1
|
Kanagarajah P, Ekwenna O, Ayyathurai R, Burk GW, Ciancio G. Feasibility of renal transplantation after unroofing of a large renal cyst in an expanded criteria donor. Urol Ann 2013; 5:206-8. [PMID: 24049388 PMCID: PMC3764906 DOI: 10.4103/0974-7796.115755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 12/11/2011] [Indexed: 11/30/2022] Open
Abstract
We present a case in which a deceased donor kidney with a large simple cyst was successfully unroofed and transplanted to a 61-year-old male. The donor was a 62-year-old male with a history of hypertension for 2 years; cerebral vascular accident was the cause of death. A large 8-cm cyst distorting the renal hilum was identified upon the procurement of the deceased donor kidney. Prior to transplantation, the large cyst was unroofed from the allograft; the frozen section confirmed a benign cyst and the transplant was performed. Postoperatively, the serum creatinine level was 1.4 mg/ml at 22-month follow-up and the patient was normotensive. Deceased donor kidneys with giant cysts distorting the renal hilum can be effectively transplanted.
Collapse
|
2
|
Kanagarajah P, Ayyathurai R, Manoharan M, Narayanan G, Kava BR. Current concepts in the management of adrenal incidentalomas. Urol Ann 2012; 4:137-44. [PMID: 23248518 PMCID: PMC3519103 DOI: 10.4103/0974-7796.102657] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 01/08/2012] [Indexed: 11/27/2022] Open
Abstract
Adrenal tumors are among the commonest incidental findings discovered. The increased incidence of diagnosing adrenal incidentalomas is due to the widespread availability and use of noninvasive imaging studies. Extensive research has been conducted to define a cost-effective diagnostic and therapeutic protocol to guide physicians in managing incidental adrenal lesions. However, there is little consensus on the optimal management strategy. Published literature to date, describes a wide spectrum of treatment options ranging from excision of all adrenal lesions regardless of the size and functional status to extensive hormonal and radiological evaluation to avoid surgery. In this review, we present a comprehensive overview of the presentation, evaluation and management of adrenal incidentalomas. Additionally, we propose a management algorithm to optimally manage these tumors.
Collapse
|
3
|
Joshi S, Gorin MA, Ayyathurai R, Ciancio G. Development of a surgical safety checklist for the performance of radical nephrectomy and tumor thrombectomy. Patient Saf Surg 2012; 6:27. [PMID: 23241448 PMCID: PMC3546874 DOI: 10.1186/1754-9493-6-27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 12/12/2012] [Indexed: 11/13/2022] Open
Abstract
Background The surgical management of renal cell carcinoma with invasion of the renal vein or inferior vena cava is associated with significant rates of perioperative morbidity and mortality. In this report we propose a surgical checklist aimed at reducing adverse events associated with the resection of these tumors. Methods This review describes the development of an evidence- and experience-based surgical checklist aimed at improving the perioperative safety of patients undergoing radical nephrectomy and tumor thrombectomy. Results Reducing the risk of complications during the surgical management of renal tumors with venous invasion begins with appropriate pre-operative imaging aimed at defining the cranial extent of the tumor thrombus, thus facilitating accurate preoperative planning. Other key elements of the checklist are aimed at ensuring clear and precise pre-, intra- and postoperative communication between members of the multidisciplinary-care team. Conclusion A standardized surgical checklist may help to increase the perioperative safety of patients undergoing radical nephrectomy and tumor thrombectomy. Future validation studies are required to determine the clinical feasibility and post-implementation safety profile of this new checklist.
Collapse
|
4
|
Gorin MA, Ayyathurai R, Soloway MS. Diagnosis and treatment of bladder cancer: how can we improve? Postgrad Med 2012; 124:28-36. [PMID: 22691896 DOI: 10.3810/pgm.2012.05.2545] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The majority of patients with bladder cancer will be diagnosed following an episode of hematuria. With few exceptions, these patients should be referred for a complete urologic evaluation, including a history and physical examination, flexible cystoscopy, imaging of the upper urinary tract, and optional urine cytology. Those found to have a bladder tumor should undergo transurethral resection for the combined purposes of initial staging and treatment. Delays in diagnosing invasive bladder cancer are associated with adverse outcomes. In this review, we cover the diagnosis and management of bladder cancer. In addition, we discuss ways to improve outcomes through increased public awareness, improvements in tumor detection, accurate staging, and regimented patient surveillance.
Collapse
|
5
|
Joshi S, Ayyathurai R, Satyanarayana R, Ciancio G. Important surgical considerations in the management of renal cell carcinoma (rcc) with inferior vena cava (ivc) tumour thrombus. BJU Int 2012; 110:E327-8; author reply E328. [PMID: 22954031 DOI: 10.1111/j.1464-410x.2012.10975_1.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
6
|
Kanagarajah P, Ayyathurai R, Lynne CM. Male infertility and adult polycystic kidney disease--revisited: case report and current literature review. Andrologia 2012; 44 Suppl 1:838-41. [PMID: 21950684 DOI: 10.1111/j.1439-0272.2011.01221.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Adult polycystic kidney disease (APKD) is one of the most common inherited disorders affecting one in 800-1000 live births. Extra-renal manifestation of APKD is not uncommon. Cysts involving the male and female reproductive system have been reported. However, fertility is affected only in male subjects. Among cysts involving the reproductive system, seminal vesicle cysts have been reported to be the most common. The effect of seminal vesicle cysts on male fertility has been controversial. Current literature reports that majority of men remain fertile. However, uraemia and its implications on fertility and abnormal semen parameters in men with seminal vesicle cysts must be taken into consideration. We herein present two patients with APKD with contrasting semen parameters and also review the current literature.
Collapse
|
7
|
Ayyathurai R, Garcia-Roig M, Gorin MA, González J, Manoharan M, Kava BR, Soloway MS, Ciancio G. Bland thrombus association with tumour thrombus in renal cell carcinoma: analysis of surgical significance and role of inferior vena caval interruption. BJU Int 2012; 110:E449-55. [DOI: 10.1111/j.1464-410x.2012.11128.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
8
|
Ayyathurai R, Joshi S, Ekwenna O, Sageshima J, Chen L, Burke G, Ciancio G. 2272 RHABDOMYOLYSIS WITH ACUTE RENAL FAILURE IN DECEASED DONORS IS NOT A CONTRAINDICATION FOR KIDNEY DONATION. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.2450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
9
|
katkoori D, Eldefrawy A, Ayyathurai R, Manoharan M. V1885 ROBOTIC ASSISTED RADICAL CYSTECTOMY AND URINARY DIVERSION USING A MODIFIED PFANNENSTIEL INCISION. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.2040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Ayyathurai R, Ekwenna O, Ciancio G. Re: Graft reconstruction of inferior vena cava for renal cell carcinoma stage pT3b or greater. (Urology 2011;78:838-843). Urology 2012; 79:486-7. [PMID: 22310770 DOI: 10.1016/j.urology.2011.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 10/30/2011] [Accepted: 10/31/2011] [Indexed: 11/26/2022]
|
11
|
Soloway MS, Garcia-Roig M, Gorin MA, Ayyathurai R. How Can We Improve Outcomes for Upper Tract Urothelial Carcinoma? Eur Urol 2012; 61:254-6; discussion 256-7. [DOI: 10.1016/j.eururo.2011.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 10/06/2011] [Indexed: 10/16/2022]
|
12
|
Abstract
Upper urinary tract (UUT) transitional cell carcinoma (TCC) is relatively rare tumor. Approximately 0.7-4% of patients with primary bladder cancer develops UUT-TCC. The symptoms related to an UUT-TCC often occur with an advanced stage which leads one to emphasize a surveillance strategy to monitor the UUT to allow for an earlier diagnosis. Although the risk of UUT-TCC after bladder cancer is well established, there is a paucity of recommendations suggesting the optimal method and frequency of monitoring the UUT and there is no consensus among them. This article reviews the recommendations on monitoring the UUT in patients with bladder cancer.
Collapse
|
13
|
Kanagarajah P, Ayyathurai R, Saleem U, Manoharan M. Small cell carcinoma arising from the bulbar urethra: a case report and literature review. Urol Int 2011; 88:477-9. [PMID: 22041867 DOI: 10.1159/000332154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 08/19/2011] [Indexed: 11/19/2022]
Abstract
Primary neuroendocrine carcinomas of the genitourinary tract are rare and aggressive tumors carrying a bad prognosis. With squamous cell and transitional cell carcinoma being the most commonly reported urethral malignancies, primary small cell carcinoma (SCC) of the urethra is extremely rare. To date, only 5 cases have been reported in the literature. We present the first case of primary SCC occurring in the bulbar urethra in an 89-year-old male. We discuss the clinical, histological and immunohistochemical features of SCC of the urethra. Furthermore, we summarize the available literature and discuss the possible treatment options for this rare yet aggressive neoplasm.
Collapse
|
14
|
Chi A, Shirodkar SP, Escudero DO, Ekwenna OO, Yates TJ, Ayyathurai R, Garcia-Roig M, Gahan JC, Manoharan M, Bird VG, Lokeshwar VB. Molecular characterization of kidney cancer: association of hyaluronic acid family with histological subtypes and metastasis. Cancer 2011; 118:2394-402. [PMID: 21887686 DOI: 10.1002/cncr.26520] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 07/12/2011] [Accepted: 07/15/2011] [Indexed: 01/21/2023]
Abstract
BACKGROUND Molecular profiling of renal cell carcinomas (RCCs) may improve the distinction between oncocytoma and malignant RCC subtypes and aid in early detection of metastasis. The hyaluronic acid (HA) family includes HA synthases (HAS1, HAS2, HAS3), hyaluronidases (HYAL-1, HYAL-2, HYAL-3, HYAL-4, PH20, HYAL-P1), and HA receptors (CD44s, CD44v, RHAMM). HA family members promote tumor growth and metastasis. The authors evaluated the expression of HA family members in kidney specimens. METHODS By using quantitative polymerase chain reaction, mRNA levels of 12 HA family members were measured in tumor specimens obtained from 86 consecutive patients undergoing nephrectomy; 80 of them also provided normal specimens. Mean and median follow-up were 15.2 ± 8.8 and 13.8 months. RCC specimens included clear cell RCC: 65; papillary: 10; chromophobe: 5; oncocytoma: 6; metastasis positive: 17. RESULTS Median HAS1, CD44s, and RHAMM transcript levels were elevated 3- to 25-fold in clear cell RCC and papillary and chromophobe tumors when compared with normal tissues. HYAL-4, CD44s, and RHAMM levels were elevated 4- to 12-fold in clear cell RCC and papillary tumors when compared with oncocytomas; only HYAL-4 levels distinguished between chromophobe and oncocytoma (P = .009). CD44s and RHAMM levels were significantly higher in tumors <4 cm (510 ± 611 and 19.6 ± 20.8, respectively) when compared with oncocytoma (46.4 ± 20 and 3.8 ± 2.5; P ≤ .006). In univariate and multivariate analyses, CD44s (P < .0001), RHAMM (P < .0001), stage, tumor size, and/or renal vein involvement were significantly associated with metastasis. The combined CD44s + RHAMM marker had 82% sensitivity and 86% specificity to predict metastasis. CONCLUSIONS CD44s and RHAMM levels distinguish between oncocytoma and RCC subtypes regardless of tumor size and are potential predictors of RCC metastasis.
Collapse
|
15
|
Ayyathurai R, Santos RDL, Manoharan M. Role of maximum androgen blockade in advanced prostate cancer. Indian J Urol 2011; 25:47-51. [PMID: 19468428 PMCID: PMC2684298 DOI: 10.4103/0970-1591.45536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Androgen ablation is the mainstay treatment for advanced prostate cancer (PC). Researchers proposed that maximum androgen blockade (MAB) therapy with antiandrogen agent in combination with castration might result in a better outcome among patients with advanced PC. In the last two decades, numerous trials and pooled data analyses were conducted to optimize the role of MAB in the treatment of metastatic PC. Non-steroidal antiandrogens administered as part of MAB proved to have a small (3%) survival benefit, however, the magnitude of this difference is of questionable clinical significance. Available evidence suggests that MAB should not be routinely offered to patients with metastatic PC, however, it should remain a reasonable option when discussing management. The standard first line treatment should be a monotherapy, consisting of orchiectomy or LHRH agonist. MAB still has a role as a short-term therapy (2-4 weeks). The ongoing large sample population based prospective studies may add new dimensions in the use of MAB in treatment of the prostate cancer in future.
Collapse
|
16
|
Kava BR, Ayyathurai R, Soloway CT, Suarez M, Kanagarajah P, Murugesan M. Prospective randomized comparison of the safety, efficacy, and cosmetic outcome associated with mini-transverse and mini-longitudinal radical prostatectomy incisions. Indian J Urol 2011; 26:345-9. [PMID: 21116351 PMCID: PMC2978431 DOI: 10.4103/0970-1591.70563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aims: Open radical retropubic prostatectomy (ORP) has traditionally been performed through a lower midline incision. Prior efforts to reduce pain and expedite recovery include a variety of alterations in length and the orientation of the incision. The aim of our study is to compare the safety, efficacy, and cosmetic outcomes associated with transverse and longitudinal mini-radical prostatectomy incisions. Materials and Methods: Consecutive patients undergoing ORP at a single institution were studied. Patients were randomized to receive either a modified transverse or longitudinal incision. In all patients, the length of the incision was 7cm. The following parameters were compared between the two groups: Perioperative blood loss, duration of surgery, technical factors, pain and analgesic requirements, length of hospital stay (LOS), and pathological stage. The Patient and Observer Scar Assessment Scale (POSAS) was used to compare the cosmetic aspects associated with the incisions. Results: Fifty-six patients underwent a transverse (n=27) and longitudinal (n=29) mini- incision ORP. No significant differences were noted in the perioperative parameters that were compared (P>0.116). None of the patients required blood transfusion, there were no wound complications. Perioperative pain and analgesic requirements were not significantly different among the two study arms (P>0.433). The POSAS indicated no significant difference in cosmesis scores with both incisions (P>0.09). Conclusions: Seven-centimeter transverse and longitudinal mini-incisions offer alternatives to the standard ORP incision, and to minimally invasive approaches. Both incisions are safe, associated with little postoperative pain, and a short postoperative LOS. Both incisions provide highly satisfactory cosmesis for the patient.
Collapse
|
17
|
Kanagarajah P, Ayyathurai R, Caruso DJ, Gomez C, Gousse AE. Role of botulinum toxin-A in refractory idiopathic overactive bladder patients without detrusor overactivity. Int Urol Nephrol 2011; 44:91-7. [PMID: 21643644 DOI: 10.1007/s11255-011-9979-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 04/19/2011] [Indexed: 01/28/2023]
Abstract
BACKGROUND To evaluate the efficacy of intradetrusor botulinum toxin-A (BTX-A) in idiopathic overactive bladder patients (OAB) refractory to anti-muscarinic therapy, without detrusor overactivity (DOA) on urodynamics. METHODS Patients with refractory idiopathic OAB without DOA on urodynamics were prospectively enrolled. Subjects completed a 3-day voiding diary (3-VD), urogenital distress inventory-6 questionnaire (UDI-6) and graded their quality of life on a 10-cm visual analog scale (VAS) prior to study enrollment and at week 12 postinjection. All patients underwent multichannel urodynamics at study enrollment and 12 weeks postinjection. Improvement was analyzed based on 3-VD, UDI-6 questionnaire, VAS scores, and urodynamic parameters at week 12 postinjection compared to study enrollment. RESULTS The study included 32 patients. Mean ± SD age was 56 ± 16. There were 27 women and 5 men. Nineteen patients had OAB without incontinence (OAB-dry) and 13 patients had OAB with incontinence (OAB-wet). In OAB-dry patients, mean ± SD urinary frequency dropped from 24 ± 11 to 10 ± 4 by week 12. In OAB-wet patients, mean ± SD urge incontinence episodes dropped from 7.9 ± 5 to 0 ± 2.6 by week 12. Mean UDI-6 and VAS scores improved significantly in both groups by week 12 (P = 0.0001). On comparing urodynamic parameters, OAB-wet patients showed significant decrease in maximum detrusor pressure during the voiding phase at week 12 compared to baseline values (P = 0.02). CONCLUSIONS Refractory idiopathic OAB patients without DOA on urodynamics may benefit from intradetrusor BTX-A.
Collapse
|
18
|
Kava BR, Kanagarajah P, Ayyathurai R. Contemporary revision penile prosthesis surgery is not associated with a high risk of implant colonization or infection: a single-surgeon series. J Sex Med 2011; 8:1540-6. [PMID: 21366878 DOI: 10.1111/j.1743-6109.2011.02222.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Revision penile prosthesis surgery has traditionally been associated with a greater risk of postoperative infection than primary implant placement. This has been attributed to the high prevalence of asymptomatic bacteria found surrounding the implant at the time of revision surgery. AIM To validate whether contemporary revision surgery remains associated with a high risk of asymptomatic colonization and postoperative infection. METHODS A comprehensive, prospective database consisting of consecutive patients undergoing primary and revision penile prosthesis surgery at our center was analyzed. MAIN OUTCOME MEASURES The infection risk in primary and revision implant surgery was compared. The prevalence of asymptomatic implant colonization during revision surgery, and whether this was associated with clinical infection was evaluated. The spectrum of bacterial species causing infection in this contemporary single-surgeon series was described. RESULTS One hundred seventeen primary and 72 revision implant recipients were studied. Infection developed in four (3.4%) patients undergoing primary implants, two (4.3%) patients undergoing removal and replacement for mechanical malfunction, and three (12%) patients undergoing rerouting for extrusion (P = 0.26). Intraoperative cultures were positive in 5 (9.8%) of 51 revision patients, none of whom developed infections. Organisms causing infection included Staphylococcus aureus and Enterobacter aerogenes. Unexpectedly, an adjuvant, alcohol-based skin prep in our last 83 patients reduced the infection risk to 1.2%. CONCLUSIONS In our series, the infection risk associated with revision of malfunctioning devices was no greater than primary implant placement. Rerouting was associated with a higher infection risk, likely due to technical factors, and not implant colonization. Less than 10% of our revision implants were colonized, and this had no bearing on the development of a postoperative infection. S. epidermidis was not the most common organism implicated in device infections. Finally, our experience with an adjuvant, alcohol-based skin prep warrants further randomized prospective evaluation.
Collapse
|
19
|
Soloway MS, Hepps D, Katkoori D, Ayyathurai R, Manoharan M. Radical cystectomy for BCG failure: has the timing improved in recent years? BJU Int 2010; 108:182-5. [PMID: 21070578 DOI: 10.1111/j.1464-410x.2010.09830.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE • To analyse if there is a trend in recent years towards performing radical cystectomy (RC) before muscle invasion or extravesical spread after failure of bacille Calmette-Guérin (BCG) for high grade Ta/T1 bladder cancer. Although BCG is indicated for prophylaxis after endoscopic tumour resection there is still a risk of progression. PATIENTS AND METHODS • A retrospective analysis of our RC database (1992-2008) was performed to identify patients who underwent RC after receiving BCG. • Relevant clinical and pathological data for the patients with clinical stage Ta, T1 and/or Tis at initial transurethral resection of bladder tumour were analysed. • Pathological stage and survival for patients undergoing RC from 2003 to 2007 (group 2) were compared with those for patients operated between 1992 and 2002 (group 1). RESULTS • A total of 152 patients were included (75 in group 2 and 77 in group 1). Both groups were similar in T-stage before BCG initiation, number of BCG cycles received and time interval to RC. • There was no change in the proportion of patients undergoing RC with ≥ pT2 bladder cancer in recent years (P= 0.5). • Fifty-two percent of group 2 and 43% of group 1 had ≥ pT2 BC. The 5-year survival was similar. CONCLUSIONS • Despite concerns about delay in performing RC for patients failing one or more courses of BCG we have not observed a trend towards a lower pathological stage for patients undergoing RC after BCG. • A high proportion of patients have muscle-invasive bladder cancer; more than 10% have lymph node metastasis.
Collapse
|
20
|
Kanagarajah P, Ayyathurai R, Gousse AE. Lower Urinary Tract Symptoms: Defining Syndromes in Urology. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0068-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
21
|
Bird VG, Kanagarajah P, Morillo G, Caruso DJ, Ayyathurai R, Leveillee R, Jorda M. Differentiation of oncocytoma and renal cell carcinoma in small renal masses (<4 cm): the role of 4-phase computerized tomography. World J Urol 2010; 29:787-92. [PMID: 20717829 DOI: 10.1007/s00345-010-0586-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 07/09/2010] [Indexed: 12/24/2022] Open
Abstract
PURPOSE We investigate the use of 4-phase computerized tomography with intravenous contrast to help distinguish oncocytoma from renal cell carcinoma (RCC) in tumors <4 cm. METHODS We retrospectively identified patients who underwent surgical management for renal tumors <4 cm from 2005 to 2008. Patients who had pre-operative CT evaluation as per our institution's renal mass protocol and had confirmed pathological diagnosis of either oncocytoma or RCC were included in the study. Enhancement readings were obtained for the tumor and the renal cortex using the same slice simultaneously. RESULTS Our cohort involved 69 patients (46 men, 23 women; mean age 66) who presented with 79 renal masses. Histopathologically 40 were clear cell, 22 papillary, 5 chromophobe RCC and 12 oncocytoma. On the arterial, venous and delayed phase images, oncocytoma showed the highest mean enhancement change, i.e.,546, 396 and 239% followed by clear cell RCC 261, 261 and 174%, chromophobe RCC 147, 127 and 66% and papillary RCC 137, 184 and 118%, respectively. The enhancement pattern differed significantly on comparing oncocytoma with RCC (P < 0.007). The mean percentage contrast excreted at the end of the delayed phase was 33.3, 13.8, 32 and 53% for clear cell, papillary, chromophobe and oncocytoma, respectively. CONCLUSION The enhancement and washout values in Hounsfield units obtained by multiphasic CT scan aid in distinguishing oncocytoma from the commonly seen subtypes of RCC in renal masses <4 cm. This preliminary study demonstrates that arterial phase enhancement greater than 500% and washout values of greater than 50% are exclusively seen in renal oncocytomas.
Collapse
|
22
|
Caruso DJ, Kanagarajah P, Cohen BL, Ayyathurai R, Gomez C, Gousse AE. What is the predictive value of urodynamics to reproduce clinical findings of urinary frequency, urge urinary incontinence, and/or stress urinary incontinence? Int Urogynecol J 2010; 21:1205-9. [PMID: 20559620 DOI: 10.1007/s00192-010-1180-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to determine the predictive value of urodynamics to reproduce clinical findings of urinary frequency (UF), urge urinary incontinence (UUI), and/or stress urinary incontinence (SUI). METHODS We retrospectively reviewed the data of patients diagnosed with UF, UUI, and/or SUI and subsequently underwent urodynamics. Urodynamic findings were correlated with clinical findings to determine the predictive value of urodynamics. RESULTS A total of 537 patients (366 females and 171 males) met study criteria. Two hundred seventy-eight patients had symptoms of UUI; 59% demonstrated detrusor overactivity on urodynamics. Three hundred eight patients had SUI on history and physical examination; 45% had urodynamic stress incontinence. A low maximum cystometric capacity (<200 ml) was not significantly associated with urinary frequency (p = 0.4). CONCLUSIONS Urodynamics has a low predictive value to reproduce clinical findings of UF, UUI, and/or SUI. Many patients with evidence of UF, UUI, and/or SUI on history and/or physical examination do not demonstrate supporting urodynamic evidence.
Collapse
|
23
|
Bird V, Kanagarajah P, Morillo G, Caruso D, Ayyathurai R, Leveillee R. 2005 DIFFERENTIATION OF ONCOCYTOMA AND RENAL CELL CARCINOMA IN SMALL RENAL MASSES (<4CM): THE ROLE OF 4 PHASE COMPUTERIZED TOMOGRAPHY. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.2038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
24
|
Kava B, Aziz M, Bird V, Katkoori D, Ayyathurai R, Ramanathan R, Manoharan M, Ciancio G, Soloway M, Leveillee R. 829 IMPACT OF BMI AND TUMOR LOCATION ON THE INCIDENCE OF BENIGN HISTOLOGY AT THE TIME OF NEPHRON- SPARING SURGERY FOR T1 RENAL MASSES. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
25
|
Manoharan M, Ayyathurai R, de Los Santos R, Nieder AM, Soloway MS. Presentation and outcome following radical cystectomy in Hispanics with bladder cancer. Int Braz J Urol 2009; 34:691-8; discussion 698. [PMID: 19111073 DOI: 10.1590/s1677-55382008000600003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2008] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Significant racial and ethnic differences in the epidemiology of bladder cancer (BC) exist. Studies have shown African Americans to have lower incidence of bladder cancer than Caucasians, but higher incidence of invasive BC. Hispanics are the largest minority group in the United States. However, no reported studies on bladder cancer among Hispanics are available to date. As our center is in a unique position to study BC in Hispanic patients we were prompted to assess presentation and outcome of patients undergoing radical cystectomy (RC) for BC. MATERIALS AND METHODS Between January 1992 and May 2006, 448 RC were performed. All relevant data were collected and entered into a database. Patients were categorized by ethnicity as Hispanic and non-Hispanic White. African-American and other minority groups were excluded because of the small number. Comparative analysis of Hispanic and non-Hispanic White patients was performed. RESULTS 67 (17%) patients were Hispanic. Mean follow-up period was 41 (SD +/- 40) months. Clinical and pathological data between these two groups were compared. Pre-cystectomy T stage was not significantly different between both groups. However, after RC incidence of < or = T1 disease in Hispanics was lower (22%) than Caucasians (37%). This difference, statistically significant (P = 0.024) indicates that Hispanics who undergo RC present with higher stage disease. Kaplan-Meier log rank test indicated a difference in disease free survival and disease specific survival between the two groups but however it did not reach statistical significance (Log Rank P = 0.082, P = 0.063). No significant difference in overall survival was observed (P = 0.465). CONCLUSIONS Hispanic patients managed with RC for bladder carcinoma present with higher stage disease.
Collapse
|