These unacceptably very high posttreatment PSA nadir levels can only be explained by a totally inadequate ablation or poor selection of cases with occult metastatic disease. One

cannot condemn the technology, but rather the Bosutinib nmr surgeons whose poor surgical technique likely led to high failure rates. In the subset of men in the Ripert study who achieved posttreatment PSA nadirs < 0.2 ng/mL-which Inhibitors,research,lifescience,medical would reflect both good surgical technique and the selection of candidates who in fact have localized disease-approximately 75% of men achieved durable (6-year) biochemical-free survival. Dr. Uchida is a highly experienced HIFU surgeon who uses the Sonablate 500 device, which I believe is superior technology due to its more precise delivery of energy and monitoring

of tissue destruction compared with the Ablatherm device. Uchida and colleagues reported 5-year BCR rates of only 16% and 34% for low- and intermediate-risk disease, respectively, Inhibitors,research,lifescience,medical using the Phoenix definition of BCR.2 These are impressive outcomes and clearly rival those achieved with RT. In my opinion, these impressive outcomes reflect the advanced capabilities of Sonablate technology and the skill of the operator. There is no doubt that successful surgical outcomes are often related to clinical experience. A rigorous community-based Inhibitors,research,lifescience,medical study of outcomes following radical prostatectomy reported severe incontinence rates of approximately 10%.3 In the community setting, the average urologist performs about five radical prostatectomies a year, similar to the number performed by Ripert and colleagues. I have personally performed over Inhibitors,research,lifescience,medical 4000 radical prostatectomies and my reported severe incontinence rate is 2%. It is, therefore, not surprising that experienced HIFU surgeons achieve superior results, no different than experienced surgeons who perform radical prostatectomy as well as any complex surgical procedure. So, in my opinion, the Ripert report is consistent with the literature. When the prostate is appropriately ablated in legitimately selected cases, low PSA nadir levels are achieved. Even Ripert achieved good outcomes when the prostate Inhibitors,research,lifescience,medical was adequately

treated. The challenge, as with any new technology, is to minimize the learning Olopatadine curve for those who embrace this new technology.
Acute appendicitis presenting with renal colic secondary to ureteral stenosis is a very rare event.1 Our patient presented with an acute complicated appendicitis with stercolith and perforation causing appendiceal abscess and leading to right ureteral stenosis and hydronephrosis. Case Presentation A 60-year-old woman was admitted to the emergency room with a 7-day history of right renal colic and low abdominal pain. There were no urinary symptoms. Past medical history was unremarkable. On physical examination, her temperature was 39°;C/102°;F and the lower abdominal region was mildly tender upon palpation.