Molecular and reconstructive urology: a coming together

Appreciation of the clinical utility of the protein product of kallikrein gene 3, prostate-specific antigen (PSA), has resulted in earlier diagnosis of prostate cancer and an associated increase in the number of radical prostatectomies performed. A consequence of this change in surgical practice has been an improved understanding of sphincter anatomy and methods for sphincter preservation, which in turn have led to enhanced popularity for orthotopic urinary diversion for invasive bladder cancer. In this paper, molecular and basic science research being undertaken in an to attempt to overcome problems and limitations of the PSA/transrectal ultrasonographic biopsy approach to diagnosis are discussed. Also detailed are (1) the development of a bladder acellular matrix graft to serve as an "off the shelf" scaffold on which urothelium regenerates, (2) attempts to create a simpler, more durable bowel continence mechanism, and (3) a novel experimental technique for renal preservation based on considering the urine-producing and urine-directing roles of the upper tract as surgically separable entities. These research endeavors serve to illustrate how developments at the molecular and basic science levels promise to lead to further reconstructive surgical approaches when translating new developments into patient benefits during the year 2000 and beyond.