Molecular and reconstructive urology: A coming together

Appreciation of the clinical utility of the protein product of kallikrein g ene 3, prostate-specific antigen (PSA), has resulted in earlier diagnosis o f prostate cancer and an associated increase in the number of radical prost atectomies performed. A consequence of this change in surgical practice has been an improved understanding of sphincter anatomy and methods for sphinc ter preservation, which in turn have Led to enhanced popularity for orthoto pic urinary diversion for invasive bladder cancer. In this paper, molecular and basic science research being undertaken in an to attempt to overcome p roblems and limitations of the PSA/transrectal ultrasonographic biopsy appr oach 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 durabl e bowel continence mechanism, and (3) a novel experimental technique for re nal preservation based on considering the urine-producing and urine-directi ng roles of the upper tract as surgically separable entities. These researc h endeavors serve to illustrate how developments at the molecular and basic science levels promise to lead to further reconstructive surgical approach es when translating new developments into patient benefits during the year 2000 and beyond.