UPMC Physician Resources

Archives for Urology

Erectile Dysfunction Drugs Could Protect Liver from Sepsis-Induced Damage, Says Pitt Team

PITTSBURGH, Jan. 29, 2015 – Drugs that are on the market to treat erectile dysfunction (ED) could have another use—they might be able to protect the liver from damage caused by sepsis, a systemic inflammatory response to infection, say researchers at the University of Pittsburgh School of Medicine. They recently published their findings in Science Signaling.

Infection can lead to the release of chemicals that cause whole-body inflammation, which can cause life-threatening damage to organs including the liver and kidneys, explained senior investigator Timothy Billiar, M.D., professor and chair of surgery, Pitt School of Medicine. Sepsis is a leading cause of death in the intensive care unit.

“Sepsis is a very challenging problem, so the possibility that we might be able to repurpose a drug that is in use and well understood is very exciting,” Dr. Billiar said.

Sepsis triggers production of a protein called tumor necrosis factor, or TNF, which helps fight infection but is harmful at sustained high levels. The researchers found in a mouse model of sepsis that sildenafil, more commonly known as Viagra, induced the liver to produce greater amounts of a protein called cyclic GMP, which in turn led cells to shed surface proteins called TNF receptor, reducing TNF signaling in the cells and preventing  liver damage. Experiments with human liver cells also showed the protective effects of the drug.

“Our study suggests that increasing the bioavailability of cyclic GMP might be beneficial in ameliorating the inflammation associated with sepsis,” Dr. Billiar said. “Sildenafil and other ED drugs might be a good approach to try early in the course of the illness to forestall organ damage.”

The research team plans to verify their findings in a large animal model of sepsis.

Other investigators include lead author Meihong Deng, Ph.D., Patricia A. Loughran, Ph.D., Liyong Zhang, Ph.D., and Melanie J. Scott, M.D., Ph.D., all of the University of Pittsburgh. The project was funded by National Institutes of Health grants GM044100 and GM050441.

Pitt Team Evaluates Tensile Strength of the Human Ureter

PITTSBURGH, Jan. 3, 2015 – Few published studies have examined the mechanical properties of the animal ureter and none have determined the tensile strength of the human ureter, which may help prevent iatrogenic injuries. Researchers at the University of Pittsburgh conducted a trial to determine the tensile strength in the human ureter, and the preliminary results were published in a recent issue of the Journal of Endourology.  

Yaniv Shilo, MD, assistant professor of urology at the University of Pittsburgh and lead author of the study, and colleagues harvested 11 human proximal ureters from patients undergoing nephrectomy, and uniaxially tested tissue strips circumferentially and longitudinally. Corresponding force and displacement were recorded, and stress at failure was noted as the tensile strength of the sample.

The tensile strength of the ureter in circumferential and longitudinal orientations was found to be 457.52±33.74 Ncm(-2) and 902.43±122.08 Ncm(-2), respectively (P<0.001). The circumferential strength in the proximal portion of the ureter was 409.89±35.13 Ncm(-2) in comparison with 502.89±55.85 Ncm(-2) in the distal portion (P=0.08).

The authors found that the “circumferential tensile strength of the ureter was significantly lower than the longitudinal strength” and “circumferential tensile strength was also lower with more proximal parts of the ureter.” The results may be important for the design of “intelligent” devices and simulators to prevent ureteral injuries.

Additional authors included Joseph Pichamuthu, Timothy Averch, MD, and David A. Vorp, PhD, all of the University of Pittsburgh.

To view the full abstract, please visit PubMed.gov.

Pitt Experts Review Limitations of Animal Models in Studies of Underactive Bladder

PITTSBURGH, Oct. 1, 2014 – Experts from the University of Pittsburgh were part of a group researchers that reviewed the current understanding of the pathophysiology and animal models used to study the underactive bladder (UAB). Results of the study recently were published in International Urology and Nephrology.

The study’s lead author was Pradeep Tyagi, PhD, assistant professor of urology at the University of Pittsburgh. Dr. Tyagi’s research interests include developing new therapies for interstitial cystitis treatment via intravesical liposomes, using muscle stem cells to treat stress urinary incontinence, and identifying new markers and molecular targets of drug therapy for painful bladder syndromes, such as interstitial cystitis.

In their report, the researchers concluded that “despite the difficulties associated with animal modeling, there is no substitute for their use as tools to advance understanding and develop medical interventions for UAB. The various models that have been used to date have different strengths and weaknesses, and the findings should ideally be reproduced in more than one mammalian species before extrapolating data to human subjects.”

Additional authors on the study were William C. de Groat, PhD, Lori A. Birder, PhD, Christopher J. Chermansky, MD, and Naoki Yoshimura, MD, all of the University of Pittsburgh; Phillip P. Smith, MD, and George A. Kuchel, MD, of the University of Connecticut; Rosalyn M. Adam, PhD, of Harvard Medical School; Vincent Tse of the University of Sydney; and Michael B. Chancellor, MD, of Beaumont Hospital in Royal Oak, Mich.

To view the full abstract, please visit PubMed.gov.

Genetic Discovery Yields Prostate Cancer Test, Promise of Future Therapy

PITTSBURGH, Sept. 15, 2014 – A genetic discovery out of the University of Pittsburgh School of Medicine is leading to a highly accurate test for aggressive prostate cancer and identifies new avenues for treatment.

The analysis, published today in the American Journal of Pathology, found that prostate cancer patients who carry certain genetic mutations have a 91 percent chance of their cancer recurring. This research was funded by the National Institutes of Health (NIH), American Cancer Society and University of Pittsburgh Cancer Institute (UPCI).

“Being able to say, with such certainty, that a patient is nearly guaranteed to see a recurrence of his prostate cancer means that doctors and patients can elect to be more aggressive in treating the cancer, knowing that the benefits likely outweigh the risks,” said Jian-Hua Luo, M.D., Ph.D., professor of pathology, Pitt School of Medicine and member of UPCI. “Eventually, this could lead to a cure for prostate cancer through genetic therapy. With this discovery, we’re at the tip of the iceberg in terms of possibilities for improving patient outcomes.”

Prostate cancer is the second most common cancer among men (behind skin cancer), with one in seven men diagnosed with prostate cancer in their lifetime. The American Cancer Society estimates that this year in the U.S., about 233,000 new cases of prostate cancer will be diagnosed, and 29,480 men will die of prostate cancer.

Despite the high incidence rate, only a fraction of men diagnosed with prostate cancer develop metastases, and even fewer die from the disease.

“In some cases, this can make the treatment more dangerous than the disease, so doctors need more accurate tests to tell them which patients would most benefit from aggressive therapies, such as surgery, radiation and chemotherapy,” said Dr. Luo.

Dr. Luo and his team sequenced the entire genome of prostate tissue samples from five prostate cancer patients who experienced aggressive recurrence of their cancer and compared them to normal tissue samples from men without cancer.

In the patients with prostate cancer recurrence, they identified 76 genetic fusion transcripts, which are hybrid genes formed from two previously separate genes and often are associated with cancer. After further testing, eight of the genetic fusion transcripts were found to be strongly associated with prostate cancer.

The researchers then screened for the eight fusion transcripts in 127 samples from patients with aggressive prostate cancer recurrence, 106 samples from prostate cancer patients with no recurrence at least five years after surgery, and 46 samples from prostate cancer patients with no recurrence less than five years after surgery. The samples came from UPMC, Stanford University Medical Center and University of Wisconsin Madison Medical Center.

In those samples, 91 percent with aggressive recurrence of their prostate cancer were positive for at least one of the fusion transcripts. Two of the fusion transcripts in particular were strongly associated with poor outcomes — none of the patients whose samples contained them survived to five years.

In contrast, 68 percent of patients whose samples did not contain at least one of the transcripts remained cancer-free.

Dr. Luo said if continued clinical trials of the test do well, it could be available to all prostate cancer patients in a few years.

In addition, studies are being developed to further investigate the genetic fusion transcripts most strongly associated with aggressive prostate cancer. Drugs and therapies could be developed to correct or stop the mutations, thereby halting the cancer progression, Dr. Luo explained.

Additional researchers on this study are Yan P. Yu, M.D., Ph.D., Ying Ding, Ph.D., Zhanghui Chen, Ph.D., Silvia Liu, B.S., Amantha Michalopoulos, B.S., Riu Chen, B.S., Kathleen Cieply, M.S., Alyssa Luvison, B.S., Bao-Guo Ren, M.D., Joel B. Nelson, M.D., George Michalopoulos, M.D., Ph.D., and George C. Tseng, Sc.D., all of Pitt; Zulfiqar G. Gulzar, Ph.D., and James D. Brooks, M.D., both of Stanford; and Bing Yang, Ph.D., and David Jarrard, M.D., both of the University of Wisconsin.

This research was supported by the NIH grants RO1 CA098249 and 1U01CA152737-01, American Cancer Society grant RSG-08-137-01-CNE and UPCI.

Pitt Team Publishes Case Study on Segmental Testicular Infarction and Minocycline-Induced Vasculitis

PITTSBURGH, Aug. 1, 2014 – A team of researchers from the University of Pittsburgh recently published a case study of a 47-year-old man with minocycline-induced vasculitis in Urology. The study’s lead author was Timothy Lyon, MD, a urology resident at UPMC.

The subject presented with right testicular pain and swelling associated with fevers, night sweats, abdominal pain, myalgias, headache, and extremity numbness. He also had rosacea, for which he took minocycline. Testicular ultrasound revealed an avascular hypoechoic intratesticular lesion, which matured into a wedge-shaped infarct one week after presentation. Serum was positive for antineutrophil cytoplasmic antibody, and testis tumor markers were negative. He was diagnosed with minocycline-induced vasculitis, and his symptoms resolved with cessation of minocycline.

Additional authors on the study were Matthew C. Ferroni, MD, Daniel P. Casella, MD, Louis A. D’Agostino, MD, Stephen V. Jackman, MD, all currently or formerly of the University of Pittsburgh.

To view the full abstract, please visit PubMed.gov.

Pennsylvania Recognizes May as Bladder Cancer Awareness Month

PITTSBURGH, May 20, 2014 The month of May has been officially recognized as Bladder Cancer Awareness Month by the State of Pennsylvania. Resolution #699 was sponsored by Representative Robert Freeman, and overwhelmingly passed by the PA House of Representatives. This recognition by the state of PA aligns with the national efforts of the Bladder Cancer Advocacy Network (BCAN). Marge Coffin, the Lehigh Valley-Central PA Chapter President of the BCAN, worked with Representative Freeman’s office to make the recognition official.

“I believe that Resolution #699 is a positive step forward in our efforts to raise awareness and understanding of this disease,” Coffin says.

In the United States, bladder cancer is the sixth most commonly diagnosed form of cancer and approximately 75,000 will be diagnosed this year. There is little public awareness of the disease, despite the fact that more than 500,000 people are currently living it. The signs and symptoms of bladder cancer can be similar to those of other conditions, which has often led to later diagnoses and poor outcomes. Throughout the month, the BCAN will provide educational materials, host events, and will focus on women and bladder cancer.

For more information about Bladder Cancer Awareness Month, please visit BCAN.org.

Jeffrey Gingrich, MD, from the Department of Urology at UPMC discusses the management and treatment of  bladder cancer in the following video: Neoadjuvant Chemotherapy in the Management of Bladder Cancer.

UPMC Physician Reaches Rare Milestone with 3000th Prostate Surgery

PITTSBURGH, May 1, 2014 Joel B. Nelson, M.D., chair of the Department of Urology at UPMC, has performed 3,000 radical prostatectomies since coming to Pittsburgh in 1999. He joins only a handful of surgeons in the world to reach this milestone.

Prostate cancer is the second most common cancer in American men, after skin cancer, with several treatments available for the disease. But often men shy away from surgical treatment because they believe it will leave them incontinent and impotent. Nerve-sparing radical prostatectomy is one of the most effective treatments because the cancer can be removed without harming nerves that control erections.

“The nerve-sparing approach not only removes the cancer but lowers the risk of impotence and bladder control problems, providing a better quality of life for the patient,” said Dr. Nelson. “Our vast experience distinguishes us from other programs and that helps give patients peace of mind when they seek treatment.”

Dr. Nelson has gained considerable recognition for both his clinical work and research. He has been featured in several publications due to the great strides he has made in the treatment of prostate cancer and is the recipient of multiple awards.

“We have seen remarkable results over the past decade. Currently, about 95 percent of patients undergo a bilateral nerve-sparing procedure with a prostate cancer-specific survival rate of 99.3 percent at five years and 98 percent at 10 years,” Dr. Nelson said.

Dr. Nelson also serves on the editorial boards for several scientific journals, including The Journal of Urology, and is an ad hoc reviewer for several other medical publications, including The New England Journal of Medicine.

Electrical Stimulation of Foot Nerves Increases Bladder Capacity in Healthy Human Subjects, Pitt Team Finds

PITTSBURGH, May 1, 2014 – Researchers from the University of Pittsburgh found that foot stimulation can delay bladder filling sensations and increase bladder capacity in healthy humans who do not have overactive bladder. The study’s lead author was Mang L. Chen, MD, assistant professor of urology, and the results recently were published in The Journal of Urology.

To determine if electrical stimulation of somatic afferent nerves in the foot could delay bladder filling sensations and increase bladder capacity in healthy subjects, the researchers evaluated eight subjects who each underwent 90-minute foot stimulation with a transcutaneous electrical nerve stimulator. Subjects completed a three-day voiding diary, during which foot stimulation was applied on the second day.

Stimulation parameters were:

  • Pulse frequency 5 Hz
  • Rectangular waveform pulse width 0.2 milliseconds
  • Intensity two to six times the minimal stimulation current necessary to induce toe twitch

Stimulation intensity was set by each subject to a maximal level without causing discomfort. Subjects also were provided with 500 to 1,000 mL of water to drink during stimulation.

The authors found that stimulation significantly increased bladder capacity, writing, “although the study group was small, our results support moving forward with clinical trials of foot neuromodulation in patients with overactive bladder.” 

Additional authors on the study were Christopher J. Chermansky, MD, Bing Shen, James R. Roppolo, PhD, William C. de Groat, PhD, and Changfeng Tai, PhD, all of the University of Pittsburgh.

To view the full abstract, please visit PubMed.gov.

Timothy Averch, MD, Named 2014-2015 Gallagher Health Policy Scholar By AUA

The American Urological Association (AUA) named Timothy D. Averch, MD, professor of urology and director of endourology at UPMC, the 2014-2015 Gallagher Health Policy Scholar.

“I hope this position helps me reach people who don’t have connections, get them educated in health policy, and give them an outlet to become active participants in the process so we can make a difference in quality improvement and patient safety,” said Dr. Averch.

The Gallagher Health Policy Scholar Program aims to train the next generation of leaders in urologic health policy. Scholars spend one year involved in national seminars, conferences, and meetings. Scholars receive mentoring from senior AUA physicians, participate in a week-long health policy seminar, and contribute to other educational activities to build their understanding of health policy issues of importance to urology.

“In a field of impressive applicants, Dr. Averch’s accomplishments, particularly his activity on behalf of urology at the national level, stood out and earned him the honor of being selected as the fifth Gallagher Health Policy Scholar,” said David F. Penson, MD, MPH, AUA Health Policy Chair.

Dr. Averch has authored several articles in peer-reviewed journals, volunteers both nationally and regionally, and serves as both vice chair of the AUA’s Quality Improvement & Patient Safety Committee and the Pennsylvania representative to the AUA’s Northeastern Section Board of Directors.

To read more about Dr. Averch’s participation in the program, read the full press release on the American Urological Association website.

Children’s Hospital of Pittsburgh of UPMC Study Reveals Success Rate of Minimally Invasive Surgical Approaches in Infants

PITTSBURGH, April 10, 2013 – Blockage between the kidney and the ureter in infants can be successfully repaired with minimally invasive surgical approaches, according to a Children’s Hospital of Pittsburgh of UPMC study. The findings are published in the April issue of The Journal of Urology.
Ureteropelvic junction (UPJ) obstruction is the most common obstructive urinary system disease in infants, according to senior investigator Michael Ost, M.D., chief, Division of Pediatric Urology at Children’s Hospital. The problem typically has been repaired with a procedure called pyeloplasty, in which an incision is made in the infant’s side to reach and remove scar tissue where the kidney meets the ureter, the tube that carries urine to the bladder.
The minimally invasive approach – called transperitoneal laparoscopic pyeloplasty, which can also be done with robot assistance – has emerged as a safe, effective alternative to the standard open pyeloplasty. Both laparoscopic and open pyeloplasty have comparable effectiveness in pediatric patients, but the role of infants is less well defined.
“This population can be challenging to treat laparascopically because of the small size of the abdomen and caliber of the ureter,” Dr. Ost said.
His team reviewed records of 29 children younger than 12 months old treated with transperitoneal laparoscopic pyeloplasty for UPJ obstruction from May 2005 to February 2012. Of the 24 patients for whom follow-up data was available, 22 (92 percent) had successful repairs. Two patients required a second, open procedure to correct the obstruction.
“Our results show the laparoscopic approach is a safe and effective option for the surgical management of UPJ obstruction in the infant population,” said Dr. Ost. “Our early experience reveals a developing success rate comparable to that of other treatment modalities with minimal morbidity.”
Children’s is a national leader in minimally invasive procedures, having performed more than 1,000 such surgeries in the last year. So far in fiscal year 2013, Children’s surgeons have performed more than 760 MIS operations.
Children’s is also one of just a handful of pediatric hospitals in the world that features the top-of-the-line surgical robot system, called the daVinci SI Dual Consol Surgical System. The technology allows Children’s surgeons to perform some minimally invasive procedures that in the past couldn’t be performed laproscopically. Increasingly complex, delicate operations can be done through very small surgical openings by specially trained surgeons through the use of the daVinci. Growth in robotic procedures has increased markedly across surgical services.
For more information on Dr. Ost and to learn more about minimally invasive and robotic-assisted surgeries at Children’s Hospital, please visit http://www.chp.edu/minimally+invasive+surgery.
Page 1 of 2:1 2 »