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Shenot PJ, Teplitsky S, Margules A, Miller A, Das AK. Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients. J Spinal Cord Med 2022; 45:614-621. [PMID: 33054669 PMCID: PMC9246097 DOI: 10.1080/10790268.2020.1829420] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Context: Spinal cord injury (SCI) patients with neurogenic bladder and the inability to self-catheterize may require incontinent diversion to provide low-pressure drainage while avoiding the use of indwelling catheters. We demonstrate that in patients with significant functional improvement, the ileovesicostomy can be a reversible form of diversion, with simultaneous bladder augmentation using the same segment of ileum utilized for the ileovesicostomy. Multidisciplinary management should be utilized to assure mastery of intermittent catheterization before urinary undiversion. This technique allows for transition to a regimen of intermittent self-catheterization with excellent functional and urodynamic outcomes.Design: Case Series.Setting: Tertiary care hospital, Philadelphia, Pennsylvania.Participants: Three individuals with an SCI.Interventions: Conversion of bladder management from an incontinent ileovesicostomy to an augmentation ileocystoplasty, with intermittent catheterization.Outcome Measures: Ability to regain urinary continence with preservation of renal function as determined by serum creatinine and renal ultrasound.Results: Three SCI patients who had an incontinent ileovesicostomy developed sufficient functional improvement to intermittently self-catheterize reliably and underwent conversion of ileovesicostomy to ileocystoplasty. For each, the ileovesicostomy channel was taken down and detubularized, then used to create an ileal patch for augmentation ileocystoplasty. Intermittent catheterization was then used for periodic bladder drainage. All achieved large capacity, low-pressure bladders with complete continence and stable creatinine.Conclusion: In motivated SCI patients, it is possible to regain continence by converting the ileovesicostomy into augmentation ileocystoplasty, avoiding the disadvantages of a urostomy. A multidisciplinary collaborative approach facilitates the optimal rehabilitation of SCI individuals.
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Affiliation(s)
- Patrick J. Shenot
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA,Correspondence to: Patrick J. Shenot, Department of Urology, Thomas Jefferson University, 1025 Walnut St, Ste 1112, Philadelphia, PA19107, USA.
| | - Seth Teplitsky
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew Margules
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aaron Miller
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Akhil K. Das
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Zheng Y, Major N, Silverii H, Lim C, Margules A, Gracely A, Rames R, Cox L, Rovner E. Is it the Surgeon? A Re-examination of Mid-urethral Sling Complications. Urology 2021; 157:269-273. [PMID: 34375650 DOI: 10.1016/j.urology.2021.07.024] [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] [Received: 05/11/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify potential technical factors during initial mid-urethral sling (MUS) placement that contribute to subsequent sling revision procedures. METHODS A retrospective chart review was performed examining synthetic MUS reoperations at a single institution from 2008-2020. The implanting surgeon's operative note, when available, was critically reviewed with respect to trocar placement, sling location, and tensioning technique. The reoperative report was reviewed for aberrant intraoperative findings relating to the index surgery. RESULTS A total of 306 women underwent revision of their MUS. Operative reports from the implanting surgeon were available for 276 (90.2%) women. Review of index operative reports revealed 47 unambiguous descriptions of improper technique, including 19 cases of described excessive tensioning and 2 cases of MUS placement despite noted urethral injury during the index case. Indications for reoperation were clinical obstruction (63%), pain (40%), and mesh erosion/exposure (33%). In 186 (67.4%) women, there was an intraoperative finding during the revision that likely contributed to the need for reoperation. Among these 186 women, 110 (59.1%) slings were noted to have been placed too proximally, 78 (41.9%) were over-suspended, and 57 (30.6%) were placed too deep in the periurethral fascia. CONCLUSION Review of the index operative note and findings at operative re-exploration of MUS surgeries, often reveals evidence that the initial MUS implantation was technically suboptimal. Such findings suggest that intraoperative surgical technique is a critically important factor contributing to postoperative complications in MUS surgery. This underscores the importance of surgical training and adherence to surgical principles during the placement of a synthetic MUS.
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Affiliation(s)
- Yu Zheng
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Nicholas Major
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Hailey Silverii
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Caitlin Lim
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Andrew Margules
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Alyssa Gracely
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Ross Rames
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Lindsey Cox
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Eric Rovner
- Department of Urology, Medical University of South Carolina, Charleston, SC.
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Murphy A, Teplitsky S, Das AK, Leong JY, Margules A, Lallas CD. Medical evaluation and management of male and female voiding dysfunction: a review. Rom J Intern Med 2019; 57:220-232. [PMID: 30990789 DOI: 10.2478/rjim-2019-0009] [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] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Indexed: 06/09/2023]
Abstract
A significant workforce shortage of urologists available to serve the US population has been projected to occur over the next decade. Accordingly, much of the management of urologic patients will need to be assumed by other specialties and practitioners. Since primary care physicians are often first evaluate common urologic complaints, it makes sense that these physicians are in an excellent position to intervene in the management of these patients when appropriate. One of the most common complaints in urology is voiding dysfunction. The incidence of voiding dysfunction increases with age, with conservative estimates showing that over 50% of elderly patients suffer. Despite this high prevalence and its negative impact on quality of life, however, few seek or receive treatment, as many do not readily disclose these impactful yet personal symptoms. We sought to summarize the typical presentation, evaluation, assessment and therapeutic options for both male and female patients presenting with voiding dysfunction.
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MESH Headings
- Cystitis, Interstitial/diagnosis
- Cystitis, Interstitial/etiology
- Cystitis, Interstitial/therapy
- Female
- Humans
- Male
- Prostatism/diagnosis
- Prostatism/etiology
- Prostatism/therapy
- Urinary Bladder, Overactive/diagnosis
- Urinary Bladder, Overactive/etiology
- Urinary Bladder, Overactive/therapy
- Urinary Bladder, Underactive/diagnosis
- Urinary Bladder, Underactive/etiology
- Urinary Bladder, Underactive/therapy
- Urinary Incontinence, Stress/diagnosis
- Urinary Incontinence, Stress/etiology
- Urinary Incontinence, Stress/therapy
- Urination Disorders/diagnosis
- Urination Disorders/etiology
- Urination Disorders/therapy
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Affiliation(s)
- Alana Murphy
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Seth Teplitsky
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Akhil K Das
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Andrew Margules
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Costas D Lallas
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Margules A, Lee L, Smith W, Shah M, Murphy A, Das A, Shenot P. PD04-11 LONG TERM URODYNAMIC RESULTS FOLLOWING EXTERNAL SPHINCTEROTOMY IN SPINAL CORD INJURY PATIENTS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.289] [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: 11/28/2022]
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Abstract
BACKGROUND The overall rate of complications after ankle fracture fixation varies between 5% and 40% depending on the population investigated, and wound complications have been reported to occur in 1.4% to 18.8% of patients. Large studies have focused on complications in terms of readmission, but few studies have examined risk factors for wound-related issues in the outpatient setting in a large number of patients. A review was performed to identify risk factors for wound complications tracked in the hospital and outpatient setting. METHODS Four hundred and seventy-eight patients underwent open reduction and internal fixation of an ankle fracture between 2003 and 2010 by a single surgeon at a single institution. Demographic characteristics, time to surgery, comorbidities, and postoperative care were tracked. Wound complications were defined as those requiring dressing care and oral antibiotics or requiring further surgical treatment. RESULTS Of the 478 patients who were followed, six (1.25%) had wounds requiring surgical debridement. Fourteen patients (2.9%) required further dressing care or a course of oral antibiotics. There were significant associations between wound complications and a history of diabetes (p < 0.001), peripheral neuropathy (p = 0.003), wound-compromising medications (p = 0.011), open fractures (p = 0.05), and postoperative noncompliance (p = 0.027). There was a significant difference in age between patients with and without wound complications (p = 0.045). We did not identify a relationship between time to surgery and complications. CONCLUSIONS These results highlight the difficulty of treating medically complex and noncompliant patient populations. With careful preoperative monitoring of swelling, time to surgery does not affect wound outcome. The failure of the patient to adhere to postoperative instructions should be a concern to the treating surgeon.
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Affiliation(s)
- Adam G Miller
- Department of Orthopedics, Thomas Jefferson University Hospital, Curtis Building #801, 1015 Walnut Street, Philadelphia, PA 19107, USA
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Healy KA, Margules A, Kundavaram C, Hubosky SG, Lallas CD. Laparoscopic pelvic nephrectomy: essential preoperative and intraoperative considerations. Can J Urol 2012; 19:6299-6302. [PMID: 22704319] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pelvic kidneys are typically asymptomatic, but surgical intervention may be required in select cases. Laparoscopic pelvic nephrectomy is a feasible option. Given the highly variable vascular anatomy, careful surgical planning and meticulous technique are necessary. We present our experience with this minimally invasive approach. A 46-year-old male with a painful, non-functioning left pelvic kidney initially underwent left ureteral stent placement. He was noncompliant and lost to follow up. He re-presented and elected for laparoscopic pelvic nephrectomy. The procedure was performed without complications. Key features included detailed preoperative vascular imaging, ureteral catheterization, optimal port placement, and dissection from a cephalad to caudal direction. Laparoscopic nephrectomy is a safe and efficacious treatment for diseased pelvic kidneys.
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Affiliation(s)
- Kelly A Healy
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Kelly D, Margules A, Kundavaram C, Narins H, Gomella L, Shenot P, Trabulsi E, Lallas C. 854 THE
DA VINCI
SKILLS SIMULATOR: A VALIDATION STUDY. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.947] [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: 10/28/2022]
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Steward NA, Bauer TL, Margules A, Cephas A. Assessing the impact of smoke-related illness on smoking cessation efforts. Del Med J 2007; 79:151-6. [PMID: 17477015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Klevens RM, Cashman SB, Margules A, Fulmer HS. Special contribution: transforming a neighborhood health center into a community-oriented primary care practice. Am J Prev Med 1992; 8:62-5. [PMID: 1576003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe a community-oriented primary care (COPC) preventive medicine residency. Through the residency, medical, nursing, dental, and other health professionals work as fellows to combine clinical and public health skills in primary care practices. We describe the steps that fellows used to begin transforming one community health center into a COPC practice, and we highlight the activities of one specific environmental cleanliness project as an example. COPC activities have laid the foundation for further advances in developing a professional partnership between the center and the community it serves.
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Affiliation(s)
- R M Klevens
- Community-Oriented Primary Care Program, Carney Hospital, Boston, MA 02124
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Anthony WA, Margules A, Collingwood TR. Rehabilitation counseling: a decisive approach. J Rehabil 1974; 40:18-20. [PMID: 4449108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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