1
|
Hinojosa-Gonzalez DE, Roblesgil-Medrano A, Torres-Martinez M, Alanis-Garza C, Estrada-Mendizabal RJ, Gonzalez-Bonilla EA, Flores-Villalba E, Olvera-Posada D. Single-port versus multiport robotic-assisted radical prostatectomy: A systematic review and meta-analysis on the da Vinci SP platform. Prostate 2022; 82:405-414. [PMID: 34985775 DOI: 10.1002/pros.24296] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/14/2021] [Accepted: 12/20/2021] [Indexed: 12/29/2022]
Abstract
CONTEXT Prostate cancer is the most common cancer in men; robotic prostatectomy has cemented itself as part of the standard of care. Since its approval by the Food and Drug Administration in 2018, the SP console's application has been increasingly studied and compared with the multiport (MP) robotic approach. METHODS Following PRISMA guidelines and PROSPERO registration CRD42021228744, a systematic review was performed in April 2021 on single-port robotic-assisted radical prostatectomies (SP-RARPs) compared to MP. Outcomes of interest were operative time, bleeding, complications, analgesic use, and postoperative continence, and erectile function. Data were analyzed with Review Manager 5.3. RESULTS Seven studies were included, of which six studies met the inclusion criteria for quantitative synthesis, totalling 1068 patients, out of which 324 underwent SP-RARP and 744 underwent MP-RARP. No differences were found in baseline characteristics such as age, body mass index, prostatic-specific antigen, or stage. No differences in blood loss-15.77 mL [-42.44, 10.89], p = 0.25, operative time 3.93 min [-4.12, 11.98], p = 0.34, or positive surgical margins, with an odds ratio (OR) of 0.78 [0.55, 1.10], p = 0.15-were found. Length of stay was significantly shorter in SP -0.94 days [-1.56, -0.33], p = 0.003, with no differences in complication rates, with an OR of 1.29 [0.78, 2.14], p = 0.32, continence rates, with an OR of 1.29 [0.90, 1.83], p = 0.16, erectile function, with an OR of 0.86 [0.52, 1.40], p = 0.54, or biochemical recurrence. Qualitative evidence suggests decreased opioid consumption. CONCLUSION SP-RARPs are feasible alternatives to the traditional MP with possible benefits in pain management and length of stay. Future high-quality studies are needed to confirm these findings.
Collapse
Affiliation(s)
| | | | | | - Cordelia Alanis-Garza
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L., México
| | | | | | - Eduardo Flores-Villalba
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L., México
| | - Daniel Olvera-Posada
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L., México
| |
Collapse
|
2
|
Hinojosa-Gonzalez DE, Flores-Villalba E, Eisner BH, Olvera-Posada D. Tranexamic acid vs placebo and its impact in bleeding, transfusions and stone-free rates in percutaneous nephrolithotomy: a systematic review and meta-analysis. Cent European J Urol 2022; 75:81-89. [PMID: 35591967 PMCID: PMC9074054 DOI: 10.5173/ceju.2022.0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Percutaneous nephrolithotomy (PCNL) is the standard of care for the treatment of large renal stones. Bleeding-related complications remain a major concern when performing this procedure. Tranexamic acid (TXA) has recently been studied in both urologic and non-urologic procedures to reduce bleeding, transfusions and complications. Material and methods In June 2021 a systematic review was conducted following PRISMA guidelines on randomized prospective studies comparing the effects of TXA on bleeding complications during PCNL. Data was analyzed using Review Manager 5.3. Results Eight studies were included with a total 1,201 patients, of which 598 received TXA and 603 received placebo. TXA was associated with less bleeding (decreased change in hemoglobin) -0.79 Hb g/dl [-1.09, -0.65] p <.00001 and decreased transfusion rates (OR 0.31 [0.18, 0.52] p <0.0001). This was also associated with lower complication rates, both minor, major and overall, OR 0.59[0.41, .85] p = 0.005, OR 0.31 [0.17, 0.56] p = 0.0001 and OR 0.40 [0.29, 0.56] p <0.00001 respectively. TXA was also associated with improved stone-free rates as compared with placebo (OR 1.79 [1.23, 2.62] p = 0.003). TXA resulted in shorter operative times (11.51 minutes [-16.25, -6.77] p =.001) and length of stay (-0.74 days [-1.13 -0.34] p = 0.0006). Two pulmonary embolisms were registered in a single study in the TXA group. Conclusions In this meta-analysis, the use of TXA during PCNL was associated with a statistically significant reduction in the following parameters when compared with placebo: change in hemoglobin, transfusion rates, complication rates, operative time, and length of stay. It was also associated with improvement in stone-free rates. These data should be considered by surgeons performing PCNL.
Collapse
Affiliation(s)
- David Eugenio Hinojosa-Gonzalez
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Tecnologico de Monterrey, School of Medicine and Health Sciences, NL, Mexico
| | | | - Brian H. Eisner
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | |
Collapse
|
3
|
Hinojosa-Gonzalez DE, Roblesgil-Medrano A, Gonzalez-Bonilla EA, Flores-Villalba E, Olvera-Posada D. Comment on Perioperative and Oncologic Outcomes of Single-Port vs Multiport Robot-Assisted Radical Prostatectomy: A Meta-Analysis. J Endourol 2021; 36:421-422. [PMID: 34779229 DOI: 10.1089/end.2021.0772] [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)
| | | | | | | | - Daniel Olvera-Posada
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, México
| |
Collapse
|
4
|
Basulto-Martínez M, Olvera-Posada D, Velueta-Martínez IA, Méndez-Probst C, Flores-Tapia JP, Penniston K, Guerrero-Putz MD, Heinze A. Quality of life in patients with kidney stones: translation and validation of the Spanish Wisconsin Stone Quality of Life Questionnaire. Urolithiasis 2020; 48:419-424. [DOI: 10.1007/s00240-020-01192-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/24/2020] [Indexed: 11/24/2022]
|
5
|
Aquil S, Olvera-Posada D, Navaratnam R, Mikhail D, Levine MA, Luke PP, Sener A. Comparative Study Assessing Postoperative Renal Loss Using Two Different Partial Nephrectomy Techniques: Off-Clamp versus Standard On-Clamp Surgery. Curr Urol 2020; 14:38-43. [DOI: 10.1159/000499262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/26/2019] [Indexed: 11/19/2022] Open
|
6
|
Olvera-Posada D, Welk B, McClure JA, Winick-Ng J, Izawa JI, Pautler SE. A Population-Based Cohort Study of the Impact of Infectious Complications Requiring Hospitalization after Prostate Biopsy on Radical Prostatectomy Surgical Outcomes. Urology 2018; 121:139-146. [PMID: 30171923 DOI: 10.1016/j.urology.2018.07.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare radical prostatectomy outcomes in men with and without exposure to a major infectious event within 30-days of a prior TRUS-biopsy. MATERIALS AND METHODS This retrospective cohort study included men who underwent radical prostatectomy from 2002 to 2013 in Ontario, Canada. Several linked administrative databases were used. Exposure was defined as hospitalization with evidence of a urinary tract infection or sepsis during the first 30-days after a prostate biopsy. The primary outcome was a composite of procedures indicative of a likely serious complication of radical prostectomy within the first 12 months after surgery. Secondary outcomes included oncological, functional, and hospital related events within 2 years of radical prostatectomy. RESULTS A total of 26,254 patients were included in this study and 530 (2.02%) had a post-TRUS-biopsy infection. A similar proportion of patients with and without a post-TRUS-biopsy infectious event experienced the composite primary outcome (1.7% vs 1.1%; odds ratio [OR] 1.61, 95% confidence interval [CI] 0.82-3.14; P = .16). However, exposed patients had significantly higher odds of perioperative blood transfusion (OR 1.61, 95% CI 1.30-2.00; P <.001), bladder neck contracture (OR 1.35, 95% CI 1.12-1.63; P = .002), and 30-day hospital readmission (OR 2.08, 95% CI 1.47-2.95; P <.001), and a small but significant increase in length of hospital stay (P = 0.005). No other significant differences were observed. CONCLUSION Although prior infectious events are associated with increased risk of blood transfusion, bladder neck contracture, and hospital readmission following radical prostatectomy, results from this study suggest that major surgical complications, are not adversely affected by TRUS-biopsy related infections.
Collapse
Affiliation(s)
- Daniel Olvera-Posada
- Division of Urology, Department of Surgery, The University of Western Ontario, London, Canada
| | - Blayne Welk
- Division of Urology, Department of Surgery, The University of Western Ontario, London, Canada; Institute for Clinical Evaluative Sciences, London, Canada; Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Canada
| | | | | | - Jonathan I Izawa
- Division of Urology, Department of Surgery, The University of Western Ontario, London, Canada; Division of Surgical Oncology, Department of Oncology, The University of Western Ontario, London, Canada
| | - Stephen E Pautler
- Division of Urology, Department of Surgery, The University of Western Ontario, London, Canada; Division of Surgical Oncology, Department of Oncology, The University of Western Ontario, London, Canada.
| |
Collapse
|
7
|
Olvera-Posada D, Lin S, Aboalsamh G, Haig A, Lobb I, Grewal J, Saha MN, Sener A. A novel approach to off-clamp partial nephrectomy demonstrates significant improvements in renal injury in an experimental porcine model. Can Urol Assoc J 2018; 11:E390-E395. [PMID: 29384471 DOI: 10.5489/cuaj.4305] [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: 11/19/2022]
Abstract
INTRODUCTION We sought to design a partial nephrectomy (PN) with contralateral total nephrectomy porcine model and assess the underlying mechanisms of ischemia reperfusion injury (IRI) after PN using a novel, clinically approved resection device. METHODS Domestic male pigs (n=9) underwent left lower pole PN, allocated to either standard (Group 1) or no ischemia PN (Group 2), followed by contralateral nephrectomy. Biochemical studies were performed at baseline, Day 2, and Day 7; after sacrifice, kidneys were processed for histological analysis. Apoptotic markers were measured by Western blot analyses. Urinary biomarkers were measured to assess acute kidney injury. RESULTS At Day 2 following PN, there was a significant rise in serum creatinine in Group 1 compared to Group 2 (355 vs. 136 mmol/L; p=0.008). Intra-renal tissue oxygen saturation after PN was inversely correlated with postoperative creatinine (rs -0.75; p=0.012) and the grade of acute tubular necrosis (rs -0.70; p=0.036). We observed a rise in expression of pro-apoptotic markers and pro-inflammatory markers in Group 1 following PN compared to Group 2. Histological analysis revealed higher grade of apoptosis in Group 1. CONCLUSIONS IRI associated with standard PN has a deleterious impact on acute renal function, markers of tissue injury, and histological parameters, compared to off-clamp PN using the ALTRUS device. We identified several intraoperative and postoperative markers that may be used as predictors for functional and histological injury following PN.
Collapse
Affiliation(s)
- Daniel Olvera-Posada
- Departments of Surgery, Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico
| | - Shouzhe Lin
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON, Canada
| | - Ghaleb Aboalsamh
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON, Canada
| | - Aaron Haig
- Department of Pathology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ian Lobb
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON, Canada
| | - Jaskirandeep Grewal
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON, Canada
| | - Manujendra N Saha
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON, Canada
| | - Alp Sener
- Departments of Surgery, Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON, Canada
| |
Collapse
|
8
|
Olvera-Posada D, Welk B, Pautler S. Author Reply. Urology 2017; 106:131-132. [DOI: 10.1016/j.urology.2017.03.051] [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: 10/19/2022]
|
9
|
Olvera-Posada D, Welk B, McClure JA, Winick-Ng J, Izawa JI, Pautler SE. The Impact of Multiple Prostate Biopsies on Risk for Major Complications Following Radical Prostatectomy: A Population-based Cohort Study. Urology 2017; 106:125-132. [DOI: 10.1016/j.urology.2017.03.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/23/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
|
10
|
Olvera-Posada D, Dayarathna T, Dion M, Alenezi H, Sener A, Denstedt JD, Pautler SE, Razvi H. KIM-1 Is a Potential Urinary Biomarker of Obstruction: Results from a Prospective Cohort Study. J Endourol 2016; 31:111-118. [PMID: 27852120 DOI: 10.1089/end.2016.0215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 12/13/2022] Open
Abstract
INTRODUCTION Partial or complete obstruction of the urinary tract is a common and challenging urological condition that may occur in patients of any age. Serum creatinine is the most commonly used method to evaluate global renal function, although it has low sensitivity for early changes in the glomerular filtration rate or unilateral renal pathology. Hence, finding another measurable parameter that reflects the adaptation of the renal physiology to these circumstances is important. Several recent studies have assessed the use of new biomarkers of acute kidney injury (AKI), but the information among patients with stone disease and those with obstructive uropathy is limited. MATERIAL AND METHODS A prospective cohort study was conducted to determine the urinary levels of kidney injury molecule-1 (KIM-1), Total and Monomeric neutrophil gelatinase-associated lipocalin (NGAL) in patients with hydronephrosis secondary to renal stone disease, congenital ureteropelvic junction obstruction or ureteral stricture. Comparison between patients with hydronephrosis and no hydronephrosis was carried out along with correlation analysis to detect factors associated with biomarker expression. RESULTS Urinary levels of KIM-1 significantly decreased after hydronephrosis treatment in patients with unilateral obstruction (1.19 ng/mL vs 0.76 ng/mL creatinine, p = 0.002), additionally KIM-1 was significantly higher in patients with hydronephrosis compared to stone disease patients without radiological evidence of obstruction (1.19 vs 0.64, p = 0.006). Total and Monomeric NGAL showed a moderate correlation with the presence of leukocyturia. We found that a KIM-1 value of 0.735 ng/mg creatinine had a sensitivity of 75% and specificity of 67% to predict the presence of hydronephrosis in preoperative studies (95% CI 0.58-0.87, p = 0.006). CONCLUSION Our results show that KIM-1 is a promising biomarker of subclinical AKI associated with hydronephrosis in urological patients. NGAL values were influenced by the presence of leukocyturia, limiting its usefulness in this population.
Collapse
Affiliation(s)
- Daniel Olvera-Posada
- 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada .,2 TEC Salud, Escuela Nacional de Medicina, Instituto de Cirugia, Monterrey, México
| | - Thamara Dayarathna
- 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada
| | - Marie Dion
- 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada
| | - Husain Alenezi
- 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada
| | - Alp Sener
- 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada
| | - John D Denstedt
- 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada
| | - Stephen E Pautler
- 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada
| | - Hassan Razvi
- 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Canada
| |
Collapse
|
11
|
Olvera-Posada D, Welk B, McClure JA, Winick-Ng J, Izawa J, Pautler SE. The impact of multiple prostate biopsies on radical prostatectomy outcomes: A population-based analysis. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e16554] [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: 11/20/2022] Open
Affiliation(s)
- Daniel Olvera-Posada
- St. Joseph Health Care London, University of Western Ontario, London, ON, Canada
| | - Blayne Welk
- St. Joseph Health Care London, University of Western Ontario, London, ON, Canada
| | | | | | - Jonathan Izawa
- London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Stephen E. Pautler
- St. Joseph Health Care London, University of Western Ontario, London, ON, Canada
| |
Collapse
|
12
|
Olvera-Posada D, Naushad Ali S, Alenezi H, Dion M, Denstedt JD, Razvi H. PD18-01 NATURAL HISTORY OF RESIDUAL FRAGMENTS AFTER PERCUTANEOUS NEPHROLITHOTOMY (PCNL). J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1180] [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: 11/30/2022]
|
13
|
|
14
|
Olvera-Posada D, Welk B, McClure JA, Winick-Ng J, Izawa JI, Pautler SE. MP57-12 THE IMPACT OF INFECTIOUS COMPLICATIONS AFTER PROSTATE BIOPSY ON RADICAL PROSTATECTOMY SURGICAL OUTCOMES: A POPULATION-BASED ANALYSIS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.666] [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: 10/22/2022]
|
15
|
Tailly TO, Okhunov Z, Nadeau BR, Huynh MJ, Labadie K, Akhavein A, Violette PD, Olvera-Posada D, Alenezi H, Amann J, Bird VG, Landman J, Smith AD, Denstedt JD, Razvi H. Multicenter External Validation and Comparison of Stone Scoring Systems in Predicting Outcomes After Percutaneous Nephrolithotomy. J Endourol 2016; 30:594-601. [PMID: 26728427 DOI: 10.1089/end.2015.0700] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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
BACKGROUND AND PURPOSE Several scoring systems have recently emerged to predict stone-free rate (SFR) and complications after percutaneous nephrolithotomy (PCNL). We aimed to compare the most commonly used scoring systems (Guy's stone score, S.T.O.N.E. nephrolithometry, and CROES nomogram), assess their predictive accuracy for SFR and other postoperative variables, and develop a risk group stratification based on these scoring systems. MATERIALS AND METHODS We performed a retrospective review of patients who have had a PCNL at four academic institutions between 2006 and 2013. Primary outcome was SFR within 3 weeks of the surgery and secondary outcomes were operative time (OT), complications, and length of stay (LOS). We performed chi-squared, t-test, logistic, linear, and Poisson regressions, as well as receiver operating characteristics curve with area under the curve (AUC) calculation. RESULTS We identified 586 patients eligible for analysis. Of these, 67.4% were stone free. Guy's, S.T.O.N.E., and CROES score were predictive of SFR on multivariable logistic regression (odds ratio [OR]: 1.398, 95% confidence interval [CI]: 1.056, 1.852, p = 0.019; OR: 1.417, 85% CI: 1.231, 1.631, p < 0.001; OR: 0.993, 95% CI: 0.988, 0.998, p = 0.004) and have similar predictive accuracy with AUCs of 0.629, 0.671, and 0.646, respectively. On multivariable linear regression, only S.T.O.N.E. was an independent predictor of longer OT (β = 14.556, 95% CI: 12.453, 16.660, p < 0.001). None of the scores were independent predictors of postoperative complications or a longer LOS. Poisson regression allowed for risk group stratification and showed the S.T.O.N.E. score and CROES nomogram to have the most distinct risk groups. CONCLUSIONS The three evaluated scoring systems have similar predictive accuracy of SFR. S.T.O.N.E. has additional value in predicting OT. Risk group stratification can be used for patient counseling. Further research is needed to identify whether or not any is superior to the others with regard to clinical usefulness and predictive accuracy.
Collapse
Affiliation(s)
- Thomas O Tailly
- 1 Division of Urology, Department of Surgery, Western University , London, Ontario, Canada .,2 Department of Urology, Ghent University Hospital , Ghent, Belgium
| | - Zhamshid Okhunov
- 3 Department of Urology, University of California , Irvine, California
| | - Brandon R Nadeau
- 4 Department of Radiology, Western University , London, Ontario, Canada
| | - Melissa Jessica Huynh
- 1 Division of Urology, Department of Surgery, Western University , London, Ontario, Canada
| | - Kevin Labadie
- 3 Department of Urology, University of California , Irvine, California
| | - Arash Akhavein
- 5 Department of Urology, University of Florida , Gainesville, Florida
| | - Philippe D Violette
- 1 Division of Urology, Department of Surgery, Western University , London, Ontario, Canada
| | - Daniel Olvera-Posada
- 1 Division of Urology, Department of Surgery, Western University , London, Ontario, Canada
| | - Husain Alenezi
- 1 Division of Urology, Department of Surgery, Western University , London, Ontario, Canada
| | - Justin Amann
- 4 Department of Radiology, Western University , London, Ontario, Canada
| | - Vincent G Bird
- 5 Department of Urology, University of Florida , Gainesville, Florida
| | - Jaime Landman
- 3 Department of Urology, University of California , Irvine, California
| | - Arthur D Smith
- 6 The Smith Institute for Urology, North Shore LIJ Health System , New Hyde Park, New York
| | - John D Denstedt
- 1 Division of Urology, Department of Surgery, Western University , London, Ontario, Canada
| | - Hassan Razvi
- 1 Division of Urology, Department of Surgery, Western University , London, Ontario, Canada
| |
Collapse
|
16
|
Tailly T, Larish Y, Nadeau B, Violette P, Glickman L, Olvera-Posada D, Alenezi H, Amann J, Denstedt J, Razvi H. Combining Mean and Standard Deviation of Hounsfield Unit Measurements from Preoperative CT Allows More Accurate Prediction of Urinary Stone Composition Than Mean Hounsfield Units Alone. J Endourol 2016; 30:453-9. [PMID: 26597058 DOI: 10.1089/end.2015.0209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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
INTRODUCTION AND OBJECTIVES The mineral composition of a urinary stone may influence its surgical and medical treatment. Previous attempts at identifying stone composition based on mean Hounsfield Units (HUm) have had varied success. We aimed to evaluate the additional use of standard deviation of HU (HUsd) to more accurately predict stone composition. METHODS We identified patients from two centers who had undergone urinary stone treatment between 2006 and 2013 and had mineral stone analysis and a computed tomography (CT) available. HUm and HUsd of the stones were compared with ANOVA. Receiver operative characteristic analysis with area under the curve (AUC), Youden index, and likelihood ratio calculations were performed. RESULTS Data were available for 466 patients. The major components were calcium oxalate monohydrate (COM), uric acid, hydroxyapatite, struvite, brushite, cystine, and CO dihydrate (COD) in 41.4%, 19.3%, 12.4%, 7.5%, 5.8%, 5.4%, and 4.7% of patients, respectively. The HUm of UA and Br was significantly lower and higher than the HUm of any other stone type, respectively. HUm and HUsd were most accurate in predicting uric acid with an AUC of 0.969 and 0.851, respectively. The combined use of HUm and HUsd resulted in increased positive predictive value and higher likelihood ratios for identifying a stone's mineral composition for all stone types but COM. CONCLUSIONS To the best of our knowledge, this is the first report of CT data aiding in the prediction of brushite stone composition. Both HUm and HUsd can help predict stone composition and their combined use results in higher likelihood ratios influencing probability.
Collapse
Affiliation(s)
- Thomas Tailly
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| | - Yaniv Larish
- 2 Division of Urology, Lenox Hill Hospital , New York, New York
| | - Brandon Nadeau
- 3 Department of Radiology, The University of Western Ontario , London, Ontario, Canada
| | - Philippe Violette
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| | - Leonard Glickman
- 4 Division of Urology, Hackensack University Medical Center , Hackensack, New Jersey
| | - Daniel Olvera-Posada
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| | - Husain Alenezi
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| | - Justin Amann
- 3 Department of Radiology, The University of Western Ontario , London, Ontario, Canada
| | - John Denstedt
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| | - Hassan Razvi
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| |
Collapse
|
17
|
Gavin CT, Ali SN, Tailly T, Olvera-Posada D, Alenezi H, Power NE, Hou J, St Amant AH, Luyt LG, Wood S, Wu C, Razvi H, Leong HS. Novel Methods of Determining Urinary Calculi Composition: Petrographic Thin Sectioning of Calculi and Nanoscale Flow Cytometry Urinalysis. Sci Rep 2016; 6:19328. [PMID: 26771074 PMCID: PMC4725893 DOI: 10.1038/srep19328] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/09/2015] [Indexed: 11/09/2022] Open
Abstract
Accurate determination of urinary stone composition has significant bearing on understanding pathophysiology, choosing treatment modalities and preventing recurrence. A need exists for improved methods to determine stone composition. Urine of 31 patients with known renal calculi was examined with nanoscale flow cytometry and the calculi collected during surgery subsequently underwent petrographic thin sectioning with polarized and fluorescent microscopy. Fluorescently labeled bisphosphonate probes (Alendronate-fluorescein/Alendronate-Cy5) were developed for nanoscale flow cytometry to enumerate nanocrystals that bound the fluorescent probes. Petrographic sections of stones were also imaged by fluorescent and polarized light microscopy with composition analysis correlated to alendronate +ve nanocrystal counts in corresponding urine samples. Urine samples from patients with Ca2+ and Mg2+ based calculi exhibited the highest alendronate +ve nanocrystal counts, ranging from 100–1000 nm in diameter. This novel urine based assay was in agreement with composition determined by petrographic thin sections with Alendronate probes. In some cases, high alendronate +ve nanocrystal counts indicated a Ca2+ or Mg2+ composition, as confirmed by petrographic analysis, overturning initial spectrophotometric diagnosis of stone composition. The combination of nanoscale flow cytometry and petrographic thin sections offer an alternative means for determining stone composition. Nanoscale flow cytometry of alendronate +ve nanocrystals alone may provide a high-throughput means of evaluating stone burden.
Collapse
Affiliation(s)
- Carson T Gavin
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, Ontario, Canada
| | - Sohrab N Ali
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, Ontario, Canada
| | - Thomas Tailly
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Daniel Olvera-Posada
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Husain Alenezi
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Nicholas E Power
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Jinqiang Hou
- Department of Chemistry, Western University, London, Ontario, Canada
| | - Andre H St Amant
- Department of Chemistry, Western University, London, Ontario, Canada
| | - Leonard G Luyt
- Department of Chemistry, Western University, London, Ontario, Canada
| | - Stephen Wood
- Department of Earth Sciences, Western University, London, Ontario, Canada
| | - Charles Wu
- Department of Earth Sciences, Western University, London, Ontario, Canada
| | - Hassan Razvi
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Hon S Leong
- Department of Surgery, Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, Ontario, Canada
| |
Collapse
|
18
|
Olvera-Posada D, Alenezi H, Tailly T, Dion M, Denstedt JD, Razvi H. Assessing the Magnitude of Effect of Bone Structures on Shockwave Lithotripsy Fragmentation: Results from an In Vitro Study. J Endourol 2016; 30:544-9. [PMID: 26732533 DOI: 10.1089/end.2015.0641] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Several anatomic and clinical factors have been implicated in the failure rates of shock wave lithotripsy (SWL), including the attenuating effects of bony structures. We designed an in vitro model that incorporates the lumbar spine, including vertebral bodies and transverse processes along the pathway of shockwaves, to mimic the clinical scenario during SWL of upper ureteral stones. We hypothesized that the presence of bone structures in the SWL pathway significantly affects the fragmentation rate. MATERIALS AND METHODS An ordnance gelatin (OG) model was conceptualized and created to allow a pig's lumbar spine to be embedded within it. Artificial urinary calculi weighing 2 ± 0.1 g (1.2-cm diameter) were prepared using BegoStone plaster. The trial was divided into two arms: group 1 models had OG only and served as the control and group 2 models had the bone embedded in the gelatin with stone wells placed above the transverse processes. Twenty-four stones per group were subjected to SWL using the STORZ MODULITH SLX-F2 lithotripter, using the same treatment parameters. Fragments were sieved through 2- and 4-mm filters, and the fragmentation coefficients (FC) were calculated. The Mann-Whitney test was used to compare FC between the two groups. RESULTS The mean fragmentation rate of group 1 was statistically significantly higher compared with group 2 using a 4-mm sieve (43% vs 0.62%, p < 0.001) and the 2-mm filter (18% vs 0.52%, p < 0.001). CONCLUSIONS The presence of bone structures dramatically reduces the fragmentation rate of phantom stones using an OG in vitro model. The OG model is inexpensive and simple to use to simulate clinical situations during SWL.
Collapse
Affiliation(s)
- Daniel Olvera-Posada
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario , London, Ontario, Canada
| | - Husain Alenezi
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario , London, Ontario, Canada
| | - Thomas Tailly
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario , London, Ontario, Canada
| | - Marie Dion
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario , London, Ontario, Canada
| | - John D Denstedt
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario , London, Ontario, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario , London, Ontario, Canada
| |
Collapse
|
19
|
Gonzalez-Sanchez B, Cendejas-Gomez J, Alejandro Rivera-Ramirez J, Herrera-Caceres JO, Olvera-Posada D, Villeda-Sandoval CI, Castillejos-Molina RA, Feria-Bernal G, Garcia-Mora A, Rodriguez-Covarrubias F. The correlation between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED): results from a survey in males from Mexico City (MexiLUTS). World J Urol 2015; 34:979-83. [DOI: 10.1007/s00345-015-1703-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/30/2015] [Indexed: 11/28/2022] Open
|
20
|
Olvera-Posada D, Dion M, Alenezi H, Razvi H, Pautler SE. Robotic Proximal Ureteropyelostomy After Unsuccessful Endourologic Management of Complicated Proximal Ureteral Stone Disease. J Endourol Case Rep 2015; 1:30-2. [PMID: 27579381 PMCID: PMC4996569 DOI: 10.1089/cren.2015.29012.dop] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We present a clinical case of a 66-year-old female with a left ureteropelvic junction impacted renal calculi associated with a tortuous ureter. After a failed combined retrograde and antegrade endoscopic procedure, a robot-assisted laparoscopic ureteropyelostomy was successful.
Collapse
Affiliation(s)
- Daniel Olvera-Posada
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Marie Dion
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Husain Alenezi
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Stephen E Pautler
- Divisions of Urology and Surgical Oncology, Departments of Surgery and Oncology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| |
Collapse
|
21
|
Alenezi H, Olvera-Posada D, Cadieux PA, Denstedt JD, Razvi H. The Effect of Renal Cysts on the Fragmentation of Renal Stones During Shockwave Lithotripsy: A Comparative In Vitro Study. J Endourol 2015; 30 Suppl 1:S12-7. [PMID: 26414112 DOI: 10.1089/end.2015.0253] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the potential effect of simple renal cysts (SRC) on stone fragmentation during shockwave lithotripsy (SWL) in an in vitro model. MATERIALS AND METHODS The in vitro model was constructed using 10% ordnance gelatin (OG). Models were created to mimic four scenarios: Model A-with an air-filled cavity (suboptimal for stone fragmentation); model B-without a cavity (normal anatomy); model C-with a 3-cm serum filled cavity (to represent a small SRC); model D-with a 4-cm serum filled cavity (to represent a larger SRC). SWL was applied to 24 standardized phantom stones (weight of 2±0.1 g) in each model using a standardized protocol. Stone fragments were retrieved, then dried overnight at room air temperature. Fragmentation coefficient (FC) was calculated for each stone, for fragments<4 mm and <2 mm. RESULTS The OG in vitro model was robust enough for the proposed research. There was no fragmentation evident in model A as expected. The mean FC was 29.7 (±20.5) and 39.7 (±23.7) for <4 mm fragments (P=0.069) and 7.6 (±4.1) and 10.6 (±6.7) for <2 mm fragments (P=0.047), for noncystic and cystic models, respectively. The mean FC was 29.7 (±20.5), 38.8 (±26.2) and 40.7 (±21.3) for <4 mm fragments (P=0.213) and 7.6 (±4.1), 11.1 (±8) and 10.2 (±5.3) for <2 mm fragments (P=0.138), for models B, C, and D, respectively. CONCLUSION Our in vitro experiment confirms better stone fragmentation associated with SWL in the presence of adjacent SRC.
Collapse
Affiliation(s)
- Husain Alenezi
- 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Ontario, Canada
| | - Daniel Olvera-Posada
- 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Ontario, Canada
| | - Peter A Cadieux
- 2 Department of Microbiology and Immunology, The University of Western Ontario , London, Ontario, Canada .,3 School of Health Sciences, Fanshawe College , London, Ontario, Canada
| | - John D Denstedt
- 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Ontario, Canada
| | - Hassan Razvi
- 1 Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario , London, Ontario, Canada
| |
Collapse
|
22
|
Olvera-Posada D, Tailly T, Violette P, Alenezi H, Denstedt J, Razvi H. MP30-20 MAJOR POSTOPERATIVE COMPLICATIONS AFTER PERCUTANEOUS NEPHROLITHOTOMY (PCNL) IN A SINGLE TERTIARY REFERRAL CENTRE. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.602] [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: 10/23/2022]
|
23
|
Affiliation(s)
- Daniel Olvera-Posada
- Division of Urology, Department of Surgery, The University of Western Ontario, London, Canada
| | - Stephen E Pautler
- Division of Urology, Department of Surgery, The University of Western Ontario, London, Canada; Division of Surgical Oncology, Department of Oncology, The University of Western Ontario, London, Canada
| |
Collapse
|
24
|
Olvera-Posada D, Rodriguez-Covarrubias F. Reply by the authors. Urology 2014; 84:989. [PMID: 25260463 DOI: 10.1016/j.urology.2014.07.016] [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: 07/07/2014] [Revised: 07/07/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Daniel Olvera-Posada
- Department of Urology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | | |
Collapse
|
25
|
Olvera-Posada D, Armengod-Fischer G, Vázquez-Lavista LG, Maldonado-Ávila M, Rosas-Nava E, Manzanilla-García H, Castillejos-Molina RA, Méndez-Probst CE, Sotomayor M, Feria-Bernal G, Rodríguez-Covarrubias F. Emphysematous pyelonephritis: multicenter clinical and therapeutic experience in Mexico. Urology 2014; 83:1280-4. [PMID: 24726310 DOI: 10.1016/j.urology.2014.02.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/06/2014] [Accepted: 02/07/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the outcomes of emphysematous pyelonephritis (EPN), the impact of different treatment modalities, and to determine risk factors associated with mortality. METHODS We retrospectively reviewed cases of EPN from 3 tertiary care institutions in Mexico. The diagnosis was confirmed with computed tomographic scan. Treatment was classified as follows: medical management (MM), minimally invasive, and surgical. Demographic, clinical, biochemical, and radiological characteristics were assessed and compared between survivors and nonsurvivors. Comparison was assessed using 1-way analysis of variance and chi-square. Univariate and multivariate logistic regression analyses were performed to determine prognostic factors. Main end point was mortality. RESULTS A total of 62 patients were included (49 women and 13 men), with a mean age of 53.9 years. The most common comorbidities were diabetes (69.3%) and hypertension (40.3%). Escherichia coli was the most common isolated microorganism (62.7%). MM was provided to 24.2%, minimally invasive treatment to 51.6%, open drainage to 19.3%, and emergency nephrectomy to 4.8%. Overall mortality was 14.5% and was similar among different treatment modalities (P=.06). Survivors were younger (P=.004), had lower creatinine (P=.002), and better estimated glomerular filtration rate (P=.007). In univariate analysis, age (P=.009), creatinine (P=.009), and need for nephrectomy (P=.03) were associated with mortality. In multivariate logistic regression analysis, creatinine (odds ratio 1.56, 95% confidence interval 1.03-2.35, P=.03) and nephrectomy (odds ratio 9.7, 95% confidence interval 1.007-93.51, P=.049) remained significant predictors of mortality. CONCLUSION EPN needs an aggressive MM and stepwise approach; nephrectomy should be the last resort of treatment. Creatinine level and need for nephrectomy are the strongest predictors of mortality according our analysis.
Collapse
Affiliation(s)
- Daniel Olvera-Posada
- Department of Urology, Salvador Zubirán National Institute of Medical Sciences and Nutrition (INNSZ), Mexico City, México
| | | | - Luis G Vázquez-Lavista
- Department of Urology, Social Security Institute of Mexican State and Municipalities (ISSEMyM), Estado de México, México
| | | | - Emmanuel Rosas-Nava
- Department of Urology, General Hospital of Mexico (HGM), Mexico City, México
| | | | - Ricardo A Castillejos-Molina
- Department of Urology, Salvador Zubirán National Institute of Medical Sciences and Nutrition (INNSZ), Mexico City, México
| | - Carlos E Méndez-Probst
- Department of Urology, Salvador Zubirán National Institute of Medical Sciences and Nutrition (INNSZ), Mexico City, México
| | - Mariano Sotomayor
- Department of Urology, Salvador Zubirán National Institute of Medical Sciences and Nutrition (INNSZ), Mexico City, México
| | - Guillermo Feria-Bernal
- Department of Urology, Salvador Zubirán National Institute of Medical Sciences and Nutrition (INNSZ), Mexico City, México
| | | |
Collapse
|
26
|
Romero-Velez G, Lisker-Cervantes A, Villeda-Sandoval CI, Sotomayor de Zavaleta M, Olvera-Posada D, Sierra-Madero JG, Arreguin-Camacho LO, Castillejos-Molina RA. Erectile Dysfunction Among HIV Patients Undergoing Highly Active Antiretroviral Therapy: Dyslipidemia as a Main Risk Factor. Sex Med 2014; 2:24-30. [PMID: 25356298 PMCID: PMC4184613 DOI: 10.1002/sm2.25] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To assess the prevalence and risk factors of erectile dysfunction (ED) in HIV patients from the HIV clinic of a tertiary referral center in Mexico City. DESIGN Prevalence was obtained from cross-sectional studies, and the International Index of Erectile Function (IIEF), a standardized method, was used to assess ED. METHODS A cross-sectional study was performed in the HIV clinic. Participants completed the IIEF to allow ED assessment. Information on demographics, clinical and HIV-related variables was retrieved from their medical records. RESULTS One hundred and nine patients were included, with a mean age of 39.9 ± 8.8 years. ED was present in 65.1% of the individuals. Patients had been diagnosed with HIV for a mean of 92.7 ± 70.3 months and had undergone a mean 56.4 ± 45.5 months of HAART. The only variable associated with ED in the univariate analysis was dyslipidemia, and this association was also found in the multivariate analysis (P = 0.01). CONCLUSIONS ED is highly prevalent in HIV patients. Dyslipidemia should be considered as a risk factor for ED in HIV patients. Romero-Velez G, Lisker-Cervantes A, Villeda-Sandoval CI, Sotomayor de Zavaleta M, Olvera-Posada D, Sierra-Madero JG, Arreguin-Camacho LO, and Castillejos-Molina RA. Erectile dysfunction among HIV patients undergoing highly active antiretroviral therapy: Dyslipidemia as a main risk factor. Sex Med 2014;2:24-30.
Collapse
Affiliation(s)
- Gustavo Romero-Velez
- Urology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City, Mexico
| | - Andrés Lisker-Cervantes
- Urology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City, Mexico
| | | | | | - Daniel Olvera-Posada
- Urology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City, Mexico
| | - Juan Gerardo Sierra-Madero
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City, Mexico
| | - Lucrecia O Arreguin-Camacho
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City, Mexico
| | | |
Collapse
|
27
|
Olvera-Posada D, Velazquez D, Castillejos-Molina R, Villeda-Sandoval C, Ramirez M, González-Cuenca E, Mendez-Probst C. PD28-04 ASSESSMENT OF A SIMPLIFIED VERSION OF THE URETERAL STENT SYMPTOM QUESTIONNAIRE: MINI-USSQ (M-USSQ). J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
28
|
Olvera-Posada D, Suárez-Santos M, Castillejos-Molina R, Gabilondo-Navarro F, Méndez-Probst CE. Validation of the Spanish version of Ureteral Stent Symptom Questionnaire: prevalence of symptoms in a tertiary care center in Mexico. J Endourol 2013; 28:377-82. [PMID: 24112085 DOI: 10.1089/end.2013.0537] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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
OBJECTIVES To develop and to validate the Spanish version of the Ureteral Stent Symptom Questionnaire (USSQ). Describe the prevalence of symptoms associated with the presence of ureteral stent in a Spanish-speaking population. METHODS We developed and delivered the Spanish USSQ version to patients who underwent ureteral stent placement after endourological procedures. We determined the internal consistency and the instrument's sensitivity to change. Results of the patients were compared with a control group of healthy individuals. We analyzed the prevalence of symptoms in the six domains of the questionnaire and the overall quality of life. We compared the means of the results by gender to find significant differences in associated symptoms. RESULTS We obtained good internal consistency values of the instrument. Significant differences were obtained after sensitivity to change analysis in the scores of all domains except sexual performance. The correlation between the domains of urinary symptoms, pain, and general health was high. The analysis of specific symptoms showed important affection in all domains, being more significant in urinary symptoms and pain. The ureteral catheter also affected the daily life and work performance. There were no significant differences when comparing the symptoms by gender or age. CONCLUSIONS Spanish version of the USSQ is appropriate for assessing the symptoms associated with ureteral stent in the Spanish-speaking population. The ureteral catheter significantly affects the various aspects of life in this population.
Collapse
Affiliation(s)
- Daniel Olvera-Posada
- Urology Department, Instituto Nacional de Nutrición Salvador Zubirán, Mexico City, México
| | | | | | | | | |
Collapse
|
29
|
Olvera-Posada D, Villeda-Sandoval C, Ramírez-Bonilla M, Sotomayor M, Rodriguez-Covarrubias F, Feria-Bernal G, Méndez-Probst C, Castillejos-Molina R. Natural history of pyuria and microhematuria after prostate surgery. Actas Urol Esp 2013; 37:625-9. [PMID: 23768502 DOI: 10.1016/j.acuro.2013.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 02/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Urinalysis alterations are common after prostatic surgery. However, time to normalization has not been established. Presence of pyuria and microhematuria can lead to unnecessary diagnostic procedures. The objective of this study is to determine the time to normalization for both parameters. MATERIAL AND METHODS We reviewed medical records of patients who underwent prostatic surgery without infectious complications during follow-up. We included patients who underwent transurethral resection of the prostate (TURP) with either monopolar or bipolar energy, or open prostatectomy (OP). Kaplan-Meier curves were used to determine the time of persistence of both parameters. ANOVA was used to compare the 3 groups according to the type of surgery. We analyzed the impact of preoperative use of 5-α-reductase inhibitors, and searched for a correlation between the weight of resected tissue and persistence of both parameters. RESULTS 85 patients were analyzed: 44 underwent monopolar TURP, 27 bipolar TURP, and 14 OP. Persistence of pyuria was significantly longer than microhematuria with a median of 274 days vs. 176 days. Neither the use of monopolar or bipolar energy, nor the use of preoperative 5α-reductase inhibitors affected the persistence time. We found a positive correlation between the resected tissue weight and the persistence of leukocyturia after endoscopic surgery: 23 g was the best cut-off point. CONCLUSIONS Pyuria persists longer than microhematuria regardless of the type of surgery. There is a correlation between the resected tissue weight and the persistence of pyuria. The presence of pyuria and microhematuria after prostatic surgery is not always a pathological finding.
Collapse
|
30
|
Olvera-Posada D, García-Mora A, Culebro-García C, Castillejos-Molina R, Sotomayor M, Feria-Bernal G, Rodríguez-Covarrubias F. [Prognostic factors in emphysematous pyelonephritis]. Actas Urol Esp 2013; 37:228-32. [PMID: 23260183 DOI: 10.1016/j.acuro.2012.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 03/10/2012] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The purpose of this study is to analyze our experience with 18 cases of Emphysematous pyelonephritis (EPN) in a tertiary care center and describe our treatment strategy. MATERIAL AND METHODS Of 262 patients admitted with acute pyelonephritis, 18 had CT findings of EPN. The Wan and Huang classifications were used. We assessed the clinical, radiological, and therapeutic characteristics of these patients and investigated potential prognostic factors of mortality. RESULTS Between 2005 and 2010, 17 women and 1 man with EPN were treated. Mean age was 52.4 years. Diabetes was found in 66% and hypertension in 72%. The most common clinical findings were tachycardia (11), fever (11) and flank pain (9); 66% (12) presented with severe sepsis and 2 had septic shock. Acute renal injury developed in 61%. Nine patients were treated exclusively with conservative management; 5 had double J stenting, 3 had CT-guided PCD and 1 required nephrectomy after unsuccessful medical management. Mortality was 11%. Altered consciousness (P=.0001), multiple organ failure (P=.0004), hyperglycemia (P=.003) and elevated leukocyte count (> 20000 K) (P=.01) were more frequent among patients dying from EPN. No difference in mortality was found between patients managed conservatively and those undergoing invasive therapy. CONCLUSIONS Although rare, EPN should be suspected in patients with multiple comorbidities presenting with severe sepsis. Altered consciousness, multiple organ failure, hyperglycemia and elevated leukocyte count are poor prognosis indicators. Invasive management should be used judiciously and medical treatment can be a safe strategy in selected cases.
Collapse
|
31
|
Olvera-Posada D, Ramírez M, Villeda-Sandoval C, Sotomayor M, Rodríguez-Covarrubias F, Méndez-Probst C, Feria-Bernal G, Castillejos-Molina R. 1728 NATURAL HISTORY OF PYURIA AND MICROHEMATURIA AFTER TRANSURETHRAL RESECTION OF THE PROSTATE AND OPEN PROSTATECTOMY. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1689] [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]
|
32
|
|