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Item Evolving concepts of micropapillary variant urothelial carcinoma(AME, 2016-12) Monn, M. Francesca; Cheng, Liang; Department of Urology, School of MedicineMicropapillary variant (MPV) urothelial carcinoma remains an uncommon, challenging to treat entity. Recent research has emerged that examines the genetic expression profile of MPV urothelial carcinoma and provides a new perspective on this challenging to treat form of bladder cancer. Ongoing research is necessary to determine the most appropriate treatment algorithms for managing patients with MPV urothelial carcinoma.Item Holmium Laser Enucleation of the Prostate(Liebert, 2018-05) Rivera, Marcelino E.; Lingeman, James E.; Krambeck, Amy E.; Urology, School of MedicineIntroduction: Holmium laser enucleation of the prostate (HoLEP) offers superior voiding outcomes to traditional transurethral resection and less morbidity than open simple prostatectomy. Likewise, HoLEP has been determined to result in excellent outcomes regardless of gland size. We present a step-by-step surgical approach to HoLEP describing both the traditional enucleation technique and a modified “top-down” surgical technique. Materials and Methods: In this video, two techniques are presented that were performed by two (A.E.K., J.E.L.) surgeons at our institution. Results: In the examples of the two enucleation techniques mentioned, outcomes are similar with regard to surgical and functional outcomes. Conclusions: HoLEP as a treatment for BPH with associated lower urinary tract symptoms (LUTS) results in excellent patient outcomes and can be offered to patients regardless of prostate volume.Item Iatrogenic pathology of the urinary bladder(Elsevier, 2018) Lopez-Beltran, Antonio; Montironi, Rodolfo; Raspollini, Maria R.; Cheng, Liang; Netto, George J.; Pathology and Laboratory Medicine, School of MedicineIntravesical immunotherapy, chemotherapy, and neoadjuvant systemic chemotherapy are among the most frequent therapeutic procedures to treat malignancies of the urinary bladder. These treatment modalities produce reactive morphologic changes in the urothelium that can mimic urothelial carcinoma in situ, urothelial dysplasia or true invasive urothelial neoplasia. Mitomycin C used after transurethral resection of bladder tumor to reduce recurrences, BCG intravesical immunotherapy to treat high risk non-muscle invasive bladder cancer and urothelial carcinoma in situ, and platinum-based systemic chemotherapy to improve post-cystectomy disease-specific survival some of the causes of therapy related atypia in urinary bladder. In addition, a number of systemic drugs in use to treat other systemic diseases, such as cyclophosphamide used to treat certain auto-immune disorders or hematologic malignancies, or the anesthetics ketamine increasingly used as illegal recreational drug, may produce similarly relevant atypical changes in the urothelium, and therefore, need to be differentiated from intraepithelial neoplasia. Immunohistochemical approach to reactive urothelium from CIS using CK20, p53, and CD44 may also be of utility in the pos-therapy scenario.