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PURPOSE: Ultrasound-based solutions for diagnosis and prognosis of prostate cancer are highly desirable. The authors have devised a method for detecting prostate cancer using a vibroelastography (VE) system developed in our group and a tissue classification approach based on texture analysis of VE images. METHODS: The VE method applies wide-band mechanical vibrations to the tissue. Here, the authors report on the use of this system for cancer detection and show that the texture of VE images characterized by the first and the second order statistics of the pixel intensities form a promising set of features for tissue typing to detect prostate cancer. The system was used to image patients prior to radical surgery. The removed specimens were sectioned and studied by an experienced histopathologist. The authors registered the whole-mount histology sections to the ultrasound images using an automatic registration algorithm. This enabled the quantitative evaluation of the performance of the authors' imaging method in cancer detection in an unbiased manner. The authors used support vector machine (SVM) classification to measure the cancer detection performance of the VE method. Regions of tissue of size 5 × 5 mm, labeled as cancer and noncancer based on automatic registration to histology slides, were classified using SVM. RESULTS: The authors report an area under ROC of 0.81 ± 0.10 in cancer detection on 1066 tissue regions from 203 images. All cancer tumors in all zones were included in this analysis and were classified versus the noncancer tissue in the peripheral zone. This outcome was obtained in leave-one-patient-out validation. CONCLUSIONS: The developed 3D prostate vibroelastography system and the proposed multiparametric approach based on statistical texture parameters from the VE images result in a promising cancer detection method.

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INTRODUCTION: We assessed outcomes and costs of open prostatectomy (OP) versus robotic-assisted prostatectomy (RAP) at a single tertiary care university hospital. METHODS: We retrospectively analyzed 200 consecutive OP by 1 experienced open surgeon (MG) and 200 consecutive RAP by an experienced open surgeon (SLG), after allowing for a short learning curve of 70 cases. RESULTS: The 2 groups had similar demographics, including mean age (64.7 vs. 64.2) and mean body mass index (27.2 vs. 27.2). The OP group had a higher proportion of higher risk cancers compared to the RAP group (32.5% vs. 8.5%). Mean skin-to-skin operative room time was less for the OP (114.2 vs. 234.1 minutes). Transfusion rates were similar at 1.5% with OP compared to 3.5% with RAP. The mean length of stay was 1.78 days for OP compared to 1.76 days for RAP, for the last 100 patients in each group. The OP group had more high-grade disease in the prostatectomy specimen, with Gleason ≥8 in 23.5% compared to 3.5% in the RAP group. Positive surgical margin rates were comparable at 31% for OP and 24.6% for RAP, and remained similar after stratification for pT2 and pT3 disease. The grade I and II perioperative complication rate (Clavien-Dindo classification) was lower in the OP group (8.5% vs. 20%). Postoperative stress urinary incontinence rates (4.8% for OP and 4.6% for RAP) and biochemical-free status (91.8% for OP and 96% for RAP) did not differ at 12 months post-surgery. The additional cost of RAP was calculated as $5629 per case. The main limitations of this study are its retrospective nature and lack of validated questionnaires for evaluation of postoperative functional outcomes. CONCLUSION: While hospital length of stay, transfusion rates, positive surgical margin rates and postoperative urinary incontinence were similar, OP had a shorter operative time and a lower cost compared to the very early experience of RAP. Future parallel prospective analysis will address the impact of the learning curve on these outcomes.

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INTRODUCTION: The TVT-Secur, a single incision sling, was introduced in 2006. It is implanted using either the "hammock" or the "U-method" technique. With the latter, the sling is tightened to create a "pillowing effect" on the urethra until a negative stress test is obtained. Short-term results seem promising. However, no study has ever reported on the voiding pattern 12 months after its implantation. Our objective was to assess whether the "U-method" technique creates an obstructive voiding pattern on pressure-flow study (PFS) 12 months after the surgery. METHODS: In this retrospective study, we reviewed the charts of 33 women who underwent the "U-method" TVT-Secur. Patients were evaluated before and 12 months postoperatively with regard to different urodynamic studies (UDS). The incontinence status was also assessed 12 months after surgery. RESULTS: At 12 months after the operation, 12.5% (4/32) of the patients reported an improvement of their stress urinary incontinence, while 78.1% (25/32) reported being cured from it. The objective cure rate was 63% (19/30). One patient had a suspected bladder outlet obstruction (BOO) based on PFS. Maximal flow rate (Q(max)) was significantly lower 12 months after surgery (26.0 mL/s [range: 19.0-36.5] vs. 21.5 mL/s [range: 16.0-32.3]). However, median voided volume was lower on the postoperative uroflowmetry (446 mL [range: 348-605] vs. 320 mL [range: 243-502]). Furthermore, none of the patients complained of voiding symptoms after surgery. CONCLUSIONS: Although one patient had findings compatible with BOO, none complained of voiding symptoms. TVT-Secur may result in a lower Q(max). However, this finding may be due to a lower voiding volume on the postoperative UDS.

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OBJECTIVE: The objective was to report our experience on the implantation of the Prolift system since 2005. METHODS: Fifty-six patients were operated on between July 2005 and August 2008 by 1 surgeon. The patients were implanted with the transvaginal mesh, the Prolift system, for the treatment of recurrent or high-grade (Baden-Walker stage III or IV) multiple compartment pelvic organ prolapse (POP) associated with symptoms. A concomitant anti-incontinence surgery was performed in 38 patients (68%). RESULTS: The population had a mean age of 68 (range 46-88), a body mass index of 27 (range 21-40) and a parity average of 3 (range 1-16). Previous POP repair had been performed in 17 patients (30%) and a hysterectomy in 43 (77%). The operating room time was on average 98 minutes (range 70-135), blood loss 81 mL (range 50-300) and hospital stay 3 days (range 1-10). With a median follow-up of 21 months, we found that the cure rate for POP was 91% (48/53) and the reoperation rate was 8% (4/53). Perioperative complications included 1 rectal laceration and 1 prolonged bleeding. Short-term postoperative complications included 10 episodes of transient urinary retention that required immediate tape release in 4 patients. Long-term complications included 5 POP recurrences, 2 low grade and 3 high grade. CONCLUSION: The Prolift system appears to be a relatively safe and effective alternative to conventional surgeries for the treatment of recurrent or high-grade multiple compartment POP, because of a high mid-term cure rate and a satisfactory complication profile. However, long-term follow-up is still needed to confirm these results.

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OBJECTIVES: To observe the satisfaction of local anesthesia during the implantation of the tension-free vaginal tape (TVT)-SECUR (Gynecare, Ethicon, Somerville, NJ) for the treatment of stress urinary incontinence, using questionnaires completed by the patients, and to evaluate the short-term safety and efficacy of the sling. METHODS: Forty-eight women were operated between January 2007 and October 2008. The implantation of the TVT-SECUR was done under local anesthesia by 1 surgeon. The "Hammock" technique was used in the first 23 patients and the "U-Method" in the last 25 patients. RESULTS: Mean patient age was 61 years (range, 38-85). Visual analogue scale for pain immediately and 1 week after surgery showed a mean score of 19/100 and 29/100, respectively. Overall, 93% (43/46) of the patients would recommend this type of anesthesia. At 1 week, 2 months, and 6 months after surgery, the improvement in incontinence symptoms rate was 82% (18/22), 76% (16/21), and 69% (11/16) for the Hammock technique, compared with 75% (18/24), 92% (22/24), and 100% (22/22) for the U-Method. At 6 months, the difference was statistically significant (P = .0087). Postoperative complications included 6 partial tape exposures, all with the Hammock technique. CONCLUSIONS: Local anesthesia with light sedation represents an appropriate choice for the implantation of this new sling. The TVT-SECUR using the U-Method appears to be relatively safe, and the short-term efficacy rates seem to compare with traditional midurethral slings, with long-term efficacy still to be determined. This is the first report showing better outcomes of one technique over the other.

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INTRODUCTION: For different reasons, urology appears to be one of the least known specialties in medicine. In this study, the main objective was to measure the knowledge about urology in the general population. METHODS: A questionnaire was completed by 150 respondents. Seventy-five respondents were from Sherbrooke, QC (a French-speaking city) and 75 were from Burlington, VT (an English-speaking city). RESULTS: Of the 150 respondents, 75% (113) said they knew little or nothing about urology and 63% (95) did not know that urology involves surgery. Also, when asked to name 3 diseases within the field of urology, 59% (89) of the respondents were unable to name at least 1 disease. CONCLUSION: This study demonstrates the lack of knowledge about urology in the general population. As urologists, we have to consider the need to conduct an informational campaign to increase the awareness of urology and the services urologists provide.

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INTRODUCTION: Nutcracker syndrome (NCS) is a rare condition characterized by the entrapment of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta. It was first described in 1950 and the term nutcracker was attributed by de Schepper in 1972. CLINICAL CASE: A 20-year-old female patient was admitted to the urology department with a history of hematuria and left flank pain. Basic hematuria investigation was inconclusive. Further investigation revealed a nutcracker syndrome on retrograde phlebography. Surveillance was the option first chosen. Three years later and after several symptomatic episodes, an intravascular stenting procedure was performed. DISCUSSION: NCS is defined by the compression of the LRV between the SMA and the aorta. Clinical manifestations include left flank pain, hematuria and pelvic congestion syndrome (PCS). Diagnosis is based on history, physical examination, basic lab tests and imaging. Sequence of tests can be composed of Doppler ultrasound (DUS), computed tomography scan (CT scan) or magnetic resonance imaging study (MRI) and retrograde phlebography with pressure gradient to confirm the diagnosis. Management options include surveillance, intravascular and extravascular stenting procedures as well as open procedures. CONCLUSION: NCS is a rare condition that represents a challenge for urologists in terms of accurate diagnosis and proper management.

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