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Re: Urothelial Carcinoma with Prominent Squamous Differentiation in the Setting of Neurogenic Bladder: Role of Human Papillomavirus Infection
Urological Survey Infection and Inflammation of Genitourinary Tract Re: Timing of Surgical Antibiotic Prophylaxis and the Risk of Surgical Site Infection M. T. Hawn, J. S. Richman, C. C. Vick, R. J. Deierhoi, L. A. Graham, W. G. Henderson and K. M. Itani Birmingham Center for Surgical and Medical Acute Care Research and Transitions, Birmingham Veterans Administration Hospital and Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama JAMA Surg 2013; 148: 649e657.
Abstract available at http://jurology.com/ Editorial Comment: This retrospective analysis of more than 32,000 operations assesses the timing of antibiotic prophylaxis and the occurrence of surgical site infection (SSI) for patients undergoing orthopedic, colorectal, vascular and gynecologic procedures. Median time of administration of prophylactic antibiotics was 28 minutes before initiation of the procedure. Higher SSI rates were observed when the antibiotic was administered more than 60 minutes before the incision. Interestingly, higher SSI rates were not seen if the antibiotic was administered after the incision. One of the other interesting findings from the study was that there were variations in SSIs among different approved antibiotic regimens. In multivariable analysis the timing of the prophylactic antibiotic ranked 15th among the 16 variables included in the analysis. The most significant predictors of surgical site infection in these models included patient based factors such as smoking and diabetes as well as duration of the operation. Another key factor in this multivariable model was the antibiotic agent. Within urological specialties these data suggest that we should continuously track our own surgical site infection rate, as this analysis highlights that for specific surgical procedures combination antibiotics may be better than single agents. Edward M. Schaeffer, M.D., Ph.D.
Re: Urothelial Carcinoma with Prominent Squamous Differentiation in the Setting of Neurogenic Bladder: Role of Human Papillomavirus Infection E. B. Blochin, K. J. Park, S. K. Tickoo, V. E. Reuter and H. Al-Ahmadie Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York Mod Pathol 2012; 25: 1534e1542.
Abstract available at http://jurology.com/ Editorial Comment: Infectious agents have been linked to multiple cancer types, including bacteria with stomach cancer, and viruses with liver and cervical cancer. These authors report 2 cases of squamous cell carcinoma arising from the bladder in individuals with a nonfunctioning (neurogenic)
0022-5347/13/1906-2102/0 THE JOURNAL OF UROLOGY® © 2013 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
2102
j
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2013.08.067 Vol. 190, 2102-2105, December 2013 Printed in U.S.A.
DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE
bladder undergoing catheterization with strong staining for human papillomavirus (HPV). They report that histopathologically these tumors morphologically closely resembled HPV associated tumors from other organs. This report highlights an association between viral infection and bladder tumor. In these 2 instances the individuals had neurogenic bladder and were undergoing intermittent catheterization. It is unclear whether the intermittent catheterization increased the risk of HPV associated tumors. Other larger series of noninvasive squamous lesions have not demonstrated or described HPV infection. Thus, this does not appear to be a common mechanism of induction of squamous cell carcinoma, even in neurogenic bladders, although it certainly speaks to the ever increasing association of infectious agents and malignancies in general. Edward M. Schaeffer, M.D., Ph.D.
Re: Toll-Like 4 Receptor Variant, Asp299Gly, and Reduced Risk of Hemorrhagic Cystitis after Hematopoietic Stem Cell Transplantation € ppner, N. Pfaffendorf-Regler, J. Beck, F. Zintl, S. Bartholoma €, K. M. Debatin B. Gruhn, N. Klo and D. Steinbach Department of Pediatrics, University Hospital of Jena, Jena, Germany Biol Blood Marrow Transplant 2012; 18: 958e963.
Abstract available at http://jurology.com/ Editorial Comment: This fascinating study evaluates the association between different functional single nucleotide polymorphisms (SNPs) of toll-like receptor 4 (TLR4) and hemorrhagic cystitis following stem cell transplantation. The authors devised this strategy because there are TLR4 variants that are associated with decreased risks of recurrent urinary tract infection and variants associated with reduced inflammation after instillation of bacteria into the bladder. The authors investigated whether these TLR4 variants are also associated with decreased rates of hemorrhagic cystitis after stem cell transplantation. Interestingly they found that the SNP variant that is associated with reduced inflammation in the urinary tract as well as airway responsiveness is also associated with decreases in rates of hemorrhagic cystitis. These effects were observed when the favorable SNP genotype was present in either the donor or the recipient. To my knowledge this is the first report of genetic risk factors for hemorrhagic cystitis, and it suggests that we are making inroads into understanding the basic biology of this sometimes crippling disorder. Whether these rules apply to individuals who are undergoing radiation treatment for urological malignancies has yet to be determined. Edward M. Schaeffer, M.D., Ph.D.
Diagnostic Urology, Urinary Diversion and Perioperative Care Re: Stratifying Risk of Urinary Tract Malignant Tumors in Patients with Asymptomatic Microscopic Hematuria R. K. Loo, S. F. Lieberman, J. M. Slezak, H. M. Landa, A. J. Mariani, G. Nicolaisen, A. M. Aspera and S. J. Jacobsen Department of Urology, Southern California Permanente Medical Group, Los Angeles, California Mayo Clin Proc 2013; 88: 129e138.
Abstract available at http://jurology.com/
2103
Abstract available at http://jurology.com/ Editorial Comment: This retrospective analysis of more than 32,000 operations assesses the timing of antibiotic prophylaxis and the occurrence of surgical site infection (SSI) for patients undergoing orthopedic, colorectal, vascular and gynecologic procedures. Median time of administration of prophylactic antibiotics was 28 minutes before initiation of the procedure. Higher SSI rates were observed when the antibiotic was administered more than 60 minutes before the incision. Interestingly, higher SSI rates were not seen if the antibiotic was administered after the incision. One of the other interesting findings from the study was that there were variations in SSIs among different approved antibiotic regimens. In multivariable analysis the timing of the prophylactic antibiotic ranked 15th among the 16 variables included in the analysis. The most significant predictors of surgical site infection in these models included patient based factors such as smoking and diabetes as well as duration of the operation. Another key factor in this multivariable model was the antibiotic agent. Within urological specialties these data suggest that we should continuously track our own surgical site infection rate, as this analysis highlights that for specific surgical procedures combination antibiotics may be better than single agents. Edward M. Schaeffer, M.D., Ph.D.
Re: Urothelial Carcinoma with Prominent Squamous Differentiation in the Setting of Neurogenic Bladder: Role of Human Papillomavirus Infection E. B. Blochin, K. J. Park, S. K. Tickoo, V. E. Reuter and H. Al-Ahmadie Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York Mod Pathol 2012; 25: 1534e1542.
Abstract available at http://jurology.com/ Editorial Comment: Infectious agents have been linked to multiple cancer types, including bacteria with stomach cancer, and viruses with liver and cervical cancer. These authors report 2 cases of squamous cell carcinoma arising from the bladder in individuals with a nonfunctioning (neurogenic)
0022-5347/13/1906-2102/0 THE JOURNAL OF UROLOGY® © 2013 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
2102
j
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2013.08.067 Vol. 190, 2102-2105, December 2013 Printed in U.S.A.
DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE
bladder undergoing catheterization with strong staining for human papillomavirus (HPV). They report that histopathologically these tumors morphologically closely resembled HPV associated tumors from other organs. This report highlights an association between viral infection and bladder tumor. In these 2 instances the individuals had neurogenic bladder and were undergoing intermittent catheterization. It is unclear whether the intermittent catheterization increased the risk of HPV associated tumors. Other larger series of noninvasive squamous lesions have not demonstrated or described HPV infection. Thus, this does not appear to be a common mechanism of induction of squamous cell carcinoma, even in neurogenic bladders, although it certainly speaks to the ever increasing association of infectious agents and malignancies in general. Edward M. Schaeffer, M.D., Ph.D.
Re: Toll-Like 4 Receptor Variant, Asp299Gly, and Reduced Risk of Hemorrhagic Cystitis after Hematopoietic Stem Cell Transplantation € ppner, N. Pfaffendorf-Regler, J. Beck, F. Zintl, S. Bartholoma €, K. M. Debatin B. Gruhn, N. Klo and D. Steinbach Department of Pediatrics, University Hospital of Jena, Jena, Germany Biol Blood Marrow Transplant 2012; 18: 958e963.
Abstract available at http://jurology.com/ Editorial Comment: This fascinating study evaluates the association between different functional single nucleotide polymorphisms (SNPs) of toll-like receptor 4 (TLR4) and hemorrhagic cystitis following stem cell transplantation. The authors devised this strategy because there are TLR4 variants that are associated with decreased risks of recurrent urinary tract infection and variants associated with reduced inflammation after instillation of bacteria into the bladder. The authors investigated whether these TLR4 variants are also associated with decreased rates of hemorrhagic cystitis after stem cell transplantation. Interestingly they found that the SNP variant that is associated with reduced inflammation in the urinary tract as well as airway responsiveness is also associated with decreases in rates of hemorrhagic cystitis. These effects were observed when the favorable SNP genotype was present in either the donor or the recipient. To my knowledge this is the first report of genetic risk factors for hemorrhagic cystitis, and it suggests that we are making inroads into understanding the basic biology of this sometimes crippling disorder. Whether these rules apply to individuals who are undergoing radiation treatment for urological malignancies has yet to be determined. Edward M. Schaeffer, M.D., Ph.D.
Diagnostic Urology, Urinary Diversion and Perioperative Care Re: Stratifying Risk of Urinary Tract Malignant Tumors in Patients with Asymptomatic Microscopic Hematuria R. K. Loo, S. F. Lieberman, J. M. Slezak, H. M. Landa, A. J. Mariani, G. Nicolaisen, A. M. Aspera and S. J. Jacobsen Department of Urology, Southern California Permanente Medical Group, Los Angeles, California Mayo Clin Proc 2013; 88: 129e138.
Abstract available at http://jurology.com/
2103