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Shapiro K, Anger J, Cameron AP, Chung D, Daignault-Newton S, Ippolito GM, Lee U, Mourtzinos A, Padmanabhan P, Smith AL, Suskind AM, Tenggardjaja C, Van Til M, Brucker BM. Antibiotic use, best practice statement adherence, and UTI rate for intradetrusor onabotulinumtoxin-A injection for overactive bladder: A multi-institutional collaboration from the SUFU Research Network (SURN). Neurourol Urodyn 2024; 43:407-414. [PMID: 38032120 DOI: 10.1002/nau.25334] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/11/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Onabotulinumtoxin A (BTX-A) is a well-established treatment for overactive bladder (OAB). The American Urological Association (AUA) 2008 Antibiotic Best Practice Statement (BPS) recommended trimethoprim-sulfamethoxazole or fluoroquinolone for cystoscopy with manipulation. The aim of the study was to evaluate concordance with antibiotic best practices at the time of BTX-A injection and urinary tract infection (UTI) rates based on antibiotic regimen. METHODS Men and women undergoing first-time BTX-A injection for idiopathic OAB with 100 units in 2016, within the SUFU Research Network (SURN) multi-institutional retrospective database were included. Patients on suppressive antibiotics were excluded. The primary outcome was concordance of periprocedural antibiotic use with the AUA 2008 BPS antimicrobials of choice for "cystoscopy with manipulation." As a secondary outcome we compared the incidence of UTI among women within 30 days after BTX-A administration. Each outcome was further stratified by procedure setting (office vs. operating room; OR). RESULTS Of the cohort of 216 subjects (175 women, 41 men) undergoing BTX-A, 24 different periprocedural antibiotic regimens were utilized, and 98 (45%) underwent BTX-A injections in the OR setting while 118 (55%) underwent BTX-A injection in the office. Antibiotics were given to 86% of patients in the OR versus 77% in office, and 8.3% of subjects received BPS concordant antibiotics in the OR versus 82% in office. UTI rates did not vary significantly among the 141 subjects who received antibiotics and had 30-day follow-up (8% BPS-concordant vs. 16% BPS-discordant, CI -2.4% to 19%, p = 0.13). A sensitivity analysis of UTI rates based on procedure setting (office vs. OR) did not demonstrate any difference in UTI rates (p = 0.14). CONCLUSIONS This retrospective multi-institutional study demonstrates that antibiotic regimens and adherence to the 2008 AUA BPS were highly variable among providers with lower rates of BPS concordant antibiotic use in the OR setting. UTI rates at 30 days following BTX-A did not vary significantly based on concordance with the BPS or procedure setting.
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Affiliation(s)
- Katherine Shapiro
- Department of Urology, New York University, New York City, New York, USA
| | - Jennifer Anger
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Doreen Chung
- Department of Urology, Columbia University Medical Center, New York City, New York, USA
| | | | - Giulia M Ippolito
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Una Lee
- Virginia Mason Medical Center, Seattle, Washington, District of Columbia, USA
| | - Arthur Mourtzinos
- Department of Urology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Priya Padmanabhan
- Department of Urology, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Ariana L Smith
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anne M Suskind
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | | | - Monica Van Til
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Benjamin M Brucker
- Department of Urology, New York University, New York City, New York, USA
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Zheng Y, Major N, Silverii H, Rac G, Rolef J, Rittenberg L, Mourtzinos A, Moynihan M, Westney OL, Metro MJ, Herschorn S, Locke J, Neu S, Rames R, Cox L, Rovner E. Urinary retention after AdVance™ Sling: A multi-institutional retrospective study. Neurourol Urodyn 2020; 40:515-521. [PMID: 33348444 DOI: 10.1002/nau.24591] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/24/2020] [Accepted: 11/19/2020] [Indexed: 11/10/2022]
Abstract
AIMS To identify risk factors for urinary retention following AdVance™ Sling placement using preoperative urodynamic studies to evaluate bladder contractility. METHODS A multi-institutional retrospective review of patients who underwent an AdVance Sling for post-prostatectomy stress urinary incontinence from 2007 to 2019 was performed. Acute urinary retention (AUR) was defined as the complete inability to void or elevated post-void residual (PVR) leading to catheter placement or the initiation of intermittent catheterization at the first void trial postoperatively. Bladder contractility was evaluated based on preoperative urodynamics. RESULTS Of the 391 patients in this study, 55 (14.1%) experienced AUR, and 6 patients (1.5%) had chronic urinary retention with a median follow-up of 18.1 months. In total, 303 patients (77.5%) underwent preoperative urodynamics, and there was no significant difference between average PdetQmax (26.4 vs. 27.4 cmH2 O), Qmax (16.6 vs. 16.2 ml/s), PVR (19.9 vs. 28.1 ml), bladder contractility index (108 vs. 103) for patients with or without AUR following AdVance Sling. Impaired bladder contractility preoperatively was not predictive of AUR. Time to postoperative urethral catheter removal was predictive of AUR (odds ratio, 0.83; 95% confidence interval, 0.73-0.94; p = .003). CONCLUSIONS Chronic urinary retention after AdVance Sling placement is uncommon and acute retention is generally self-limiting. No demographic or urodynamic factors were predictive of AUR. Patients who developed AUR were more likely to have their void trials within 2 days following AdVance Sling placement versus longer initial catheterization periods, suggesting that a longer duration of postoperative catheterization may reduce the occurrence of AUR.
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Affiliation(s)
- Yu Zheng
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicholas Major
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Hailey Silverii
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Goran Rac
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jennifer Rolef
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lauren Rittenberg
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Arthur Mourtzinos
- Department of Urology, Lahey Health and Medical Center, Burlington, Massachusetts, USA
| | - Matthew Moynihan
- Department of Urology, Lahey Health and Medical Center, Burlington, Massachusetts, USA
| | - Ouida L Westney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael J Metro
- Department of Urology, Temple University, Philadelphia, Pennsylvania, USA
| | - Sender Herschorn
- Division of Urology, University of Toronto, Toronto, Ontario, USA
| | - Jennifer Locke
- Division of Urology, University of Toronto, Toronto, Ontario, USA
| | - Sarah Neu
- Division of Urology, University of Toronto, Toronto, Ontario, USA
| | - Ross Rames
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lindsey Cox
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Eric Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
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MacLachlan L, Mourtzinos A. Current Update on Management of Male Stress Urinary Incontinence. Curr Bladder Dysfunct Rep 2018. [DOI: 10.1007/s11884-018-0485-0] [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: 10/27/2022]
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Rolef J, Rac G, Rittenberg L, Cox L, Mourtzinos A, Moynihan M, Westney L, Metro M, Rovner E. PD39-10 URINARY RETENTION AFTER ADVANCE® SLING: A MULTI-INSTITUTIONAL RETROSPECTIVE STUDY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1922] [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: 11/29/2022]
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Stensland K, Vance J, Sluis B, Schober J, Mourtzinos A, Maclachlan L. MP85-17 FACTORS ASSOCIATED WITH DURABILITY OF THERAPEUTIC BOTULINUM TOXIN A INJECTION FOR OVERACTIVE BLADDER. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2679] [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: 10/19/2022]
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Stensland K, Sluis B, Vance J, Schober J, Maclachlan L, Mourtzinos A. MP85-18 GENDER DIFFERENCES IN THE SUCCESS OF SACRAL NERVE STIMULATION IN PATIENTS WITH OVERACTIVE BLADDER. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2680] [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: 10/19/2022]
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Affiliation(s)
- Arthur Mourtzinos
- Institute of Urology, Lahey Health and Medical Center, Department of Urology, Tufts Medical School, Burlington, Massachusetts
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Rac G, Younger A, Clemens JQ, Kobashi K, Khan A, Nitti V, Jacobs I, Lemack GE, Brown ET, Dmochowski R, MacLachlan L, Mourtzinos A, Ginsberg D, Koski M, Rames R, Rovner ES. Stress urinary incontinence surgery trends in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications. Neurourol Urodyn 2016. [PMID: 27460448 DOI: 10.1002/nau.23080.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS To investigate the possible effects of the Food and Drug Administration (FDA) Public Health Notifications in 2008 and 2011 regarding surgical trends in transvaginal mesh (TVM) placement for stress urinary incontinence (SUI) and related mesh revision surgery in Female Pelvic Medicine & Reconstructive Surgery (FPMRS) practice in tertiary care academic medical centers in the United States. METHODS Surgical volume for procedures performed primarily by FPMRS surgeons at eight academic institutions across the US was collected using Current Procedural Terminology (CPT) codes for stress urinary incontinence repair and revision surgeries from 2007 to 2013. SAS statistical software was used to assess for trends in the data. RESULTS There was a decrease in the use of synthetic mesh sling for the treatment of SUI at academic tertiary care centers over the past 7 years; however, this was not statistically significant. While the total number of surgical interventions for SUI remained stable, there was an increase in the utilization of autologous fascia pubovaginal slings (AFPVS). The number of mesh sling revision surgeries, including urethrolysis and removal or revision of slings, increased almost three-fold at these centers. CONCLUSIONS These observed trends suggest a possible effect of the FDA Public Health Notifications regarding TVM on surgical practice for SUI in academic centers, even though they did not specifically warn against the use of synthetic mesh for this indication. Indications for surgery, complications, and outcomes were not evaluated during this retrospective study. However, such data may provide alternative insights into reasons for the observed trends. Neurourol. Urodynam. 36:1155-1160, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Goran Rac
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Austin Younger
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - James Q Clemens
- Department of Urology, University of Michigan Health Science Center, Ann Arbor, Michigan
| | - Kathleen Kobashi
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
| | - Aqsa Khan
- Department of Urology, New York University Langone Medical Center, New York, New York
| | - Victor Nitti
- Department of Urology, New York University Langone Medical Center, New York, New York
| | - Ilana Jacobs
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gary E Lemack
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elizabeth T Brown
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lara MacLachlan
- Institute of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Arthur Mourtzinos
- Institute of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - David Ginsberg
- Institute of Urology, Keck Medicine of University of Southern California, Los Angeles, California
| | - Michelle Koski
- Urology of Kaiser Permanente Medical Center, San Diego, California
| | - Ross Rames
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
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Rac G, Younger A, Clemens JQ, Kobashi K, Khan A, Nitti V, Jacobs I, Lemack GE, Brown ET, Dmochowski R, MacLachlan L, Mourtzinos A, Ginsberg D, Koski M, Rames R, Rovner ES. Stress urinary incontinence surgery trends in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications. Neurourol Urodyn 2016; 36:1155-1160. [PMID: 27460448 DOI: 10.1002/nau.23080] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/05/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Goran Rac
- Department of Urology; Medical University of South Carolina; Charleston South Carolina
| | - Austin Younger
- Department of Urology; Medical University of South Carolina; Charleston South Carolina
| | - James Q. Clemens
- Department of Urology; University of Michigan Health Science Center; Ann Arbor Michigan
| | - Kathleen Kobashi
- Section of Urology and Renal Transplantation; Virginia Mason Medical Center; Seattle Washington
| | - Aqsa Khan
- Department of Urology; New York University Langone Medical Center; New York New York
| | - Victor Nitti
- Department of Urology; New York University Langone Medical Center; New York New York
| | - Ilana Jacobs
- Department of Urology; University of Texas Southwestern Medical Center; Dallas Texas
| | - Gary E. Lemack
- Department of Urology; University of Texas Southwestern Medical Center; Dallas Texas
| | - Elizabeth T. Brown
- Department of Urologic Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Roger Dmochowski
- Department of Urologic Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Lara MacLachlan
- Institute of Urology; Lahey Hospital and Medical Center; Burlington Massachusetts
| | - Arthur Mourtzinos
- Institute of Urology; Lahey Hospital and Medical Center; Burlington Massachusetts
| | - David Ginsberg
- Institute of Urology; Keck Medicine of University of Southern California; Los Angeles California
| | - Michelle Koski
- Urology of Kaiser Permanente Medical Center; San Diego California
| | - Ross Rames
- Department of Urology; Medical University of South Carolina; Charleston South Carolina
| | - Eric S. Rovner
- Department of Urology; Medical University of South Carolina; Charleston South Carolina
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Abstract
Benign prostatic hypertrophy (BPH) is a common cause of voiding dysfunction. BPH may lead to bladder outlet obstruction and resultant troublesome lower urinary tract symptoms. Initial management of BPH and bladder outlet obstruction is typically conservative. However, when symptoms are severe or refractory to medical therapy or when urinary retention, bladder stone formation, recurrent urinary tract infections, or upper urinary tract deterioration occur, surgical intervention is often necessary. Numerous options are available for surgical management of BPH ranging from simple office-based procedures to transurethral operative procedures and even open and robotic surgeries. This article reviews the current, most commonly used techniques available for surgical management of BPH.
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Affiliation(s)
- Jessica Mandeville
- Department of Urology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
| | - Arthur Mourtzinos
- Department of Urology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, USA
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Younger A, Rac G, Clemens JQ, Kobashi K, Khan A, Nitti V, Jacobs I, Lemack GE, Brown ET, Dmochowski R, Maclachlan L, Mourtzinos A, Ginsberg D, Koski M, Rames R, Rovner E. Pelvic Organ Prolapse Surgery in Academic Female Pelvic Medicine and Reconstructive Surgery Urology Practice in the Setting of the Food and Drug Administration Public Health Notifications. Urology 2016; 91:46-51. [DOI: 10.1016/j.urology.2015.12.057] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/28/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
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Nitti VW, Mourtzinos A, Brucker BM. Correlation of patient perception of pad use with objective degree of incontinence measured by pad test in men with post-prostatectomy incontinence: the SUFU Pad Test Study. J Urol 2014; 192:836-42. [PMID: 24650425 DOI: 10.1016/j.juro.2014.03.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Many investigators have used the number of pads to determine the severity of post-prostatectomy incontinence and yet the accuracy of this tool remains unproven. We determined whether the patient perception of pad use and urine loss reflects actual urine loss. We also identified a quality of life measure that distinguishes patients by severity of incontinence. MATERIALS AND METHODS We prospectively enrolled 235 men from a total of 18 sites 6 months or more after radical prostatectomy who had incontinence requiring protection. Patients completed a questionnaire on the perception of pad number, size and wetness, a quality of life question, several standardized incontinence questionnaires and a 24-hour pad test that assessed pad number, size and weight. SPSS® was used for statistical analysis. RESULTS Perception of the number of pads used closely agreed with the number of pads collected during a 24-hour pad test. Perceived and actual pad size had excellent concordance (76%, p <0.001). Patients with wet and soaked pads had statistically and clinically significantly different pad weights that were uniquely different from each other and from those of patients who were almost dry and slightly wet. Response to the quality of life question separated the men into 4 statistically significantly different groups based on mean 24-hour pad weight. CONCLUSIONS Patients accurately described the number, size and degree of wetness of pads collected during a 24-hour pad test. These values correlated well with actual urine loss. The single question, "To what extent does urine loss affect your quality of life?" separated men into distinct categories.
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Affiliation(s)
- Victor W Nitti
- New York University Langone Medical Center, New York, New York, and Tufts Medical School (AM), Boston, Massachusetts.
| | - Arthur Mourtzinos
- New York University Langone Medical Center, New York, New York, and Tufts Medical School (AM), Boston, Massachusetts
| | - Benjamin M Brucker
- New York University Langone Medical Center, New York, New York, and Tufts Medical School (AM), Boston, Massachusetts
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Kowalik C, DeLong J, Mourtzinos A. 1374 THE ADVANCE® TRANSOBTURATOR MALE SLING FOR POST-PROSTATECTOMY INCONTINENCE: OBJECTIVE AND SUBJECTIVE OUTCOMES WITH 3 YEARS FOLLOW-UP. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2728] [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: 10/27/2022]
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Nitti V, Brucker B, Mourtzinos A. 557 HOW WELL PATIENT PERCEPTION OF PAD USE CORRELATES WITH THE DEGREE OF INCONTINENCE IN POST PROSTATECTOMY INCONTINENCE: THE SUFU PAD TEST STUDY. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1953] [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: 10/27/2022]
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Abstract
Patients with spina bifida require longitudinal urological care as they transition from childhood to adolescence and then to adulthood. Issues important to urological health, such as protection of the upper tracts and prevention of incontinence, need vigilant follow-up throughout the patient's life. As the child ages, additional issues such as sexual functioning also become increasingly important for social integration. Despite this need for regular assessment, many adult patients with spina bifida lose coordinated urological care after leaving specialized pediatric spina bifida clinics. Consequently, urologists frequently encounter an adult patient with spina bifida in practice and they need to understand the basic urological treatment goals and potential complications for this population.
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Affiliation(s)
- Arthur Mourtzinos
- Department of Urology, Lahey Clinic, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, USA
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Abstract
The National Institute for Clinical Excellence recommends that cystometry need not be performed before conservative therapy for incontinence in women, nor is cystometry routinely recommended in the small group of women with a clearly defined diagnosis of pure stress incontinence. Nonetheless, it is frequently utilized in the assessment of women with stress urinary incontinence in the hope that results will shed light on preoperative risk factors for failure or postoperative voiding dysfunction. The ability of urodynamic studies to characterize these parameters reliably remains under investigation. Because urodynamic studies are invasive, costly, and not always available, it is imperative that its benefit be carefully explored. This review highlights the recent arguments for and against this recommendation.
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Affiliation(s)
- Arthur Mourtzinos
- Tufts School of Medicine, Institute of Urology, Continence Center, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
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Hanley RS, Stoffel JT, Zagha RM, Mourtzinos A, Bresette JF. Multimodal therapy for painful bladder syndrome / interstitial cystitis: pilot study combining behavioral, pharmacologic, and endoscopic therapies. Int Braz J Urol 2009; 35:467-74. [DOI: 10.1590/s1677-55382009000400011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2009] [Indexed: 11/21/2022] Open
Affiliation(s)
- Robert S. Hanley
- Anne Arundel Urology; Lahey Clinic Medical Center; Florida Medical Center, USA
| | - John T. Stoffel
- Anne Arundel Urology; Lahey Clinic Medical Center; Florida Medical Center, USA
| | - Ralph M. Zagha
- Anne Arundel Urology; Lahey Clinic Medical Center; Florida Medical Center, USA
| | - Arthur Mourtzinos
- Anne Arundel Urology; Lahey Clinic Medical Center; Florida Medical Center, USA
| | - John F. Bresette
- Anne Arundel Urology; Lahey Clinic Medical Center; Florida Medical Center, USA
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Mourtzinos A, Maher MG, Raz S, Rodríguez LV. Spiral Sling Salvage Anti-Incontinence Surgery for Women With Refractory Stress Urinary Incontinence: Surgical Outcome and Satisfaction Determined by Patient-Driven Questionnaires. Urology 2008; 72:1044-8; discussion 1048-50. [DOI: 10.1016/j.urology.2008.05.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 05/13/2008] [Accepted: 05/13/2008] [Indexed: 11/29/2022]
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Zabihi N, Mourtzinos A, Maher MG, Raz S, Rodríguez LV. The effects of bilateral caudal epidural S2-4 neuromodulation on female sexual function. Int Urogynecol J 2007; 19:697-700. [PMID: 18060341 DOI: 10.1007/s00192-007-0504-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 10/29/2007] [Indexed: 10/22/2022]
Abstract
This is a pilot study to evaluate the effects of caudal epidural S2-4 neuromodulation on female sexual function in a population of women with voiding dysfunction. We prospectively studied 36 consecutive female patients who underwent caudal epidural sacral neuromodulation. Patients received the Female Sexual Function Index (FSFI) questionnaire preoperatively and 6 months postoperatively. Six months after permanent implantation, the overall score on the FSFI improved by 52% (p = 0.05). Results were better in patients who underwent the treatment for voiding dysfunction compared to those who had pain as their primary complaint. In this group, the overall score improved by 157% (p = 0.004). Stimulation of S2-4 by bilateral caudal epidural neuromodulation in this small group of women with voiding dysfunction, retention, and/or pelvic pain resulted in self-reported improvements in sexual function. Further studies are needed to evaluate the potential role of S2-4 sacral stimulation in the treatment of female sexual dysfunction.
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Affiliation(s)
- Nasim Zabihi
- The Geffen School of Medicine at UCLA, 924 Westwood Blvd suite 520, Los Angeles, CA 90024, USA
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Zabihi N, Mourtzinos A, Maher MG, Raz S, Rodríguez LV. Short-term results of bilateral S2-S4 sacral neuromodulation for the treatment of refractory interstitial cystitis, painful bladder syndrome, and chronic pelvic pain. Int Urogynecol J 2007; 19:553-7. [PMID: 17925994 DOI: 10.1007/s00192-007-0466-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 09/05/2007] [Indexed: 12/26/2022]
Abstract
We evaluated the efficacy of bilateral caudal epidural sacral neuromodulation for the treatment of refractory chronic pelvic pain (CPP), painful bladder syndrome, and interstitial cystitis (IC). Thirty consecutive patients (21 female, 9 male) with severe refractory symptoms underwent bilateral S2-S4 sacral neuromodulation for CPP/IC. Patients were evaluated with the O'Leary IC symptom and problem index (ICSI, ICPI), the short form of the Urogenital Distress Inventory (UDI-6), and the RAND 36-item health survey (SF-36) preoperatively and 6 months postoperatively. The mean and minimum follow-up were 15 and 6 months, respectively. Of the 30 patients, 23 (77%) had a successful trial stimulation and were permanently implanted. Among these patients, the ICSI and ICPI scores improved by 35 (p = 0.005) and 38% (p = 0.007), respectively. The pain score improved by 40% (p = 0.04) and the UDI-6 score by 26% (p = 0.05). On average, patients reported a 42% improvement in their symptoms. SF-36 scores did not improve significantly. In refractory patients, bilateral caudal epidural sacral neuromodulation is another possible mode of treatment, which appears to improve both pelvic pain and voiding symptoms.
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Affiliation(s)
- Nasim Zabihi
- The Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA
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Maher MG, Mourtzinos A, Zabihi N, Laiwalla UZ, Raz S, Rodríguez LV. Bilateral Caudal Epidural Neuromodulation for Refractory Urinary Retention: A Salvage Procedure. J Urol 2007; 177:2237-40; discussion 2241. [PMID: 17509329 DOI: 10.1016/j.juro.2007.01.147] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE Sacral neuromodulation with InterStim is approved for idiopathic urinary retention with a success rate of approximately 69%. To our knowledge currently no alternatives exist for patients in whom S3 neuromodulation fails. We report a new technique and our experience with bilateral caudal epidural neuromodulation in patients in urinary retention in whom unilateral or bilateral S3 InterStim failed. MATERIALS AND METHODS Eight patients with multifactorial urinary retention in whom S3 InterStim previously failed underwent retrograde placement of bilateral tined leads into the caudal epidural space for sacral nerve stimulation. Patients with a 50% or greater clinical response underwent stage 2 Synergy-Versitrel implantable pulse generator placement. Patients were evaluated with voiding diaries, the Urinary Distress Inventory Questionnaire short form, quality of life assessment, need for catheterization and post-void residual urine preoperatively, and 6 months after implantation. RESULTS Five of the 8 patients experienced return of micturition and underwent placement of a permanent implantable pulse generator. At 6-month followup 4 of the 5 patients voided to completion. One patient improved more than 50% and now catheterizes once daily with a post-void residual urine of 200 cc. There was a significant decrease in obstructive symptoms on the Urinary Distress Inventory Questionnaire short form and improved overall quality of life. CONCLUSIONS To our knowledge this is the first report of the use of bilateral caudal epidural neuromodulation for refractory urinary retention. This therapy can be successful in patients in whom prior InterStim therapy failed.
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Zabihi N, Allee T, Maher MG, Mourtzinos A, Raz S, Payne CK, Rodríguez LV. Bladder necrosis following hydrodistention in patients with interstitial cystitis. J Urol 2007; 177:149-52; discussion 152. [PMID: 17162025 DOI: 10.1016/j.juro.2006.08.095] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Bladder hydrodistention is used to diagnose and treat patients with interstitial cystitis. This procedure has been shown to have minimal morbidity and provide symptomatic relief in a subset of patients with interstitial cystitis. We report our experience with almost total bladder necrosis after hydrodistention at 2 institutions. To our knowledge this rare complication has not been previously reported in the literature. We also reviewed the literature regarding complications of hydrodistention and discuss their possible etiology. MATERIALS AND METHODS We report 3 cases of bladder necrosis after therapeutic hydrodistention for interstitial cystitis at 2 institutions. All records were reviewed, and the clinical presentation, findings and treatments are discussed. A literature review was performed to evaluate the effectiveness and complications of hydrodistention for interstitial cystitis. RESULTS There were 2 female and 1 male patient between ages 29 and 46. All patients had a previous diagnosis of interstitial cystitis and had been previously treated with hydrodistention. All patients presented with severe abdominal pain and had necrosis of the entire bladder wall with sparing of the trigone. Two patients were treated with supratrigonal cystectomy. A review of the literature revealed little data on the effectiveness of hydrodistention for interstitial cystitis. CONCLUSIONS Vesical necrosis is a rare but devastating complication of hydrodistention. It can occur in young patients in the absence of a contracted bladder and it usually presents as severe postoperative abdominal pain. At exploration bladder necrosis with sparing of the trigone was observed. All patients required enterocystoplasty.
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Affiliation(s)
- Nasim Zabihi
- Geffen School of Medicine at University of California-Los Angeles, Los Angeles, USA
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Abstract
PURPOSE OF REVIEW Innumerable techniques have been described for vaginal vault prolapse and enterocele repair including abdominal (open, laparoscopic, and robotic) and vaginal techniques. Recently, the use of surgical mesh in pelvic floor surgery has become increasingly popular due to the high incidence of recurrence with primary repairs and no surrogate material. The increasing variety of available materials and techniques, combined with a lack of well conducted clinical trials, make the choice of repair to use difficult. RECENT FINDINGS This article provides an update review on the different procedures available to the urogynecologist and female urologist for repair of vault prolapse. We will also discuss a new surgical technique for the repair of vault prolapse, which recreates the sacrouterine-cardinal ligament complex and reconstructs the pelvic floor with mesh. SUMMARY The best approach to vaginal vault prolapse remains unknown. Surgeon comfort and preference as well as proper patient selection remain critical. The use of graft materials in pelvic floor reconstruction should have limited use in a carefully selected patient population. There is a need for well powered, controlled, long-term, randomized studies with patient generated quality-of-life questionnaires comparing the short and long-term outcomes of these techniques.
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Affiliation(s)
- Arthur Mourtzinos
- Lahey Clinic Medical Center, Institute of Urology, Burlington, MA 01805, USA.
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Wotkowicz C, Libertino JA, Sorcini A, Mourtzinos A. Management of renal cell carcinoma with vena cava and atrial thrombus: minimal access vs median sternotomy with circulatory arrest. BJU Int 2006; 98:289-97. [PMID: 16879667 DOI: 10.1111/j.1464-410x.2006.06272.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To review our experience with approaches for managing renal cell carcinoma (RCC) with venous thrombi extension at and above the level of the hepatic veins, comparing surgery and peri-operative outcomes in patients with cardiopulmonary bypass (CPB) with deep hypothermic cardiac arrest (DHCA) either by minimal access (MA) or traditional median sternotomy (TMS). PATIENTS AND METHODS From 1986 to 2005, 50 radical nephrectomies with inferior vena cava (IVC) thrombectomies were performed at our institution using TMS (22 patients) and MA (28) techniques. Patient demographics were compared using Student's t-, Fisher's exact and Pearson chi-square tests. The duration of surgery, CPB, DHCA, mechanical ventilation, length of stay, and peri-operative transfusion requirements, were compared using the Mann-Whitney U-test. Estimates of survival were constructed using Kaplan-Meier curves and analysed with the log-rank test. Subgroups were analysed excluding TMS patients undergoing concurrent coronary revascularization. RESULTS There were no significant differences in patient demographics or comorbidities between the MA and TMS group. There were significant decreases in the MA vs the TMS group (P < 0.05) in the duration of surgery, mechanical ventilation, length of stay and peri-operative transfusion requirements. When patients with coronary revascularization were excluded, the MA group had significant decreases (P < 0.05) in duration of surgery, hospital stay and transfusion requirements. Peri-operative mortality was not statistically different between the TMS (14%) and MA (4%) patients. Overall and organ system-specific complications also were not statistically different. The overall median survival in the TMS and MA groups was 0.62 and 2.84 years, respectively (P = 0.06, hazard ratio 2.02; 95% confidence interval, CI, 0.97-4.72). Patients with tumour thrombus extending into the right atrium had a median survival of 1.02 years, vs 2.84 years with no intracardiac extension (P = 0.15, hazard ratio 1.82, 95% CI 0.81-4.0). CONCLUSIONS MA surgical techniques in conjunction with DHCA for the treatment of RCC with extensive tumour thrombus provides quicker surgery and a shorter hospital stay. In addition there was less requirement for mechanical ventilation and transfusion than with TMS. Our findings suggest that MA techniques provide significant advantages over TMS.
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Affiliation(s)
- Arthur Mourtzinos
- Pelvic Reconstruction and Female Urology, Department of Urology, University of California, Los Angeles, Los Angeles, California
| | - Shlomo Raz
- Pelvic Reconstruction and Female Urology, Department of Urology, University of California, Los Angeles, Los Angeles, California
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Mourtzinos A, Maher MG, Zabihi N, Rodriguez LV, Raz S. 913: To Sling or not to Sling: Should Patients Undergoing a Grade IV Cystocele Repair Have a Prophylactic Anti-Incontinence Procedure. J Urol 2006. [DOI: 10.1016/s0022-5347(18)33149-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mourtzinos A, Maher MG, Raz S. Transobturator versus retropubic suburethral tapes for stress urinary incontinence. Nat Clin Pract Urol 2006; 3:62-3. [PMID: 16470186 DOI: 10.1038/ncpuro0402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Accepted: 12/14/2005] [Indexed: 05/06/2023]
Affiliation(s)
- Arthur Mourtzinos
- Department of Urology at the Geffen School of Medicine-UCLA, 90024, USA
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Ng L, Sorcini A, Mourtzinos A, Zinman LN. 62: Management of the Complex Rectourinary Fistula with Buccal Mucosal Patch Graft and Muscle Flap Support. J Urol 2004. [DOI: 10.1016/s0022-5347(18)37324-5] [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: 11/15/2022]
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Abstract
Bladder exstrophy is a complex anomaly involving the urinary, genital, and intestinal tracts and the musculoskeletal system. The diagnosis is made typically at the newborn examination or on fetal ultrasonography that is performed by an experienced observer. Management of bladder exstrophy presents several challenges, beginning with initial repair using the more conventional staged approach or the recently re-popularized complete primary repair technique. Major goals in the management of bladder exstrophy are preservation of normal kidney function, close observation for development of adequate bladder function including urinary continence, and provision of acceptable cosmesis and function of the external genitalia. This article provides a brief overview of bladder exstrophy and a detailed description of modern management.
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Affiliation(s)
- Arthur Mourtzinos
- Children's Hospital Boston, Department of Urology, 300 Longwood Avenue, Boston, MA 02115, USA
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Moinzadeh A, Mourtzinos A, Triaca V, Hamawy KJ. A randomized double-blind prospective study evaluating patient tolerance of transrectal ultrasound-guided biopsy of the prostate using prebiopsy rofecoxib. Urology 2003; 62:1054-7. [PMID: 14665354 DOI: 10.1016/s0090-4295(03)00788-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To assess the use of a prebiopsy outpatient analgesia using the nonsteroidal anti-inflammatory agent rofecoxib (Vioxx). Urologists perform approximately 500,000 transrectal ultrasound (TRUS)-guided biopsies of the prostate per year, commonly without analgesia. Recent reports, however, have determined that a significant proportion of patients undergoing TRUS-guided biopsies have pain. METHODS We performed a prospective randomized double-blind study of 56 men referred for TRUS biopsy of the prostate. They were randomly assigned to receive 50 mg of oral rofecoxib or placebo before TRUS biopsy. After the biopsies, the patients were asked to score the severity of pain by filling out a visual analog pain scale. At the end of 1 week, all patients were asked to mail in a questionnaire regarding the morbidity of the prostate biopsy, including dysuria, hematuria, urinary retention, postbiopsy fever, and rectal bleeding. Analysis was completed to assess whether rofecoxib decreased the patients' perception of pain. The postbiopsy morbidity of patients receiving placebo versus rofecoxib was compared. RESULTS Thirty-seven percent of patients receiving placebo and 42% of patients receiving rofecoxib had significant pain (5 or greater on the visual analog pain scale). The median pain score of patients receiving rofecoxib (4.0) versus placebo (4.0) was not significantly different statistically (P = 0.3139) using a Wilcoxon rank sum analysis. The incidence of postbiopsy morbidity was not different. CONCLUSIONS Our results confirm the findings of previous studies demonstrating that a significant proportion of patients undergoing prostate biopsies have pain. More importantly, we found that prebiopsy rofecoxib did not significantly decrease the patients' severity of discomfort. Finally, the morbidity after biopsy was not increased with the use of rofecoxib.
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Affiliation(s)
- Alireza Moinzadeh
- Department of Urology, Lahey Clinic, Burlington, Massachusetts 01805, USA
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Rieger-Christ KM, Mourtzinos A, Lee PJ, Zagha RM, Cain J, Silverman M, Libertino JA, Summerhayes IC. Identification of fibroblast growth factor receptor 3 mutations in urine sediment DNA samples complements cytology in bladder tumor detection. Cancer 2003; 98:737-44. [PMID: 12910517 DOI: 10.1002/cncr.11536] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Mutations in fibroblast growth factor 3 receptor (FGFR3) are frequent events in low-grade bladder tumors. To assess the potential utility of the detection of FGFR3 mutations in a screening modality, the authors analyzed urine sediment DNA samples from 192 patients in a retrospective study. METHODS Urine sediment DNA samples from 192 patients were prepared. Seventy-two patients had undergone transurethral resection (TURBT group) of mainly Ta lesions and 120 patients had undergone cystectomy (cystectomy group). The majority of patients in the cystectomy group had more advanced tumors compared with patients in the TURBT group. DNA preparations were screened for FGFR3 mutations in exons 7, 10, and 15 using single-strand conformation polymorphism (SSCP) and DNA sequencing. RESULTS Using SSCP, 67% of patients in the TURBT group and 28% in the cystectomy group displayed FGFR3 mutations. Comparative analysis of cytology results and FGFR3 mutational analysis were performed in 122 cases. Within the TURBT group, FGFR3 mutation analysis outperformed cytology. FGFR3 mutation analysis identified change in 68% of urine sediment DNA samples whereas cytology recorded the presence of tumor cells in 32% of the DNA samples. In the cystectomy group, cytology outperformed FGFR3 mutation analysis. Cytology recorded tumor detection in 90% of patients, while SSCP identified mutational change in 24%. CONCLUSIONS Combining FGFR3 mutation results with cytology in both groups correctly identified tumor presence in 105 of 122 (86%) of patients. The greater sensitivity of FGFR3 mutation detection over cytology in identifying the presence of low-grade, superficial bladder tumors represents a potential new tool to complement standard cytology in screening patients for bladder tumors and recurrent disease.
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Affiliation(s)
- Kimberly M Rieger-Christ
- Cell and Molecular Biology Laboratory, Robert E. Wise M. D. Research and Education Institute, Burlington, Massachusetts, USA
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