1
|
Franco A, Ditonno F, Manfredi C, Licari LC, Bologna E, Cherullo EE, Chow AK, Vourganti S, Autorino R. Robot-assisted single-port transvesical enucleation of the prostate: step-by-step technique and early single-centre experience. BJU Int 2024; 133:778-782. [PMID: 38483153 DOI: 10.1111/bju.16324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Licari LC, Bologna E, Manfredi C, Franco A, Ditonno F, De Nunzio C, Antonelli A, Simone G, De Sio M, Cindolo L, Olweny EO, Cherullo EE, Leonardo C, Autorino R. Incidence and management of BPH surgery-related urethral stricture: results from a large U.S. database. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00841-z. [PMID: 38714780 DOI: 10.1038/s41391-024-00841-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/10/2024]
Abstract
INTRODUCTION AND OBJECTIVES Urethral stricture (US) is a well-known complication after surgical treatment of benign prostatic hyperplasia (BPH). This study aimed to evaluate the contemporary incidence of the US after different types of BPH surgery, to identify associated risk factors and to assess its management. METHODS A retrospective analysis was conducted using the PearlDiver™ Mariner database, containing de-identified patient records compiled between 2011 and 2022. Specific International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes were employed to identify population characteristics and outcomes. All the most employed surgical procedures for BPH treatment were considered. Multivariable logistic regression was employed to evaluate factors associated with diagnosis of post-operative US. RESULTS Among 274,808 patients who underwent BPH surgery, 10,918 developed post-operative US (3.97%) within 12 months. Higher incidence of US was observed following TURP (4.48%), Transurethral Incision of the Prostate (TUIP) (3.67%), Photoselective Vaporization of the Prostate (PVP) (3.92%), HoLEP/ThuLEP (3.85%), and open Simple Prostatectomy (SP) (3.21%). Lower incidence rates were observed after laparoscopic\robot-assisted SP (1.76%), Aquablation (1.59%), Prostatic Urethral Lift (PUL) (1.07%), Rezum (1.05%), and Prostatic Artery Embolization (PAE) (0.65%). Multivariable analysis showed that patients undergoing PUL, Rezum, Aquablation, PAE, and PVP were associated with a reduced likelihood of developing US compared to TURP. US required surgical treatment in 18.95% of patients, with direct visual internal urethrotomy (DVIU) and urethroplasty performed in 14.55% and 4.50% of cases, respectively. Urethral dilatation (UD) in an outpatient setting was the primary management in most cases (76.7%). CONCLUSIONS The present analysis from a contemporary large dataset suggests that the incidence of US after BPH surgery is relatively low (<5%) and varies among procedures. Around 94% of US cases following BPH surgery are managed using minimally invasive treatment approaches such as UD and DVIU.
Collapse
Affiliation(s)
- Leslie Claire Licari
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Marco De Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luca Cindolo
- Department of Urology, Villa Stuart Hospital, Rome, Italy
| | | | | | - Costantino Leonardo
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | | |
Collapse
|
3
|
Ditonno F, Manfredi C, Licari LC, Bologna E, Franco A, Pandolfo SD, De Sio M, De Nunzio C, Fiori C, Cherullo EE, Olweny EO, Antonelli A, Autorino R. Benign Prostatic Hyperplasia Surgery: A Snapshot of Trends, Costs, and Surgical Retreatment Rates in the USA. Eur Urol Focus 2024:S2405-4569(24)00058-0. [PMID: 38670842 DOI: 10.1016/j.euf.2024.04.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/22/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND An increasing number of novel surgical treatments (NSTs) for benign prostatic hyperplasia (BPH) have been proposed over time to achieve similar functional outcomes, but better perioperative and sexual outcomes than traditional procedures. OBJECTIVE To assess the trends in the utilization and costs of BPH surgical procedures over the past decade, and to analyze the need for surgical retreatment after each procedure. DESIGN, SETTING, AND PARTICIPANTS A retrospective observational population-based analysis was conducted using the PearlDiver Mariner (PearlDiver Technologies, Colorado Springs, CO, USA) database, including all-payer nationally available claims records collected from 2011 to 2022. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The number and type of BPH surgical procedures per year, costs associated with each BPH surgical treatment, incidence of BPH surgical retreatment rate, and time to BPH surgical retreatment were assessed. Negative binomial regression and Cochran-Armitage test were used for the temporal trend analysis. A multivariable logistic regression analysis evaluated the predictors of BPH surgical retreatment. RESULTS AND LIMITATIONS In the study period, 274 808 patients received surgical treatment for BPH. The most common procedure was transurethral resection of the prostate (TURP; 71.7%). The overall utilization of BPH surgical treatment increased over the study period. Traditional surgery remained most performed for the entire period (87.8%), but a statistically significantly rising trend of NSTs was recorded. The mean reimbursements paid per procedure was 1.43 times higher (p < 0.001) for NSTs than for traditional procedures. The surgical retreatment rate was 9.4%. The mean time to surgical retreatment was 25.3 mo, with 85.5% of cases re-treated within 5 yr. At the multivariable analysis, transurethral incision of the prostate, photoselective vaporization of the prostate, prostatic urethral lift, convective water vapor energy, and prostatic artery embolization had a significantly greater likelihood of surgical retreatment than TURP. Holmium/thulium laser enucleation of the prostate (HoLEP/ThuLEP), open simple prostatectomy (SP), and laparoscopic/robot-assisted SP were associated with a lower probability of resurgery than TURP, but a similar probability between these procedures. Retrospective design and a lack of relevant clinical data were the main limitations. CONCLUSIONS Over the past decade, there has been a progressive increase in the adoption of NSTs. The rate of surgical retreatment appears <10%, with patients undergoing SP and HoLEP/ThuLEP experiencing a statistically significantly lower probability of surgical retreatment. PATIENT SUMMARY We investigated the trends, costs, and surgical retreatments of benign prostatic hyperplasia surgery. Transurethral resection of the prostate remains the most common procedure. Novel surgical treatments are associated with an upward trend, despite appearing more expensive overall. Retreatment is necessary in <10% of patients and generally within 5 yr.
Collapse
Affiliation(s)
- Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA; Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA; Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Leslie Claire Licari
- Department of Urology, Rush University, Chicago, IL, USA; Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University, Chicago, IL, USA; Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA; Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Savio D Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, "Federico II" University, Naples, Italy
| | - Marco De Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Cristian Fiori
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | | | | | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | | |
Collapse
|
4
|
Ditonno F, Franco A, Manfredi C, Sturgis MR, Feng CL, Roadman DF, Mossak SM, Bologna E, Licari LC, De Nunzio C, Corsi NJ, Rogers C, Abdollah F, Antonelli A, Cherullo EE, Olweny EO, Autorino R. Trends and Costs of Minimally Invasive Surgery for Kidney Cancer in the US: A Population-based Study. Urology 2024:S0090-4295(24)00278-4. [PMID: 38670274 DOI: 10.1016/j.urology.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To analyze temporal trends and costs associated with the use of minimally invasive surgery (MIS) for kidney cancer in the US over the past decade. To examine the impact of social determinants of health (SDOH) on perioperative outcomes. METHODS The PearlDiver Mariner, a national database of insurance billing records, was queried for this retrospective observational cohort analysis. The MIS population was identified and stratified according to treatment modality, using International Classification of Diseases and current procedural terminology codes. SDOH were assessed using International Classification of Diseases codes. Negative binomial regression was used to evaluate the overall number of renal MIS and Cochran-Armitage tests to compare the utilization of different treatment modalities, over the study period. Multivariable logistic regression analysis identified predictors of perioperative complications. RESULTS A total of 80,821 MIS for kidney cancer were included. Minimally invasive partial nephrectomy adoption as a fraction of total MIS increased significantly (slope of regression line, reg. = 0.026, P <.001). Minimally invasive radical nephrectomy ($26.9k ± 40.9k) and renal ablation ($18.9k ± 31.6k) were the most expensive and cheapest procedures, respectively. No statistically significant difference was observed in terms of number of complications (P = .06) and presence of SDOH (P = .07) among the treatment groups. At multivariable analysis, patients with SDOH undergoing minimally invasive radical nephrectomy had higher odds of perioperative complications, while renal ablation had a significantly lower probability of perioperative complications. CONCLUSION This study describes the current management of kidney cancer in the US, offering a socioeconomic perspective on the impact of this disease in everyday clinical practice.
Collapse
Affiliation(s)
- Francesco Ditonno
- Department of Urology, Rush University Medical Center, Chicago, IL; Department of Urology, University of Verona, Verona, Italy
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, Chicago, IL; Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University Medical Center, Chicago, IL; Urology Unit, Department of Woman, Child and General and Specialized Surgery, "Luigi Vanvitelli" University, Naples, Italy
| | - Morgan R Sturgis
- Department of Urology, Rush University Medical Center, Chicago, IL
| | - Carol L Feng
- Department of Urology, Rush University Medical Center, Chicago, IL
| | - Daniel F Roadman
- Department of Urology, Rush University Medical Center, Chicago, IL
| | - Spencer M Mossak
- Department of Urology, Rush University Medical Center, Chicago, IL
| | - Eugenio Bologna
- Department of Urology, Rush University Medical Center, Chicago, IL; Urology Unit, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Leslie Claire Licari
- Department of Urology, Rush University Medical Center, Chicago, IL; Urology Unit, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Nicholas J Corsi
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI
| | - Craig Rogers
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI
| | | | | | - Ephrem O Olweny
- Department of Urology, Rush University Medical Center, Chicago, IL
| | | |
Collapse
|
5
|
Bologna E, Licari LC, Franco A, Ditonno F, Manfredi C, De Nunzio C, Antonelli A, De Sio M, Leonardo C, Simone G, Cherullo EE, Autorino R. Incidental Prostate Cancer in Patients Treated for Benign Prostatic Hyperplasia: Analysis from a Contemporary National Dataset. Diagnostics (Basel) 2024; 14:677. [PMID: 38611590 PMCID: PMC11011333 DOI: 10.3390/diagnostics14070677] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Prostate Cancer (PCa) may be incidentally diagnosed during the microscopic evaluation of resected tissue from BPH surgeries, characterizing the clinical condition known as incidental PCa (iPCa). This study aims to assess the prevalence of iPCa following BPH surgery to evaluate the associated surgical procedures and to scrutinize preoperative and postoperative management. (2) Methods: A retrospective analysis was conducted using the PearlDiver™ Mariner database, containing patient records compiled between 2011 and 2021. International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes were employed to identify the population and outcomes. Our primary objective was to assess the prevalence of iPCa, categorized by the type of procedures, and to evaluate the subsequent treatment strategies. The secondary aim was to assess the impact of prostate biopsy (PB) and prostate MRI on iPCa detection. (3) Results: The overall cohort, accounting for 231,626 patients who underwent BPH surgery, exhibited a 2.2% prevalence rate of iPCa. The highest rate was observed for TURP (2.32%), while the lowest was recorded for RASP (1.18%). Preoperative MRI and PB demonstrated opposing trends over the years. Of the 5090 patients identified with iPCa, nearly 68% did not receive active treatment. The most common treatments were RT and ADT; 34.6% underwent RT, 31.75% received ADT, and 21.75% were treated with RT+ADT. RP was administered to approximately 9% of patients undergoing endoscopic procedures. Multivariate logistic regression analysis revealed age and openSP as additional risk factors for iPCa. Conversely, PB and MRI before surgery were linked to a decreased risk. (4) Conclusions: The contemporary prevalence of iPCa after BPH surgery is <3%. The increase in the use of prostate MRI mirrors a decline in the PB biopsy prior to BPH surgery but without resulting in an increased detection rate of iPCa. In contemporary routine clinical practice, iPCa is mostly managed in a different way when compared to biopsy-detected PCa.
Collapse
Affiliation(s)
- Eugenio Bologna
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy; (E.B.); (L.C.L.)
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.M.); (E.E.C.)
| | - Leslie Claire Licari
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy; (E.B.); (L.C.L.)
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.M.); (E.E.C.)
| | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.M.); (E.E.C.)
- Department of Urology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy;
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.M.); (E.E.C.)
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, 37129 Verona, Italy;
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.M.); (E.E.C.)
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy;
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, 37129 Verona, Italy;
| | - Marco De Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Costantino Leonardo
- Department of Urology, “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (C.L.); (G.S.)
| | - Giuseppe Simone
- Department of Urology, “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (C.L.); (G.S.)
| | - Edward E. Cherullo
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.M.); (E.E.C.)
| | - Riccardo Autorino
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.M.); (E.E.C.)
| |
Collapse
|
6
|
Ditonno F, Franco A, Licari LC, Bologna E, Manfredi C, Katz DO, Huang JH, Latchamsetty KC, Coogan CL, Cherullo EE, Chow AK, Vourganti S, Autorino R. Implementation of single-port robotic urologic surgery: experience at a large academic center. J Robot Surg 2024; 18:119. [PMID: 38492003 DOI: 10.1007/s11701-024-01884-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/24/2024] [Indexed: 03/18/2024]
Abstract
The Single-Port (SP) robotic system is increasingly being implemented in the United States, allowing for several minimally invasive urologic procedures to be performed. The present study aims to describe our single-center experience since the adoption of the SP platform. We retrospectively collected and analyzed consecutive SP cases performed at a major teaching hospital in the Midwest (Rush University Medical Center) from December 2020 to December 2023. Demographic variables were collected. Surgical and pathological outcomes were analyzed in the overall cohort and for each type of procedure. The study timeframe was divided into two periods to assess the evolution of SP technical features over time. In total, 160 procedures were performed, with robot-assisted radical prostatectomy (RARP) being the most common (49.4%). Overall, 54.4% of the procedures were extraperitoneal, with a significantly higher adoption of this approach in the second half of the study period (30% vs 74.3%, p < 0.001). A "plus one" assistant port was adopted in 38.1% of cases, with a shift towards a "pure" single-port surgery in the most recent procedures (21.1% vs 76.7%, p < 0.001). The median LOS was 33.5 h (30-48), with a rate of any grade and CD ≥ 3 postoperative complications of 9.4% and 2.5%, respectively, and a 30-day readmission rate of 1.9%. SP robotic surgery can be safely and effectively implemented for various urologic procedures. With increasing experience, the SP platform allows shifting away from transperitoneal procedures, potentially minimizing postoperative pain, and shortening hospital stay and postoperative recovery.
Collapse
Affiliation(s)
- Francesco Ditonno
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - Leslie Claire Licari
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - Eugenio Bologna
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - Celeste Manfredi
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - David O Katz
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - Jonathan H Huang
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - Kalyan C Latchamsetty
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - Christopher L Coogan
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - Edward E Cherullo
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - Alexander K Chow
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - Srinivas Vourganti
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA.
| |
Collapse
|
7
|
Ditonno F, Franco A, Manfredi C, Sturgis M, Vourganti S, Cherullo EE, De Sio M, Porpiglia F, De Nunzio C, Antonelli A, Olweny E, Autorino R. Minimally Invasive Adrenalectomy: A Population-Based Analysis of Contemporary Trends, Outcomes, Costs, and Impact of Social Determinants of Health. Urol Pract 2024; 11:293-302. [PMID: 38305188 DOI: 10.1097/upj.0000000000000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION We sought to analyze temporal trends in the utilization of minimally invasive vs open adrenalectomy in the United States; to assess costs, perioperative outcomes, and the determining factors influencing these variables. METHODS A retrospective analysis of claims data obtained from PearlDiver Mariner, a Health Insurance Portability and Accountability Act-compliant deidentified nationwide database of insurance billing records, was performed. Per-population utilization rates and trends were analyzed using negative binomial regression and trends tests respectively. Continuous and categorical variables were compared using 2-sided t tests and χ2 tests. Multivariable logistic regression analysis was conducted to identify predictors of perioperative complication. RESULTS A total of 10,753 patients were identified (mean age 53.3 ± 16.1 years). Using the 2011 to 2014 time frame as reference, utilization of adrenalectomy decreased over time (incidence rate ratio for 2015-2018: 0.65 [95% CI 0.62-0.68, P < .001]; incidence rate ratio for 2019-2021: 0.39 [95% CI 0.37-0.41, P < .001]). Minimally invasive adrenalectomies increased significantly over time (P < .001). A greater number of adrenalectomies were performed by general surgeons compared with urologists (70.4% vs 29.5%). Complications were not significantly predicted by any surgical specialty. Significant predictors for complication rates were Charlson comorbidity index > 1 (odds ratio [OR] 1.11, 95% CI 1.09-1.13), presence of social determinants of health (OR 1.5, 95% CI 1.18-1.88) and open approach (OR 1.54, 95% CI 1.34-1.77). CONCLUSIONS The number of adrenalectomies in the United States decreased over the past decade, with a shift towards minimally invasive approach. No difference in outcomes for general surgeons vs urologists can be observed. Social determinants of health are independent predictors of increased rate of complications.
Collapse
Affiliation(s)
- Francesco Ditonno
- Department of Urology, Rush University Medical Center, Chicago, Illinois
- Department of Urology, University of Verona, Verona, Italy
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, Chicago, Illinois
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University Medical Center, Chicago, Illinois
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University, Naples, Italy
| | - Morgan Sturgis
- Department of Urology, Rush University Medical Center, Chicago, Illinois
| | - Srinivas Vourganti
- Department of Urology, Rush University Medical Center, Chicago, Illinois
| | - Edward E Cherullo
- Department of Urology, Rush University Medical Center, Chicago, Illinois
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University, Naples, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | | | - Ephrem Olweny
- Department of Urology, Rush University Medical Center, Chicago, Illinois
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
8
|
Licari LC, Bologna E, Franco A, Ditonno F, Manfredi C, Huang J, Latchamsetty K, Coogan C, Olweny EO, Cherullo EE, Chow AK, Vourganti S, Autorino R. Single-port vs multi-port robot-assisted partial nephrectomy: A single center propensity score-matched analysis. Eur J Surg Oncol 2024; 50:108011. [PMID: 38359726 DOI: 10.1016/j.ejso.2024.108011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/27/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION AND OBJECTIVES The aim of the study is to compare key outcomes of Single-Port (SP) and Multi-Port (MP) robot-assisted partial nephrectomy (RAPN). METHODS A retrospective analysis was conducted on our prospectively collected database of patients who underwent SP-RAPN or MP-RAPN at our institution from January 2021 to August 2023. To adjust for potential baseline pre-operative confounders, a 1:1 propensity-score matching analysis (PSMa) was performed. The primary endpoint was to compare perioperative outcomes between the two groups. The secondary endpoint was to compare the achievement of the "Trifecta" outcome (defined as negative surgical margins, absence of high-grade complications and change in eGFR values (ΔeGFR) < 10% at 6 months follow-up) in the matched cohort. RESULTS After PSMa, 30 SP cases were matched 1:1 to 30 MP cases. In the matched cohort, there were no significant differences between SP and MP approaches in operative time, estimated blood loss, ischemia time, transfusions rate, intraoperative complications, postoperative complications, and positive surgical margin rates. Patients who underwent SP-RAPN had a shorter median length of stay [25 (IQR:24.0-34.5) vs 34 (IQR:30.2-48.0) hours, p < 0.003]. The Trifecta outcome was achieved in 16 (57%) of SP patients and 17 (63%) of MP patients (p = 0.8). CONCLUSIONS SP-RAPN can be safely implemented in a Center with an established MP-RAPN program. Despite being early in the SP-RAPN experience, key surgical outcomes are not compromised. While offering comparable perioperative and short-term functional outcomes, SP-RAPN can translate into faster recovery and shorter LOS, paving the way for outpatient robotic surgery.
Collapse
Affiliation(s)
| | | | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
| | | | | | - Jonathan Huang
- Department of Urology, Rush University, Chicago, IL, USA
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Ditonno F, Franco A, Manfredi C, Veccia A, De Nunzio C, De Sio M, Vourganti S, Chow AK, Cherullo EE, Antonelli A, Autorino R. Single-port robot-assisted simple prostatectomy: techniques and outcomes. World J Urol 2024; 42:98. [PMID: 38393399 DOI: 10.1007/s00345-024-04778-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/09/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE To describe the surgical techniques and to analyse the outcomes of single-port robot-assisted simple prostatectomy (SP RASP) procedure for the surgical treatment of benign prostatic hyperplasia (BPH). METHODS Three databases (PubMed®, Web of Science™, and Scopus®) were queried to identify studies reporting on the technical aspects and outcomes of SP RASP. Different combinations of keywords were used, according to a free-text protocol, to identify retrospective and prospective studies, both comparative and non-comparative, systematic reviews (SR) and meta-analysis (MA) describing surgical techniques for SP RASP and the associated surgical and functional outcomes. RESULTS The transvesical approach represents the most common approach for SP RASP. A decrease in terms of estimated blood loss was observed when SP RASP was compared to open simple prostatectomy (OSP) and multi-port (MP) RASP. Furthermore, this technique allowed for a shorter length of hospital stay (LoS) and a lower post-operative complication rate, compared to OSP. Post-operative subjective and objective functional outcomes are satisfying and comparable to OSP and MP RASP. CONCLUSION SP RASP represents a safe and feasible approach for the surgical management of BPH. It provides comparable surgical and functional outcomes to MP RASP, enabling for minimal invasiveness, enhanced recovery, and potential for improving patient care.
Collapse
Affiliation(s)
- Francesco Ditonno
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli" University, Naples, Italy
| | | | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli" University, Naples, Italy
| | - Srinivas Vourganti
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - Alexander K Chow
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | - Edward E Cherullo
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA
| | | | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, 1725 W. Harrison Street, Suite 970, Chicago, IL, 60612, USA.
| |
Collapse
|
10
|
Franco A, Ditonno F, Manfredi C, Pellegrino AA, Licari LC, Bologna E, Feng C, Antonelli A, De Sio M, De Nunzio C, Porpiglia F, Cherullo EE, Kaouk J, Crivellaro S, Autorino R. Single port robot-assisted radical and simple prostatectomy: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00787-2. [PMID: 38263281 DOI: 10.1038/s41391-024-00787-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Aim of our study was to review the current evidence on single port robot-assisted radical prostatectomy (SP-RARP) and SP robot-assisted simple prostatectomy (SP-RASP) procedures. METHODS A comprehensive bibliographic search on multiple databases was conducted in July 2023. Studies were included if they assessed patients with non-metastatic prostate cancer or candidate for benign prostatic hyperplasia surgery (P) who underwent SP-RARP or SP-RASP, respectively, (I), compared or not with other surgical techniques (C), evaluating perioperative, oncological, or functional outcomes (O). Prospective and retrospective original articles were included (S). A meta-analysis of comparative studies between SP-RARP and MP-RARP was performed. RESULTS A total of 21 studies investigating 1400 patients were included in our systematic review, 18 were related to SP-RARP while 3 to SP-RASP. Only 8 comparative studies were eligible for meta-analysis. Mean follow-up was 8.1 (±5.8) months. Similar outcomes were observed for SP-RARP and MP-RARP in terms of operative time, catheterization time, pain score, complications rate, continence and potency rates, positive surgical margin, and biochemical recurrence. Length of hospital stay was shorter in the SP group after sensitivity analysis (WMD -0.58, 95% IC -1.17 to -0.9, p < 0.05). Subgroup analysis by extraperitoneal approach did not show any statistical difference, except for a lower positive margins rate in the SP extraperitoneal technique compared to MP-RARP. Overall, SP-RASP exhibited shorter hospital stay and lower rate of de novo urinary incontinence when compared to other techniques, while no differences were reported in terms of postoperative International Prostate Symptom Score, post void residual and maximum flow. CONCLUSIONS Overall comparable oncological, functional, and perioperative outcomes can be achieved with SP platform. Subgroup analysis by different approaches did not reveal significant variations in outcomes. However, the retrospective nature of the studies, the limited follow-up, and the relatively small sample size of selected Centers may impact these results.
Collapse
Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Urology Unit, "Luigi Vanvitelli" University, Naples, Italy
| | | | - Leslie Claire Licari
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Carol Feng
- Department of Urology, Rush University, Chicago, IL, USA
| | | | - Marco De Sio
- Urology Unit, "Luigi Vanvitelli" University, Naples, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Jihad Kaouk
- Department of Urology, Glickman Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | | |
Collapse
|
11
|
Bologna E, Franco A, Licari LC, Ditonno F, Manfredi C, Emerson JT, Cherullo EE, Autorino R. Transperitoneal single-port robotic Firefly-guided bladder diverticulectomy and simple prostatectomy. Cent European J Urol 2024; 77:161-162. [PMID: 38645816 PMCID: PMC11032038 DOI: 10.5173/ceju.2023.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/05/2023] [Accepted: 12/19/2023] [Indexed: 04/23/2024] Open
Affiliation(s)
- Eugenio Bologna
- Department of Urology, Rush University Medical Center, Chicago, IL, United States of America
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, Chicago, IL, United States of America
| | - Leslie Claire Licari
- Department of Urology, Rush University Medical Center, Chicago, IL, United States of America
| | - Francesco Ditonno
- Department of Urology, Rush University Medical Center, Chicago, IL, United States of America
| | - Celeste Manfredi
- Department of Urology, Rush University Medical Center, Chicago, IL, United States of America
| | - Jacob T Emerson
- Department of Urology, Rush University Medical Center, Chicago, IL, United States of America
| | - Edward E Cherullo
- Department of Urology, Rush University Medical Center, Chicago, IL, United States of America
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, United States of America
| |
Collapse
|
12
|
Manfredi C, Ditonno F, Franco A, Bologna E, Licari LC, Arcaniolo D, Tubaro A, De Nunzio C, Antonelli A, De Sio M, Cherullo EE, Autorino R. Prostate Cancer in Transgender Women: Epidemiology, Clinical Characteristics, and Management Challenges. Curr Oncol Rep 2023; 25:1431-1443. [PMID: 37910274 DOI: 10.1007/s11912-023-01470-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW To systematically review the evidence on prostate cancer (PCa) in transgender women (TGW). RECENT FINDINGS A total of 25 studies were included. Fourteen articles were case reports or case series describing 21 TGW with PCa; 11 papers focused primarily on assessing the incidence or screening of PCa in TGW. The median (range) age of patients with PCa was 63 (45-78) years. Median (range) PSA at diagnosis was 7.5 (0.4-1710) ng/mL. Prostate biopsy detected ISUP 3-5 in 10 (67%) cases. T3-4 stages were described in 7 (64%) patients. Three (14.3%) cases of nodal involvement and 2 (9.5%) of metastases were reported at diagnosis. First-line therapy included radical prostatectomy or radiotherapy ± androgen deprivation therapy in 14 (74 %) subjects. Median (range) follow-up was 24 (2-120) months. A good response to first-line therapy was recorded in 8 (47.1%) cases. Median (range) incidence of PCa in TGW was 44.1 (4.34-140) cases per 100,000 person-years. PCa was significantly less frequent in TGW than in cisgender males (HR 0.4, 95% CI 0.2-0.9). Risk of death after PCa diagnosis was significantly higher in TGW compared to cisgender males (HR 1.91, 95% CI 1.06-3.45). TGW had lower lifetime PSA rates (48% vs. 64.6%, p = 0.048) than cisgender males. Few cases of PCa in TGW are currently reported. PCa seems significantly less frequent in TGW than in cisgender males; however, some data suggest a possible higher mortality in this cohort. TGW appear to have less access to PSA testing than cisgender men.
Collapse
Affiliation(s)
- Celeste Manfredi
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
- Unit of Urology, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Leslie Claire Licari
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
- Unit of Urology, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Davide Arcaniolo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marco De Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Edward E Cherullo
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA.
| |
Collapse
|
13
|
Ditonno F, Franco A, Manfredi C, Chow AK, Vourganti S, Cherullo EE, Autorino R. Single Port Robotic Pyeloplasty: early single-center experience. Int Braz J Urol 2023; 49:757-762. [PMID: 37903009 PMCID: PMC10947613 DOI: 10.1590/s1677-5538.ibju.2023.0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/13/2023] [Indexed: 11/01/2023] Open
Abstract
PURPOSE Ureteropelvic junction obstruction (UPJO) is a prevalent cause of hydronephrosis, especially in young patients. The treatment paradigm for this condition has shifted from open to minimally invasive pyeloplasty. In the present study we describe our initial single centre experience with single port (SP) robot-assisted pyeloplasty (RAP) via periumbilical incision. MATERIAL AND METHODS With the patient in a 60-degree left flank position, the SP system is docked with the Access port (Intuitive Surgical, Sunnyvale, CA, US) placed in a periumbilical 3 cm incision. Robotic instruments are deployed as follows: camera at 12 o'clock, bipolar grasper at 9 o'clock, scissors at 3 o'clock and Cadiere at 6 o'clock. After isolation and identification of the ureter and the ureteropelvic junction (UPJ), the ureter is transected at this level and then spatulated. Anastomosis is carried out by two hemicontinuous running sutures, over a JJ stent. RESULTS Between 2021 and 2023, a total of 8 SP RAP have been performed at our institution, with a median (interquartile range, IQR) of 23 years (20.5-36.5). Intraoperative outcomes showed a median (IQR) OT of 210.5 minutes (190-240.5) and a median (IQR) estimated blood loss (EBL) of 50 mL (22.5-50). No postoperative complications were encountered, with a median (IQR) length of stay (LOS) of 31 hours (28.5-34). CONCLUSION In the present study we evaluated the feasibility and safety of SP RAP. The observed outcomes and potential benefits, combined with the adaptability of the SP platform, hold promising implications for the application of SP system in pyeloplasty treatment.
Collapse
Affiliation(s)
- Francesco Ditonno
- Rush University Medical CenterDepartment of UrologyChicagoILUSADepartment of Urology, Rush University Medical Center. Chicago, IL, USA;
- University of VeronaDepartment of UrologyVeronaItalyDepartment of Urology, University of Verona. Verona, Italy;
| | - Antonio Franco
- Rush University Medical CenterDepartment of UrologyChicagoILUSADepartment of Urology, Rush University Medical Center. Chicago, IL, USA;
- La Sapienza UniversitySant'Andrea HospitalDepartment of UrologyRomeItalyDepartment of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy;
| | - Celeste Manfredi
- Rush University Medical CenterDepartment of UrologyChicagoILUSADepartment of Urology, Rush University Medical Center. Chicago, IL, USA;
- "Luigi Vanvitelli" UniversityDepartment of Woman, Child and General and Specialized SurgeryUrology UnitNaplesItalyUrology Unit, Department of Woman, Child and General and Specialized Surgery, "Luigi Vanvitelli" University. Naples, Italy
| | - Alexander K. Chow
- Rush University Medical CenterDepartment of UrologyChicagoILUSADepartment of Urology, Rush University Medical Center. Chicago, IL, USA;
| | - Srinivas Vourganti
- Rush University Medical CenterDepartment of UrologyChicagoILUSADepartment of Urology, Rush University Medical Center. Chicago, IL, USA;
| | - Edward E. Cherullo
- Rush University Medical CenterDepartment of UrologyChicagoILUSADepartment of Urology, Rush University Medical Center. Chicago, IL, USA;
| | - Riccardo Autorino
- Rush University Medical CenterDepartment of UrologyChicagoILUSADepartment of Urology, Rush University Medical Center. Chicago, IL, USA;
| |
Collapse
|
14
|
Pandolfo SD, Cerrato C, Wu Z, Franco A, Del Giudice F, Sciarra A, Verze P, Lucarelli G, Imbimbo C, Perdonà S, Cherullo EE, Porpiglia F, Derweesh IH, Autorino R. A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications: Large tumors (cT2-T3), solitary kidney, completely endophytic, hilar, recurrent, and multiple renal tumors. Asian J Urol 2023; 10:390-406. [PMID: 38024426 PMCID: PMC10659988 DOI: 10.1016/j.ajur.2023.06.001] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/18/2023] [Accepted: 06/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Robot-assisted partial nephrectomy (RAPN) has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses. The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses, large tumors (cT2-T3), renal cell carcinoma in solitary kidney, recurrent tumors, completely endophytic and hilar masses, and simultaneous and multiple tumors. Methods A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers. The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered. The secondary endpoint was to evaluate the surgical and functional outcomes. Results After screening 1250 records, 43 full-text manuscripts were selected, comprising over 8500 patients. Twelve and thirteen studies reported data for endophytic and hilar renal masses, respectively. Five and three studies reported outcomes for cT2-T3 and solitary kidney patients, respectively. Four studies focused on redo-RAPN for recurrent tumors. Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney. Conclusion Over the past decade, evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown. Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes, the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result. Certainly, a higher likelihood of complication might be expected when facing extremely challenging cases. However, none of these indications should be considered per se an exclusion criterion for performing RAPN. Ultimately, a risk-adapted approach should be employed.
Collapse
Affiliation(s)
- Savio Domenico Pandolfo
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, “Federico II” University, Naples, Italy
| | - Clara Cerrato
- Department of Urology, University of Verona, Verona, Italy
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Urology, Sant’ Andrea Hospital, La Sapienza University, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, La Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urologic Sciences, La Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, “Federico II” University, Naples, Italy
| | - Sisto Perdonà
- Department Uro-Gynecology, IRCCS G. Pascale Foundation, Naples, Italy
| | | | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Ithaar H. Derweesh
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
15
|
Pandolfo SD, Del Giudice F, Chung BI, Manfredi C, De Sio M, Damiano R, Cherullo EE, De Nunzio C, Cacciamani GE, Cindolo L, Porpiglia F, Mirone V, Imbimbo C, Autorino R, Crocerossa F. Robotic assisted simple prostatectomy versus other treatment modalities for large benign prostatic hyperplasia: a systematic review and meta-analysis of over 6500 cases. Prostate Cancer Prostatic Dis 2023; 26:495-510. [PMID: 36402815 DOI: 10.1038/s41391-022-00616-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [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: 08/11/2022] [Revised: 10/20/2022] [Accepted: 11/07/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Current guidelines recommend simple prostatectomy or endoscopic enucleation of the prostate (EEP) as treatment of choice for bladder prostatic obstruction (BPO) caused by large prostate glands. We aimed to provide a wide-ranging analysis of the currently available evidence, comparing safety and effectiveness of robot-assisted simple prostatectomy (RASP) versus open simple prostatectomy (OSP), laparoscopic simple prostatectomy (LSP), and laser EEP. METHODS A systematic search was performed across MEDLINE, EMBASE, and Web of Science databases for retrospective and prospective studies comparing RASP to OSP or LSP or laser EEP (HoLEP/ThuLEP). Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations were followed to design the search strategies, selection criteria, and evidence report. A meta-analysis evaluated perioperative safety and effectiveness outcomes. The weighted mean difference and risk ratio were used to compare continuous and dichotomous variables, respectively. Quality was assessed using the Newcastle-Ottawa scale and the Cochrane Collaboration's tool for RCT article assessing risk of bias. RESULTS 15 studies, including 6659 patients, were selected for meta-analysis: 13 observational studies, 1 non-randomized prospective study, and 1 randomized controlled trial. RASP was associated with statistically significant longer operative time (OT) and lower postoperative complication rate, length of stay (LOS), estimated blood loss (EBL), and transfusion rate (TR) compared to OSP. LSP showed longer LOS and lower postoperative SHIM score, with no difference in OT, EBL, and complications. Compared to laser EEP, RASP presented longer LOS and catheterization time and higher TR. ThuLEP presented shorter OT than RASP. No difference were found in functional outcomes between groups both subjectively (IPSS, QoL) and objectively (Qmax, PVR). CONCLUSION RASP has become a size-independent treatment for the management of BPO caused by a large prostate gland. It can duplicate the functional outcomes of OSP while offering a better safety profile. When compared to LSP, the latter still stands as a valid lower-cost option, but it requires solid laparoscopic skill sets and therefore it is unlikely to spread on larger scale. When compared to laser EEP, RASP offers a shorter learning curve, but it still suffers from longer catheterization time and LOS.
Collapse
Affiliation(s)
- Savio Domenico Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
- Department of Urology, Stanford Medical Center, Stanford, CA, USA
| | - Benjamin I Chung
- Department of Urology, Stanford Medical Center, Stanford, CA, USA
| | - Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rocco Damiano
- Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Edward E Cherullo
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Cosimo De Nunzio
- Urology Unit, Ospedale Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Luca Cindolo
- Department of Urology, Villa Stuart, Private Hospital, Rome, Italy
| | - Francesco Porpiglia
- Division of Urology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA.
| | - Fabio Crocerossa
- Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| |
Collapse
|
16
|
Grob G, Rogers D, Pandolfo SD, Vourganti S, Buscarini M, Mehrazin R, Grob BM, Mir MC, Perdonà S, Derweesh IH, Franco A, Cherullo EE, Hemal AK, Autorino R. Oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma: a literature review. Transl Androl Urol 2023; 12:1351-1362. [PMID: 37680219 PMCID: PMC10481200 DOI: 10.21037/tau-22-882] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/10/2023] [Indexed: 09/09/2023] Open
Abstract
Background and Objective Radical nephroureterectomy (RNU) represents the gold standard treatment for non-metastatic upper tract urothelial cancer. We sought to provide a comprehensive review of reported oncologic outcomes of the RNU procedure and of factors that might impact these outcomes. Methods A non-systematic review of the literature was conducted by performing an electronic literature search using PubMed with "radical nephroureterectomy" and "oncologic outcomes" as free text search terms. Both original articles and systematic reviews were considered. Search was limited to articles in English that were published in the last 20 years. Key Content and Findings Open and laparoscopic RNU offer comparable oncologic outcomes. In more recent years, the discussion has de facto shifted towards the "oncological safety" of robotic RNU, which also seems to offer comparable oncologic outcomes. Several studies have looked at the impact of different treatment-, patient- and tumor-related factors. Among treatment-related factors, attention has been given to diagnostic ureteroscopy and the risk of intravesical recurrence. Surgical wait time and perioperative blood transfusion have also been studied. Perioperative chemotherapy, specifically adjuvant therapy, was shown to improve survival. Among patient-related factors, baseline chronic kidney disease, diabetes mellitus, body mass index, and systemic inflammation have gained recent attention. Some tumor related factors, such as stage, grade, location, and multifocality may negatively impact survival outcomes. Lymphovascular invasion and histologic variants are clinically significant pathological findings. Conclusions RNU is a procedure with measured long-term oncologic outcomes. Minimally invasive techniques have gained an established role as they seem to offer comparable oncologic "safety", although special attention is needed in relation to the method of bladder cuff excision. Robotic RNU is gaining popularity, and while evidence remains limited, the current literature supports the oncologic safety of this procedure. Several factors, which can be categorized as treatment-related, patient-related, and tumor-related, might impact the oncologic outcomes of UTUC patients undergoing RNU. These factors can provide crucial information to stratify patients based on their relative risk of disease recurrence and mortality which may guide clinical decision-making.
Collapse
Affiliation(s)
| | - Devin Rogers
- Division of Urology, VCU Health, Richmond, VA, USA
| | - Savio D. Pandolfo
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | | | - Maurizio Buscarini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Maria C. Mir
- Department of Urology, Hospital Universitario La Ribera, Valencia, Spain
| | - Sisto Perdonà
- Uro-Gynecological Department, Fondazione “G. Pascale” IRCCS, Naples, Italy
| | | | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
| | | | - Ashok K. Hemal
- Department of Urology, Wake Forest University, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | | |
Collapse
|
17
|
Khusid E, Sturgis MR, Dorafshar AH, Schechter LS, Olweny EO, Cherullo EE, Becerra AZ. Association Between Mental Health Conditions and Postoperative Complications After Gender-Affirming Surgery. JAMA Surg 2022; 157:1159-1162. [PMID: 36169965 PMCID: PMC9520432 DOI: 10.1001/jamasurg.2022.3917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/18/2022] [Indexed: 01/11/2023]
Abstract
This cohort study assesses whether postoperative complications are associated with having been diagnosed with a mental health condition in patients who have undergone gender-affirming surgery.
Collapse
Affiliation(s)
| | - Morgan R. Sturgis
- Department of Urology, Rush University Medical Center, Chicago, Illinois
| | - Amir H. Dorafshar
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Loren S. Schechter
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ephrem O. Olweny
- Department of Urology, Rush University Medical Center, Chicago, Illinois
| | - Edward E. Cherullo
- Department of Urology, Rush University Medical Center, Chicago, Illinois
| | - Adán Z. Becerra
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
18
|
Setia SA, Massie PL, Epsten MJ, Sharma A, Fogg L, Cherullo EE, Chow AK. Renal Forniceal Rupture in the Setting of Obstructing Ureteral Stones: An Analysis of Stone Characterization and Urologic Intervention Pattern. J Endourol 2021; 34:373-378. [PMID: 31950872 DOI: 10.1089/end.2019.0706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction and Objective: Forniceal rupture due to obstructing ureterolithiasis (FROU) is a seldom encountered radiographic finding, but the impact of this diagnosis and influence on stone management has not been well studied in the literature. The purpose of the study is to examine stone characteristics and intervention patterns of patients with radiographic evidence of FROU. Materials and Methods: A retrospective analysis of all patients with radiographic evidence of FROU was compared with patients with obstructing ureteral stones without forniceal ruptures (noFROU). All patients presented to our Emergency Department from January 2015 until December 2018. Data analyzed included patient demographics, clinical presentation, stone characteristics, and management pattern. Primary outcome was need for hospital admission and surgical intervention. Results: Thirty-two patients with FROU (mean age = 45) were compared with 50 patients with noFROU (mean age = 57). Univariate analysis revealed that age, history of diabetes mellitus, history of hypertension, days of symptoms, degree of hydronephrosis, and degree of perinephric stranding were associated with forniceal rupture (p ≤ 0.05). On multivariate analysis, only degree of perinephric stranding remained significant (p ≤ 0.05). Average maximum axial stone diameter in the FROU group was 5.1 mm vs 4.7 mm in the noFROU group (p = 0.66). Overall, 68.8% of stones were located within the distal ureter in the FROU group vs 48.8% in the noFROU group (p = 0.09). There was no difference in hospital admission (FROU 37.5% vs noFROU 44%, p = 0.56) and need for surgical intervention (FROU 50% vs noFROU 48%, p = 0.86). There were no 30-day complications in patients with FROU. Conclusions: Ureteral stone location and size does not seem to impact the presence of FROU. FROU may be an alarming reported finding but its presence does not appear to impact clinical outcomes or affect urological management, including admission or need for urologic intervention.
Collapse
Affiliation(s)
- Shaan A Setia
- Department of Surgery, Division of Urology, Rush University Medical Center, Chicago, Illinois
| | | | | | - Avishkar Sharma
- Department of Radiology, Rush University Medical Center, Chicago, Illinois
| | - Louis Fogg
- Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University, Chicago, Illinois
| | - Edward E Cherullo
- Department of Surgery, Division of Urology, Rush University Medical Center, Chicago, Illinois
| | - Alexander K Chow
- Department of Surgery, Division of Urology, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
19
|
Chow AK, Bhatt R, Cao D, Wahba B, Coogan CL, Vourganti S, Cherullo EE, Bhayani SB, Venkatesh RJ, Figenshau RS. A Case Series of Delayed Proximal Ureteral Strictures After Nephron-Sparing Treatment of Renal Masses. J Endourol Case Rep 2020; 6:544-547. [PMID: 33457725 DOI: 10.1089/cren.2020.0182] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Delayed proximal ureteral stricture (DPUS) after nephron-sparing treatment (partial nephrectomy [PN] and image-guided percutaneous ablation) of renal masses is a rare complication that occurs because of an unrecognized injury to the proximal ureter and/or its associated vascular supply. We present a multi-institutional series of patients who developed DPUS after nephron-sparing treatment and review relevant tumor characteristics, timing of DPUS presentation, presenting symptoms, and outcome of stricture management. Case Presentation: Between 2000 and 2019, nine patients (five PN and four ablation) were found to have DPUS diagnosed at an average of 9 (6-119) months after PN and 5.5 (1-6) after ablation. Average tumor size was 4.5 (2.9-7.3) cm and 3.6 (3-4.1) cm for those treated with PN and ablation, respectively. Nephrometry score was 8.3 (6-11) and 6.5 (5-8), respectively. For resected tumors, all were located in the lower pole, but uniformity was not found as far as medial vs lateral (3 vs 2), anterior vs posterior (2 vs 2, 1 N/A), and right vs left (3 vs 2). For ablated tumors, all four tumors were right sided, anterior, medial, and lower pole. Initial signs and symptoms include sepsis (2), flank pain (5), and asymptomatic hydronephrosis (2). Concomitant urinoma (2) and retroperitoneal abscess (1) was found on imaging. Initial management included ureteral stenting (5) and percutaneous nephrostomy tube (4). Three underwent nephrectomy. Two had spontaneous resolution of DPUS after a course of ureteral stenting. Conclusion: Potential risk factors associated with DPUS after nephron-sparing treatment, including medial and lower pole tumors, and particularly right-sided anterior masses for ablation and higher complexity nephrometry score for PN. Recognition of delayed symptoms and imaging abnormalities in the surveillance period should cue clinical suspicion to DPUS.
Collapse
Affiliation(s)
- Alexander K Chow
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rohit Bhatt
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David Cao
- Division of Urology, Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brandon Wahba
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christopher L Coogan
- Division of Urology, Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Srinivas Vourganti
- Division of Urology, Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward E Cherullo
- Division of Urology, Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Sam B Bhayani
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ramakrishna J Venkatesh
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert Sherb Figenshau
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
20
|
Chow AK, Rosenberg BJ, Capoccia EM, Cherullo EE. Risk Factors and Management Options for the Adult Failed Ureteropelvic Junction Obstruction Repair in the Era of Minimally Invasive and Robotic Approaches: A Comprehensive Literature Review. J Endourol 2020; 34:1112-1119. [PMID: 32024376 DOI: 10.1089/end.2019.0737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Guidelines for the management of pyeloplasty failure remain elusive given the rarity of this condition and the difficulty of integrating and analyzing reported outcomes given the varying definition of failures. In this article, we aim to review the existing literature on risk factors that may influence the surgical outcomes of reconstructive pyeloplasty for ureteropelvic junction obstruction. Furthermore, we discuss management options and review success outcomes of treatment options for patients with pyeloplasty failure.
Collapse
Affiliation(s)
- Alexander K Chow
- Division of Urology, Department of General Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bryan J Rosenberg
- Division of Urology, Department of General Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward M Capoccia
- Division of Urology, Department of General Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward E Cherullo
- Division of Urology, Department of General Surgery, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
21
|
Kiechle JE, Kim SP, Yu JB, Maurice MJ, Dong S, Cherullo EE, Abouassaly R. Economic Burden Associated with Hospitalization for Radiation Cystitis: Results from a Statewide Inpatient Database. Urol Pract 2016; 3:437-442. [PMID: 37592565 DOI: 10.1016/j.urpr.2015.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Radiation cystitis is associated with a significant burden to patients and the health care system. However, the regional burden of treatment and its associated costs remains poorly described. We assessed the health care costs and need for intervention among patients admitted to the hospital with radiation cystitis. METHODS Using data from the Ohio Hospital Association we identified patients admitted with a diagnosis of radiation cystitis from 2009 to 2013. The primary outcome was the adjusted inpatient cost (adjusted to 2013 U.S. dollars) associated with in-hospital treatment of radiation cystitis. Secondary outcomes included percentage of patients requiring endoscopic urological procedures, blood transfusions and nephrostomy tubes. We used a generalized estimating equation model to determine in-hospital costs. Multivariate logistic regression analyses were used to determine factors associated with requiring an invasive procedure. RESULTS We identified 1,111 patients admitted to Ohio hospitals between 2009 and 2013 with a diagnosis of radiation cystitis. Mean patient age (±SD) was 73.9 (±12.5) years. Median length of stay was 4 days (IQR 3-8). The adjusted median cost of hospitalization per admission in 2013 for these patients was $7,151 (IQR $4,251-$16,569). Overall 28.9% of patients required blood transfusions, 34.4% required endourological procedures and 3.4% required nephrostomy tubes. The odds of undergoing an invasive procedure were associated with increasing length of stay, need for blood transfusion and male gender. CONCLUSIONS This study is the first population based study to our knowledge to assess the treatment burden and health care costs from radiation cystitis. A diagnosis of radiation cystitis carries with it a significant economic and treatment associated burden.
Collapse
Affiliation(s)
- Jonathan E Kiechle
- University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, Ohio
| | - Simon P Kim
- University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, Ohio
| | - James B Yu
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut
| | - Matthew J Maurice
- University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, Ohio
| | - Shan Dong
- University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, Ohio
| | - Edward E Cherullo
- University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, Ohio
| | - Robert Abouassaly
- University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, Ohio
| |
Collapse
|
22
|
Kiechle JE, Abouassaly R, Gross CP, Dong S, Cherullo EE, Zhu H, Trinh QD, Sun M, Meropol NJ, Hoimes CJ, Ialacci S, Kim SP. Racial Disparities in Partial Nephrectomy Persist Across Hospital Types: Results From a Population-based Cohort. Urology 2015; 90:69-74. [PMID: 26724412 DOI: 10.1016/j.urology.2015.10.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/11/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the national utilization of partial nephrectomy (PN) for T1a renal masses across different racial groups by hospital type. Although clinical guidelines recommend PN for small renal masses (SRMs), racial disparities persist in the use of PN. High-volume and academic hospitals have been associated with greater use of PN for SRMs. However, it is unknown whether racial disparities persist in the use of PN across different types of hospitals. METHODS Using the National Cancer Database, we identified patients with localized T1a renal cancer (≤4 cm) from 1998 to 2011. The primary outcome was receipt of PN among patients surgically treated for SRMs. Multivariable logistic regression analyses were used to assess for racial differences in treatment with PN stratified by hospital characteristics. RESULTS Among 118,207 patients diagnosed with clinical T1a renal masses, 36.5% underwent PN (n = 43,134). Overall, a greater proportion of white patients underwent PN (37.3%) compared with African-American (32.4%) and Hispanic (33.7%) patients with SRMs (P <.001). When stratified by hospital type, disparities persisted in the use of PN; African-American patients had lower adjusted odds ratios for being treated with PN when treated at comprehensive community cancer (odds ratio: 0.90; P = .003) and academic (odds ratio: 0.65; P <.001) hospitals compared with white patients. CONCLUSIONS In this population-based cohort, we found that racial disparities persist across all types of hospitals in the use of PN for SRMs. Further research is needed to identify, and target for intervention, the factors contributing to racial disparities in the surgical management of SRMs.
Collapse
Affiliation(s)
- Jonathan E Kiechle
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH
| | - Robert Abouassaly
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH
| | - Cary P Gross
- Department of Internal Medicine, Yale University, New Haven, CT; Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Shan Dong
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH
| | - Edward E Cherullo
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH
| | - Hui Zhu
- Louis Stokes Veterans Affairs Medical Center, Cleveland, OH; Cleveland Clinic Foundation, Cleveland, OH
| | - Quoc-Dien Trinh
- Division of Urologic Surgery, Harvard Medical School, Boston, MA
| | | | - Neal J Meropol
- University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Christopher J Hoimes
- University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Sarah Ialacci
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH
| | - Simon P Kim
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH; Department of Internal Medicine, Yale University, New Haven, CT.
| |
Collapse
|
23
|
Tabayoyong W, Abouassaly R, Kiechle JE, Cherullo EE, Meropol NJ, Shah ND, Dong S, Thompson RH, Smaldone MC, Zhu H, Ialacci S, Kim SP. Variation in Surgical Margin Status by Surgical Approach among Patients Undergoing Partial Nephrectomy for Small Renal Masses. J Urol 2015; 194:1548-53. [DOI: 10.1016/j.juro.2015.06.076] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2015] [Indexed: 01/20/2023]
Affiliation(s)
- William Tabayoyong
- Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Robert Abouassaly
- Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
- Center for Health Care Quality and Outcomes, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
- Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Jonathan E. Kiechle
- Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Edward E. Cherullo
- Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
- Center for Health Care Quality and Outcomes, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Neal J. Meropol
- Division of Hematology and Oncology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
- Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Nilay D. Shah
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
| | - Shan Dong
- Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | | | - Marc C. Smaldone
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Hui Zhu
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
- Department of Urology, Cleveland Clinic, Cleveland, Ohio
| | - Sarah Ialacci
- Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
- Center for Health Care Quality and Outcomes, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Simon P. Kim
- Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
- Center for Health Care Quality and Outcomes, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
- Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
- Department of Internal Medicine, Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, Connecticut
| |
Collapse
|
24
|
Kiechle JE, Abouassaly R, Smaldone MC, Shah ND, Dong S, Cherullo EE, Nakamoto D, Zhu H, Cooney MM, Kim SP. National Trends of Local Ablative Therapy Among Young Patients With Small Renal Masses in the United States. Urology 2015; 86:962-7. [PMID: 26341571 DOI: 10.1016/j.urology.2015.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess national trends in the usage of local ablative therapy for small renal masses (SRMs) in a cohort of young patients. Ablation of SRMs has been shown to offer cancer control with limited follow-up. Although ablation is considered effective for patients with limited life expectancy, its use among younger patients may be considered controversial. METHODS We used the National Cancer Data Base to identify patients between the ages of 40 and 65 years who were diagnosed with SRMs from 2004 to 2011. The primary outcome was the use of local ablative therapy. Multivariable logistic regression analysis was used to identify patient and hospital factors associated with ablation therapies in this cohort. RESULTS During the study period, we identified 49,441 patients with SRMs, of which 2789 (5.6%) were treated with ablative therapies. The proportion of patients undergoing ablation gradually rose from 2.2% in 2004 to 6.2% in 2011 (P < .001). On multivariable analysis, patients were more likely to receive local ablation at academic hospitals (odds ratio [OR]: 1.5; P < .001) compared with community hospitals, or primarily insured by Medicaid (OR: 1.4; P < .001) or Medicare (OR: 1.3; P < .001) compared with private insurance. CONCLUSION The use of local ablative therapies is gradually rising but has so far been limited to a small fraction of young patients with SRMs. Patients treated at high-volume, academic hospitals or insured with Medicaid or Medicare were treated to a greater degree with ablation. These results have important implications for the adoption of ablation and the need for long-term surveillance.
Collapse
Affiliation(s)
- Jonathan E Kiechle
- Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH
| | - Robert Abouassaly
- Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH; Center for Health Care Quality and Research, University Hospitals Case Medical Center, Cleveland, OH; Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH
| | - Marc C Smaldone
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Nilay D Shah
- Division of Health Policy and Research, Mayo Clinic, Rochester, MN
| | - Shan Dong
- Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH
| | - Edward E Cherullo
- Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH; Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH
| | - Dean Nakamoto
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH; Department of Radiology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH
| | - Hui Zhu
- Louis Stokes Veteran's Affairs Medical Center, Cleveland, OH; Cleveland Clinic Foundation, Cleveland, OH
| | - Matthew M Cooney
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH; Department of Medical Oncology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH
| | - Simon P Kim
- Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH; Center for Health Care Quality and Research, University Hospitals Case Medical Center, Cleveland, OH; Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH.
| |
Collapse
|
25
|
Kiechle JE, Wang E, Yu JB, Gross CP, Abouassaly R, Cherullo EE, Smaldone MC, Shah ND, Trinh QD, Sun M, Kim SP. MP56-06 ASSOCIATION BETWEEN PROVIDER-LEVEL FACTORS AND LYMPH NODE DISSECTION OUTCOMES DURING RADICAL PROSTATECTOMY: A NATIONAL CANCER DATABASE ANALYSIS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2070] [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]
|
26
|
Dong S, Kiechle JE, Kim SP, Abouassaly R, Cherullo EE, Ponsky L, Gross CP, Shah ND, Zhu H. MP44-10 TREATMENT TRENDS OF SMALL RENAL MASSES IN PATIENTS OF ADVANCED AGE. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1552] [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]
|
27
|
Wang EH, Yu JB, Gross CP, Abouassaly R, Cherullo EE, Smaldone MC, Shah ND, Kiechle J, Trinh QD, Sun M, Kim SP. Association between Surgeon and Hospital Characteristics and Lymph Node Counts From Radical Prostatectomy and Pelvic Lymph Node Dissection. Urology 2015; 85:890-5. [DOI: 10.1016/j.urology.2015.01.006] [Citation(s) in RCA: 8] [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: 09/30/2014] [Revised: 12/25/2014] [Accepted: 01/06/2015] [Indexed: 10/23/2022]
|
28
|
Kiechle JE, Wang E, Yu JB, Gross CP, Abouassaly R, Cherullo EE, Smaldone MC, Shah N, Trinh QD, Sun M, Kim SP. Association between provider-level factors and lymph node dissection outcomes during radical prostatectomy: A national cancer database analysis. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.89] [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: 11/20/2022] Open
Abstract
89 Background: Lymph node counts have been proposed as a quality metric for patients undergoing radical prostatectomy (RP) and pelvic lymph node dissection (PLND). It is unclear whether surgical approach and hospital characteristics independently determine the number of lymph nodes removed at PLND. Therefore, we assessed the variation in lymph node counts from a population-based cohort of patients undergoing surgery for intermediate and high-risk prostate cancer. Methods: Using the National Cancer Database, we identified all surgically treated patients diagnosed with pre-treatment intermediate or high-risk prostate cancer from 2010 to 2011. The primary outcome was the number of lymph nodes retrieved at the time of RP. Generalized estimating equations were used to assess for differences in the adjusted number of lymph nodes retrieved after accounting for patient and hospital characteristics and surgical approach. Results: Overall, 35,876 patients were diagnosed with intermediate (61.2%) and high-risk (38.8%) prostate cancer and underwent RP and PLND. On multivariable analysis, open radical prostatectomy (ORP) and high volume and academic hospitals were independently associated with greater lymph node counts compared to robotic-assisted radical prostatectomy (RARP) and medium/low and community hospitals, respectively (all p<0.001). After adjusting for patient and hospital variables, higher adjusted lymph nodes counts were observed for ORP compared to RARP (7.1 vs. 6.1; p<0.001). Adjusted counts were also higher for high volume compared to medium/low volume hospitals (7.8 vs. 5.9; p<0.001), and academic compared to community hospitals (7.3 vs. 5.6; p<0.001). Conclusions: Among patients with aggressive prostate cancer treated with RP and PLND, lymph node counts varied by surgical approach and hospital characteristics.
Collapse
Affiliation(s)
| | - Elyn Wang
- Yale School of Medicine, New Haven, CT
| | | | | | - Robert Abouassaly
- Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
| | | | | | - Nilay Shah
- Mayo Clinic, Rochester, MN, Rochester, MN
| | - Quoc-Dien Trinh
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Maxine Sun
- University of Montréal, Montréal, QC, Canada
| | | |
Collapse
|
29
|
Maurice MJ, Cherullo EE. Urologic stenting-induced trauma: a comprehensive review and case series. Urology 2014; 84:36-41. [PMID: 24745795 DOI: 10.1016/j.urology.2014.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/08/2013] [Accepted: 01/02/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To characterize traumatic injuries secondary to ureteral stent manipulation and analyze factors associated with their occurrence. METHODS We performed a comprehensive retrospective review of the literature and of our institutional records for occurrences of iatrogenic injury because of retrograde ureteral stent procedures. RESULTS Overall, 22 cases were identified, including 3 cases at our institution. Most injuries involved a major artery (52%) or vein (30%), with the remainder (17%) limited to the genitourinary tract. Associated factors included: hydronephrosis, pelvic malignancy, indwelling or chronic ureteral stents, chemoradiation, and urinary diversion. CONCLUSION Ureteral stenting-induced trauma is a rare but potentially life-threatening event. Recognition of the risk factors that predispose patients to iatrogenic stent trauma may help to prevent such injuries or, alternatively, it may facilitate their prompt diagnosis and treatment.
Collapse
Affiliation(s)
- Matthew J Maurice
- Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Edward E Cherullo
- Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
| |
Collapse
|
30
|
Abstract
En bloc removal of the prostate has traditionally been an integral component of radical cystectomy for men with bladder cancer owing to a high incidence of occult prostatic malignancy. However, the risk of functional morbidity following this procedure is considerable and can delay patient acceptance of cystectomy, which can adversely affect the long-term prognosis. Recently, some investigators have advocated prostate-sparing cystectomy (PSCx) to improve postoperative continence and potency rates, and this may also improve timely patient acceptance of cystectomy. Several of these PSCx series describe excellent functional results postoperatively and PSCx may also facilitate a laparoscopic approach, offering further dividends. However, valid concerns regarding the oncologic efficacy of this procedure still predominate and protocols for patient selection, technique and postoperative surveillance are not well defined. The concept of PSCx is arguably one of the most controversial topics in the field of bladder cancer today.
Collapse
Affiliation(s)
- John C Kefer
- Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
| | | | | | | | | |
Collapse
|
31
|
Maurice MJ, Cherullo EE. A novel, nonoperative treatment for delayed penile zipper injury. Am J Emerg Med 2013; 31:419-20. [DOI: 10.1016/j.ajem.2012.08.034] [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] [Received: 08/25/2012] [Revised: 08/28/2012] [Accepted: 08/29/2012] [Indexed: 11/25/2022] Open
|
32
|
Salem S, Ponsky LE, Abouassaly R, Cherullo EE, Isariyawongse JP, MacLennan GT, Nakamoto D, Haaga JR. Image-guided biopsy of small renal masses in the era of ablative therapies. Int J Urol 2012. [DOI: 10.1111/iju.12010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Sepehr Salem
- Urologic Oncology and Minimally Invasive Therapies Center; Urology Institute; University Hospitals Case Medical Center; Cleveland; Ohio; USA
| | - Lee E Ponsky
- Urologic Oncology and Minimally Invasive Therapies Center; Urology Institute; University Hospitals Case Medical Center; Cleveland; Ohio; USA
| | - Robert Abouassaly
- Urologic Oncology and Minimally Invasive Therapies Center; Urology Institute; University Hospitals Case Medical Center; Cleveland; Ohio; USA
| | - Edward E Cherullo
- Urologic Oncology and Minimally Invasive Therapies Center; Urology Institute; University Hospitals Case Medical Center; Cleveland; Ohio; USA
| | - Justin P Isariyawongse
- Urologic Oncology and Minimally Invasive Therapies Center; Urology Institute; University Hospitals Case Medical Center; Cleveland; Ohio; USA
| | - Gregory T MacLennan
- Department of Pathology; Case Western Reserve University School of Medicine; Cleveland; Ohio; USA
| | - Dean Nakamoto
- Department of Radiology; University Hospitals Case Medical Center; Case Western Reserve University School of Medicine; Cleveland; Ohio; USA
| | - John R Haaga
- Department of Radiology; University Hospitals Case Medical Center; Case Western Reserve University School of Medicine; Cleveland; Ohio; USA
| |
Collapse
|
33
|
Bhaskaran N, Shukla S, Ponsky LE, Cherullo EE, Gupta S. Abstract 2569: Lyc-O-Mato causes cell cycle arrest and apoptosis in human bladder transitional carcinoma cells. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-2569] [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: 11/16/2022]
Abstract
Abstract
Approximately two thirds of new bladder cancer cases in the United States are superficial papillary transitional cell carcinoma (TCC), the majority of which are low-grade neoplasms. Data suggest that bladder carcinogenesis is a multi-step, multi-focal (field effect) process, possibly involving the spread of pre-malignant clones-all of which are prerequisites for effective preventive and/or interventional approaches. Epidemiological data suggests an inverse relationship between serum levels of carotenoids and risk of bladder cancer which has encouraged further investigation. In this study, we evaluated the effect of Lyc-O-Mato® (a crude tomato extract containing 10% lycopene and other tomato phytonutrients viz. tocopherols, phytoene, phytofluene, beta-carotene, phospholipids and phytosterols) on human bladder cancer cell growth, cell cycle modulation, induction of apoptosis, and associated molecular alterations. Treatment of bladder cancer cell lines (T-24, high-grade TCC and TCC-SUP, high-grade invasive tumor) with Lyc-O-Mato® at doses of 1-60µM resulted in inhibition of cell growth along with a G1 arrest in T24 cells and G2/M arrest in TCCSUP cells at 24 h post-treatment. In other studies, Lyc-O-Mato® treatment strongly induced the expression of p21/waf1 and p27/kip1, and resulted in a decrease in cyclin-dependent kinases (CDKs) and cyclins involved in G1 and G2/M progression in T24 and TCC SUP cells. Lyc-O-Mato® exposure to these cells showed an increased interaction between cyclin dependent kinase inhibitors (CDKIs)-cyclin-dependent kinases (CDKs) and decrease in the interaction of cyclins and CDKs with their respective stages of the cell cycle. Furthermore, Lyc-O-Mato® treatment significantly reduced the phosphorylation of Retinoblastoma at Serine780, although no significant changes were observed in the total levels of this protein. In additional studies, Lyc-O-Mato® showed a dose- and time-dependent apoptotic death in both T24 and TCC SUP cells which was associated with significant downregulation of survivin along with the enhancement of pro-apoptotic protein, Bax. These observations provide a strong rationale for further evaluating preventive and/or intervention strategies for Lyc-O-Mato® in pre-clinical models of bladder cancer.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2569. doi:1538-7445.AM2012-2569
Collapse
|
34
|
Vykhovanets EV, MacLennan GT, Vykhovanets OV, Cherullo EE, Ponsky LE, Gupta S. Molecular imaging of nuclear factor-κB in bladder as a primary regulator of inflammatory response. J Urol 2012; 187:330-7. [PMID: 22099998 PMCID: PMC3714865 DOI: 10.1016/j.juro.2011.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 03/25/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Nuclear factor-κB activation is implicated in chronic inflammatory disorders and it is a key regulator of genes involved in the response to infection, inflammation and stress. Interstitial cystitis and painful bladder syndrome are common inflammatory disorders of the bladder characterized by frequent urination and bladder pain. The role of nuclear factor-κB activation in bladder inflammation is not well defined. MATERIALS AND METHODS Female transgenic nuclear factor-κB-luciferase Tag mice (The Jackson Laboratory, Bar Harbor, Maine) were used to perform serial, noninvasive in vivo and ex vivo molecular imaging of nuclear factor-κB activation in the whole body after administering arsenic trioxide (5 mg/kg), lipopolysaccharide (2 mg/kg) or cyclophosphamide (Sigma®) (200 mg/kg) to initiate acute transient bladder inflammation. Pretreatment with dexamethasone (Sigma) (10 mg/kg) was used to modulate cyclophosphamide induced nuclear factor-κB dependent luminescence in vivo. RESULTS Treatment of nuclear factor-κB-luciferase Tag mice with chemicals increased luminescence in a time and organ specific manner in vivo and ex vivo. The highest levels of bladder nuclear factor-κB dependent luminescence were observed 4 hours after cyclophosphamide administration. Pretreatment with dexamethasone 1 hour before cyclophosphamide injection significantly down-regulated cyclophosphamide induced bladder nuclear factor-κB dependent luminescence, ameliorated the grossly evident pathological features of acute inflammation and decreased cellular immunostaining for nuclear factor-κB in the bladder. CONCLUSIONS Nuclear factor-κB activity may have an important role in the pathophysiology of bladder inflammation. Nuclear factor-κB-luciferase mice can serve as a useful model in which to screen potential candidate drugs for cystitis associated with aberrant nuclear factor-κB activity. Such screening may significantly aid the development of therapeutic strategies to manage inflammatory bladder disorders.
Collapse
Affiliation(s)
- Eugene V. Vykhovanets
- Department of Urology, Case Western Reserve University & The Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio-44106
| | - Gregory T. MacLennan
- Department of Pathology, Case Western Reserve University & The Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio-44106
| | - Olena V. Vykhovanets
- Department of Urology, Case Western Reserve University & The Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio-44106
| | - Edward E Cherullo
- Department of Urology, Case Western Reserve University & The Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio-44106
| | - Lee E Ponsky
- Department of Urology, Case Western Reserve University & The Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio-44106
| | - Sanjay Gupta
- Department of Urology, Case Western Reserve University & The Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio-44106
| |
Collapse
|
35
|
Vricella GJ, Haaga JR, Adler BL, Dean Nakamoto, Cherullo EE, Flick S, Ponsky LE. Percutaneous Cryoablation of Renal Masses: Impact of Patient Selection and Treatment Parameters on Outcomes. Urology 2011; 77:649-54. [DOI: 10.1016/j.urology.2010.08.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 07/31/2010] [Accepted: 08/14/2010] [Indexed: 11/26/2022]
|
36
|
Vricella GJ, Ross JH, Vourganti S, Cherullo EE. Laparoendoscopic Single-Site Nephrectomy: Initial Clinical Experience in Children. J Endourol 2010; 24:1957-61. [DOI: 10.1089/end.2010.0034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Gino J. Vricella
- Department of Urology, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Jonathan H. Ross
- Department of Urology, University Hospitals Case Medical Center, Cleveland, Ohio
- Division of Pediatric Urology, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Srinivas Vourganti
- Department of Urology, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Edward E. Cherullo
- Department of Urology, University Hospitals Case Medical Center, Cleveland, Ohio
| |
Collapse
|
37
|
Vricella GJ, Boncher NA, Jankowski JT, Ponsky LE, Cherullo EE. Metastatic Renal Cell Carcinoma within a Previous Port-Site following Retroperitoneoscopic Radical Nephrectomy. Curr Urol 2009. [DOI: 10.1159/000253377] [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: 11/19/2022] Open
|
38
|
Sawyer MD, Cherullo EE, Elmunzer BJ, Schomisch S, Ponsky LE. Pure natural orifice translumenal endoscopic surgery partial cystectomy: intravesical transurethral and extravesical transgastric techniques in a porcine model. Urology 2009; 74:1049-53. [PMID: 19758685 DOI: 10.1016/j.urology.2009.03.057] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Revised: 01/17/2009] [Accepted: 03/25/2009] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To describe 2 pure natural orifice translumenal endoscopic surgery (NOTES) techniques for partial cystectomy in a porcine model. NOTES is a new minimally invasive modality for performing abdominal surgery without transcutaneous incision. METHODS Transurethral-A rigid cystoscope is inserted into the porcine bladder with CO(2) insufflation. With an endoscopic loop device and a grasping device, the targeted area of the bladder is manipulated into the loop. The bladder segment is excised with electrocautery. Transgastric-A gastrotomy is made with a dual channel endoscope in the porcine stomach. The endoscope is inserted and pneumoperitoneum is established by insufflation through a channel. After identifying bladder, 2 endoscopic loops are placed at the intended area of resection. An incision is made between the loops to excise the specimen. In both cases, full-thickness specimen is removed en bloc with the scope and the defect is reapproximated with endoscopic clips. RESULTS Transurethral and transgastric NOTES approaches were achieved using standard endoscopic equipment in a porcine model. Transurethral NOTES partial cystectomy was successful in acute (n = 2) and chronic (n = 2) models. The transgastric NOTES approach was successfully performed in an acute animal. CONCLUSIONS NOTES partial cystectomy could potentially reduce morbidity of conventional methods of partial cystectomy. Transurethral NOTES may be the least invasive method possible for partial cystectomy. Potential advantages of a transgastric NOTES approach include visualization of adjacent structures, access to sites difficult to reach transurethrally, and lymph node sampling. However, a gastrotomy could be a source of morbidity. Further investigation is required to assess safety, efficacy, and adequate bladder healing.
Collapse
Affiliation(s)
- Mark D Sawyer
- Department of Urology, Center for Urologic Oncology and Minimally Invasive Therapies, University Hospitals Case Medical Center, Cleveland, Ohio 44106 , USA
| | | | | | | | | |
Collapse
|
39
|
Ponsky LE, Steinway ML, Lengu IJ, Hartke DM, Vourganti S, Cherullo EE. A Pfannenstiel Single-site Nephrectomy and Nephroureterectomy: A Practical Application of Laparoendoscopic Single-site Surgery. Urology 2009; 74:482-5. [DOI: 10.1016/j.urology.2009.06.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 05/23/2009] [Accepted: 06/06/2009] [Indexed: 10/20/2022]
|
40
|
Steinway ML, Lengu IJ, Cherullo EE, Ponsky LE. Laparoendoscopic Single-Site (LESS) Nephrectomy Through a Pfannenstiel Incision: Porcine Model. J Endourol 2009; 23:1293-6. [DOI: 10.1089/end.2009.0091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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)
- Matthew L. Steinway
- Center for Urologic Oncology and Minimally Invasive Therapies, Institute for Surgery and Innovation, Department of Urology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Irma J. Lengu
- Center for Urologic Oncology and Minimally Invasive Therapies, Institute for Surgery and Innovation, Department of Urology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Edward E. Cherullo
- Center for Urologic Oncology and Minimally Invasive Therapies, Institute for Surgery and Innovation, Department of Urology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Lee E. Ponsky
- Center for Urologic Oncology and Minimally Invasive Therapies, Institute for Surgery and Innovation, Department of Urology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
41
|
Lengu IJ, Steinway ML, Sawyer MD, Trunzo JA, Cherullo EE, Ponsky LE. NOTES TRANS-GASTRIC PARTIAL CYSTECTOMY. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61218-0] [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: 10/21/2022]
|
42
|
Lengu IJ, Steinway ML, Trunzo JA, Sawyer MD, Cherullo EE, Ponsky LE. NOTES TRANSGASTRIC PARTIAL CYSTECTOMY. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61694-3] [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: 10/21/2022]
|
43
|
Sawyer MD, Cherullo EE, von Gruenigen VE, Ponsky LE. RIGID CYSTOSCOPE PLATFORM FOR NOTES & SUB-CENTIMETER LESS IN A PORCINE MODEL. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61221-0] [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: 11/25/2022]
|
44
|
Isariyawongse JP, McGee MF, Rosen MJ, Cherullo EE, Ponsky LE. Pure natural orifice transluminal endoscopic surgery (NOTES) nephrectomy using standard laparoscopic instruments in the porcine model. J Endourol 2008; 22:1087-91. [PMID: 18419337 DOI: 10.1089/end.2007.0404] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an emerging technology that uses endoscopic instruments passed into the peritoneal cavity through hollow viscera to perform surgical procedures without the use of abdominal incisions. There are, however, limitations regarding the equipment available to simulate traditional surgery. The aim of this study was to determine the feasibility of a pure NOTES nephrectomy by using standard laparoscopic instruments through a modified transvaginal trocar. MATERIALS AND METHODS One 40-kg female swine underwent transgastric peritoneoscopy. Transgastric endoscopic visualization guided the introduction of a second transvaginal endoscope through a novel laparoscopic trocar/endoscopic overtube device. The retroflexed transgastric endoscope provided triangulated visualization as standard endoscopic instruments provided retraction, which allowed dissection of the kidney with standard laparoscopic instruments through our modified transvaginal trocar device. Each renal hilum, artery, vein, and ureter was dissected and divided with a transvaginal laparoscopic stapler. RESULTS Transgastric and transvaginal NOTES accesses were easily achieved, and bilateral nephrectomies were performed. Completion of peritoneoscopy revealed complete hemostasis and identification of ligated ureters and hilar vessels. Total operative time was 40 and 20 minutes for the right and left kidney, respectively. One kidney was captured with a laparoscopic retrieval sac and removed intact through the vaginal defect. CONCLUSIONS Pure NOTES nephrectomies are technically feasible in the porcine model by using standard laparoscopic instruments. Survival studies are necessary to determine the long-term complications and physiologic implications of NOTES nephrectomy. The development of innovative NOTES access trocars may allow for an increased armamentarium of NOTES instruments.
Collapse
Affiliation(s)
- Justin P Isariyawongse
- Center for Urologic Oncology & Minimally Invasive Therapies, Department of Urology, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA
| | | | | | | | | |
Collapse
|
45
|
Ponsky LE, Cherullo EE, Sawyer M, Hartke D. Single access site laparoscopic radical nephrectomy: initial clinical experience. J Endourol 2008; 22:663-6. [PMID: 18324901 DOI: 10.1089/end.2007.0427] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We present the initial clinical experience with single access site (SAS) laparoscopic radical nephrectomy. MATERIALS AND METHODS An 86-year-old woman presented with an 8-cm central-enhancing right renal lesion. The patient elected to undergo a laparoscopic radical nephrectomy. A 7-cm paramedian incision was made just lateral to the left rectus muscle and cranial to the umbilicus. A GelPort was inserted into the incision. Three trocars (12 mm, 10 mm, and 5 mm) were placed through the access port, and only standard laparoscopic instruments were used. The kidney was mobilized in the standard fashion. Controlling the renal artery with nonabsorbable polymer clips and the renal vein with a stapling device, the specimen was manipulated into a laparoscopic retrieval bag and removed intact. Hemostasis was confirmed, the GelPort was removed, and the 7-cm incision was closed. RESULTS The procedure was completed in 96 minutes without complications. Blood loss was estimated to be 10 mL. Postoperatively, the patient was treated with intermittent intravenous and oral analgesics. She was discharged on postoperative day 2 and tolerated a regular diet. CONCLUSION This represents the initial report of an SAS laparoscopic radical nephrectomy, with intact specimen extraction. Using standard laparoscopic instrumentation, the procedure was performed safely and effectively, with minimal blood loss, and short hospitalization. Additional evaluation and development of this type of approach and instrumentation may allow for further expansion of SAS laparoscopic surgery in the future.
Collapse
Affiliation(s)
- Lee E Ponsky
- Center for Urologic Oncology and Minimally Invasive Therapies, Department of Urology, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA.
| | | | | | | |
Collapse
|
46
|
Sawyer MD, Ponsky LE, Isariyawongse JP, McGee MF, Cherullo EE. NOTES NEPHRECTOMY: TECHNICAL CONSIDERATIONS OF COMBINED TRANSVAGINAL AND TRANSGASTRIC NEPHRECTOMY. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60449-8] [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: 10/22/2022]
|
47
|
Abstract
PURPOSE We evaluate the feasibility of applying minimally invasive techniques for fetal vesicostomy. We also evaluate whether transuterine fetal vesicostomy can be performed laparoscopically. MATERIALS AND METHODS A total of 25 pregnant ewes were time dated at approximately 90 days of gestation. With the animals under general anesthesia a low open abdominal incision was made and the uterus was brought out through the incision. With a 14 gauge needle the amniotic sac was filled with 1 to 2 l warm glycine. Three to 4, 5/12 blunt tip balloon trocars were placed in the uterus. Using laparoscopic techniques, a low transverse incision was made in the fetal abdomen, the bladder was opened at the dome and 2 running sutures were placed approximating the fetal abdominal wall to the edge of the fetal bladder. The trocar sites in the uterus were closed, and the maternal abdominal incision was closed. RESULTS Of the 25 pregnant ewes the technique was developed in the initial 15. In the subsequent 10 animals the complete procedure was accomplished successfully. Following these 10 procedures 5 abortions occurred on postoperative day 2, and there was 1 intrauterine fetal demise. Three fetuses were alive and delivered by cesarean section on postoperative days 10, 30 and 31. In the first fetus in which we used an interrupted suture for the vesicostomy a large hernia was noted at the vesicostomy site. The other 2 fetuses had a patent, well healed vesicostomy and were alive at cesarean section delivery on postoperative days 10 and 31. The last fetus was allowed to deliver at term by standard vaginal delivery. The fetus was alive and well, and the vesicostomy had strictured down to a pinhole in size, which was not unexpected as it was not an obstructed model. CONCLUSIONS Although technically challenging, transuterine laparoscopic fetal vesicostomy is technically feasible in the ewe model. Continued evaluation of this technique should include intensive fetal monitoring and the use of tocolytics to decrease the incidence of spontaneous abortion.
Collapse
Affiliation(s)
- Lee E Ponsky
- Section of Laparoscopic and Minimally Invasive Surgery and Pediatric Urology, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
| | | | | | | |
Collapse
|
48
|
Abstract
PURPOSE Ureterocalicostomy is a reconstructive option in the rare patient with surgically failed or difficult ureteropelvic junction (UPJ) obstruction with fibrosis and significant hydronephrosis. We introduce the technique of laparoscopic ureterocalicostomy. MATERIALS AND METHODS Laparoscopic ureterocalicostomy was performed in 2 patients, of whom 1 had UPJ obstruction and multiple secondary calculi in a dilated, dependent lower pole calix, and 1 had surgically failed UPJ obstruction with a scarred pelvis and significant hydronephrosis. Using a transperitoneal technique the UPJ was dismembered and suture ligated, the cut end of the ureter was spatulated, the attenuated lower pole renal parenchyma was amputated and mucosa-to-mucosa ureterocaliceal anastomosis was performed with running 4-zero absorbable suture over a stent. In the first case 32 renal calculi were also removed using a combination of laparoscopic nephroscopy and intraoperative ultrasonography. RESULTS In cases 1 and 2 operative time was 5.2 and 2.5 hours, estimated blood loss was 200 and 75 cc, and hospital stay was 2 days, respectively. There were no intraoperative complications. The stent was removed at 8 and 5 weeks, respectively. Postoperative retrograde pyelogram and diuretic renal scan confirmed anastomotic patency and improved drainage in each patient. At 9 months patient 1 remains without flank symptoms and a second renal scan at 6 months showed further improvement in drainage. Patient 2, who continued to be symptomatic with flank discomfort despite objective improvement in drainage parameters, elected secondary nephrectomy at 6 months. CONCLUSIONS Laparoscopic ureterocalicostomy is feasible and it effectively duplicates established open surgical principles. To our knowledge the initial experience in the literature is presented.
Collapse
Affiliation(s)
- Inderbir S Gill
- Section of Laparoscopic and Minimally Invasive Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
| | | | | | | | | | | | | |
Collapse
|
49
|
Ponsky LE, Cherullo EE, Banks KLW, Greenstein M, Streem SB, Klein EA, Zippe CD. Laparoscopic radical nephrectomy: incorporating advantages of hand assisted and standard laparoscopy. J Urol 2003; 169:2053-6. [PMID: 12771717 DOI: 10.1097/01.ju.0000065238.06490.8a] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [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: 11/25/2022]
Abstract
PURPOSE We present an approach to laparoscopic radical nephrectomy and intact specimen extraction, which incorporates hand assisted and standard laparoscopic techniques. MATERIALS AND METHODS A refined approach to laparoscopic radical nephrectomy is described and our experience is reviewed. A low, muscle splitting Gibson incision is made just lateral to the rectus muscle and the hand port is inserted. A trocar is placed through the hand port and pneumoperitoneum is established. With the laparoscope in the hand port trocar 2 additional trocars are placed under direct vision. The laparoscope is then repositioned through the middle trocar and standard laparoscopic instruments are used through the other 2 trocars including the one in the hand port. If at any time during the procedure the surgeon believes the hand would be useful or needed, the trocar is removed from the hand port and the hand is inserted. RESULTS This approach has been applied to 7 patients. Mean estimated blood loss was 200 cc (range 50 to 300) and mean operative time was 276.7 minutes (range 247 to 360). Mean specimen weight was 767 gm. (range 538 to 1,170). Pathologically 6 specimens were renal cell carcinoma (grades 2 to 4) and 1 was oncocytoma. Mean length of hospital stay was 3.71 days (range 2 to 7). There were no major complications. CONCLUSIONS We believe that this approach enables the surgeon to incorporate the advantages of the hand assisted and standard laparoscopic approaches.
Collapse
Affiliation(s)
- Lee E Ponsky
- The Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
PURPOSE Ureterocalicostomy is occasionally indicated for reconstruction of recurrent, recalcitrant ureteropelvic junction obstruction associated with postoperative fibrosis and a relatively inaccessible renal pelvis. We investigated the feasibility of performing laparoscopic ureterocalicostomy in a survival porcine model. Anatomical, histological and chronic functional outcomes were evaluated. MATERIALS AND METHODS Laparoscopic ureterocalicostomy was performed in 10 survival female swine. A ureteropelvic junction obstruction model was created by laparoscopic ligation of a 2 to 3 cm. segment of upper ureter. After an interval of complete ureteropelvic junction obstruction laparoscopic ureterocalicostomy was performed in a manner duplicating the steps of conventional open surgery. After transverse amputation of the lower renal pole end-to-end anastomosis of the proximal ureter to the inferior calix was formed by laparoscopic freehand suturing and knot-tying techniques. RESULTS Mean ureter stricture length was 2.2 cm. (range 1.7 to 3.1). Mean duration of obstruction before laparoscopic ureterocalicostomy was 6.3 days (range 2 to 18). Mean operative time for laparoscopic ureterocalicostomy was 165.3 minutes (range 105 to 240). Mean estimated blood loss was 145 cc (range 25 to 400). Mean stent duration in 6 pigs was 8.7 days (range 7 to 11). Excretory urograms demonstrated immediate function with symmetrical and unobstructed drainage in all operated renal units. At 4 to 8 weeks of followup no urine leaks were noted and histological examination documented complete urothelial healing without fibrosis or scar formation. CONCLUSIONS Laparoscopic ureterocalicostomy is technically feasible in the porcine model and it effectively duplicates the established principles of open surgery. Our technique further extends the application of laparoscopic surgery for difficult ureteropelvic junction obstruction.
Collapse
Affiliation(s)
- Edward E Cherullo
- Section of Laparoscopic and Minimally Invasive Surgery, Glickman Urological Institute and Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | | | | | | | | | | |
Collapse
|