Urology Team

Vertical-cavity surface-emitting laser (VCSEL) structures emitting near 940 nm were grown by solid source molecular beam epitaxy (MBE) on Ge(001) substrates. The VCSEL MBE-growth was realized upon a virtual substrate composed of GaAs on Ge grown by melatorganic vapour phase epitaxy (MOVPE). In situ monitoring during MBE growth employed multispectral reflectometry and magnification-inferred curvature imaging for real-time growth analysis. Curvature measurements revealed progressive compressive stress, while optical reflectivity data confirmed uniform layer growth and accurate stopband formation. Fabricated devices with mesa diameters of 35-40 $μ$m, corresponding to oxide apertures of approximately 11-16 $μ$m, exhibited room-temperature lasing under continuous-wave bias with threshold currents below 3 mA. To the best of our knowledge, this is the first demonstration of monolithically integrated 940 nm VCSELs grown on Ge substrates by MBE. These results confirm the viability of MBE-grown VCSELs on Ge with in situ process control for scalable optoelectronic integration.

Bladder cancer is a significant public health and economic burden, with non-muscle-invasive bladder cancer comprising around 75% of diagnoses. Standard of care involves transurethral resection of the bladder followed by adjuvant therapies such as BCG or Mitomycin-C (MMC). With BCG facing shortages and nonetheless many side effects, there is a need to explore alternative treatments that are equally or more effective, less toxic, and more readily available. This article reviews novel device therapies for NIMBC, focusing on electromotive drug administration of MMC (EMDA-MMC), chemohyperthermia devices, intravesical drug delivery device like TAR-200 (GemRIS system), and reverse thermal gel containing MMC (UGN-102). EMDA-MMC enhances drug penetration into bladder tissue, showing promising outcomes in preventing recurrence and progression. Chemohyperthermia devices utilize hyperthermia to potentiate the cytotoxic effects of chemotherapy. RITE (Synergo®) and HIVEC are two devices that have shown promising results. Investigational device, TAR-200 (GemRIS system), is an implantable gemcitabine-releasing medical device, offering a novel approach to prolong drug exposure and minimize side effects. Reverse thermal gel containing MMC, UGN-102, is another innovative treatment option designed to increase urinary drug dwell time and improve efficacy. Ongoing clinical trials aim to further evaluate the safety and efficacy of these novel device therapies. Challenges such as small sample sizes and heterogeneity between studies populations exist, but these innovative approaches offer potential advancements in non-muscle-invasive bladder cancer management, focusing on quality of life and improved oncological outcomes.

This is a report of our institutional experience regarding pharyngoesophageal diverticula formation following anterior cervical spine surgery (ACSS). It is a retrospective chart review of institutional patients from January 2008 to May 2020. Patients at our institution were identified by our two senior authors. Inclusion criteria includedpatients > 18 years old, a history of prior ACSS, and a confirmed diagnosis of pharyngoesophageal diverticulum with radiographic imaging. Three patients were identified to have an ACSS-related diverticulum. The case presentations describe surgical management and the subsequent postoperative course. One patient had a particularly complicated course with recurrent diverticulum formation despite prior excision. The patient continued to have dense scar tissue adhering the posterior esophageal wall to the nearby cervical spine plates, despite prior excision and rotation of nearby tissue. This difficult case demonstrated the need for an open and aggressive approach. ACSS-related diverticula that form in patients with a history of prior anterior cervical spine surgery appear to be a form of traction diverticulum due to dense scar tissue that adheres the pharyngoesophageal mucosa to the adjacent cervical spinal plate. This type of diverticulum differs from Zenker's diverticulum.Surgical management is recommended to resolve patients' symptoms.

No AccessUrology PracticeEditorial Comment1 Mar 2024Editorial CommentaryThis article comments on the following:Exploring the Demands of Urology: On-Call Compensation, Frequency, and Variability John N. Cabri and Jonathan Bergman John N. CabriJohn N. Cabri David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California and Jonathan BergmanJonathan Bergman David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California Los Angeles County Department of Health Services, Los Angeles, California Veterans Health Affairs Greater Los Angeles, Los Angeles, California Editorial Committee, Urology Practice View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000546AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, Publish Ahead of Print, pp.

Introduction Advancements in radiological imaging technology have increased the discovery of adrenal incidentalomas. Large adrenal tumors (LATs) are not common, and the likelihood of malignancy increases with tumor size. LATs were defined as tumors larger than four centimeters (cm) with various pathologic diagnoses.Traditionally, open adrenalectomy was considered the gold standard for LATs, but with recent advancements in minimally invasive surgery (MIS), optimum perioperative and long-term outcomes are achievable by the MIS approach.The findings presented in this paper show that even large adrenal masses measuring up to 21 centimeterscan be safely removed using a minimally invasive approach. Methodology After Institutional Review Board (IRB) approval, we reviewed medical records of adult patients who had adrenalectomies at two Saudi Arabian centers from January 2013 to February 2023. Inclusion criteria were laparoscopic or robotic adrenalectomy and adrenal lesions ≥5cm. Pediatric patients and those with open adrenalectomies were excluded. Pre-surgery, patients had imaging studies to assess mass characteristics. Pheochromocytoma patients received a 2-week adrenergic blocker treatment. Perioperative data including demographics, comorbidities, mass characteristics, surgery details, and follow-up were analyzed using SPSS-23.Patients provided informed consent and had follow-up appointments and imaging. Results Our experience involved 35 patients, 29 of whom received laparoscopic treatment and six of whom underwent robotic surgery. Of the 35 patients, more than half were females (57.1%), with a mean age of 41.7±14.9 years, the youngest and oldest participants being 16 and 73 years of age, respectively. The mean body mass index (BMI) of the participants was in the overweight range (26±6.0 kg/m2). The most common mode of presentation was incidental (42.9%), followed by hypertension (17.1%). Most patients had right-sided adrenal gland involvement (48.6%), with only four patients showing bilateral involvement. Most of the patients were classified as American Society of Anesthesiology score (ASA) 2 (40.0%) or ASA 3 (40.0%). Most of the patients were diagnosed with myelolipoma or adenoma (22.9% each) followed by pheochromocytoma (17.1%).The average estimated blood loss (EBL) was 189.3±354.6 ml for patients who underwent laparoscopic surgery and 80.0 ±34.6 ml for patients who underwent robotic surgery. The average operative room time (ORT) was 220.1±98.7 minutes (min) for laparoscopic surgery and 188.3±10.3 min for robotic surgery. One patient had to be converted from laparoscopic to open surgery due to aortic injury. The average length of stay (LOS) was 9.5±6.7days for laparoscopic treatment and 5.5±1.9 days for robotic surgery. The mean tumor size in the greatest dimension was 8.0±4.4 cm. Only one patient who underwent unilateral laparoscopy experienced perioperative complications and converted to open surgery; nine patients who underwent unilateral laparoscopy required blood transfusion, and none of the patients who underwent robotic surgery required transfusion. None of the 35 patients experienced a recurrence of their adrenal disease during the mean follow-up period which lasted around 58 months. Conclusion MIS in Saudi Arabia is growing and is a safe method for LATs, with satisfactory surgical results compared to the traditional open surgery approach. It offers advantages in terms of EBL, complications, and disease recurrence.

No AccessUrology PracticeEditorial Comment28 Feb 2024Editorial CommentaryThis article comments on the following:Initial Experience and Clinical Assessment of the Karl Storz FLEX-XC1 Single-Use Flexible Ureteroscope Eugenio Bologna, Leslie C. Licari, and Riccardo Autorino Eugenio BolognaEugenio Bologna https://orcid.org/0000-0002-1140-0590 Department of Urology, Rush University Medical Center, Chicago, Illinois , Leslie C. LicariLeslie C. Licari https://orcid.org/0000-0002-3274-1247 Department of Urology, Rush University Medical Center, Chicago, Illinois , and Riccardo AutorinoRiccardo Autorino https://orcid.org/0000-0001-7045-7725 Department of Urology, Rush University Medical Center, Chicago, Illinois Editorial Committee, Urology Practice® View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000545AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, Publish Ahead of Print, pp.