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Anis O, Rimon U, Ramon J, Khaitovich B, Zilberman DE, Portnoy O, Dotan ZA. Selective Arterial Embolization for Large or Symptomatic Renal Angiomyolipoma: 10 Years of Follow-up. Urology 2019; 135:82-87. [PMID: 31618658 DOI: 10.1016/j.urology.2019.09.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/25/2019] [Accepted: 09/29/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess long-term outcome after selective arterial embolization (SAE) as first-line treatment for large or symptomatic AML. DESIGN, SETTING, AND PARTICIPANTS Data from a prospectively maintained database on 71 patients who underwent SAE for large or symptomatic AML were reviewed. Patients with sporadic and tuberous-sclerosis-complex (TSC) were included. OUTCOME MEASUREMENTS The main endpoints were re-embolization rates, occurrence of clinical events related to AML, size of AML, and renal function. RESULTS Thirteen (19.1%) patients reported at least 1 major clinical event. Major complications affected 2 patients (2.9%), both ending in complete loss of renal unit function. Four renal units (5.9%) were eventually treated surgically. The re-embolization rate was 41.1%, with an average time from the initial to a repeat SAE of 2.18 years (range 0.31-10.65 years). The size of the tumor prior to SAE and after 5 and 10 years of follow-up were 8.9 cm (7-12), 6.5 cm (4-7.5), 7 cm (4-7.8), respectively [median (IQR)]. These results are translated to a size reduction of 27% in 10 years follow-up. Patients with TSC had larger tumors on long-term follow-up (77.8 vs 41.3 mm, P = .045). The long-term follow-up estimated average glomerular filtration rate was 81.97 (range 26-196). No patient needed renal replacement therapy, and disease-specific survival was 100%. CONCLUSIONS SAE is a safe treatment option for patients with symptomatic or large AML. It represents a minimally invasive intervention with good long-term outcome. SAE may be offered as first-line treatment in most cases, though, it is associated with high retreatment rates.
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Nissenkorn A, Erlich T, Zilberman DE, Sarouk I, Krauthammer A, Kitrey ND, Heimer G, BenZeev B, Mor Y. Secondary enuresis and urological manifestations in children with ataxia telangiectasia. Eur J Paediatr Neurol 2018; 22:1118-1123. [PMID: 30100180 DOI: 10.1016/j.ejpn.2018.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/11/2018] [Accepted: 07/18/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ataxia telangiectasia (AT) is a neurodegenerative cerebellar disorder, caused by mutations in the ATM gene, involved in DNA repair. Radiosensitivity, progressive ataxia, immune deficiency and malignancies, are well known symptoms, but urological manifestations are scarcely described. OBJECTIVE To characterize urologic manifestations in a large cohort of AT patients. METHODS Retrospective cross-sectional chart study comprising 52 AT patients followed at a National AT Center. RESULTS 25% of the cohort (13 patients/8 males) had urologic symptoms, which presented at 11 ± 4.3 years. The most common symptom was secondary enuresis affecting 15% of the patients (8 children/4 males). Incontinence appeared at 8 ± 6.2 years of age, and resolved spontaneously within 15 ± 8.3 months in 6 patients. It preceded loss of ambulatory capacity by 1-2 years in 7 patients. Lumbosacral MRI were normal (4 children) and urine cultures (all) were negative. Urodynamic evaluation that was performed in only one patient revealed overactive bladder. Additional manifestations were macroscopic hematuria due to bladder telangiectasia in a 12-year-old, and renal cell carcinoma in a 22-year-old. Other manifestations unrelated to AT were neprolithiasis, vesico-ureteral reflux and scrotal pain, each in 1 patient. DISCUSSION Transient secondary enuresis is a frequent finding in AT patients, heralding loss of ambulatory capacity, tough it's pathophysiological mechanism is largely no understood.
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Abu-Ghanem Y, Shvero A, Kleinmann N, Winkler HZ, Zilberman DE. 24-h urine metabolic profile: is it necessary in all kidney stone formers? Int Urol Nephrol 2018; 50:1243-1247. [PMID: 29876775 DOI: 10.1007/s11255-018-1902-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 05/23/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE A 24-h urine metabolic profile (24-UMP) is an integral part of nephrolithiasis work-up. We aimed to explore whether it can be waived under certain circumstances. MATERIALS AND METHODS We reviewed our prospective registry database of patients seen at our outpatient clinic for nephrolithiasis between the years 2010 and 2017. Data included: gender, age at first stone, body mass index (BMI), self-reported comorbidities and family history of nephrolithiasis. A 24-UMP was obtained from each patient under random diet. The following were recorded: urine volume, urinary levels of sodium, calcium, uric acid, oxalate and citrate. Presence of at least one comorbidity (i.e., hypertension/diabetes/hyperlipidemia) was defined as "associated comorbidities" (AC). Their absence was defined as "no comorbidities" (NC). Subjects were divided into two subgroups: first-time and recurrent stone formers, which were further divided into two subgroups: 1st + AC; 1st + NC; recurrent + AC; recurrent + NC. 24-UMPs have been compared between the four groups. RESULTS Four hundred and fifty-seven patients were included in the study. In the AC groups, patients demonstrated higher BMI levels (p = 0.001), and were statistically significantly obese (BMI > 30, p = 0.001) and older at first stone event (p = 0.001). First formers, either with AC or NC were more likely to have low urine volume (LUV) compared with recurrent formers (72.5 vs. 59.5%, p = 0.005). In the remaining metabolic abnormalities, no such differences were observed. CONCLUSIONS First-time stone formers, either with or without AC are likely to demonstrate LUV as their primary metabolic abnormality in 24-UMP. Therefore, 24-UMP may be postponed until recurrent stone event.
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Haifler M, Mor Y, Dotan Z, Ramon J, Zilberman DE. Prophylactic antibiotic treatment following laparoscopic robot-assisted radical prostatectomy for the prevention of catheter-associated urinary tract infections: did the AUA guidelines make a difference? J Robot Surg 2016; 11:367-371. [DOI: 10.1007/s11701-016-0667-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
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Abu-Ghanem Y, Kleinmann N, Winkler HZ, Zilberman DE. Nephrolithiasis in Israel: Epidemiological Characteristics of Return Patients in a Tertiary Care Center. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2016; 18:725-728. [PMID: 28457074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The prevalence and etiology of nephrolithiasis vary, depending on geography, gender and ethnicity. OBJECTIVES To analyze the demographic data of return nephrolithiasis patients in a tertiary care center. METHODS We retrospectively reviewed our prospective registry database of return patients seen at our outpatient clinic for nephrolithiasis. Data included gender, age at first visit, age at first stone event, body mass index (BMI), self-reported hypertension, diabetes mellitus (DM), and hyperlipidemia. All patients were seen at least twice and had undergone a metabolic workup. RESULTS A total of 260 return patients were seen during the period 2010-2015. The male:female ratio was 3.1:1. Mean age at the first stone event was 44.1 years. Median time elapsed since the first stone event to medical evaluation was 5 years (interquartile range 1-12 years). Hypertension was reported by 33.1% of the patients, DM by 23.5% and hyperlipidemia by 30.4%. All three diseases were reported by 11.5% of patients. The metabolic abnormalities detected were hypocitraturia (60%), low urine volume (LUV) (60%), hypercalciuria (40.8%), hyperoxaluria (24.2%), hyperuricosuria (16.5%) and hyperuricemia (13.5%). Stone compositions from most to least frequent were calcium-oxalate (81%), calcium-phosphate (11.9%) and uric acid (7.1%). We also found that 24.6% were obese (BMI ≥ 30 kg/m2) and showed higher rates of hypertension, DM, hyperlipidemia, hyperuricemia and hyperuricosuria compared with non-obese patients. Significantly higher rates of obesity and LUV were detected in females compared with males. Patients over age 45 had lower rates of hyperuricemia compared with patients ≥ 45 years old (P = 0.038). CONCLUSIONS Factors related to nephrolithiasis can potentially differ among populations and countries. Our findings emphasize the significance of individualized national health programs to address local issues.
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Abu-Ghanem Y, Dotan Z, Kaver I, Zilberman DE, Ramon J. The use of Haemostatic Agents does not impact the rate of hemorrhagic complications in patients undergoing partial nephrectomy for renal masses. Sci Rep 2016; 6:32376. [PMID: 27572274 PMCID: PMC5004111 DOI: 10.1038/srep32376] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/02/2016] [Indexed: 11/16/2022] Open
Abstract
Hemostatic agents(HAs) have gained increasing popularity as interventions to improve perioperative haemostasis and diminish the need for allogeneic red cell transfusion(PBT) despite a paucity of data supporting the practice. The aim of the current study is to examine the efficacy of HAs in reducing the rate of hemorrhagic complications during partial nephrectomy(PN). Data on 657 patients, who underwent elective PN between 2004–2013, were analyzed. The impact of HAs and SURGICEL was evaluated by comparing four sequential groups of patients: Group1 = Sutures alone, Group2 = sutures and HA, Group3 = sutures and SURGICEL, Group4 = both HA and SURGICEL. Complications included post-operative urinary leak(UL), PBT rate, delayed bleeding and post-operative renal failure. Results showed that the use of HAs did not engender a statistically significant difference in overall complications rate. Specifically, the addition of HAs did not reduce the rate of PBT, delayed bleeding or UL. Further analysis revealed that patients who received SURGICEL had significantly higher PBT rate and higher prevalence of UL cases. Addition of HAs to SURGICEL had no effect on the rate of these complications. In the current study, the use of HAs during open and laparoscopic PN did not reduce the rate of negative outcomes. Adequate suture renorrhaphy may be sufficient to prevent hemorrhagic complications.
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Abu-Ghanem Y, Dotan Z, Kaver I, Zilberman DE, Ramon J. PD48-01 THE IMPACT OF PERIOPERATIVE BLOOD TRANSFUSION ON CANCER RECURRENCE AND SURVIVAL FOLLOWING NEPHRECTOMY FOR NON-METASTATIC RENAL CELL CARCINOMA (RCC). J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2723] [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]
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Zilberman DE, Mor Y, Fridman E, Ramon J. Mesenteric Fibromatosis Mimicking Tumor Recurrence Following Radical Cystectomy and Bladder Replacement. Urol Case Rep 2016; 3:40-1. [PMID: 26793495 PMCID: PMC4714273 DOI: 10.1016/j.eucr.2014.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 11/25/2022] Open
Abstract
We report an unusual case of benign tumor mimicking tumor recurrence following radical cystectomy and bladder replacement for high grade urothelial carcinoma.
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Zilberman DE, Rimon U, Morag R, Winkler HZ, Ramon J, Mor Y. Non-surgical treatment of latrogenic postoperatively diagnosed ureteral injuries. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2015; 17:227-230. [PMID: 26040048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND latrogenic ureteral injury may be seen following abdominopelvic surgeries. While ureteral injuries identified during surgery should be immediately and surgically repaired, those that are postoperatively diagnosed may be treated non-surgically by draining the ipsilateral kidney. Data regarding the outcome of this approach are still missing. OBJECTIVES To evaluate the success rates of non-surgical management of ureteral injuries diagnosed following abdominopelvic surgeries. METHODS We retrospectively reviewed the files of all patients treated for iatrogenic ureteral injuries diagnosed following abdominopelvic surgeries. Patients' ipsilateral kidney was percutaneously drained following diagnosis of injury by either nephrostomy tube (NT)/nephro-ureteral stent (NUS) or double-J stent (DJS) inserted retrogradely. The tube was left in place until a pyelogram confirmed healing or a conservative approach was abandoned due to failure. RESULTS Twenty-nine patients were identified as having ureteral injury following abdominopelvic surgery. Median time from injury to renal drainage was 9 days, interquartile range (IQR) 4-17 days. Seven cases (24%) had surgical repair. Among the other 22 patients, in 2 oncology patients the conservative approach was maintained although renal drainage failed to resolve the injury. In the remaining 20, median drainage length was 60 days (IQR 43.5-85). Calculated overall success rates following renal drainage was 69% (18/29), and with NUS approached 78.5%. CONCLUSIONS Ureteral injuries diagnosed following abdominopelvic surgeries can be treated conservatively. Ipsilateral renal drainage should be the first line of treatment before surgical repair, and NUS may be the preferred drainage to obtain spontaneous ureteral healing.
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Rosenzweig B, Mor Y, Zilberman DE, Rimon U, Garniek A. Bagless nephron-ephroureterostomy for bilateral ureteral obstruction: a simple modification to improve patients' quality of life. J Vasc Interv Radiol 2013; 24:295-6. [PMID: 23369563 DOI: 10.1016/j.jvir.2012.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/06/2012] [Accepted: 10/09/2012] [Indexed: 11/16/2022] Open
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Zilberman DE, Golomb J, Kitrey ND, Inbar Y, Heyman Z, Kleinnbaum Y, Mor Y. Long-term urinary bladder function following unilateral refluxing low loop cutaneous ureterostomy. Korean J Urol 2012; 53:355-9. [PMID: 22670196 PMCID: PMC3364476 DOI: 10.4111/kju.2012.53.5.355] [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] [Received: 10/04/2011] [Accepted: 02/10/2012] [Indexed: 11/29/2022] Open
Abstract
Purpose Unilateral low loop cutaneous ureterostomy (LLCU) has been offered as the preferred method of temporary urinary diversion in cases of massively dilated and refluxing ureters. We sought to explore whether LLCU is effective in preserving urinary bladder function in the long term. Materials and Methods The charts of all patients who had undergone temporary unilateral LLCU as newborns in the presence of massive vesico-ureteric reflux were retrospectively reviewed. Demographic data, follow-up length, and presence of incontinence were recorded. Patients were interviewed regarding lower urinary tract symptoms (LUTS), and their urination patterns were recorded by using uroflow and post-void residual (PVR) measurements. Results Between 1972 and 2003, a total of 24 patients underwent unilateral LLCU in the presence of massively refluxing ureters. Eight patients were included in the final analysis. The median age at diversion was 12 days, the median time to closure was 22.5 months, and the median follow-up was 12.5 years. Urinary bladders showed normal contour, normal capacities, and minimal PVRs in most cases. None of the patients required augmentation cystoplasty. One patient suffered from urinary leakage and few demonstrated minimal LUTS. Conclusions Unilateral refluxing LLCU is an effective method of urinary diversion that preserves urinary bladder function for the long term. Larger studies are required to confirm this finding.
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Tsivian M, Zilberman DE, Ferrandino MN, Madden JF, Mouraviev V, Albala DM. Apical Surgical Margins Status in Robot-Assisted Laparoscopic Radical Prostatectomy Does Not Depend on Disease Characteristics. J Endourol 2012; 26:361-5. [DOI: 10.1089/end.2011.0336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Zilberman DE, Luthringer T, Young D, Albala DM. Societal Changes and the Etiology of Stone Disease. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zilberman DE, Lipkin ME, Ferrandino MN, Simmons WN, Mancini JG, Raymundo ME, Zhong P, Preminger GM. The digital flexible ureteroscope: in vitro assessment of optical characteristics. Int Braz J Urol 2011. [DOI: 10.1590/s1677-55382011000300015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Zilberman DE, Tsivian M, Yong D, Albala DM. Surgical Steps That Elongate Operative Time in Robot-Assisted Radical Prostatectomy Among the Obese Population. J Endourol 2011; 25:793-6. [DOI: 10.1089/end.2010.0428] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lipkin ME, Mancini JG, Zilberman DE, Raymundo ME, Yong D, Ferrandino MN, Miller MJ, Yoshizumi TT, Preminger GM. Reduced radiation exposure with the use of an air retrograde pyelogram during fluoroscopic access for percutaneous nephrolithotomy. J Endourol 2011; 25:563-7. [PMID: 21426236 DOI: 10.1089/end.2010.0431] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Fluoroscopy with retrograde pyelogram is commonly used to obtain access for percutaneous nephrolithotomy (PNL). Our practice uses room air for retrograde identification of calyceal anatomy. Herein we explore whether an air pyelogram was associated with a decrease in radiation exposure compared with standard retrograde pyelogram. METHODS We retrospectively reviewed all PNL procedures performed at our institution over the past 2 years. Of the 260 PNL procedures performed during the study period, 96 had information on radiation dosage required for analysis. The effective dose (ED) was calculated using accepted conversion tables. Multivariable linear regression was used to determine the association between ED and the use of air pyelogram controlling for factors thought to affect radiation exposure. RESULTS Of the 96 PNL procedures included in the study, 60 (63%) were performed with an air retrograde pyelogram (AP) and 36 (37%) used contrast retrograde pyelogram (CP). Both groups were matched in terms of age, body mass index, stone burden, and number of access tracts. Multivariable linear regression showed significantly lower radiation exposure in the AP group than in the CP group (p = 0.001). There was no difference in fluoroscopy time between the two groups. Using an AP lowered the mean adjusted ED nearly twofold, from 7.67 (CI = 5.99-9.81) to 4.45 (CI = 3.68-5.38) mSv. CONCLUSIONS An air retrograde pyelogram is associated with decreased radiation exposure during PNL when compared with a contrast retrograde pyelogram.
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Raymundo EM, Lipkin ME, Bañez LB, Mancini JG, Zilberman DE, Preminger GM, Inman BA. Third Prize: The Role of Endoscopic Nephron-Sparing Surgery in the Management of Upper Tract Urothelial Carcinoma. J Endourol 2011; 25:377-84. [DOI: 10.1089/end.2010.0276] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zilberman DE, Lipkin ME, Ferrandino MN, Simmons WN, Mancini JG, Raymundo ME, Zhong P, Preminger GM. The digital flexible ureteroscope: in vitro assessment of optical characteristics. J Endourol 2011; 25:519-22. [PMID: 21361823 DOI: 10.1089/end.2010.0206] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Recent advances in endoscope design have placed the charged coupled device chip on the tip of the endoscope. The image is instantly digitalized and converted into an electrical signal for transmission. Digital technology was first introduced into flexible cystoscopes/nephroscopes and subsequently into rigid and flexible ureteroscopes. Herein, we assess the image characteristics and advantages of a new generation of digital flexible ureteroscopes. METHODS The Olympus URF-V flexible digital ureteroscope and the Olympus URF-P3 fiberoptic ureteroscope were assessed in vitro for image resolution, distortion, color representation, grayscale imaging, field of view, and depth of field. RESULTS The digital ureteroscope had a higher resolution at 3, 5, 10, and 20 mm (25.2 lines/mm vs. 8.0, 14.1 vs. 5.0, 6.3 vs. 2.8, and 3.2 vs. 1.3), respectively. Distortion with the digital flexible ureteroscope was lower, though not statistically significant. Color representation was better with the digital ureteroscope, whereas contrast evaluation was comparable between both scopes. The digital flexlible ureteroscope produced a 5.3 times larger image size compared with the standard fiberoptic flexible uretersocpe with a narrower field of view. The depth of field was limited by light and not the optic or the camera for both ureteroscopes. CONCLUSIONS The development of digital flexible ureteroscopes represents a significant technological advance in urology. These devices offer significantly improved resolution and color reproduction as compared with traditional fiberoptic flexible ureteroscopes. Future clinical trials are warranted to ultimately determine the advantages of these innovative endoscopes.
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Zilberman DE, Tsivian M, Lipkin ME, Ferrandino MN, Frush DP, Paulson EK, Preminger GM. Low dose computerized tomography for detection of urolithiasis--its effectiveness in the setting of the urology clinic. J Urol 2011; 185:910-4. [PMID: 21239024 DOI: 10.1016/j.juro.2010.10.052] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Indexed: 12/17/2022]
Abstract
PURPOSE Low dose noncontrast computerized tomography is becoming a common imaging tool to diagnose urolithiasis. We investigated its usefulness as a diagnostic tool in the outpatient setting. MATERIALS AND METHODS A total of 62 patients with suspected urolithiasis underwent standard renal stone protocol computerized tomography with a tube current of 160 mA. Images were modified by adding image noise to simulate tube currents of 70, 100 and 130 mA. Three urologists independently interpreted the original and simulated dose scans for stone number, location and associated signs of obstruction. In addition, the investigators rated the ease of interpreting the scans and their overall level of confidence. RESULTS There were no statistically significant differences in interobserver and intra-observer variability for stone detection or obstruction signs except significant interobserver variability in hydronephrosis and intra-observer variability in stranding categories. Each 1 mm increase in stone size increased the likelihood of a concordant response 3.55, 2.7 and 2-fold when reducing the tube current level by 19%, 38% and 56%, respectively (p=0.001, 0.008 and 0.021, respectively). Multiple stones or index stone location were not associated with agreement. The overall level of confidence decreased with lower simulated doses, particularly in the bony pelvis (p<0.02). CONCLUSIONS Low dose computerized tomography may serve as an effective tool in the setting of the urology clinic in patients with urolithiasis. This imaging tool can better assess urolithiasis and associated obstruction than plain abdominal radiographs, but it may be problematic with small stones (less than 2 mm) and evidence of distal ureteral obstruction. Its effectiveness as a long-term followup tool requires further prospective trials.
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Yong DZ, Tsivian M, Zilberman DE, Ferrandino MN, Mouraviev V, Albala DM. Predictors of prolonged operative time during robot-assisted laparoscopic radical prostatectomy. BJU Int 2010; 107:280-2. [DOI: 10.1111/j.1464-410x.2010.09511.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zilberman DE, Preminger GM. Editorial comment. Urology 2009; 74:1221; author reply 1221-2. [PMID: 19962517 DOI: 10.1016/j.urology.2009.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 06/30/2009] [Accepted: 06/30/2009] [Indexed: 10/20/2022]
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Zilberman DE, Preminger GM. Long-Term Results of Percutaneous Nephrolithotomy: Does Prophylactic Medical Stone Management Make a Difference? J Endourol 2009; 23:1773-6. [DOI: 10.1089/end.2009.0118] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zilberman DE, Cohen Y, Amariglio N, Fridman E, Ramon J, Rechavi G. AKT1 E17 K pleckstrin homology domain mutation in urothelial carcinoma. ACTA ACUST UNITED AC 2009; 191:34-7. [PMID: 19389506 DOI: 10.1016/j.cancergencyto.2009.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 01/16/2009] [Indexed: 10/20/2022]
Abstract
The PI3K/AKT pathway is frequently activated in human cancer. Recently, a G to A point mutation (E17K) was found in the pleckstrin homology domain of AKT1. We aimed to explore this mutation in cases of urothelial carcinoma. Using chip-based matrix-assisted laser desorption-time-of-flight (MALDI-TOF) mass spectrometer, AKT1 E17K mutation was searched in 26 total RNA samples obtained from 26 patients known to have urothelial carcinoma. Mutation was found in one out of 26 (3.8%) patients - a 46 year old female with a low grade transitional cell carcinoma located to the lamina propria (Ta disease). Our finding is in line with previous studies showing AKT1 E17K mutation to be rare. Yet, further studies are required to determine whether this mutation is indeed related to less aggressive disease and carries better prognosis.
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Robinson MR, Scales CD, Lack BD, Ferrandino MN, Zilberman DE, Preminger GM. DOES RISING URINE PH INCREASE THE STONE FORMATION RATE? J Urol 2009. [DOI: 10.1016/s0022-5347(09)61472-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Antonelli J, Ferrandino MN, Zilberman DE, Pierre SA, Albala DM, Preminger GM. TUBELESS-STENTLESS PERCUTANEOUS NEPHROLITHOTOMY: A FURTHER ADVANCE IN PERCUTANEOUS URINARY STONE MANAGEMENT. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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