PSA, there may be a history of dyspepsia in cases of metastatic signet-ring cell carcinoma in association with contemporaneous primary signet-ring cell carcinoma of the stomach or there may be a past history of surgical treatment for signet-ring cell carcinoma of the gastrointestinal tract, or bleeding from the gastrointestinal tract in cases of upper gastrointestinal tract and rectal bleeding as well as change in bowel habit for primary tumours of the anorectal region, retention of urine, and rarely a rectal mass in the case of SRCCP with an anorectal primary tumour. In order to exclude a primary signet ring cell carcinoma elsewhere, a detailed past medical history is required as well as radiology imaging including contrast – enhanced computed tomography (CECT) scan and contrast-enhanced magnetic resonance imaging (CEMRI) scan as well as upper gastrointestinal endoscopy and colonoscopy to exclude a primary lesion within the gastrointestinal tract. Diagnosis of SRCCP requires utilization of the histopathology and immunohistochemistry examination features of prostate biopsy, prostatic chips obtained from trans-urethral resection of prostate specimen or radical prostatectomy specimen. SRCCPs upon immunohistochemistry staining studies tend to show tumour that tend to exhibit positive staining for the following tumour markers as follows: PSA – positive staining for PSA has been variable in some studies, AE1/AE3, CAM 5.2, Ki-67 with a mean of 8%, PAS-diastase, Mucicarmine (50%), Alcian blue (60%), Alpha-methyl-acyl coenzyme A racemase (P504S), and Cytokeratin 5/6. SRCCPs also tend to exhibit negative staining for: Bcl2 (rare positive), and CEA (80%). Traditionally the treatment of Primary Signet-Ring Cell Carcinoma of the Prostate Gland has tended to be similar to the treatment of the traditional adenocarcinoma of the prostate gland which does include: hormonal treatment, radiotherapy, and surgery. Nevertheless, considering that primary SRCCPs and metastatic SRCCPs that have been reported in the literature have generally tended to be associated with an aggressive biological behaviour, even though there is no consensus opinion on the treatment of the disease it would be strongly recommended that these tumours that tend to be associated with rapid progress of the disease and poor survival there is an urgent need to treat all these tumours with aggressive surgery including radical prostatectomy plus adjuvant therapies including: radical radiotherapy, combination chemotherapy, selective prostatic angiography and super-selective embolization of the artery feeding the tumour including intra-arterial infusion of chemotherapy agents directly to the tumour, radiofrequency ablation of the tumour as well as irreversible electroporation of the tumour which should form part of a global multicentre study of various treatment options. With regard to metastatic signet-ring cell carcinomas of the prostate gland with a contemporaneous primary tumour elsewhere the primary tumour should also be treated by radical and complete excision of the primary tumour plus radical surgery and aggressive adjuvant therapy. Considering that SRCCPs have tendered not to respond well to available chemotherapy agents, there is need for urologists, oncologists, and pharmacotherapy research workers to identify new chemotherapy medicaments that would more effectively and safely destroy signet-ring cell tumours in order to improve upon the prognosis.

Prostate cancer in transgender women: what does a urologist need to know?

To review of the existing literature, current guidelines and standard of practice related to prostate cancer in transgender women, as the transgender population share many of the same healthcare needs as their cisgender counterparts, but may have additional specialist needs. We performed a non-systematic review of the literature, current guidelines and standard of practice related to prostate cancer in transgender women. Our search revealed 10 case reports of prostate cancer in transgender women, four specialist opinion papers, six cohort studies, and four systematic reviews. The information in these publications were assimilated to produce a review of prostate cancer in transgender women. The risk of prostate cancer in transgender women who are not on gender-affirming hormone therapy (GAHT) or who have not had gender-affirming surgery (GAS) and gender non-conforming individuals (who may never commence GAHT or have GAS) is the same as that in the cis male population. In these patients, healthcare professionals need to be able to discuss screening, diagnostic and treatment options considering future wishes for gender-affirming treatment. Prostate cancer incidence in transgender women on GAHT or following GAS is lower than age-matched cis-male counterparts, but diagnosis and treatment is more nuanced. The present review discusses the existing literature about development and incidence of prostate cancer in this population, and makes recommendations about screening, the usefulness of diagnostic tools e.g. prostate-specific antigen and magnetic resonance imaging, and considerations when formulating treatment. Potential directions for future research are discussed, which will hopefully lead to development of robust evidence-based guidelines for the diagnosis and management of prostate cancer in transgender women.

Signet-Ring Cell Carcinoma of the Urinary Bladder: A Review and Update

Signet-Ring Cell Carcinoma of the Urinary Bladder: A Review and Update

BCG-unresponsive high-grade non-muscle invasive bladder cancer: what does the practicing urologist need to know?

PurposeBacille Calmette-Guérin (BCG) is a well-established treatment for preventing or delaying tumour recurrence following high-grade nonmuscle invasive bladder cancer (NMIBC) resection. However, many patients will experience recurrence or progression during or following BCG. This scenario has been one of the most challenging in urologic oncology for several decades since BCG implementation. Finally, significant progress has occurred lately. The aim of this review was to summarize for the practising urologist the current treatment options available in 2020 or expected to be ready for routine use in the near future for patients with high-risk NMIBC who experience BCG failure.MethodsNarrative review using data through the end of 2020.ResultsFirst, the definition of BCG unresponsive disease which is critical in counseling and managing patients has finally reached a consensus. Second, some promising options other than radical cystectomy are finally available and many other should be in a near future. The options can be categorized as chemotherapy, device-assisted therapy, check-point inhibitors, new intravesical and systemic agents and sequential combinations of these newer modalities with conventional therapy.ConclusionsConsidering the options that are currently under scrutiny, many of which in phase III trials, clinicians should have at their disposal several new treatment options in the next five years.

What Is Fecal Incontinence That Urologists Need to Know?

Fecal incontinence (FI) undoubtedly reduces quality of life and adversely affects the social life of the affected individual. FI has a higher prevalence with age and has an equivalent prevalence to urinary incontinence in patients with genitourinary disease, but is often not confirmed in these cases. A thorough investigation is needed to diagnose FI, with the common etiology of this condition in mind, and several questionnaires can be used to identify symptoms. The physical examination contains digital rectal examination carries out to identify the patient’s condition. Ultrasound, colonoscopy, and rectum pressure test can be performed. Patients educated in diet-related issues, bowel movements, and defecation mechanism. Nonoperative options such as diet control and Kegel exercise should be performed at first. Surgical treatment of FI is considered when conservative management and oral medications produce no improvement. Surgical options include less invasive procedures like bulking agent injections, and more involved approaches from sacral nerve stimulation to invasive direct sphincter repair and artificial bowel sphincter insertion. Good outcomes in FI cases have also recently been reported for barrier devices.

Strategies to Encourage Medical Student Interest in Urology.

Purpose of ReviewUrology residency positions have steadily increased but applications have remained stagnant. This is an alarming trend given the aging general population and thus increased need for urologists. The purpose of this review is to describe barriers and suggest strategies to encourage medical students to pursue urology.Recent FindingsBarriers to interest in urology include educational factors, such as timing of exposure to urology in medical school, USMLE scores, research experience, and deciding in time for an early match, as well as socioeconomic barriers, such as cost, being underrepresented in medicine, and gender. Steps the urological community can take include increasing involvement in medical school curricula, increasing faculty mentor availability, and broadening students’ range of urological experiences.SummaryStrategies to encourage interest in urology fall into three categories: creating interest, supporting interest, and removing barriers for students considering urology. Ultimately, the goal is to garner excellent residents in a field that must expand to meet the needs of a growing and aging population.

Ureterocele in lower moiety of duplicated draining system a rare case

Ureterocele is dilatation of lower ureter at its entry into urinary bladder. It is classified as single or duplex system and acquired or congenital. Acquired type is commonly seen in adults. Duplicated ureters are often associated with an obstructed upper pole moiety and a refluxing lower pole moiety. In our case report adult type simple ureterocele is presented in lower moiety of duplex system with impacted calculus. Because of rarity of the presentation and diagnosis of the condition, urologist need to be aware of etiology and appearance. Treatment options depend on the extension of the ureterocele, obstruction to draining system. Since few cases have been reported in literature, clinicians need to have understanding and orientation towards diagnosis, investigations and treatment of this condition.

Re: Cancer Screening in the Pediatric Cancer Patient: A Focus on Genitourinary Malignancies, and Why Does a Urologist Need to Know About This?

Re: Cancer Screening in the Pediatric Cancer Patient: A Focus on Genitourinary Malignancies, and Why Does a Urologist Need to Know About This?

Lynch Syndrome in Urologic Malignancies – What Does the Urologist Need to Know?

Lynch Syndrome (LS) entails a defective DNA mismatch repair system, which is the postreplicative proofreading and editing system, ensuring our genome's integrity. LS predisposes to several cancers, most commonly colorectal and endometrial cancers. LS occurs in approximately 1 in 250-1000 people. LS is associated with urological malignancies with upper tract urothelial carcinoma the most common, although still clinically underestimated. Other urologic malignancies possibly associated with LS include bladder, prostate, testis, and renal cell carcinoma. Ascertaining their true prevalence in LS is mandatory for their and their relatives' diagnosis and treatment. Awareness regarding identifying patients at risk for LS through assessment of personal and familial oncologic history is critical among urologists.

Review Article: Physician Burnout in Urology

IntroductionPhysician burnout is highly prevalent and impacts the quality of health care in the United States. MethodsThe existing literature on physician burnout was reviewed with a focus on burnout among surgeons. ResultsAlthough burnout has not been specifically studied in urologists, many other groups of surgeons have been assessed for burnout. Women and physicians experiencing work/home conflicts seem to be at increased risk for burnout. As the need for urologists increases with an aging patient population and improved access to health care, physician burnout threatens to impact the number of practicing urologists. This issue is especially concerning as the number of women in urology increases because female physicians experience more burnout than their male counterparts. ConclusionsThe incidence of burnout in practicing urologists needs to be further studied. While several strategies have been proposed to alleviate physician burnout, additional work is needed to mitigate the risk of burnout.

Micropapillary variant of urothelial carcinoma – a review of the literature

The micropapillary variant of urothelial carcinoma is one of the variants of urothelial carcinoma that was added to the World Health Organization (WHO) classification in 2004. This variant of urothelial carcinoma is uncommon and, therefore, a number of practitioners have not yet encountered the tumour in their clinical practice. In view of this, the diagnostic features and the biological behaviour of this tumour are not well known by practitioners. This review documents the diagnostic features, management and outcome of the micropapillary variant of urothelial carcinoma. Various internet search engines were used to identify literature on the micropapillary variant of urothelial carcinoma, including case reports and case series, which formed the basis of the literature review. At least 500 cases of the micropapillary variant of urothelial carcinoma have been reported since it was first described in 1994. The gross morphology is variable and there are no special features to differentiate this variant from other variants or from conventional urothelial carcinoma. The micropapillary variant may be sessile, papillary, ulcerative or polypoid or may manifest as an infiltrative mass of variable size, ranging from microscopic to > 10 cm. The microscopic features of this variant of urothelial carcinoma exhibit an architecture that is reminiscent of the papillary configuration of ovarian papillary serous tumours. The nuclei of the micropapillary variant cells are commonly of high grade and show reverse polarity to the external surface of the tumour nests. A minority of the tumour-containing spaces represent actual lymphovascular invasion, which is supported by their characteristic immunohistochemical staining with endothelial markers. Lymphovascular invasion can be found in most cases of the invasive micropapillary variant of urothelial carcinoma if the specimens are adequately sampled, but a majority of the tumour-containing lacunae do not have endothelial lining and, therefore, do not represent true lymphovascular invasion. Psammoma bodies, which are common in ovarian papillary serous tumours, are rare in the micropapillary variant of urothelial carcinoma, and most of these tumours exhibit deep muscle invasion. Urine cytology exhibits papillary/spheroid clusters of tumour cells that have a high nuclear grade. The micropapillary variant of urothelial carcinoma is a rare and aggressive variant and may be under-reported as some pathologists may not be aware of its diagnostic features. Reports so far would indicate that this variant is associated with poor prognosis and adjuvant chemotherapy may have a questionable efficacy. Because of the rarity of this variant of urothelial carcinoma, there is no consensus opinion regarding the optimal treatment. Therefore, there is a need for urologists and oncologists throughout the world to report cases of the micropapillary variant of urothelial carcinoma so that the biological behaviour of the tumour can be ascertained. There is also a need for multicentre trials of treatment of this variant of urothelial carcinoma so that lessons can be learnt regarding the biological behaviour of the tumour and a consensus opinion can be established regarding the best treatment modality for such an apparently aggressive tumour.

Brown Tumor and Staghorn Calculi in Primary Hyperparathyroidism

A case of primary hyperparathyroidism with bilateral renal staghorn calculi and brown tumor right thumb is reported in these images, along with the appropriate sequential management. Percutaneous nephrolithotomy (PCNL)was done after management of hypercalcemia and after parathyroidectomy. This case highlights the need for urologists and general practitioners to have a holistic approach in patient management.

Interactions Between Hemodynamics and Pharmacology in Kidney Transplantation

Introduction Renal transplantation (RT) is considered the treatment of choice for patients with end-stage renal disease due to the improved short- and long-term survival benefits over dialysis treatment. The success of RT can be improved by working within a multidisciplinary team. Objective The aim of this work was to assess the anesthetic management of RT to guarantee success. Discussion Anesthesiologists who work in RT should know the interactions between hemodynamics and pharmacology in these patients. But to be able to work as a team, there are three questions that need to be answered: What do the urologist and the anesthesiologist need to know about renal transplantation? What does the urologist need to know about anesthesia? Or, in other words, what do anesthesiologists really want the urologists to know, and what does an anesthesiologist want to know about RT? Conclusions RT is a complex procedure that needs a multidisciplinary approach, especially in patients with important comorbidities. It is necessary to learn how to look through the eyes of the rest of the team. Working within a multidisciplinary team is basic to ensure the success of the RT.

Mucus production after transposition of intestinal segments into the urinary tract.

Following transposition into the urinary tract, intestinal segments continue to produce mucus and problems related to excessive production do not to diminish with time. Currently, 20 human mucin genes have been described and their protein products partially or fully characterised. As the use of transposed intestinal segments in urology increases, there is now a need for a better understanding of mucins at the gene and protein levels. There is also a need for urologists to be aware of the many complications related to excess mucus production. Whilst effective therapeutic measures to reduce mucus production and its related complications remain elusive, it is now clear that without such effective mucoregulatory agents the quality of life of patients will continue to be less than satisfactory. This review describes the biology of mucus and the problems related to continued production following transposition of intestinal segments into the urinary tract. Difficulties related to quantification of urinary mucus, in addition to the structural and mucin gene changes that occur in transposed segments, are addressed.