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Deivasigamani S, Kotamarti S, Rastinehad AR, Salas RS, de la Rosette JJMCH, Lepor H, Pinto P, Ahmed HU, Gill I, Klotz L, Taneja SS, Emberton M, Lawrentschuk N, Wysock J, Feller JF, Crouzet S, Kumar M P, Seguier D, Adams ES, Michael Z, Abreu A, Jack Tay K, Ward JF, Shinohara K, Katz AE, Villers A, Chin JL, Stricker PD, Baco E, Macek P, Ahmad AE, Chiu PKF, Crawford ED, Rogers CG, Futterer JJ, Rais-Bahrami S, Robertson CN, Hadaschik B, Marra G, Valerio M, Chong KT, Kasivisvanathan V, Tan WP, Lomas D, Walz J, Guimaraes GC, Mertziotis NI, Becher E, Finelli A, Kasraeian A, Lebastchi AH, Vora A, Rosen MA, Bakir B, Arcot R, Yee S, Netsch C, Meng X, de Reijke TM, Tan YG, Regusci S, Benjamin TGR, Olivares R, Noureldin M, Bianco FJ, Sivaraman A, Kim FJ, Given RW, Dason S, Sheetz TJ, Shoji S, Schulman A, Royce P, Shah TT, Scionti S, Salomon G, Laguna P, Tourinho-Barbosa R, Aminsharifi A, Cathelineau X, Gontero P, Stabile A, Grummet J, Ledbetter L, Graton M, Stephen Jones J, Polascik TJ. Primary Whole-gland Ablation for the Treatment of Clinically Localized Prostate Cancer: A Focal Therapy Society Best Practice Statement. Eur Urol 2023; 84:547-560. [PMID: 37419773 DOI: 10.1016/j.eururo.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/25/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Abstract
CONTEXT Whole-gland ablation is a feasible and effective minimally invasive treatment for localized prostate cancer (PCa). Previous systematic reviews supported evidence for favorable functional outcomes, but oncological outcomes were inconclusive owing to limited follow-up. OBJECTIVE To evaluate the real-world data on the mid- to long-term oncological and functional outcomes of whole-gland cryoablation and high-intensity focused ultrasound (HIFU) in patients with clinically localized PCa, and to provide expert recommendations and commentary on these findings. EVIDENCE ACQUISITION We performed a systematic review of PubMed, Embase, and Cochrane Library publications through February 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. As endpoints, baseline clinical characteristics, and oncological and functional outcomes were assessed. To estimate the pooled prevalence of oncological, functional, and toxicity outcomes, and to quantify and explain the heterogeneity, random-effect meta-analyses and meta-regression analyses were performed. EVIDENCE SYNTHESIS Twenty-nine studies were identified, including 14 on cryoablation and 15 on HIFU with a median follow-up of 72 mo. Most of the studies were retrospective (n = 23), with IDEAL (idea, development, exploration, assessment, and long-term study) stage 2b (n = 20) being most common. Biochemical recurrence-free survival, cancer-specific survival, overall survival, recurrence-free survival, and metastasis-free survival rates at 10 yr were 58%, 96%, 63%, 71-79%, and 84%, respectively. Erectile function was preserved in 37% of cases, and overall pad-free continence was achieved in 96% of cases, with a 1-yr rate of 97.4-98.8%. The rates of stricture, urinary retention, urinary tract infection, rectourethral fistula, and sepsis were observed to be 11%, 9.5%, 8%, 0.7%, and 0.8%, respectively. CONCLUSIONS The mid- to long-term real-world data, and the safety profiles of cryoablation and HIFU are sound to support and be offered as primary treatment for appropriate patients with localized PCa. When compared with other existing treatment modalities for PCa, these ablative therapies provide nearly equivalent intermediate- to long-term oncological and toxicity outcomes, as well as excellent pad-free continence rates in the primary setting. This real-world clinical evidence provides long-term oncological and functional outcomes that enhance shared decision-making when balancing risks and expected outcomes that reflect patient preferences and values. PATIENT SUMMARY Cryoablation and high-intensity focused ultrasound are minimally invasive treatments available to selectively treat localized prostate cancer, considering their nearly comparable intermediate- to long term cancer control and preservation of urinary continence to other radical treatments in the primary setting. However, a well-informed decision should be made based on one's values and preferences.
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Affiliation(s)
| | - Srinath Kotamarti
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | | | | | | | - Herbert Lepor
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Peter Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hashim U Ahmed
- Division of Urology, Imperial College London & Imperial College Healthcare NHS Trust, London, UK
| | - Inderbir Gill
- Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Laurence Klotz
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Samir S Taneja
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Mark Emberton
- Division of Surgery, University College London, London, UK
| | - Nathan Lawrentschuk
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - James Wysock
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | | | | | | | - Denis Seguier
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA; Department of Urology, University Lille Nord de France, Lille, France
| | - Eric S Adams
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Zoe Michael
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Andre Abreu
- Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore
| | - John F Ward
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Katsuto Shinohara
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Aaron E Katz
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Arnauld Villers
- Department of Urology, University Lille Nord de France, Lille, France
| | - Joseph L Chin
- Department of Urology, University of Western Ontario, London, Ontario, Canada
| | | | - Eduard Baco
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Petr Macek
- Department of Urology, Institute Mutualiste Montsouris, Paris, France
| | - Ardalan E Ahmad
- Department of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter K F Chiu
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | - E David Crawford
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | - Jurgen J Futterer
- Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | - Cary N Robertson
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Giancarlo Marra
- Department of Urology, The University Hospital of Turin, Turin, Italy
| | - Massimo Valerio
- Service of Urology, University Hospital of Lausanne, Lausanne, Switzerland
| | | | | | - Wei Phin Tan
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Derek Lomas
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Jochen Walz
- Department of Urology, Paoli-Calmettes Institute Cancer Center, Marseille, France
| | | | | | | | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | | | - Amir H Lebastchi
- Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Anup Vora
- Chesapeake Urology, Silver Spring, MD, USA
| | - Mark A Rosen
- Department of Urology, Sutter Health, Sacramento, CA, USA
| | - Baris Bakir
- Department of Radiology, Istanbul University, Istanbul, Turkey
| | - Rohit Arcot
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA; Department of Urology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Samuel Yee
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | | | - Xiaosong Meng
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Theo M de Reijke
- Department of Urology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Yu Guang Tan
- Department of Urology, Singapore General Hospital, Singapore
| | - Stefano Regusci
- Department of Interventional Oncology, Swiss International Prostate Centelenor, Geneva, Switzerland
| | | | - Ruben Olivares
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Fernando J Bianco
- Urological Research Network, Urologist Specialist Group, Miami Lakes, FL, USA
| | - Arjun Sivaraman
- Division of Urology, Washington University School of Medicine, St Louis, MO, USA
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center and University of Colorado Hospital, Denver, CO, USA
| | | | - Shawn Dason
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Tyler J Sheetz
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Sunao Shoji
- Department of Urology, Tokai University School of Medicine, Tokyo, Japan
| | - Ariel Schulman
- Department of Urology, Maimonides Health Medical Center, New York, NY, USA
| | - Peter Royce
- Division of Urology, Monash University, Melbourne, Australia
| | - Taimur T Shah
- Division of Urology, Imperial College London & Imperial College Healthcare NHS Trust, London, UK
| | | | - Georg Salomon
- Martini-Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Pilar Laguna
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| | | | - Alireza Aminsharifi
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Paolo Gontero
- Department of Urology, The University Hospital of Turin, Turin, Italy
| | - Armando Stabile
- Unit of Urology/Division of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jeremy Grummet
- Division of Urology, Monash University, Melbourne, Australia
| | - Leila Ledbetter
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Margaret Graton
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | | | - Thomas J Polascik
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA.
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Zargham M, Dehghani M, Gholipour F, Emami M, Daneshvari M, Aminsharifi A. Triple-compartment strategy for abdominal sacral colpopexy using PVDF mesh: one-year report of anatomical and subjective outcomes. Int Urogynecol J 2023; 34:1907-1914. [PMID: 36795111 DOI: 10.1007/s00192-023-05471-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 01/08/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Abdominal Sacral Colpopexy (ASC) is one of the best surgical methods to repair apical or uterine prolapse. We aimed to evaluate the short-term results of a triple-compartment open ASC strategy using polyvinylidene fluoride (PVDF) mesh in the treatment of patients with severe apical or uterine prolapse. METHODS Women with high-grade uterine or apical prolapse with or without cysto-rectocele were prospectively enrolled in the study from April 2015 to June 2021. We performed all-compartment repair using a tailored PVDF mesh for ASC. We assessed the severity of pelvic organ prolapse (POP) using the Pelvic Organ Prolapse Quantification (POP-Q) system at baseline and 12 months after the operation. The patients completed the International Continence Society Questionnaire Vaginal Symptom (ICIQ-VS) questionnaire at baseline, 3, 6, and 12 months postoperatively. RESULTS Thirty-five women with a mean age of 59.8±10.0 years were included in the final analysis. Stage III and stage IV prolapse was evident in 12 and 25 patients, respectively. After 12 months, the median POP-Q stage was significantly lower compared to the baseline (4 vs 0, p=<0.0001). Vaginal symptoms score was also reduced significantly at 3-month (7.5±3.5), 6-month (7.3±3.6), and 12-month (7.2±3.1) compared to the baseline (39.5±6.7) (p values < 0.0001). We did not observe any mesh extrusion or high-grade complications. Six (16.7%) patients had cystocele recurrence during the 12-month follow-up, and two of them needed reoperation. CONCLUSIONS Our short-term follow-up showed that using an open ASC technique with PVDF mesh in treating high-grade apical or uterine prolapse is associated with a high rate of procedural success and low rates of complication.
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Affiliation(s)
- Mahtab Zargham
- Department of Urology, Isfahan University of Medical Sciences, Al-Zahra Hospital, Soffeh Blvd., Isfahan, Iran.
| | - Mehdi Dehghani
- Department of Urology, Isfahan University of Medical Sciences, Al-Zahra Hospital, Soffeh Blvd., Isfahan, Iran.
| | - Farshad Gholipour
- Isfahan Kidney Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Emami
- Department of Urology, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Daneshvari
- Department of Urology, Isfahan University of Medical Sciences, Al-Zahra Hospital, Soffeh Blvd., Isfahan, Iran
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Zhang JH, Zeinab MA, Ferguson EL, Beksac AT, Schwen ZR, Aminsharifi A, Eltemamy M, Kaouk J. Minimally-Invasive Radical Nephrectomy and Left-Sided Level II Caval Thrombectomy: A New Combined Technique. Urology 2023; 172:220-223. [PMID: 36436673 DOI: 10.1016/j.urology.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/22/2022] [Accepted: 10/02/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To present a combined multiport robotic and open approach for left radical nephrectomy and inferior vena cava thrombectomy in patients with a primary left renal mass and level II inferior vena cava (IVC) tumor thrombus. METHODS A 69-year-old female was diagnosed with an 8.9cm left renal neoplasm with level II IVC thrombus. She was placed in the left-side-up flank position. The descending colon was mobilized and the left gonadal vein was identified. The left renal vein was identified and fully dissected. The left renal artery was dissected and stapled. The kidney was dissected and left detached with exception of the renal vein. The robot was undocked and the patient was positioned supine. Through a supra-umbilical midline incision, the ascending colon and duodenum were mobilized medially. The right renal vein and IVC were identified and dissected to the level of hepatic veins. The IVC was clamped using a Satinsky clamp. The right renal artery and vein remained patent during thrombectomy. The IVC was opened, the thrombus was evacuated, and IVC was closed. Clamps were removed and the kidney was removed. RESULTS Operative time was 405 minutes. IVC clamp time was 14 minutes. Estimated blood loss was 500cc. Recovery was uncomplicated. Length of stay was 4 days. Pathology showed clear cell carcinoma with negative margins. CONCLUSION IVC thrombectomy is challenging on left sided tumors. Combining a robotic and open technique together is feasible and allows a smaller supra-umbilical midline incision compared to standard open incision.
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Affiliation(s)
- Jj H Zhang
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Ethan L Ferguson
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Alp Tuna Beksac
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Zeyad R Schwen
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Mohamed Eltemamy
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Pooyesh S, Foshati S, Sabeti M, Parvin H, Aminsharifi A. Predicting outcomes in kidney stone endoscopic surgery by rotation forest algorithm. Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization 2022. [DOI: 10.1080/21681163.2022.2131629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Shima Pooyesh
- Department of Computer Engineering, Yasooj Branch, Islamic Azad University, Yasooj, Iran
| | - Saghar Foshati
- Department of Computer Engineering, Yasooj Branch, Islamic Azad University, Yasooj, Iran
| | - Malihe Sabeti
- Department of Computer Engineering, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Hamid Parvin
- Department of Computer Engineering, Nourabad Branch, Islamic Azad University, Noorabad, Iran
| | - Alireza Aminsharifi
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Urology and Surgery, Pennsylvannia State University, Hershey, PA, USA
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Kotamarti S, Michael Z, Silver D, Teper E, Aminsharifi A, Polascik TJ, Schulman A. Device-related complications during renal cryoablation: insights from the Manufacturer and User Facility Device Experience (MAUDE) database. Urol Oncol 2022; 40:199.e9-199.e14. [DOI: 10.1016/j.urolonc.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/10/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
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Aminsharifi A, Hemal S, Aram P, Abou Zeinab M, Beksac T, Kaouk J. The performance and optimum cutoff value for pelvic cavity index as a predictor of early continence after extraperitoneal single-port robotic radical prostatectomy: Role of pelvic anatomical characteristics. J Endourol 2022; 36:927-933. [PMID: 35166121 DOI: 10.1089/end.2021.0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the value of pelvic cavity index (PCI), as an objective pelvimetry feature, to predict operative time, margin status and early urine continence after extraperitoneal single-port robotic radical prostatectomy (RP). We sought to define an optimal cutoff point for PCI in predicting postoperative outcomes. METHODS Data on 94 patients who underwent extraperitoneal single-port robotic RP and had preoperative cross-sectional imaging were enrolled. PCI was calculated as (Pelvic inlet diameter×Pelvic outlet diameter)/(Pelvic depth). The predictive value of PCI on operative time, surgical margin status and 3-month urinary continence recovery was assessed using regression models. To report the optimum cutoff value, on ROC analysis, we calculated the performance of PCI cutoff points ranging from 5.56 to 10.80 cm by every 0.01 increment. RESULTS No significant associations were noted between clinical characteristics (including PCI) and operative time. Similarly, other than pathological stage, no clinical variables (including PCI) were predictive of positive surgical margin. However, a higher PCI was associated with a significantly higher rates of continence 3-month after surgery (OR 2.44 (1.75 - 5.33); p= 0.01). On ROC- analysis, a PCI cutoff value=8.21 cm yielded the best accuracy (AUC= 0.733, %95 CI 0.615-0.851; p=0.001). No association was noted between variables and 6-month continence rate. CONCLUSION Using a single-port robotic system, operative time, positive surgical margin rate and long-term continence after prostatectomy would be independent of bony pelvis cavity. However, a higher PCI is associated with a higher rate of early continence after the surgery. PCI at a cutoff of 8.21 cm has the optimum performance to predict postoperative urine continence recovery. If validated, this information may be helpful regarding patient counseling before single-port robotic RP.
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Affiliation(s)
- Alireza Aminsharifi
- Pennsylvania State University Department of Surgery, 328945, Urology, Hershey, Pennsylvania, United States;
| | | | | | - Mahmoud Abou Zeinab
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, 9500 Euclid Ave, Cleveland, OH 44195, Cleveland, Ohio, United States, 44195;
| | | | - Jihad Kaouk
- Cleveland Clinic Foundation, Glickman Urologic Institute, 9500 Euclid Ave, Cleveland, Ohio, United States, 44195;
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Kotamarti S, Michael Z, Silver D, Teper E, Aminsharifi A, Polascik T, Schulman A. Device-related complications during renal cryoablation: Insights from the manufacturer and user facility device experience (MAUDE) database. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00307-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Beksac AT, Eltemamy M, Hemal S, Schwen Z, Lenfant L, Abou Zeinab M, Aminsharifi A, Kaouk J. Single Port Donor Nephrectomy Via Modified Pfannenstiel Incision: Initial Preclinical Experience in A Cadaveric Model and Description of Technique. J Endourol 2021; 36:183-187. [PMID: 34314234 DOI: 10.1089/end.2021.0408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the surgical technique for the single port (SP) transperitoneal donor nephrectomy through a modified Pfannenstiel incision using the da Vinci SP surgical system (Intuitive Surgical, Sunnyvale, CA, USA) on a cadaver. PATIENTS & METHODS In a male cadaver, the SP surgical system was used to perform transperitoneal donor nephrectomy. A 3 cm modified Pfannenstiel incision was made. Through the incision GelPOINT mini (Applied Medical, Rancho Santa Margarita, CA, USA) was inserted. The floating docking technique was used. Through the gel port, the dedicated 25 mm multichannel port and a 12 mm assistant port were introduced. The surgical steps for donor nephrectomy were performed in the following order. 1) Mobilization of the colon, 2) Identification of psoas muscle, ureter, and the gonadal vein, 3) hilum dissection, 4) perirenal dissection, 5) stapling the renal artery and renal vein, 6) removal of the kidney through the enlarged incision. RESULTS Transperitoneal SP donor nephrectomy was completed without any complications or capsulotomy. Additional ports were not needed. The total operative time was 63 minutes and 54 seconds. A good-quality kidney was harvested. Renal artery length was 4 cm. CONCLUSION We demonstrated the feasibility of single-port transperitoneal donor nephrectomy via modified Pfannenstiel incision, using the novel SP robotic platform. Further assessment is necessary in a clinical setting.
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Affiliation(s)
- Alp Tuna Beksac
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, 9500 Euclid Avenue Q10, Cleveland, Ohio, United States, 44195-0001;
| | - Mohamed Eltemamy
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | - Sij Hemal
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, 9500 Euclid Avenue, Glickman Urological and Kidney Institute, Cleveland, Ohio, United States, 44195-0001;
| | - Zeyad Schwen
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | - Louis Lenfant
- Cleveland Clinic's Glickman Urological and Kidney Institute Department of Urology, 537826, 9500 Euclid avenue, Cleveland, Ohio, United States, 44195-0001.,Hopital Universitaire Pitie Salpetriere, 26933, Paris, France, 75651;
| | - Mahmoud Abou Zeinab
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | | | - Jihad Kaouk
- Cleveland Clinic Foundation, Glickman Urologic Institute, 9500 Euclid Ave, Cleveland, Ohio, United States, 44195;
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Kaouk J, Eltemamy M, Aminsharifi A, Schwen Z, Wilson C, Abou Zeinab M, Garisto J, Lenfant L, Wee A. Initial Experience with Single-port Robotic-assisted Kidney Transplantation and Autotransplantation. Eur Urol 2021; 80:366-373. [PMID: 33810922 DOI: 10.1016/j.eururo.2021.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Compared with the standard open approach, multiport robotic-assisted kidney transplantation (RAKT) has emerged as a less morbid alternative. The use of a single-port robotic approach for kidney transplantation (KT) is presented in this study as having the potential for further reducing the morbidity of KT. OBJECTIVE To present the technique and evaluate perioperative and short-term (≤1 yr) postoperative outcomes of single-port RAKT. DESIGN, SETTING, AND PARTICIPANTS Prospective evaluation of peri- and postoperative outcomes in patients who underwent allograft KT (n = 6) or kidney autotransplantation (n = 3). The IDEAL model (www.ideal-collaboration.net/framework) for safe surgical innovation was used. SURGICAL PROCEDURE Kidney allografts from living or deceased donors were transplanted into six patients with end-stage renal disease. Single-port robotic surgery was performed through a 5-cm midline periumbilical abdominal incision with transperitoneal or extraperitoneal approaches. With similar incision and technique, the right or left kidney was removed and autotransplantation was performed in three patients. MEASUREMENTS Intra- and postoperative variables, and outcomes were assessed with a descriptive analysis. RESULTS AND LIMITATIONS Single-port RAKT procedures were completed successfully, with total operative and vascular anastomosis times ranging from 300 to 450 mins and from 52 to 92 mins, respectively. All six patients had excellent graft function with serum creatinine levels at the last follow-up (2 wk to 1 yr), ranging from 1.2 to 1.5 mg/dl. Renal autotransplantation was also completed successfully with a single-port robotic approach in three patients. The total operative and vascular anastomosis times ranged from 510 to 600 mins and from 65 to 83 mins, respectively. In all three cases, serum creatinine levels remained normal after the surgery and during follow-up, and all remained symptom-free at the time of this writing (4-8 mo after their surgeries). CONCLUSIONS In this initial experience, single-port RAKT is feasible with potential benefits such as offering true single-site minimally invasive surgery, extraperitoneal approach, less morbidity, and comparable short-term graft functional outcomes. PATIENT SUMMARY We presented the initial experience with the application of single-port robotic surgery for kidney transplantation and autotransplantation. This technique was found to be safe and effective, with promising postoperative outcomes and potentially with less morbidity.
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Affiliation(s)
- Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Mohamed Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alireza Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zeyad Schwen
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Clark Wilson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mahmoud Abou Zeinab
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juan Garisto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Louis Lenfant
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alvin Wee
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Aminsharifi A, Kaouk J. Author Reply : Outpatient Extraperitoneal Single-port Robotic Radical Prostatectomy. Urology 2021; 152:204. [PMID: 33647305 DOI: 10.1016/j.urology.2021.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Alireza Aminsharifi
- Department of Urology, Section of Laparoscopic & Minimally Invasive Surgery Center, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad Kaouk
- Department of Urology, Section of Laparoscopic & Minimally Invasive Surgery Center, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH.
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Lenfant L, Aminsharifi A, Kim S, Kaouk J. Predictive factors of postoperative complications and hospital readmission after implementation of the single-port robotic platform: A single-center and single-surgeon experience. Int J Urol 2021; 28:530-537. [PMID: 33527543 DOI: 10.1111/iju.14503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/20/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To measure the incidence, and identify potential risk factors of conversion, postoperative complication and readmission for patients treated with urological robotic single-port surgery. METHODS All consecutive urological surgery procedures carried out with the single-port robotic platform by the same surgeon in a single institution between September 2018 and March 2020 were included in this retrospective analysis. Demographic data, main perioperative outcomes and information related to the surgical technique were gathered and analyzed. A logistic regression model was used to assess predictive factors for any grade and high-grade (e.g. Clavien grade ≥3) postoperative complications, as well as predictive factors for readmission. RESULTS Analysis included 221 patients, of whom 194 (88%) underwent pelvic surgery and 27 (12.2%) underwent upper urinary tract surgery. Only one patient was converted to open surgery in the entire cohort. A total of 40 patients (18.1%) experienced postoperative complications, with grade ≥3 postoperative complications in 7.6% of the entire cohort. On multivariable analysis, the factors significantly associated with the risk of postoperative complication of any grade were diabetes (P < 0.001), perineal approach (P < 0.01) and postoperative pain management with opioids (P = 0.01). Only diabetes (P = 0.03) predicted a grade ≥3 complication. Overall, 17 patients (7.7%) were readmitted during the 3 months after surgery. A body mass index >30 kg/m2 was the only identified predictor of readmission (P = 0.01). CONCLUSION A wide range of pelvic, extraperitoneal and upper-tract urological procedures can be carried out using the robotic single-port platform with a minimal conversion rate and low complication or readmission rate.
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Affiliation(s)
- Louis Lenfant
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.,CRG 5, Predictive Onco-Urology, AP-HP, Pitié-Salpêtrière University Hospital, Urology, Sorbonne University, Paris, France
| | - Alireza Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soodong Kim
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Shah A, Polascik TJ, George DJ, Anderson J, Hyslop T, Ellis AM, Armstrong AJ, Ferrandino M, Preminger GM, Gupta RT, Lee WR, Barrett NJ, Ragsdale J, Mills C, Check DK, Aminsharifi A, Schulman A, Sze C, Tsivian E, Tay KJ, Patierno S, Oeffinger KC, Shah K. Implementation and Impact of a Risk-Stratified Prostate Cancer Screening Algorithm as a Clinical Decision Support Tool in a Primary Care Network. J Gen Intern Med 2021; 36:92-99. [PMID: 32875501 PMCID: PMC7858708 DOI: 10.1007/s11606-020-06124-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/07/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Implementation methods of risk-stratified cancer screening guidance throughout a health care system remains understudied. OBJECTIVE Conduct a preliminary analysis of the implementation of a risk-stratified prostate cancer screening algorithm in a single health care system. DESIGN Comparison of men seen pre-implementation (2/1/2016-2/1/2017) vs. post-implementation (2/2/2017-2/21/2018). PARTICIPANTS Men, aged 40-75 years, without a history of prostate cancer, who were seen by a primary care provider. INTERVENTIONS The algorithm was integrated into two components in the electronic health record (EHR): in Health Maintenance as a personalized screening reminder and in tailored messages to providers that accompanied prostate-specific antigen (PSA) results. MAIN MEASURES Primary outcomes: percent of men who met screening algorithm criteria; percent of men with a PSA result. Logistic repeated measures mixed models were used to test for differences in the proportion of individuals that met screening criteria in the pre- and post-implementation periods with age, race, family history, and PSA level included as covariates. KEY RESULTS During the pre- and post-implementation periods, 49,053 and 49,980 men, respectively, were seen across 26 clinics (20.6% African American). The proportion of men who met screening algorithm criteria increased from 49.3% (pre-implementation) to 68.0% (post-implementation) (p < 0.001); this increase was observed across all races, age groups, and primary care clinics. Importantly, the percent of men who had a PSA did not change: 55.3% pre-implementation, 55.0% post-implementation. The adjusted odds of meeting algorithm-based screening was 6.5-times higher in the post-implementation period than in the pre-implementation period (95% confidence interval, 5.97 to 7.05). CONCLUSIONS In this preliminary analysis, following implementation of an EHR-based algorithm, we observed a rapid change in practice with an increase in screening in higher-risk groups balanced with a decrease in screening in low-risk groups. Future efforts will evaluate costs and downstream outcomes of this strategy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ariel Schulman
- Duke University, Durham, NC, USA.,Maimonides Medical Center, New York, NY, USA
| | - Christina Sze
- Duke University, Durham, NC, USA.,Weill Cornell Medical College, New York, NY, USA
| | | | - Kae Jack Tay
- Duke University, Durham, NC, USA.,SingHealth, Duke-NUS, Singapore, Singapore
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Lenfant L, Garisto J, Sawczyn G, Wilson CA, Aminsharifi A, Kim S, Schwen Z, Bertolo R, Kaouk J. Robot-assisted Radical Prostatectomy Using Single-port Perineal Approach: Technique and Single-surgeon Matched-paired Comparative Outcomes. Eur Urol 2020; 79:384-392. [PMID: 33357990 DOI: 10.1016/j.eururo.2020.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/03/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Radical perineal prostatectomy (RPP) has been revived with the advent of single-port (SP) robotic surgery. However, its interest and precise role need to be evaluated and better defined. OBJECTIVE To describe in detail the technique of SP-RPP and compare initial perioperative outcomes with those of multiport robot-assisted transperitoneal radical prostatectomy (MP-RARP). DESIGN, SETTING, AND PARTICIPANTS From October 2018 to June 2020, perioperative data of 26 consecutive patients who underwent SP-RPP for localized prostate cancer (PCa) in a single institution were prospectively entered into an institutional review board-approved database. Data of 86 consecutive patients treated from September 2017 to September 2018 with MP-RARP by the same surgeon, before the beginning of the SP experience, were used as comparators. SURGICAL PROCEDURE SP-RPP was performed using the SP robotic platform (Intuitive Surgical, Sunnyvale, CA, USA) according to the technique described in the supplementary video. MEASUREMENTS Demographics, and intra- and postoperative data were analyzed in a matched-paired design with a 1:1 ratio on the following factors: age at surgery, prostate-specific antigen level, preoperative Gleason score, and history of abdominal surgery. RESULTS AND LIMITATIONS After matching, baseline characteristics were comparable except for the rate of prior laparotomy, which was higher in the SP-RPP group (52% vs 8%, p < 0.001). In the SP-RPP group, 84% of the patients had a high risk and an unfavorable intermediate risk of positive surgical margins (PSMs) versus 57% in the MP-RARP group (p = 0.03). While the rate of nonlimited PSMs (ie, >3 mm) was higher in the SP-RPP group (38.5% vs 7.7%, p < 0.01), the number of patients with biochemical recurrence at 1 yr was comparable between SP-RPP and MP-RARP (1 vs 3, p = 0.3). CONCLUSIONS SP-RPP is a complex procedure for patients with a complex surgical history and high-risk localized PCa with limited alternative therapeutic options. PATIENT SUMMARY Our study suggests that patients with high-risk localized prostate cancer and limited treatment options due to a complex abdominal surgical history (ie, frozen pelvis) may be suitable candidates for single-port radical perineal prostatectomy.
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Affiliation(s)
- Louis Lenfant
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Urology Department, GRC n°5, Predictive Onco-urology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Juan Garisto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Guilherme Sawczyn
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Clark A Wilson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alireza Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soodong Kim
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zeyad Schwen
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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Sawczyn G, Lenfant L, Aminsharifi A, Kim S, Kaouk J. Predictive factors for opioid-free management after robotic radical prostatectomy: the value of the SP® robotic platform. Minerva Urol Nephrol 2020; 73:591-599. [PMID: 33256359 DOI: 10.23736/s2724-6051.20.04038-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to evaluate perioperative factors associated with opioid-free management after robotic radical prostatectomy in a single institution. METHODS From January 2019 to January 2020, data from patients who underwent robotic radical prostatectomy was retrospectively entered in a preapproved IRB database. Data were analyzed according to the postoperative opioid administration in hospital and/or after discharge. Robotic radical prostatectomy was performed using either the standard multi-port Da Vinci Si robotic platform with a transperitoneal approach (MP-RALP) or the novel DaVinci SP® robotic platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA) with an extraperitoneal approach (SP-EPP). Patients undergoing minimally invasive surgery were included in the "enhanced recovery after surgery" (ERAS) protocol regardless of the surgery approach. RESULTS During the study period, 210 patients matched the selection criteria. Of those, 158(75%) patients received opioids during the hospital stay or after discharge and 52(25%) patients never received opioids. SP-EPP surgical approach and shorter LOS were predictors of never receiving opioids (Odds Ratio [OR]=4.97, (95% CI 1.81-14.77, P=0.002 and OR=0.56, CI 95% 0.35-0.86, P=0.011, respectively). SP-EPP surgical approach was increasing the odds of remaining opioid free whether in-hospital or after discharge (OR= 11.97, 95% CI 4.8-32, P<0.0001 and OR=11.6, 95% CI 4.6-31, P<0.0001, respectively). Finally, a high BMI increased the odds of receiving opioid in hospital or after discharge (OR=0.89, 95% CI 0.82-0.96, P=0.003 and OR=0.89, 95% CI 0.82-0.96, P=0.002, respectively). CONCLUSIONS In this series, after robotic radical prostatectomy the use of a less invasive approach (SP-EPP), a shorter LOS and a lower BMI, were predictive of opioid-free status.
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Affiliation(s)
- Guilherme Sawczyn
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Louis Lenfant
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Unit of Predictive Onco-urology, Department of Urology, GRC N. 5, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Alireza Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soodong Kim
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA -
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Sawczyn G, Lenfant L, Aminsharifi A, Kim S, Kaouk J. Predictive factors for opioid-free management after robotic radical prostatectomy: the value of the SP® robotic platform. Minerva Urol Nephrol 2020. [PMID: 33256359 DOI: 10.23736/s0393-2249.20.04038-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to evaluate perioperative factors associated with opioid-free management after robotic radical prostatectomy in a single institution. METHODS From January 2019 to January 2020, data from patients who underwent robotic radical prostatectomy was retrospectively entered in a preapproved IRB database. Data were analyzed according to the postoperative opioid administration in hospital and/or after discharge. Robotic radical prostatectomy was performed using either the standard multi-port Da Vinci Si robotic platform with a transperitoneal approach (MP-RALP) or the novel DaVinci SP® robotic platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA) with an extraperitoneal approach (SP-EPP). Patients undergoing minimally invasive surgery were included in the "enhanced recovery after surgery" (ERAS) protocol regardless of the surgery approach. RESULTS During the study period, 210 patients matched the selection criteria. Of those, 158(75%) patients received opioids during the hospital stay or after discharge and 52(25%) patients never received opioids. SP-EPP surgical approach and shorter LOS were predictors of never receiving opioids (Odds Ratio [OR]=4.97, (95% CI 1.81-14.77, P=0.002 and OR=0.56, CI 95% 0.35-0.86, P=0.011, respectively). SP-EPP surgical approach was increasing the odds of remaining opioid free whether in-hospital or after discharge (OR= 11.97, 95% CI 4.8-32, P<0.0001 and OR=11.6, 95% CI 4.6-31, P<0.0001, respectively). Finally, a high BMI increased the odds of receiving opioid in hospital or after discharge (OR=0.89, 95% CI 0.82-0.96, P=0.003 and OR=0.89, 95% CI 0.82-0.96, P=0.002, respectively). CONCLUSIONS In this series, after robotic radical prostatectomy the use of a less invasive approach (SP-EPP), a shorter LOS and a lower BMI, were predictive of opioid-free status.
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Affiliation(s)
- Guilherme Sawczyn
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Louis Lenfant
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Unit of Predictive Onco-urology, Department of Urology, GRC N. 5, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Alireza Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soodong Kim
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA -
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Lenfant L, Sawczyn G, Kim S, Aminsharifi A. Comparaison des résultats périopératoires de la prostatectomie totale robot-assistée mono-trocart avec le robot SP® et de la prostatectomie totale robot-assistée multi-trocarts. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shirazi M, Aminsharifi A, Ahmed F, Makarem A, Zahraei SA, Asmaarian N. The impact of post-procedural ureteric stent duration on the outcome of retrograde endopyelotomy for management of failed open pyeloplasty in children: a preliminary report. Med J Islam Repub Iran 2020. [DOI: 10.47176/mjiri.34.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Wilson CA, Aminsharifi A, Sawczyn G, Garisto JD, Yau R, Eltemamy M, Kim S, Lenfant L, Kaouk J. Outpatient Extraperitoneal Single-Port Robotic Radical Prostatectomy. Urology 2020; 144:142-146. [DOI: 10.1016/j.urology.2020.06.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 01/21/2023]
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Aminsharifi A, Wilson CA, Sawczyn G, Kim S, Lenfant L, Kaouk J. Predictors Associated with a Prolonged Hospital Stay After Single-Port Extraperitoneal Robotic Radical Prostatectomy: A Comparative Analysis of Outpatient Versus Inpatient Care. J Endourol 2020; 34:1049-1054. [DOI: 10.1089/end.2020.0389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alireza Aminsharifi
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Clark A. Wilson
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Guilherme Sawczyn
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Soodong Kim
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Louis Lenfant
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jihad Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Aminsharifi A, Kaouk J. EDITORIAL COMMENT. Urology 2020; 143:31-32. [DOI: 10.1016/j.urology.2020.03.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/26/2020] [Indexed: 11/26/2022]
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Lenfant L, Aminsharifi A, Sawczyn G, Kim S, Kaouk J. Single-Port extraperitoneal robotic-assisted radical prostatectomy in a patient with preexisting artificial urinary sphincter: First clinical experience. Urology Video Journal 2020. [DOI: 10.1016/j.urolvj.2020.100035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Miller E, Wilson C, Sawczyn G, Kim S, Aminsharifi A, Garisto J, Kaouk J, Eltemamy M, Wee A. SINGLE PORT ROBOT-ASSISTED KIDNEY TRANSPLANTATION. Transplantation 2020. [DOI: 10.1097/01.tp.0000700724.62445.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shirazi M, Aminsharifi A, Ahmed F, Makarem A, Zahraei SA, Asmaarian N. The impact of post-procedural ureteric stent duration on the outcome of retrograde endopyelotomy for management of failed open pyeloplasty in children: a preliminary report. Med J Islam Repub Iran 2020; 34:105. [PMID: 33316005 PMCID: PMC7722965 DOI: 10.34171/mjiri.34.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Indexed: 11/05/2022] Open
Abstract
Background: To evaluate the outcome of retrograde endopyelotomy as a minimally invasive option for management of failed open pyeloplasty in children and assess how the duration of post-procedural stenting may affect the endopyelotomy outcome.
Methods: A total of 15 patients with secondary UPJO (Ureteropelvic junction obstruction) underwent retrograde endopyelotomy. The procedure was done using low-energy monopolar electrocautery hook under direct vision of pediatric ureteroscope and control of fluoroscopy. Double J stent was placed after the operation in all cases. Stent was removed in another session, 8 weeks (Group A, n=7) vs. 12 weeks (Group B, n=8) after endopyelotomy. Patients in both Groups were followed one, six and twelve months after the stent removal, and the anteroposterior renal pelvis diameter (APD), renal cortical thickness (CT) and degree of hydronephrosis (HDN) were recorded using the repeated measure test. P-value less than 0.05 were significant. We analyzed the data using SPSS software, version 20.
Results: The median interquartile range (IQR) age at time of surgery for group A and B were 24 (62) months and 12 (50) months respectively. Median (IQR) times between previous pyeloplasty and endopyelotomy were 6 (6) months and 12 (8.5) months in groups A and B, respectively. The success rate of endopyelotomy after 12 months was 57.1% in group A and 87.5% in group B. The resolution of HDN was more prominent in the 12 week stenting group compared to the 8 week group during the 12 months follow-up period (p=0.030). The APD and CT in group B compared to group A was improved during follow-up period.
Conclusion: A higher one-year success rate of retrograde endopyelotomy in terms of improvements in the degree of HDN, APD and CT was observed when the double j stent was remained for 12-weeks rather than 8-weeks. This observation need to be validated in a large cohort study with a long term post procedural follow up.
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Affiliation(s)
- Mehdi Shirazi
- Department of Urology, Shiraz University of Medical Science, Shiraz, Iran
| | - Alireza Aminsharifi
- Department of Urology, Shiraz University of Medical Science, Shiraz, Iran.,Division of Urology, Duke University Hospital, Durham, NC, USA
| | - Faisal Ahmed
- Department of Urology, Shiraz University of Medical Science, Shiraz, Iran.,Urology Research Center, Althora General Hospital, Department of Urology, Ibb University of Medical Sciences, Ibb, Yemen
| | - Alireza Makarem
- Department of Urology, Shiraz University of Medical Science, Shiraz, Iran
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Lenfant L, Sawczyn G, Kim S, Aminsharifi A, Kaouk J. Single-institution Cost Comparison: Single-port Versus Multiport Robotic Prostatectomy. Eur Urol Focus 2020; 7:532-536. [PMID: 32631777 DOI: 10.1016/j.euf.2020.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/26/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND In the era of efficient value-based health care, each surgical innovation should be proven to be cost-effective for the patient and the hospital administration. OBJECTIVE To compare the costs associated with robot-assisted prostatectomy using a single-port (SP) or multiport (MP) robotic platform. DESIGN, SETTING, AND PARTICIPANTS Costs for surgical care for consecutive patients with localized prostate cancer treated from November 2018 to November 2019 were itemized and evaluated. INTERVENTION Patients were treated using either the SP (n = 78) or MP (n = 97) platform. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Demographics, perioperative data, and costs for surgical care of patients in both groups were analyzed. RESULTS AND LIMITATION The mean cost for prostatectomy was comparable between SP ($13 512 ± $1615) and MP ($13 284 ± $1360; p = 0.32). The main cost differences between the groups were the cost of hospitalization, which was lower in the SP group (p < 0.001), offset by the cost of disposables in the operating room, which was higher in the SP group (p < 0.001). The mean length of stay was significantly shorter in the SP group (9.84 ± 11.3 vs 35.5 ± 29.1 h; p < 0.001) and the proportion of patients discharged home on the day of surgery was higher in the SP group (70% vs 5%; p < 0.001). The main limitation of this study is its retrospective design. CONCLUSIONS Overall, the costs for SP and MP prostatectomy are comparable. The higher SP cost for consumable surgical materials is offset by the lower cost associated with hospitalization, which was largely due to a shorter hospital stay after SP surgery. PATIENT SUMMARY In this report, we found that implementation of the new single-port robotic platform for radical prostatectomy was not associated with higher surgical care costs compared to conventional multiport surgery.
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Affiliation(s)
- Louis Lenfant
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Sorbonne University, GRC n°5, PREDICTIVE ONCO-UROLOGY, AP-HP, Hôpital Pitié-Salpêtrière, Urology, F-75013 PARIS, France
| | - Guilherme Sawczyn
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Soodong Kim
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alireza Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, Shiraz University of MedicalSciences, Shiraz, Iran
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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Kaouk J, Aminsharifi A, Wilson C, Sawczyn G, Garisto J, Francavilla S, Abern M, Crivellaro S. Extraperitoneal versus transperitoneal single-port robotic radical prostatectomy: A comparative analysis of perioperative outcomes. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32952-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kaouk J, Sawczyn G, Wilson C, Aminsharifi A, Fareed K, Garisto J, Lenfant L. Single-Port Percutaneous Transvesical Simple Prostatectomy Using the SP Robotic System: Initial Clinical Experience. Urology 2020; 141:173-177. [DOI: 10.1016/j.urology.2020.02.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/12/2020] [Accepted: 02/24/2020] [Indexed: 02/02/2023]
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Aminsharifi A. Letter to the Editor RE: EL-Nahas, Editorial Comment on: Predicting the Postoperative Outcome of Percutaneous Nephrolithotomy with Machine Learning System: Software Validation and Comparative Analysis with Guy's Stone Score and the CROES Nomogram by Aminsharifi et al. (J Endourol 2020;34(6):699-700; DOI: 10.1089/end.2020.0203). J Endourol 2020; 34:700-701. [PMID: 32568591 DOI: 10.1089/end.2020.29085.alm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alireza Aminsharifi
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran.,Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Lenfant L, Wilson CA, Sawczyn G, Aminsharifi A, Kim S, Kaouk J. Single-Port Robot-Assisted Dismembered Pyeloplasty With Mini-Pfannenstiel or Peri-Umbilical Access: Initial Experience in a Single Center. Urology 2020; 143:147-152. [PMID: 32505618 DOI: 10.1016/j.urology.2020.05.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To assess the feasibility and describe the surgical technique for single-port robotic-assisted laparoscopic pyeloplasty using the new da Vinci SP surgical platform (Intuitive Surgical Inc., Sunnyvale, CA), and to describe the approach through a mini-pfannenstiel incision. METHODS Data from a prospectively maintained single-institution database on all patients undergoing single-port robotic-assisted pyeloplasty between November 2018 and November 2019 were reviewed. Pyeloplasty was performed with the da Vinci SP system through a pure single site approach (except for the first patient). The initial procedures were performed through a midline incision and the technique evolved to a mini-pfannenstiel incision. Patient demographics, intraoperative data, post-operative data and surgical outcomes were collected. RESULTS Overall, 10 patients were included and underwent the procedure without intraoperative complications or conversion to an alternate approach. The patients' ages ranged between 11 and 75 years. Mean operative time was 166 minutes (interquartile range [IQR] 146-181) and EBL was minimal. Pfannenstiel incision was performed for 6 patients and 4 patients had a vertical midline incision. The only complication recorded was a postoperative urinary tract infection treated with antibiotics. The median postoperative hospital stay was 21 hours (7-24). Postoperative pain management after discharge was managed exclusively with non-opioid medication. Overall success rate defined as the absence of pain and renal obstruction on post-operative imaging at 3 months after surgery was 100%. CONCLUSION Single-port robotic-assisted laparoscopic pyeloplasty is a safe and feasible procedure through a mini-pfannenstiel incision.
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Affiliation(s)
- Louis Lenfant
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Clark A Wilson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Guilherme Sawczyn
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alireza Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Sorbonne University, GRC n° 5, PREDICTIVE ONCO-UROLOGY, AP-HP, Hôpital Pitié-Salpiêtrière, Urology, Paris, France; Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soodong Kim
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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Affiliation(s)
- Alireza Aminsharifi
- Fellowship in advanced robotic urology surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Associate professor of urology, Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jihad Kaouk
- Zegarac-Pollock Professor of Surgery, Director, Center for Laparoscopic and Robotic Surgery Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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Aminsharifi A, Sawczyn G, Wilson CA, Garisto J, Kaouk J. Technical advancements in robotic prostatectomy: single-port extraperitoneal robotic-assisted radical prostatectomy and single-port transperineal robotic-assisted radical prostatectomy. Transl Androl Urol 2020; 9:848-855. [PMID: 32420199 PMCID: PMC7214976 DOI: 10.21037/tau.2019.11.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background To describe our step-by-step techniques for single-port robotic-assisted extraperitoneal and perineal radical prostatectomy as recent technical advancements in this field. Methods An English-language literature review was done using search terms including extraperitoneal, transperineal, single-port, robotic surgery, prostate cancer, radical prostatectomy in various combinations. Unique features of the da Vinci SP® platform are discussed. Details of surgical techniques with single-port robotic platform are also covered. Results The relatively recent introduction of the da Vinci SP platform has led to the development of novel techniques for radical prostatectomy. Unique features of this platform including intracorporeal triangulation and double-articulating instruments will likely lead to widespread applications of this novel system. The principles of radical prostatectomy are reproducible with both extraperitoneal and perineal approaches via a single incision. Conclusions A better cosmetic results as well as a quick recovery maybe potential advantages of single-port extraperitoneal/transperineal robotic prostatectomy. By avoiding the peritoneal cavity, a lower rate of bowel related complications and minimum systemic CO2 absorption can be expected. Adverse effects of steep Trendelenburg positioning can be avoided with these techniques. Evaluation of the oncological and functional outcomes of these techniques will be necessary. Comparative trials with standard robotic surgery and cost-analysis studies remain hot topics for research after implementation of these new platforms at any institute.
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Affiliation(s)
- Alireza Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Guilherme Sawczyn
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Clark A Wilson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juan Garisto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Kaouk J, Aminsharifi A, Sawczyn G, Kim S, Wilson CA, Garisto J, Fareed K. Single-Port Robotic Urological Surgery Using Purpose-Built Single-Port Surgical System: Single-Institutional Experience With the First 100 Cases. Urology 2020; 140:77-84. [PMID: 32142725 DOI: 10.1016/j.urology.2019.11.086] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To present a comprehensive report regarding our experience with single-port robotic surgery in our first 100 consecutive patients. We describe the diversity of procedures that can be performed with this platform as well as the challenges and complications we had with the application of this novel technology. METHODS Between September 2018 and August 2019, data on 100 patients who underwent single-port robotic surgery were consecutively collected. Preoperative, intraoperative and early postoperative outcomes after various urologic procedures were recorded and analyzed. RESULTS During the study period, 100 patients (age [range] 35-84 years; 88 [88%] Male) underwent various single-port robotic surgeries for different indications (Retroperitoneal [n = 14], Pelvic surgeries [n = 86]). Transperitoneal (n = 37), extraperitoneal (n = 53) and transvesical (n = 10) approaches have been used to access the target organs. Of these procedures, 73 (73%) were for different oncological indications: Radical prostatectomy (n = 60), Partial nephrectomy (n = 6), Retroperitoneal lymph node dissection (n = 1) and Radical cystectomy with intracorporeal diversion (n = 6). Surgery was successfully completed in all but 1 patient, in whom the surgery was converted to open surgery due to dense adhesions and failure to progress. Grades II-III postoperative complications were detected in (n = 9) patients. CONCLUSION The purpose-built single-port robotic platform can be safely incorporated into the minimally invasive armamentarium. A wide range of pelvic and retroperitoneal urological procedures can be done with different approaches using this platform. Randomized trials with adequate sample size and postoperative follow up period is advisable for further evaluation of the outcomes and to determine the added value of this emerging technology.
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Affiliation(s)
- Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| | - Alireza Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Guilherme Sawczyn
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Soodong Kim
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Clark A Wilson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Juan Garisto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Khaled Fareed
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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Sawczyn G, Aminsharifi A, Garisto J, Valero R, Kaouk J. Single-port transvesical robotic simple prostatectomy using the novel SPⓇ surgical system: Technical aspects. Urology Video Journal 2020. [DOI: 10.1016/j.urolvj.2019.100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Aminsharifi A, Irani D, Tayebi S, Jafari Kafash T, Shabanian T, Parsaei H. Predicting the Postoperative Outcome of Percutaneous Nephrolithotomy with Machine Learning System: Software Validation and Comparative Analysis with Guy's Stone Score and the CROES Nomogram. J Endourol 2020; 34:692-699. [PMID: 31886708 DOI: 10.1089/end.2019.0475] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To validate the output of a machine learning-based software as an intelligible interface for predicting multiple outcomes after percutaneous nephrolithotomy (PCNL). We compared the performance of this system with Guy's stone score (GSS) and the Clinical Research Office of Endourological Society (CROES) nomogram. Patients and Methods: Data from 146 adult patients (87 males, 59%) who underwent PCNL at our institute were used. To validate the system, accuracy of the software for predicting each postoperative outcome was compared with the actual outcome. Similarly, preoperative data were analyzed with GSS and CROES nomograms to determine stone-free status as predicted by these nomograms. A receiver operating characteristic (ROC) curve was generated for each scoring system, and the area under the ROC curve (AUC) was calculated and used to assess the predictive performance of all three models. Results: Overall stone-free rate was 72.6% (106/146). Forty of 146 patients (27.4%) were scheduled for 42 ancillary procedures (extracorporeal shockwave lithotripsy [SWL] [n = 31] or repeat PCNL [n = 11]) to manage residual renal stones. Overall, the machine learning system predicted the PCNL outcomes with an accuracy ranging between 80% and 95.1%. For predicting the stone-free status, the AUC for the software (0.915) was significantly larger than the AUC for GSS (0.615) or CROES nomograms (0.621) (p < 0.001). Conclusion: At the internal institutional level, the machine learning-based software was a promising tool for recording, processing, and predicting outcomes after PCNL. Validation of this system against an external dataset is highly recommended before its widespread application.
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Affiliation(s)
- Alireza Aminsharifi
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran.,Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dariush Irani
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sona Tayebi
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Tayebeh Shabanian
- Department of Medical Physics and Engineering, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Parsaei
- Department of Medical Physics and Engineering, Shiraz University of Medical Sciences, Shiraz, Iran.,Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Aminsharifi A, Silver D, Schulman A. Response to: Babayan, Steinberg, and Miller RE: Aminsharifi et al., Major Complications and Adverse Events Related to the Injection of the SpaceOAR Hydrogel System Before Radiotherapy for Prostate Cancer: Review of the Manufacturer and User Facility Device Experience Database (From: Babayan RK, Steinberg ML, and Miller LE, J Endourol 2020;34:240–241; DOI: 10.1089/end.2019.0742). J Endourol 2020; 34:242. [DOI: 10.1089/end.2020.29075.aam] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alireza Aminsharifi
- Division of Urology, Duke Cancer Institute, Duke University Hospital, Durham, North Carolina
| | - David Silver
- Division of Urology, Maimonides Medical Center, Brooklyn, New York
| | - Ariel Schulman
- Division of Urology, Maimonides Medical Center, Brooklyn, New York
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Tan WP, ElShafei A, Aminsharifi A, Khalifa AO, Polascik TJ. Salvage Focal Cryotherapy Offers Similar Short-term Oncologic Control and Improved Urinary Function Compared With Salvage Whole Gland Cryotherapy for Radiation-resistant or Recurrent Prostate Cancer. Clin Genitourin Cancer 2019; 18:e260-e265. [PMID: 31892490 DOI: 10.1016/j.clgc.2019.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/04/2019] [Accepted: 11/27/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND We compared the short-term oncologic and functional outcomes of salvage focal cryotherapy (SFC) with those of salvage total cryotherapy (STC) for radiotherapy (RT)-persistent/recurrent prostate cancer. MATERIALS AND METHODS We queried the Cryo On-Line Database registry for men who had undergone SFC and STC of the prostate for RT-persistent or recurrent disease. Propensity score weighting was used to match age at treatment, presalvage therapy prostate-specific antigen level, Gleason sum, and presalvage cryotherapy androgen deprivation therapy status. The primary outcome was progression-free survival. RESULTS A total of 385 men with biopsy-proven persistent or recurrent prostate cancer after primary RT were included in the present study. The median follow-up, age, prostate-specific antigen, and Gleason sum before salvage cryotherapy was 24.4 months (first and third quartile, 9.8 and 60.3), 70 years (first and third quartile, 66 and 74 years), 4 ng/dL (first and third quartile, 2.7 and 5.6 ng/dL), and 7 (first and third quartile, 6 and 8), respectively. After propensity score weighting, the difference in progression-free survival was not statistically significant between the patients who had undergone STC and those who had undergone SFC (79.8% vs. 76.98%; P = .11 on weighted log-rank test). SFC was associated with a lower probability of post-treatment transient urinary retention (5.6% vs. 22.4%; P < .001). No significant differences were found in the incidence of rectal fistula (1.4% vs. 3.8; P = .30), new-onset urinary incontinence within 12 months (9.3% vs. 15.1%; P = .19), or new-onset erectile dysfunction within 12 months (52.6% vs. 59.6%; P = .47) between the SFC and STC groups, respectively. CONCLUSIONS STC resulted in similar 2-year oncologic outcomes compared with SFC in the RT-persistent/recurrent disease population. However, the patients who had undergone SFC had a lower urinary retention rate compared with those who had undergone STC.
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Affiliation(s)
- Wei Phin Tan
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ahmed ElShafei
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Medical School, Cairo University, Cairo, Egypt
| | - Alireza Aminsharifi
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ahmad O Khalifa
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Department of Urology, Menoufia University, Shebin Al Kom, Egypt
| | - Thomas J Polascik
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC.
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Aminsharifi A, Kotamarti S, Silver D, Schulman A. Major Complications and Adverse Events Related to the Injection of the SpaceOAR Hydrogel System Before Radiotherapy for Prostate Cancer: Review of the Manufacturer and User Facility Device Experience Database. J Endourol 2019; 33:868-871. [PMID: 31452385 DOI: 10.1089/end.2019.0431] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: SpaceOAR® is a Food and Drug Administration-approved hydrogel injection used to create space between the prostate and rectum during prostate radiotherapy. It has shown to significantly reduce the rectal radiation dose with lower rates of rectal toxicity. Despite a high safety performance in initial trials, SpaceOAR remains in early clinical use. Thus, we examined emerging safety reports as the system becomes more widely utilized. Methods: We reviewed the SpaceOAR manufacturer website for the safety profile and complications associated with the SpaceOAR hydrogel. We then compared this with reports submitted to the Manufacturer and User Facility Device Experience (MAUDE) database. Results: The manufacturer website reported risks including pain, needle penetration, and/or gel injection into a nearby organ or blood vessel, local inflammation, infection, urinary retention, and local rectal injury or symptoms. There were 22 unique reports discussing 25 patient cases in the MAUDE database from January 2015 to March 2019, with an increasing number of reports each year up through 2018. Unique major complications including acute pulmonary embolism, severe anaphylaxis, prostatic abscess and sepsis, purulent perineal drainage, rectal wall erosion, and rectourethral fistula were reported. Conclusion: Despite well-documented clinical benefits of the SpaceOAR System, there are a number of severe and debilitating complications recently reported in proximity to gel injection. This highlights the need for further study of device complications in light of its increasing clinical use.
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Affiliation(s)
- Alireza Aminsharifi
- Division of Urology, Duke Cancer Institute, Duke University Hospital, Durham, North Carolina.,Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - David Silver
- Division of Urology, Maimonides Medical Center, Brooklyn, New York
| | - Ariel Schulman
- Division of Urology, Maimonides Medical Center, Brooklyn, New York
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Aminsharifi A, Schulman A, Howard LE, Tay KJ, Amling CL, Aronson WJ, Cooperberg MR, Kane CJ, Terris MK, Freedland SJ, Polascik TJ. Influence of African American race on the association between preoperative biopsy grade group and adverse histopathologic features of radical prostatectomy. Cancer 2019; 125:3025-3032. [PMID: 31042315 DOI: 10.1002/cncr.32168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/04/2019] [Accepted: 03/25/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The current study was performed to evaluate the influence of race on the association between biopsy grade group (GrGp) and the risk of detectable prostate-specific antigen (PSA) and adverse histopathological outcomes after radical prostatectomy (RP). METHODS Data regarding 4073 men (1344 African American men; 33%) who were treated with RP were categorized based on the 5-tiered GrGp system. Logistic regression was used to test the association between biopsy GrGp and PSA nadir (<0.1 ng/mL) after RP as well as adverse pathological features among all patients and stratified by race. RESULTS Those patients with a higher biopsy GrGp were found to have lower odds of achieving a PSA nadir <0.1 ng/mL after RP on unadjusted and multivariable analysis (both P < .001). On unadjusted and multivariable analysis, higher GrGp was associated with increased odds of each of the adverse pathological features, namely, GrGp ≥3, extraprostatic extension, seminal vesicle invasion, positive surgical resection margin, and positive lymph nodes (all P < .001). Race had no significant interaction with biopsy GrGp in the prediction of PSA nadir after RP (P = .91) or any adverse pathological features (all P > .06) except positive lymph nodes. When the models were stratified by race, the associations between preoperative biopsy GrGp and having a PSA nadir <0.1 ng/mL, high-grade final pathology, or other adverse histopathologic features were similar in both races except as noted for positive lymph nodes. CONCLUSIONS Higher preoperative biopsy GrGp is associated with increased odds of adverse histopathological findings as well as lower odds of a PSA nadir <0.1 ng/mL after RP. These associations are largely independent of race, suggesting that GrGp is an accurate tool for risk stratification in both black and white men.
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Affiliation(s)
- Alireza Aminsharifi
- Division of Urology, Department of Surgery, Duke Cancer Institute, Durham, North Carolina
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ariel Schulman
- Division of Urology, Department of Surgery, Duke Cancer Institute, Durham, North Carolina
| | - Lauren E Howard
- Division of Urology, Department of Surgery, Duke Cancer Institute, Durham, North Carolina
- Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, North Carolina
| | - Kae Jack Tay
- Division of Urology, Department of Surgery, Duke Cancer Institute, Durham, North Carolina
- SingHealth, Singapore General Hospital, Singapore
| | - Christopher L Amling
- Department of Urology, Oregon Health & Science University, Veterans Affairs Medical Center, Portland, Oregon
| | - William J Aronson
- Department of Urology, University of California at Los Angeles Medical Center, Veterans Affairs Medical Center, Los Angeles, California
| | - Matthew R Cooperberg
- Department of Urology, University of California at San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Christopher J Kane
- Department of Urology, University of California at San Diego Medical Center, Veterans Affairs Medical Center, San Diego, California
| | - Martha K Terris
- Urology Section, Department of Surgery, Veterans Affairs Medical Center, Augusta, Georgia
- Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, Georgia
| | - Stephen J Freedland
- Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, North Carolina
- Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Thomas J Polascik
- Division of Urology, Department of Surgery, Duke Cancer Institute, Durham, North Carolina
- Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, North Carolina
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Aminsharifi A, Simon R, Polascik TJ, Robertson CN, Sudan DL, Collins BH, Moul JW. Evaluation and Active Treatment versus Active Surveillance of Localized Prostate Cancer in Renal Transplant Patients in the Era of Low and Very Low Risk Prostate Cancer. J Urol 2019; 202:469-474. [DOI: 10.1097/ju.0000000000000207] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Alireza Aminsharifi
- Division of Urology, Duke University Medical Center, Durham, North Carolina
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ross Simon
- Division of Urology, Duke University Medical Center, Durham, North Carolina
| | - Thomas J. Polascik
- Division of Urology, Duke University Medical Center, Durham, North Carolina
| | - Cary N. Robertson
- Division of Urology, Duke University Medical Center, Durham, North Carolina
| | - Debra L. Sudan
- Abdominal Transplant Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Bradley H. Collins
- Abdominal Transplant Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Judd W. Moul
- Division of Urology, Duke University Medical Center, Durham, North Carolina
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Aminsharifi A, Jibara G, Tsivian E, Tsivian M, Elshafei A, Polascik TJ. Salvage Prostate Cryoablation for the Management of Local Recurrence After Primary Cryotherapy: A Retrospective Analysis of Functional and Intermediate-Term Oncological Outcomes Associated With a Second Therapeutic Freeze. Clin Genitourin Cancer 2019; 17:e831-e836. [DOI: 10.1016/j.clgc.2019.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/29/2019] [Accepted: 05/20/2019] [Indexed: 12/13/2022]
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Shabaniyan T, Parsaei H, Aminsharifi A, Movahedi MM, Jahromi AT, Pouyesh S, Parvin H. An artificial intelligence-based clinical decision support system for large kidney stone treatment. Australas Phys Eng Sci Med 2019; 42:771-779. [PMID: 31332724 DOI: 10.1007/s13246-019-00780-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/14/2019] [Indexed: 12/11/2022]
Abstract
A decision support system (DSS) was developed to predict postoperative outcome of a kidney stone treatment procedure, particularly percutaneous nephrolithotomy (PCNL). The system can serve as a promising tool to provide counseling before an operation. The overall procedure includes data collection and prediction model development. Pre/postoperative variables of 254 patients were collected. For feature vector, we used 26 variables from three categories including patient history variables, kidney stone parameters, and laboratory data. The prediction model was developed using machine learning techniques, which includes dimensionality reduction and supervised classification. A novel method based on the combination of sequential forward selection and Fisher's discriminant analysis was developed to reduce the dimensionality of the feature space and to improve the performance of the system. Multiple classifier scheme was used for prediction. The derived DSS was evaluated by running leave-one-patient-out cross-validation approach on the dataset. The system provided favorable accuracy (94.8%) in predicting the outcome of a treatment procedure. The system also correctly estimated 85.2% of the cases that required stent placement after the removal of a stone. In predicting whether the patient might require a blood transfusion during the surgery or not, the system predicted 95.0% of the cases correctly. The results are promising and show that the developed DSS could be used in assisting urologists to provide counseling, predict a surgical outcome, and ultimately choose an appropriate surgical treatment for removing kidney stones.
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Affiliation(s)
- Tayyebe Shabaniyan
- Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Parsaei
- Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Alireza Aminsharifi
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mehdi Movahedi
- Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Torabi Jahromi
- Electrical and Electronic Engineering Group, Engineering College, Persian Gulf University, Bushehr, Iran
| | - Shima Pouyesh
- Department of Computer Engineering, Islamic Azad University, Yasooj, Iran
| | - Hamid Parvin
- Department of Computer Engineering, Islamic Azad University, Nourabad Mamasani, Iran
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Aminsharifi A. Minimally Invasive Management of Genitourinary Fistula: Intravesical Versus Extravesical Approach. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alireza Aminsharifi
- Division of Urology, Duke University Hospital, Durham, NC and Department of Urology, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Modarresi R, Aminsharifi A, Foroughinia F. Impact of Spirulina Supplementation on Semen Parameters in Patients with Idiopathic Male Infertility: A Pilot Randomized Trial. Urol J 2019; 16:78-82. [PMID: 30033514 DOI: 10.22037/uj.v0i0.4122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the efficacy of therapy with spirulina supplement on semen parameters in patients with idiopathic male infertility. MATERIALS AND METHODS A total of 40 men with idiopathic infertility were randomly assigned into two groups. Group A received 2 g spirulina supplement as well as conventional regimen for the treatment of infertility selected by their physician (220 mg/day zinc sulfate, 500mg/day L-carnitine, and 50 mg/day clomiphene) during 12 weeksof the study, while group B received placebo plus conventional therapy during the study period. Semen parameters were analyzed at baseline and at the end of the study as a primary endpoint. The secondary endpoint was the rate of pregnancy occurring in the patients. wives. RESULT No significant differences in semen parameters were observed between the spirulina and control groups [count (16.43 vs. 46.00, P = .164), motility (51.00 vs. 48.7, P = .008), and morphology (47.50 vs. 15.00, P = NA)]. Our results showed a pregnancy rate of 5% in the spirulina group versus 0% in the control group. CONCLUSION This pilot randomized trial provides initial evidence on the possible beneficial effects of spirulina mainly in patients with impaired sperm motility or morphology. Due to the limited sample size, further larger randomized trials not only at the level of semen parameters but at the scope of paternity are required to confirmthese potential benefits.
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Affiliation(s)
- Roya Modarresi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Farzaneh Foroughinia
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Aminsharifi A, Howard LE, Amling CL, Aronson WJ, Cooperberg MR, Kane CJ, Terris MK, Polascik TJ, Freedland SJ. Statins are Associated With Increased Biochemical Recurrence After Radical Prostatectomy in Diabetic Men but no Association was Seen in Men also Taking Metformin: Results From the SEARCH Database. Clin Genitourin Cancer 2019; 17:e140-e149. [DOI: 10.1016/j.clgc.2018.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 12/19/2022]
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Aminsharifi A, Gupta RT, Tsivian E, Sekar S, Sze C, Polascik TJ. Reduced Core Targeted (RCT) biopsy: Combining multiparametric magnetic resonance imaging - transrectal ultrasound fusion targeted biopsy with laterally-directed sextant biopsies – An alternative template for prostate fusion biopsy. Eur J Radiol 2019; 110:7-13. [DOI: 10.1016/j.ejrad.2018.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
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Aminsharifi A, Polascik TJ. Re: Radical Prostatectomy, External Beam Radiotherapy, or External Beam Radiotherapy with Brachytherapy Boost and Disease Progression and Mortality in Patients with Gleason Score 9–10 Prostate Cancer. Eur Urol 2018; 74:526. [DOI: 10.1016/j.eururo.2018.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 05/25/2018] [Indexed: 02/07/2023]
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46
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Aminsharifi A, Polascik TJ, Schulman A, Tay KJ, Jibara G, Sze C, Tsivian E, Elshafei A, Jones JS. Predictors of Rectourethral Fistula Formation After Primary Whole-Gland Cryoablation for Prostate Cancer: Results from the Cryo On-Line Database Registry. J Endourol 2018; 32:791-796. [PMID: 29943657 DOI: 10.1089/end.2018.0357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To define the incidence and risk factors associated with rectourethral fistula (RUF) formation following primary whole-gland cryosurgery using a multicenter centralized registry. PATIENTS AND METHODS The Cryo On-Line Data (COLD) registry was queried for men undergoing primary whole-gland cryotherapy between 1990 and 2014 who developed a RUF. Patient factors and disease parameters were correlated with RUF using chi-square and the t-test. Variables with p < 0.25 were entered into a binary logistic regression with stepwise backward elimination to determine the factors associated with RUF formation. RESULTS A total of 4102 men underwent primary whole-gland cryotherapy in the COLD registry at the time of analysis. Postoperative RUF was documented in 50 out of 4102 cases (1.2%). Patients with RUF had similar demographic data, prostate volume, preoperative prostate-specific antigen level, and clinical stage in comparison to those without fistula. On both univariate and multivariate analyses, postoperative urinary retention (odds ratio [OR]: 6.30; confidence interval [95% CI] 3.43-11.58, p < 0.001), preoperative Gleason score of ≥7 (OR: 1.92; 95% CI 1.08-3.43, p = 0.027), and preoperative incontinence (OR: 2.95; 95% CI 1.12-7.76, p = 0.028) were the most significant risk factors associated with RUF formation. CONCLUSION Primary whole-gland cryotherapy for prostate cancer is associated with a historically low rate (1.2%) of postoperative RUF formation. The rate decreased further to 0.55% over the last several years, suggesting better patient selection and technical improvement. Postoperative urinary retention, Gleason score ≥7, and preoperative urinary incontinence were the key demographic, clinical, and pathologic features associated with RUF formation in this study.
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Affiliation(s)
- Alireza Aminsharifi
- 1 Division of Urologic Surgery, Duke Cancer Institute , Durham, North Carolina.,2 Department of Urology, Shivaz University of Sciences , Shivaz, Iran
| | - Thomas J Polascik
- 1 Division of Urologic Surgery, Duke Cancer Institute , Durham, North Carolina
| | - Ariel Schulman
- 1 Division of Urologic Surgery, Duke Cancer Institute , Durham, North Carolina
| | - Kae Jack Tay
- 1 Division of Urologic Surgery, Duke Cancer Institute , Durham, North Carolina.,3 SingHealth, Singapore General Hospital , Singapore, Singapore
| | - Ghalib Jibara
- 1 Division of Urologic Surgery, Duke Cancer Institute , Durham, North Carolina
| | - Christina Sze
- 1 Division of Urologic Surgery, Duke Cancer Institute , Durham, North Carolina
| | - Efrat Tsivian
- 1 Division of Urologic Surgery, Duke Cancer Institute , Durham, North Carolina
| | - Ahmed Elshafei
- 4 Glickman Urological Institute , Cleveland Clinic Foundation, Cleveland, Ohio.,5 Urology Department, Medical School, Cairo University , Giza, Egypt
| | - J Stephen Jones
- 4 Glickman Urological Institute , Cleveland Clinic Foundation, Cleveland, Ohio
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Aminsharifi A, Schulman A, Anderson J, Fish L, Oeffinger K, Shah K, Sze C, Tay KJ, Tsivian E, Polascik TJ. Primary care perspective and implementation of a multidisciplinary, institutional prostate cancer screening algorithm embedded in the electronic health record. Urol Oncol 2018; 36:502.e1-502.e6. [PMID: 30170982 DOI: 10.1016/j.urolonc.2018.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/03/2018] [Accepted: 07/23/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE In response to controversy regarding prostate cancer (CaP) screening recommendations, a consolidated Duke Cancer Institute (DCI) multidisciplinary algorithm for CaP screening was developed and implemented. We conducted an online survey within the year following its implementation to assess primary care provider (PCP) attitudes and adoption as well as to evaluate how this program affects screening rates. METHODS A web-based 18-item survey was programmed and was electronically mailed to practicing PCPs at clinics affiliated with the Duke Primary Care system. The survey assessed provider practices and attitudes regarding CaP screening, factors that influenced their general screening recommendations and the confidence related to communicating with patients about screening. The rate of PSA screening before and after implementation of the algorithm was reported across age and race categories. RESULTS In sum, 94 of 106 respondents (88.6%) reported discussing the benefits and harms of screening and let their patients decide (52.8%) or recommended for (31.1%) or against (4.7%) screening. Three-fourths of respondents followed a specific panel recommendation such as the United States Preventative Services Task Force (USPSTF) (48.1%), DCI (20%), or the American Urological Association (AUA) (7.4%) guidelines. After integrating this algorithm into the electronic health record, the rate of prostate screening increased between 11% and 20.4% and 15.6% and 16.4% among different age and race categories, respectively. Overall, 79.2% of PCPs felt very confident regarding their ability to communicate the topic of CaP screening with patients. CONCLUSION The DCI multidisciplinary CaP screening algorithm was well adopted among PCPs shortly after its implementation. The rate of screening increased among all age and race categories thereafter. The majority of PCPs involved in this survey felt confident regarding their CaP screening knowledge and most discuss this topic with patients in a shared decision-making model.
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Affiliation(s)
- Alireza Aminsharifi
- Division of Urological Surgery, Durham, NC; Department of Urology Shiraz University of Medical Sciences Shiraz, Iran; Duke Cancer Institute, Duke University, Durham, NC
| | | | - John Anderson
- Department of Medicine, Duke Primary Care, Durham, NC
| | - Laura Fish
- Duke Cancer Institute, Duke University, Durham, NC
| | - Kevin Oeffinger
- Department of Medicine, Duke Primary Care, Durham, NC; Duke Cancer Institute, Duke University, Durham, NC
| | - Kevin Shah
- Department of Medicine, Duke Primary Care, Durham, NC
| | | | - Kae J Tay
- Division of Urological Surgery, Durham, NC; SingHealth, Singapore General Hospital, Singapore
| | | | - Thomas J Polascik
- Division of Urological Surgery, Durham, NC; Duke Cancer Institute, Duke University, Durham, NC.
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Aminsharifi A, Polascik TJ, Tsivian M, Schulman A, Tsivian E, Tay KJ, Elshafei A, Jones JS. Does Any Racial Disparity Exist in Oncologic Outcomes After Primary Cryotherapy for Prostate Cancer? A Matched-pair Comparative Analysis of the Cryo On-Line Data Registry. Clin Genitourin Cancer 2018; 16:e1073-e1076. [PMID: 30054221 DOI: 10.1016/j.clgc.2018.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/03/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND African-American (AA) men have the greatest incidence of and disease-specific mortality from prostate cancer of any racial group. Although encouraging oncologic and functional outcomes have been reported with prostate cancer cryotherapy, little is known about how ethnicity can potentially affect the oncologic outcomes of primary cryotherapy. We report the oncologic outcomes of primary cryotherapy in AA patients through a matched-pair analysis. PATIENTS AND METHODS A 1:2 (AA to non-AA) cohort of patients was designed using the Cryo-On-Line Data Registry. The 2 arms were matched for patient age, prostate-specific antigen level, Gleason score, and prostate volume. The oncologic outcome was defined in terms of the biochemical recurrence (BCR) rates after primary cryoablation using Phoenix criteria. The results of "for-cause" post-treatment biopsies and the BCR-free survival rates were also analyzed between the 2 groups. RESULTS The 1:2 cohort of AA and non-AA men in the present study included 109 and 218 men, respectively. Their median age (69 vs. 71 years; P = .71), median prostate-specific antigen level (6.5 vs. 6.8 ng/mL; P = .95), median prostate volume (32 vs. 30 cm3; P = .31), Gleason score distribution (P = .97), and prostate cancer risk group (P = .12) were similar statistically. The median postoperative follow-up period was also comparable between the 2 groups (AA, 32 months vs. non-AA, 27 months; P = .52). The BCR rates were similar between the AA and non-AA men (14% vs. 17%; P = .52). Likewise, the rate of positive "for-cause" prostate biopsy findings was similar between the 2 groups (AA vs. non-AA, 25% vs. 36%; P = .44). Furthermore, the 5-year biochemical relapse-free survival rates were comparable for the AA and non-AA patients (74% vs. 71%; P = .37). CONCLUSION When matched for tumor characteristics, cryotherapy as a treatment modality for primary, clinically localized prostate cancer offers men of African-American descent similar oncologic outcomes to those of non-AA men.
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Affiliation(s)
- Alireza Aminsharifi
- Division of Urology, Duke Cancer Institute, Durham, NC; Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | | | - Efrat Tsivian
- Division of Urology, Duke Cancer Institute, Durham, NC
| | - Kae Jack Tay
- Division of Urology, Duke Cancer Institute, Durham, NC; SingHealth, Singapore General Hospital, Singapore
| | - Ahmed Elshafei
- Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH; Department of Urology, Medical School, Cairo University, Cairo, Egypt
| | - J Stephen Jones
- Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH
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Aminsharifi A, Irani D, Amirzargar H. Shock Wave Lithotripsy is More Effective for Residual Fragments after Percutaneous Nephrolithotomy than for Primary Stones of the Same Size: A Matched Pair Cohort Study. Curr Urol 2018; 12:27-32. [PMID: 30374277 DOI: 10.1159/000447227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/24/2017] [Indexed: 11/19/2022] Open
Abstract
Aims To compare the outcome of shock wave lithotripsy (SWL) on post-percutaneous nephrolithotomy (PCNL) residual fragments (RFs) versus primary stones of the same size through a matched pair study. Methods Patients with a single 5-15 mm fragment 3 months after PCNL were enrolled (study group n = 59). The control group (n = 67) consisted of all adult patients with a single 5-15 mm renal stone. Results The success rate of SWL was significantly higher in the study group (81.4 vs. 59.7%; p = 0.008; OR: 2.95). With a cutoff point of Hounsfield units (HU) 750: the success rate was significantly lower in patients with a stone HU ≥ 750 (OR: 3.488). This HU cutoff value had no effect on the outcome of SWL in patients with post-PCNL RF (p = 0.14). On the other hand, the outcome of SWL was significantly more favorable in control group when HU < 750 (p = 0.02). Conclusion The success rate of SWL was 2.95-fold higher for post-PCNL RFs than in a stone burden-matched control group. The likelihood of stone clearance after SWL was 3.488-fold greater when HU was less than 750. This effect of HU was more prominent in patients receiving SWL for their primary stones while SWL was evenly effective on post PCNL RFs with different HUs.
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Affiliation(s)
- Alireza Aminsharifi
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Duke University Medical Center, Department of Surgery, Division of Urologic Surgery, Durham, NC, USA
| | - Dariush Irani
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Amirzargar
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
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Aminsharifi A, Brousell SC, Chang A, León J, Inman BA. Heat-targeted drug delivery: A promising approach for organsparing treatment of bladder cancer.THERMODOX®. ARCH ESP UROL 2018; 71:447-452. [PMID: 29745934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Disease recurrence and progression remain as significant challenges for the management of non-muscle invasive bladder cancer (NMIBC). In recent years, novel drugs and delivery systems have been investigated as strategies to reduce recurrence, progression and mortality. In this review, we focus on the role of intravesical hyperthermic chemotherapy and discuss a novel approach involving a heat-activated drug delivery system (ThermoDox®) that enables local accumulation of systemic chemotherapy.
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Affiliation(s)
- Alireza Aminsharifi
- División de Urología. Duke University Medical Center. Durham. NC. USA. Departamento de Urología. Shiraz University of Medical Sciences. Shiraz. Iran
| | - Steven C Brousell
- División de Urología. Duke University Medical Center. Durham. NC. USA
| | - Andrew Chang
- División de Urología. Duke University Medical Center. Durham. NC. USA
| | - Juan León
- Servicio de Urología. Comarcal Hospital of Monforte. Monforte. Lugo. España
| | - Brant A Inman
- División de Urología. Duke University Medical Center. Durham. NC. USA
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