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Collins PM, Mcloughlin LS, Kennedy AM, Connolly S, Galvin D, O’Malley KJ, Hegarty N, Nason GJ. Primary ureteroscopy for obstructing ureteric calculi: outcome data from a tertiary centre. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00975-2] [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: 10/14/2022] Open
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Hughes NC, Collins PM, Power J, Soman N, Souza MD, McGarvey C, Cronin C, Murray J, McNicholas M, Connolly SS, Hegarty N, Nason GJ, Galvin D, O’Malley KJ. The end of TRUS: Insights from a departmental transition to transperineal prostate biopsy under local anaesthesia. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00902-8] [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: 11/28/2022] Open
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Nason GJ, Hamilton RJ. Robotic RPLND for stage IIA/B nonseminoma: the Princess Margaret Experience. World J Urol 2022; 40:335-342. [PMID: 34988650 DOI: 10.1007/s00345-021-03899-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/17/2021] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Retroperitoneal lymph node dissection (RPLND) is a treatment option for men in a primary and post-chemotherapy setting. The aim of this review was to explore the published data looking at feasibility, safety and outcomes of robotic RPLND for CSI/II NSGCT but we will in particular highlight how we have approached adoption of robotic RPLND at the Princess Margaret. METHODS A review and summary of the published data to date was performed regarding the role of robotic RPLND for stage IIA/B nonseminoma. RESULTS Published series of robotic RPLND to date have proven feasibility and safety in experienced centres. Less blood loss, shorter length of stay and decreased morbidity are promising findings. Our data from Princess Margaret strengthen the argument of oncologic efficacy as we operated only on patients with known retroperitoneal disease (Stage at RPLND was IIA (n = 15, 55.6%), IIB (n = 9, 33.3%), IIC (n = 1, 3.7%) and III (n = 2, 7.4%)), did not use adjuvant chemotherapy and found a relapse rate (11%) similar to open RPLND. CONCLUSIONS The debate is ongoing regarding the role of robotic RPLND- the excellent oncological outcomes achieved by an open RPLND are the minimum starting point for robotic RPLND. Until such time that robotic RPLND is proven to be gold standard it should be performed in experienced centres by high volume RPLND surgeons and in the setting of a protocol.
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Affiliation(s)
- G J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue - Suite - 3-130, Toronto, ON, M5G 2M9, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue - Suite - 3-130, Toronto, ON, M5G 2M9, Canada.
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Abou-Chedid W, Nason GJ, Evans AT, Yamada K, Moschonas D, Patil K, Langely SE, Perry MJ. The impact of COVID-19 on surgical volume and surgical training at a high-volume pelvic oncology centre. Urologia 2021; 89:495-499. [PMID: 34877900 DOI: 10.1177/03915603211062827] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The coronavirus (COVID-19) pandemic has overwhelmed most health services. As a result, many surgeries have been deferred and diagnoses delayed. The aim of this study was to assess the effect of the COVID-19 pandemic at a high-volume pelvic oncology centre. METHODS A retrospective review was performed of clinical activity from 2017 to 2020. We compared caseload for index procedures 2017-2019 (period 1) versus 2020 (period 2) to see the effect of the COVID pandemic. We then compared the activity during the first lockdown (March 23rd) to the rest of the year when we increased our theatre access by utilising a 'clean' site. RESULTS The average annual number of robotic assisted radical cystectomy (RARC) and robotic assisted radical prostatectomy (RARP) performed during period 1 was 82 and 352 respectively. This reduced to 68 (17.1% reduction) and 262 (25.6% reduction) during period 2. The number of patients who underwent prostate brachytherapy decreased from 308 to 243 (21% reduction). The number of prostate biopsies decreased from 420 to 234 (44.3% reduction). The number of radical orchidectomies decreased from 18 to 11 (39% reduction). The mean number of RARC and RARP per month during period 2 was 5.5 and 22. This decreased to 4 and 9 per month during the first national lockdown but was maintained thereafter despite two further lockdowns. CONCLUSION There has been a substantial decrease in urological oncology caseload during the COVID pandemic. The use of alternate pathways such as 'clean' sites can ensure continuity of care for cancer surgery and training needs.
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Affiliation(s)
| | - Gregory J Nason
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Andrew T Evans
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Kohei Yamada
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | | | - Krishna Patil
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Stephen E Langely
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Matthew Ja Perry
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Khaled Ajib
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Guan-Hee Tan
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Girish S Kulkarni
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Nason GJ, Ajib K, Tan GH, Woon DTS, Christakis GT, Nam RK. Radical nephrectomy with resection of vena cava thrombus using extracorporeal circulation and deep hypothermic circulatory arrest. Can Urol Assoc J 2020; 15:E199-E204. [PMID: 33007182 DOI: 10.5489/cuaj.6736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Patients with renal cell carcinoma (RCC) with level 3 or 4 caval thrombus have a poor prognosis, with reported five-year survival rates of 30-40%. The aim of this study was to assess the perioperative morbidity and long-term oncological outcomes for radical nephrectomy with resection of vena cava thrombus using a combined surgical approach, including extracorporeal circulation and deep hypothermic circulatory arrest. METHODS A retrospective review was performed of the institutional case log to identify all radical nephrectomies with caval thrombus performed from January 2006 to May 2020. RESULTS Twenty-five patients were identified with level 2 thrombus in one (4%), level 3 thrombus in eight (32%), and level 4 in 16 (64%). The median followup was 20.6 months (range 0.2-133.3). The median age at surgery was 68.4 years (range 44.2-85.5). Twenty-one (84%) patients were symptomatic at presentation. Six (24%) patients had distant metastases at diagnosis. The median circulatory arrest time was 15 minutes (range 6-35). The 30-day grade ≥3 complication rate was 8%. The 30-day mortality rate was 8%. The one-year, two-year, three-year, and five-year recurrence-free survival (RFS) rates were 53%, 18%, 10%, and 10%, respectively. The median time to systemic treatment was 7.7 months (range 1.2-25.7). The one-year, two-year, three-year, and five-year overall survival (OS) rates were 70%, 43%, 36%, and 31%, respectively. CONCLUSIONS Radical nephrectomy with resection of vena cava thrombus using extracorporeal circulation and deep hypothermic circulatory arrest is associated with some morbidity and mortality but remains a safe and effective strategy for advanced RCC patients who would otherwise be managed palliatively.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Khaled Ajib
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Guan Hee Tan
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Dixon T S Woon
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - George T Christakis
- Division of Cardiac Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Robert K Nam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
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Nason GJ, Wood LA, Huddart RA, Albers P, Rendon RA, Einhorn LH, Nichols CR, Kollmannsberger C, Anson-Cartwright L, Sweet J, Warde P, Jewett MA, Chung P, Bedard PL, Hansen AR, Hamilton RJ. A Canadian approach to the regionalization of testis cancer: A review. Can Urol Assoc J 2020; 14:346-351. [PMID: 32432537 PMCID: PMC7716843 DOI: 10.5489/cuaj.6268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
At the Canadian Testis Cancer Workshop, the rationale and feasibility of regionalization of testis cancer care were discussed. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician's assistants, residents and fellows, and nurses, as well as patients and patient advocacy groups.This review summarizes the discussion and recommendations of one of the central topics of the workshop - the centralization of testis cancer in Canada. It was acknowledged that non-guideline-concordant care in testis cancer occurs frequently, in the range of 18-30%. The National Health Service in the U.K. stipulates various testis cancer care modalities be delivered through supra-regional network. All cases are reviewed at a multidisciplinary team meeting and aspects of care can be delivered locally through the network. In Germany, no such network exists, but an insurance-supported online second opinion network was developed that currently achieves expert case review in over 30% of cases. There are clear benefits to regionalization in terms of survival, treatment morbidity, and cost. There was agreement at the workshop that a structured pathway for diagnosis and treatment of testis cancer patients is required.Regionalization may be challenging in Canada because of geography; independent administration of healthcare by each province; physicians fearing loss of autonomy and revenue; patient unwillingness to travel long distances from home; and the inability of the larger centers to handle the ensuing increase in volume. We feel the first step is to identify the key performance indicators and quality metrics to track the quality of care received. After identifying these metrics, implementation of a "networks of excellence" model, similar to that seen in sarcoma care in Ontario, could be effective, coupled with increased use of health technology, such as virtual clinics and telemedicine.
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Affiliation(s)
- Gregory J. Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lori A. Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Robert A. Huddart
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Peter Albers
- Department of Urology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany
| | | | - Lawrence H. Einhorn
- Department of Oncology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Craig R. Nichols
- Testicular Cancer Multidisciplinary Clinic, Virginia Mason Medical Center, Seattle, WA, United States
| | - Christian Kollmannsberger
- British Columbia Cancer Agency Vancouver Cancer Center, University of British Columbia, Vancouver, BC, Canada
| | - Lynn Anson-Cartwright
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Joan Sweet
- Department of Pathology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael A.S. Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Philippe L. Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Aaron R. Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J. Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Nason GJ, Rendon RA, Wood L, Huddart RA, Albers P, Einhorn LH, Nichols CR, Kollmannsberger C, Anson-Cartwright L, Warde P, Jewett MAS, Chung P, Bedard PL, Hansen AR, Hamilton RJ. Clinical dilemmas in local and regional testis cancer. Can Urol Assoc J 2020; 15:E58-E64. [PMID: 33007187 DOI: 10.5489/cuaj.6913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
At the Canadian Testis Cancer Workshop, the multidisciplinary management of testis cancer care was discussed. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician's assistants, residents, fellows, nurses, patients, and patient advocacy group members.This review summarizes the discussion regarding clinical dilemmas in local and regional testis cancer. We present cases that highlight the need for a coordinated approach to individualize care. Overarching themes include the importance of a multidisciplinary approach to testis cancer, willingness to involve a high-volume experienced center, and given that the oncological outcomes are excellent, a reminder that clinical decisions need to prioritize selecting a strategy with the least treatment-related morbidity when safe.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Robert A Huddart
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Peter Albers
- Department of Urology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany
| | - Lawrence H Einhorn
- Department of Oncology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Craig R Nichols
- Testicular Cancer Multidisciplinary Clinic, Virginia Mason Medical Center, Seattle, WA, United States
| | - Christian Kollmannsberger
- British Columbia Cancer Agency Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada
| | - Lynn Anson-Cartwright
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Nason GJ, Jewett MAS, Bostrom PJ, Goldberg H, Hansen AR, Bedard PL, Sturgeon J, Warde P, Chung P, Anson-Cartwright L, Sweet J, Atenafu EG, O'Malley M, Hamilton RJ. Long-term Surveillance of Patients with Complete Response Following Chemotherapy for Metastatic Nonseminomatous Germ Cell Tumor. Eur Urol Oncol 2020; 4:289-296. [PMID: 32907779 DOI: 10.1016/j.euo.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 07/13/2020] [Accepted: 08/18/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is controversy regarding the management of patients with normal markers and residual masses (≤1 cm) after chemotherapy for nonseminomatous germ cell tumors (NSGCTs). OBJECTIVE To determine long-term outcomes of a surveillance strategy in such patients. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of our multidisciplinary testicular cancer database was performed. All patients who underwent primary chemotherapy for metastatic NSGCTs were identified between 1981 and 2016. A complete response (CR) was defined as normalization of serum tumor markers and a ≤1 cm residual mass in the largest axial dimension following chemotherapy. All such patients were surveilled. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcome variables of interest were time to death, time to cancer-specific survival, and time to relapse. Overall survival and relapse-free survival were calculated using the Kaplan-Meier method, and the cumulative incidence of cause-specific survival rates was calculated using competing risk analysis. The impact of risk group and chemotherapy regimen on relapse-free survival was assessed using log-rank test. RESULTS AND LIMITATIONS During the study period, 1429 metastatic germ cell tumor patients were treated with primary chemotherapy. CR was achieved in 191 (18.5%) NSGCT patients. The median age at diagnosis was 27.4 yr, with a median follow-up of 81.1 mo. The majority had American Joint Committee on Cancer stage II at diagnosis (I: 23.8%; II: 49.2%; III: 27%) and International Germ Cell Cancer Collaborative Group good-risk disease (good: 78%; intermediate: 17.8%; poor: 4.2%). Of the 191 patients with a CR, 175 (91.6%) never relapsed and remain disease free. Sixteen (8.4%) patients relapsed after a median of 11.3 mo (range 1-332 mo), with over half (nine patients; 4.7%) relapsing in the retroperitoneum only and salvaged successfully with postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) alone. Of these nine patients, only two (1%) had viable disease in the PC-RPLND specimen. The remaining seven patients had relapses outside the retroperitoneum and received salvage chemotherapy ± postchemotherapy resection. Overall, nine (4.7%) patients have died, but only four (2.1%) from testis cancer. CONCLUSIONS Our data, the largest series to date, confirm that surveillance is safe and effective for men who achieve a CR following chemotherapy for metastatic NSGCTs. PATIENT SUMMARY Surveillance is a safe strategy for patients who achieve a complete response following chemotherapy for metastatic testis cancer.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter J Bostrom
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Hanan Goldberg
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jeremy Sturgeon
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lynn Anson-Cartwright
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Joan Sweet
- Department of Pathology and Lab Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Martin O'Malley
- Division of Abdominal Imaging, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada.
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Nason GJ, Kim JK, HeeTan G, Ajib K, Nam RK. Single-night stay for open radical prostatectomy. Can Urol Assoc J 2020; 15:E130-E134. [PMID: 32807288 DOI: 10.5489/cuaj.6600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to assess the effect of an enhanced care pathway on length of stay (LOS) for open radical prostatectomy (RP) given that robotic-assisted laparoscopic prostatectomy (RALP) is not available to all patients in Canada. METHODS A retrospective review was conducted of all RPs performed. An enhanced care pathway was established for RPs in 2011. Patients were compared in the period before (2005-2010) and after (2011-2019) the introduction of the pathway. RESULTS During the study period, 581 RPs were performed by a single surgeon with a median followup of 66.9 months (range 3-176). A total of 211 (36.3%) RPs were performed from 2005-2010, while 370 (63.9%) were performed from 2011-2019. The median age at RP was 65 years (range 44-81). Following the introduction of an enhanced care pathway, there were significant decreases in intraoperative blood loss (350 ml vs. 200 ml; p=0.0001) and the use of surgical drains (90% vs. 9.5%; p=0.0001). The median LOS over the whole study period was one day (range 1-7), which significantly decreased with the enhanced care pathway (3 vs. 1 day; p=0.0001). Since introducing the enhanced care pathway in 2011, 344 (93%) patients were discharged day 1 following surgery. There were no differences in post-discharge presentations to the emergency department (5.7% vs. 9%; p=0.15) or 30-day readmission rates (3.8% vs. 3.8%; p=1.00). CONCLUSIONS A single-night stay for open RP is safe and achievable for most patients. A dedicated, multifaceted pathway is required to attain targets for a safe and timely discharge.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto ON, Canada
| | - Justin K Kim
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto ON, Canada
| | - Guan HeeTan
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto ON, Canada
| | - Khaled Ajib
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto ON, Canada
| | - Robert K Nam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto ON, Canada
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Matta R, Hird AE, Dvorani E, Saskin R, Nason GJ, Kulkarni G, Kodama RT, Herschorn S, Nam RK. Rates of primary and secondary treatments for patients on active surveillance for localized prostate cancer-A population-based cohort study. Cancer Med 2020; 9:6946-6953. [PMID: 32757442 PMCID: PMC7541139 DOI: 10.1002/cam4.3341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/21/2020] [Accepted: 07/03/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The rate of primary and secondary treatment while on active surveillance (AS) for localized prostate cancer at the general population level is unknown. Our objective was to determine the patterns of secondary treatments after primary surgery or radiation for patients who undergo AS. METHODS This was a population-based retrospective cohort study of men aged 50-80 years old in Ontario, Canada, between 2008 and 2016. We identified 26 742 patients with prostate cancer, a Gleason grade score ≤7, and an index prostate-specific antigen ≤10 ng/mL. Patients were categorized as undergoing AS with or without delayed primary treatment (DT; treatment >6 months after diagnosis) versus immediate treatment (IT; treatment ≤6 months). Patients receiving DT and IT were propensity score matched and the rate of secondary treatment (surgery or radiation ± androgen deprivation treatment) was compared using Cox proportional hazards models. RESULTS We identified 10 214 patients who underwent AS and 11 884 patients who underwent IT. Among patients undergoing AS, 3724 (36.5%) eventually underwent DT and among them, 406 (10.9%) underwent secondary treatment. The median time to DT was 1.2 years (IQR 0.5-8.1 years). The relative rate of undergoing secondary treatment was similar in the DT vs IT group (HR 0.92; 95% CI: 0.79-1.08). The risk of death in the DT group was higher compared to patients who did not undergo treatment (HR 1.23, 95% CI: 1.01-1.49). CONCLUSIONS Among patients with localized prostate cancer on AS, one third undergo DT. The rate of secondary treatment was similar between the DT and IT groups. Patients in the DT group may experience a higher risk of mortality compared to those who remained on AS.
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Affiliation(s)
- Rano Matta
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Amanda E Hird
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Erind Dvorani
- Institute of Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada
| | - Refik Saskin
- Institute of Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada
| | - Gregory J Nason
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Girish Kulkarni
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ronald T Kodama
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sender Herschorn
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Robert K Nam
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Nason GJ, Morris J, Bhatt JR, Richard PO, Martin L, Ajib K, Tan GH, Jewett MAS, Jhaveri K, Zlotta AR, Lee JY, Perlis N, Hamilton RJ, Finelli A. Natural History of Renal Angiomyolipoma Favors Surveillance as an Initial Approach. Eur Urol Focus 2020; 7:582-588. [PMID: 32636160 DOI: 10.1016/j.euf.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/24/2020] [Accepted: 06/04/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Traditionally, intervention was recommended for angiomyolipomas (AMLs) >4 cm due to the risk of catastrophic hemorrhage. OBJECTIVE To delineate the natural history of AMLs, including growth rates and need for intervention. DESIGN, SETTING, AND PARTICIPANTS A retrospective review was performed of an AML series from 2002 to 2013, which have been followed prospectively until 2018. We defined lesion size by maximum axial diameter and categorized lesion size at baseline. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A total of 458 patients with 593 AMLs, with a median follow-up of 65.2 mo, were identified. At diagnosis, 534 (90.1%) lesions were ≤4 cm. Forty-three interventions were required for 34 (5.7%) AMLs: 30 were treated with embolization, seven surgery, two with radiofrequency ablation (RFA), three with mammalian target of rapamycin (mTOR) inhibitors, and one with nivolumab when epithelioid AML was confirmed. The median size at intervention was 4.9 cm (range 1.1-29 cm). RESULTS AND LIMITATIONS Most (94%) of the lesions grew slowly (growth rate of <0.25 cm/yr) during the period of observation. The number of AMLs <4 cm needed to treat (NNT) prophylactically to prevent one emergent bleed would have been 136 or that to prevent one blood transfusion would have been 205. The NNT (<4 cm) prophylactically to prevent one elective intervention would have been 82. On multivariate analysis, there were significant differences in intervention rates based on tuberous sclerosis complex, size at presentation, and clinical presentation. CONCLUSIONS This large single-institution updated series of renal AMLs demonstrates that early intervention is not required, regardless of the traditional 4 cm cut-off. The vast majority of AMLs are indolent lesions that are predominantly asymptomatic and slow growing. Follow-up should be no more frequent than annually. PATIENT SUMMARY The majority of angiomyolipomas (AMLs) are indolent, slow-growing lesions that do not require intervention, regardless of size at presentation. We suggest that surveillance is a safe initial approach for patients presenting with AMLs.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Jonathan Morris
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Jaimin R Bhatt
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada; Department of Urology, University Hospital Ayr, Ayr, Scotland, UK
| | - Patrick O Richard
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada; Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Lisa Martin
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Khaled Ajib
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Guan Hee Tan
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Kartik Jhaveri
- Division of Abdominal Imaging, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Jason Y Lee
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada.
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Ajib K, Tjong MC, Tan GH, Nason GJ, Berjaoui MB, Erlich A, Maganti M, Sridhar SS, Fleshner NE, Zlotta AR, Catton C, Berlin A, Chung P, Kulkarni GS. Canadian experience of neoadjuvant chemotherapy on bladder recurrences in patients managed with trimodal therapy for muscle-invasive bladder cancer. Can Urol Assoc J 2020; 14:404-410. [PMID: 32569566 DOI: 10.5489/cuaj.6459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Bladder preservation with trimodal therapy (TMT) has emerged as a feasible alternative to radical cystectomy in patients with muscle-invasive bladder cancer. Neoadjuvant chemotherapy (NAC) was proven to cause pathological downstaging. For this reason, we evaluated whether receipt of NAC decreases local bladder recurrences in TMT patients. METHODS We retrospectively analyzed our TMT database for all patients treated between 2003 and 2017. Patients were treated with maximal transurethral resection of bladder tumor (TURBT) followed by chemotherapy/radiotherapy with or without NAC. Baseline demographic and tumor characteristics were recorded. Rates of local and systemic recurrence were analyzed per receipt of NAC. Overall recurrence-free survival (RFS) and bladder (b)RFS were analyzed using the Kaplan-Meier method and Cox proportional hazards modelling. RESULTS Median age and followup periods were 72 years and 3.6 years, respectively. Fifty-four patients had NAC and concurrent chemoradiation (NAC-TMT) vs. 70 patients who had concurrent chemoradiation only (TMT). Carcinoma in situ (CIS) was present in 31% of the patients in NAC-TMT group compared to 24% in TMT group (p=0.40). After treatment, 24 (44%) and 31 (44%) patients in NAC-TMT and TMT groups, respectively, had bladder tumor recurrence. Overall RFS at three years was 46% and 50% in NAC-TMT and TMT groups, respectively (p=0.70). BRFS at three years was 55% and 69% in NAC-TMT and TMT groups, respectively (p=0.27). Multivariable analyses found that the presence of concomitant CIS (hazard ratio [HR] 2.13; 95% confidence interval CI 1.06-4.27; p=0.0036) was the primary factor associated with local bladder recurrence. CONCLUSIONS Receipt of NAC does not obviate the risk of bladder recurrence post-TMT. Patients with CIS should be monitored especially closely for local recurrence.
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Affiliation(s)
- Khaled Ajib
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michael C Tjong
- Department of Radiation Oncology of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Guan Hee Tan
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gregory J Nason
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mohamad Baker Berjaoui
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Annette Erlich
- Division of Urology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Manjula Maganti
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Srikala S Sridhar
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Neil E Fleshner
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alexandre R Zlotta
- Division of Urology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Charles Catton
- Department of Radiation Oncology of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Girish S Kulkarni
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Nason GJ, Sweet J, Landoni L, Leao R, Anson-Cartwright L, Mok S, Guzylak V, D'Angelo A, Fang ZY, Geist I, Warde P, Jewett MAS, Hamilton RJ. Discrepancy in pathology reports upon second review of radical orchiectomy specimens for testicular germ cell tumors. Can Urol Assoc J 2020; 14:411-415. [PMID: 32574142 DOI: 10.5489/cuaj.6481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We sought to evaluate the discrepancies between primary pathology report and second pathology review of radical orchiectomy (RO) specimens. METHODS A retrospective review was performed of RO specimens from the Ontario Cancer Registry. All cases required both a primary pathology report and a second pathology review from another institution. Histopathological variables assessed included histological subtype and components of mixed germ cell tumor (GCT), pathological tumor (pT) stage, lymphovascular invasion (LVI), spermatic cord invasion, and surgical margin. RESULTS Between 1994 and 2015, 5048 ROs were performed with 2719 (53.9%) seminoma and 2029 (40.2%) non-seminoma. Of these, 519 (10.3%) received a second pathology review. There was concordance between primary pathology report and second pathology review in 326 (62.8%) cases. The most common discrepancies involved a change in pT stage (n=148, 28.5%), with upstaging in 83 (16%) and downstaging in 65 (12.5%) cases relative to the original pT stage. The second most common discrepancy regarded the reporting of LVI (n=121, 23.3%), with 62 (11.9%) reporting presence of LVI when the primary pathology report did not. Other discrepancies included a change in the histological subtype in 28 (5.4%) cases and spermatic cord margin status in five (9.6%) cases. CONCLUSIONS Only 10% of orchiectomy specimens underwent a second pathology review, with nearly 40% of reviews leading to a meaningful change in parameters. Such variation could lead to incorrect tumor staging, estimate of relapse risk, and inappropriate treatment decisions. Expert pathology review of RO specimens should be considered, as it has significant implications for decision-making.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Joan Sweet
- Department of Pathology and Lab Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lauren Landoni
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ricardo Leao
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Faculty of Medicine; University of Coimbra, Portugal; Clinical Academic Center of Coimbra, Portugal
| | - Lynn Anson-Cartwright
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Spencer Mok
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Vanessa Guzylak
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andrea D'Angelo
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Zhi Yi Fang
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ilana Geist
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
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15
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Rohan P, O'Reilly MK, Nason GJ. Frailty Index: A Useful Stratification for Elderly Surgical Patients. Ir Med J 2020; 113:106. [PMID: 32816440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- P Rohan
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
| | - M K O'Reilly
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - G J Nason
- Division of Urologic Oncology, Toronto General Hospital, Toronto, ON, Canada
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16
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Nason GJ, Chung P, Warde P, Huddart R, Albers P, Kollmannsberger C, Booth CM, Hansen AR, Bedard PL, Einhorn L, Nichols C, Rendon RA, Wood LA, Jewett MAS, Hamilton RJ. Controversies in the management of clinical stage 1 testis cancer. Can Urol Assoc J 2020; 14:E537-E542. [PMID: 32569575 DOI: 10.5489/cuaj.6722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In November 2018, The Canadian Testis Cancer Workshop was convened. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician’s assistants, residents and fellows, nurses, patients and patient advocacy groups. One of the goals of the workshop was to discuss the challenging areas of testis cancer care where guidelines may not be specific. The objective was to distill through discussion around cases, expert approach to working through these challenges. Herein we present a summary of discussion from the workshop around controversies in the management of clinical stage 1 (CS1) disease. CS1 represents organ confined non-metastatic testis cancer that represents approximately 70-80% of men at presentation. Regardless of management, CS1 has an excellent prognosis. However, without adjuvant treatment, approximately 30% of CS1 nonseminomatous germ cell tumors (NSGCT) and 15% of CS1 seminoma relapse. The workshop reviewed that while surveillance has become the standard for the majority of patients with CS1 disease there remains debate in the management of patients at high-risk of relapse. The controversy in the management of CS1 testis cancer surrounds the optimal balance between the morbidity of overtreatment and the identification of patients who may derive most benefit from adjuvant treatment. The challenge lies in a shared decision process where discussion of options extends beyond the simple risk of relapse but to include the long-term toxicities of adjuvant treatments and the favorable cancer-specific survival.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Robert Huddart
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Peter Albers
- Department of Urology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany
| | - Christian Kollmannsberger
- British Columbia Cancer Agency Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada
| | - Christopher M Booth
- Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lawrence Einhorn
- Department of Oncology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Craig Nichols
- Testicular Cancer Multidisciplinary Clinic, Virginia Mason Medical Center, Seattle, WA, United States
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Lori A Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Nason GJ, Donahoe L, de Perrot M, Hamilton RJ. AUTHOR REPLY. Urology 2020; 138:76. [PMID: 32252958 DOI: 10.1016/j.urology.2019.12.055] [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: 10/24/2022]
Affiliation(s)
- G J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - L Donahoe
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - M de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - R J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Nason GJ, Rohan P, O'Reilly MK. Provision of Service During the Covid-19 Pandemic. Ir Med J 2020; 113:48. [PMID: 32268043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- G J Nason
- Division of Urologic Oncology, Toronto General Hospital, Toronto, ON, Canada
| | - P Rohan
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
| | - M K O'Reilly
- Department of Radiology, University of Washington, Seattle, WA, USA
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Rohan P, O'Reilly MK, Gibney B, Nason GJ. Supply of Personal Protective Equipment (PPE) During the Covid-19 Pandemic. Ir Med J 2020; 113:66. [PMID: 32268059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- P Rohan
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
| | - M K O'Reilly
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - B Gibney
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - G J Nason
- Division of Urologic Oncology, Toronto General Hospital, Toronto, ON, Canada
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Kim JK, Koyle MA, Lee MJ, Nason GJ, Ren LY, O'Kelly F. A systematic review of genitourinary injuries arising from rugby and football. J Pediatr Urol 2020; 16:130-148. [PMID: 32029358 DOI: 10.1016/j.jpurol.2019.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/25/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Genitourinary injuries in athletes engaging in high-impact sports such as football and rugby may have catastrophic consequences, especially in individuals with pre-existing urologic concerns, such as a solitary kidney. OBJECTIVE To summarize the current literature on football-related or rugby-related genitourinary organ injuries in both adult and pediatric populations in an effort to risk stratify the likelihood of these injuries. METHODS An independent systematic literature search for records reporting football-related or rugby-related injuries was conducted by a certified librarian and reviewer in March 2019. The search electronic databases included Medline, EMBASE, Scopus, and Web of Science. All studies reporting football-related or rugby-related genitourinary injuries were included. RESULTS Twenty-two records (11 research studies, 11 case reports) were identified. In the pediatric population, the reported football-related kidney injuries were 0.1-0.7% of all football-related injuries, 0.07-0.5% of all sports-related injuries, and 1.5-37.5% of all sports-related genitourinary injuries, with incidence ranging from 0.00000084 to 0.0000092 injuries per exposure (five studies). Pediatric football-related testicular injuries were reported to be 0.11% of all football injuries, 0-0.07% of all sports-related injuries, and 0-37.5% of all sports-related genitourinary injuries; injury per exposure was 0.0000092 (four studies). In adults, there was no proportion of genitourinary injuries that could be determined, and football-related kidney injury incidence was 0.000012 injuries per exposure (one study). No adult literature investigated testicular injuries. Eleven case reports were additionally identified. Review of the case reports suggests that patients with previously existing urologic abnormalities such as ureteropelvic junction obstruction may predispose an individual to kidney injuries. CONCLUSION There is little to suggest that those engaged in football or rugby have a significant risk of genitourinary injury; therefore, future guidelines should reflect this.
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Affiliation(s)
- Jin K Kim
- Department of Surgery, University of Toronto, Toronto, Canada; Division of Urology, The Hospital for Sick Children, Toronto, Canada.
| | - Martin A Koyle
- Department of Surgery, University of Toronto, Toronto, Canada; Division of Urology, The Hospital for Sick Children, Toronto, Canada
| | - Min Joon Lee
- Division of Urology, The Hospital for Sick Children, Toronto, Canada; Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Gregory J Nason
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Lily Yuxi Ren
- Hospital Library and Archives, The Hospital for Sick Children, Toronto, Canada
| | - Fardod O'Kelly
- Department of Surgery, University of Toronto, Toronto, Canada; Division of Urology, The Hospital for Sick Children, Toronto, Canada
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Rohan P, O'Reilly MK, Nason GJ. Artificial Intelligence - Changing the Field of Prostate Cancer? Ir Med J 2020; 113:45. [PMID: 32815705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- P Rohan
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
| | - M K O'Reilly
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - G J Nason
- Division of Urologic Oncology, Toronto General Hospital, Toronto, ON, Canada
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Abstract
Introduction: Bladder cancer is the 9th most common cancer in the world and the 4th and 8th most common cancer diagnosed in men in the United States and United Kingdom respectively. The standard of care for the treatment of MIBC is radical cystectomy. Bladder preserving treatment approaches are emerging for select patients and should be considered strongly in patients who decline a radical cystectomy.Areas covered: In this review we look at the European and American recommended guidelines, the current standard of care, bladder-preserving options in MIBC, trimodal therapy and discuss future developments in the identification of molecular biomarkers that can predict therapeutic outcomes.Expert opinion: We strongly advocate bladder preservation for the right patient with strict criteria for enrolling patients in bladder preservation. The development of a specialized bladder cancer clinic could facilitate the selection of patients to be offered trimodal therapy. We believe that the future of bladder cancer will involve individualized care plans based upon clinical, radiological, endoscopic and molecular assessments.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Khaled Ajib
- Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Guan H Tan
- Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Rohan P, O'Connell C, Nason GJ, O'Malley KJ. The Future of Irish Urology - Are We Planning Ahead Appropriately? Ir Med J 2020; 113:30. [PMID: 32407015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- P Rohan
- Department of Surgery, Wexford General Hospital, Ireland
| | - C O'Connell
- Department of Urology, Tallaght University Hospital, Ireland
| | - G J Nason
- Division of Urology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - K J O'Malley
- Department of Urology, Mater Misericordiae University Hospital, Dublin 7, Ireland
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Nason GJ, Donahoe L, de Perrot M, Aditya I, Jewett MAS, Bedard PL, Hansen AR, Chung P, Warde P, Anson-Cartwright L, Sweet J, O'Malley M, Atenafu EG, Hamilton RJ. Simultaneous Vs Sequential Retroperitoneal, Thoracic and Cervical Resection of Post Chemotherapy Residual Masses in Patients With Metastatic Nonseminomatous Germ Cell Tumors of the Testis. Urology 2020; 138:69-76. [PMID: 32004556 DOI: 10.1016/j.urology.2019.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare a simultaneous vs sequential approach to residual post chemotherapy mass resections in metastatic testis cancer. METHODS A retrospective review was performed of patients who underwent retroperitoneal and thoracic/cervical resection of post chemotherapy residual masses between 2002 and 2018. Group 1: "Simultaneous" (Combined Retroperitoneal and Thoracic/Cervical resections on the same date); Group 2: "Sequential" (Retroperitoneal and Thoracic/Cervical resections at separate dates). RESULTS During the study period, 35 simultaneous and 17 sequential resections were performed. The median age at surgery was 28 years (Range 16-61). The median follow-up from last surgical procedure was 62.7 months (Range 0.4-194). Histology revealed teratoma in 38 (73.1%) patients, necrosis in 8 (15.4%) and viable tumor in 6 (11.5%). Discordant pathology findings between thoracic/cervical and abdominal resections were noted in 16 (30.8%) patients. No differences were observed between the simultaneous vs sequential groups in median operating time (585 minutes vs 545 minutes, P = .64), blood loss (1300 vs 1300 mls, P = .42), or length of stay (9 vs 11 days, P = .14). There was no difference between the 5-year (65.7% vs 68.6%) relapse-free survival between the 2 groups (P = .84) or the 5-year (88.6% vs 100%) overall and disease-specific survival (P = .25). CONCLUSION Simultaneous resection of retroperitoneal and thoracic/cervical post chemotherapy metastases is a feasible in some patients. It requires multidisciplinary collaboration and a longer primary procedure.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Laura Donahoe
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Ishan Aditya
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Philip L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lynn Anson-Cartwright
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Joan Sweet
- Department of Pathology and Lab Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Martin O'Malley
- Division of Abdominal Imaging, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada.
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Nason GJ, O'Reilly MK. Is the Statistical Significance of P<0.05 Still Relevant? Ir Med J 2020; 113:15. [PMID: 32298561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- G J Nason
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - M K O'Reilly
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
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Herrera-Caceres JO, Nason GJ, Salgado-Sanmamed N, Goldberg H, Woon DTS, Chandrasekar T, Ajib K, Tan GH, Alhunaidi O, van der Kwast T, Finelli A, Zlotta AR, Hamilton RJ, Berlin A, Perlis N, Fleshner NE. Salvage radical prostatectomy following focal therapy: functional and oncological outcomes. BJU Int 2020; 125:525-530. [PMID: 31863617 DOI: 10.1111/bju.14976] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To report the oncological and functional outcomes of salvage radical prostatectomy (sRP) after focal therapy (FT). PATIENTS AND METHODS A retrospective review of all patients who underwent sRP after FT was performed. Clinical and pathological outcomes focussed on surgical complications, oncological, and functional outcomes. RESULTS In all, 34 patients were identified. The median (interquartile range [IQR]) age was 61 (8.25) years. FT modalities included high-intensity focussed ultrasound (19 patients), laser ablation (13), focal brachytherapy (one) and cryotherapy (one). The median (IQR) time from FT to recurrence was 10.9 (17.6) months. There were no rectal or ureteric injuries. Two (5.9%) patients had iatrogenic cystotomies and four (11.8%) developed bladder neck contractures. The mean (sd) hospital stay was 2.5 (2.1) days. The T-stage was pT2 in 14 (41.2%) patients, pT3a in 16 (47.1%), and pT3b in four (11.8%). In all, 13 (38%) patients had positive surgical margins (PSMs). Six (17.6%) patients received adjuvant radiotherapy (RT). At a mean follow-up of 4.3 years, seven (20.6%) patients developed biochemical recurrence (BCR), and of these, six (17.6%) patients required salvage RT. PSMs were associated with worse BCR-free survival (hazard ratio 6.624, 95% confidence interval 2.243-19.563; P < 0.001). The median (IQR) preoperative International Prostate Symptom Score and International Index of Erectile Function score was 7 (4.5-9.5) and 23.5 (15.75-25) respectively, while in the final follow-up the median (IQR) values were 7 (3.5-11) and 6 (5-12.25), respectively (P = 0.088 and P < 0.001). At last follow-up, 31 (91.2%) patients were continent, two (5.9%) had moderate (>1 pad/day) incontinence, and one (2.9%) required an artificial urinary sphincter. CONCLUSIONS sRP should be considered as an option for patients who have persistent clinically significant prostate cancer or recurrence after FT. PSMs should be recognised as a risk for recurrent disease after sRP.
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Affiliation(s)
- Jaime O Herrera-Caceres
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gregory J Nason
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Noelia Salgado-Sanmamed
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Hanan Goldberg
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dixon T S Woon
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Thenappen Chandrasekar
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Khaled Ajib
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Guan Hee Tan
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Omar Alhunaidi
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Theodorus van der Kwast
- Department of Pathology and Laboratory Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Neil E Fleshner
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
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Izzeldin S, Nason GJ, Elamin M, Brady CM, Power D, Sweeney P. Major Oncological Surgery (Radical Cystectomy) in Octogenarians- is it Safe? Ir Med J 2019; 112:1010. [PMID: 31651215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- S Izzeldin
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - G J Nason
- Division of Urology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - M Elamin
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - C M Brady
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - D Power
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
| | - P Sweeney
- Department of Urology, Mercy University Hospital, Cork, Ireland
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Nason GJ, O’Reilly MK. Improving Patient Care with Patient Centred Reports. Ir Med J 2019; 112:993. [PMID: 31650827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- G J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - M K O’Reilly
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
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Nason GJ, O’Kelly F, Daly MF, O’Reilly MK. Recruitment of New Consultants. Ir Med J 2019; 112:977. [PMID: 31646841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- G J Nason
- Division of Uro-Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - F O’Kelly
- Division of Paediatric Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - M F Daly
- Mental Health, Addiction and Intellectual Disability Service, Wellington Regional Hospital,
Wellington, New Zealand
| | - M K O’Reilly
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
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Rohan P, Keane GD, O’Connell C, O’Reilly MK, Nason GJ. Is the Current Consent Process Appropriate for Patients and Fair to Newly Qualified Doctors? Ir Med J 2019; 112:959. [PMID: 31538756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- P Rohan
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - G D Keane
- School of Medicine, Royal College of Surgeons, Dublin 2, Ireland
| | - C O’Connell
- Department of Urology, Beaumont Hospital, Dublin 9, Ireland
| | - M K O’Reilly
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - G J Nason
- Division of Uro-Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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31
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O’Connell C, O’Reilly MK, Nason GJ. Business in Healthcare Module- a Missed Opportunity in our Trainees’ Development? Ir Med J 2019; 112:924. [PMID: 31245970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- C O’Connell
- Department of Urology, Beaumont Hospital, Dublin 9, Ireland
| | - M K O’Reilly
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - G J Nason
- Division of Uro-Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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32
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Nason GJ, O’Connell C, Galvin DJ. Suicide Risk Associated with a Prostate Cancer Diagnosis. Ir Med J 2019; 112:892. [PMID: 31044594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- G J Nason
- Department of Urology, Mater Misericordiae University Hospital
| | - C O’Connell
- Department of Urology, Mater Misericordiae University Hospital
| | - D J Galvin
- Department of Urology, Mater Misericordiae University Hospital
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Matanhelia DM, Croghan S, Nason GJ, O’Connell C, Galvin DJ. The Management of Incidental Prostate Cancer Following TURP. Ir Med J 2019; 112:866. [PMID: 30875166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aims The aim of this study was to assess the incidence, management and outcomes of incidentally diagnosed prostate cancer following TURP. Methods A retrospective review was performed using the histopathological departments’ database of all patients who underwent a TURP across two university teaching hospitals over a ten year period. Results During the study period, a total of 826 patients underwent a TURP. 72 (10.3%) had an incidental diagnosis of CaP following TURP. 46 (63.9%) were managed expectantly while 26 (36.1%) underwent active treatment. Overall mortality was 29.2% (n=21) while cancer specific mortality was 6.9% (n=5). All these patients were in the hormonal treatment sub-group. Conclusion Our study demonstrates an expectant approach is favourable in low risk disease. Curative treatment does need to be considered for younger patients with a long life expectancy or patients with higher risk disease.
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Affiliation(s)
- D M Matanhelia
- Department of Urology, St Vincent’s University Hospital, Dublin 4
| | - S Croghan
- Department of Urology, St Vincent’s University Hospital, Dublin 4
| | - G J Nason
- Department of Urology, Mater Misericordiae University Hospital, Dublin 7
| | - C O’Connell
- Department of Urology, Mater Misericordiae University Hospital, Dublin 7
| | - D J Galvin
- Department of Urology, St Vincent’s University Hospital, Dublin 4
- Department of Urology, Mater Misericordiae University Hospital, Dublin 7
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Nason GJ, Selvarajah L, O’Connor EM, O’Kelly J, Considine SW, Moss B, MacMahon D, Heneghan J, Meyer N, Buckley J, O’Regan K, O’Brien MF. The Predictive Ability of Pre-Operative Magnetic Resonance Imaging to Detect Pathological Outcomes in Prostate Cancer. Ir Med J 2018; 111:790. [PMID: 30520617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aims Accurate preoperative knowledge of tumour stage is important in preoperative planning at radical prostatectomy (RP). The aim of this study was to assess the predictive ability of multiparametric MRI for detecting pathological outcomes. Methods A retrospective review was performed of all patients who underwent RP over a 4 year period. Results Preoperative MRI was reported as showing T3 or T4 disease in 26(17.9%) out of 145 patients undergoing RP. Of these, 10(6.9%) had ECE (extra-capsular extension) and 1(0.7%) had SVI (seminal vesicle invasion) on final histology. The sensitivity and specificity of MRI for detecting ECE were 27.3% and 87.6%, respectively. The sensitivity and specificity of MRI for detecting SVI were 11.1% and 97.8%, respectively. The positive predictive values for determining ECE and SVI were 45.5% and 25%, respectively and negative predictive values were 75.9% and 94.4%. Conclusion MRI has good specificity but poor and heterogeneous sensitivity for predicting T3 disease in RP specimen.
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Affiliation(s)
- G J Nason
- Department of Urology, Cork University Hospital, Wilton, Cork, Ireland
| | - L Selvarajah
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - E M O’Connor
- Department of Urology, Cork University Hospital, Wilton, Cork, Ireland
| | - J O’Kelly
- Department of Urology, Cork University Hospital, Wilton, Cork, Ireland
| | - S W Considine
- Department of Urology, Cork University Hospital, Wilton, Cork, Ireland
| | - B Moss
- Department of Urology, Cork University Hospital, Wilton, Cork, Ireland
| | - D MacMahon
- Department of Urology, University Hospital Waterford, Waterford, Ireland
| | - J Heneghan
- Department of Radiology, University Hospital Waterford, Waterford, Ireland
| | - N Meyer
- Department of Histopathology, Cork University Hospital, Wilton, Cork, Ireland
| | - J Buckley
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - K O’Regan
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - M F O’Brien
- Department of Urology, Cork University Hospital, Wilton, Cork, Ireland
- Department of Urology, University Hospital Waterford, Waterford, Ireland
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35
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Foran AT, Nason GJ, Rohan P, Keane GM, Connolly S, Hegarty N, Galvin D, O’Malley KJ. Iatrogenic Bowel Injury at Exchange of Supra-Pubic Catheter. Ir Med J 2018; 111:737. [PMID: 30488682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Suprapubic catheter insertion and exchange is a common urological procedure, but it is not without risks and complications. While bowel perforation is a recognised complication at suprapubic catheter insertion, it is not commonly reported at suprapubic catheter exchange. We report our experience of recognition, diagnosis and subsequent successful management of the most important complication related to suprapubic catheters.
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Affiliation(s)
- A T Foran
- Department of Urology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - G J Nason
- Department of Urology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - P Rohan
- Department of Urology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - G M Keane
- Department of Urology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - S Connolly
- Department of Urology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - N Hegarty
- Department of Urology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - D Galvin
- Department of Urology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - K J O’Malley
- Department of Urology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
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Rohan P, Keane K, Nason GJ, Caulfield RH. Is The Consent Process Appropriate - The Interns’ Perspective? Ir Med J 2018; 111:734. [PMID: 30488676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aims Consent is an integral component to any medical procedure involving a competent patient, a communicating doctor, and transfer of information about the procedure. The aim of this study was to assess interns’ experience of the consent process. Methods An online questionnaire was distributed to interns in Ireland questioning their role in the consent process within six months of starting as an intern. Results One hundred and seventy-one interns (89.1%) had consented a patient for a procedure during their first intern rotation. One hundred and forty-three (83.6%) reported their supervisors did not explain the procedure to the intern prior to consent. One hundred and fifty-eight (92.4%) respondents consented for a procedure which they had not witnessed before. Sixty (35.1%) of interns reported that they have obtained signed consent without fully discussing the procedure and the associated risks. Conclusion The most junior members of a team are independently consenting patients on a regular basis without the appropriate level of knowledge.
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Affiliation(s)
- P Rohan
- Department of Plastic Surgery, Mater Misericordiae University Hospital, Dublin 7
- Department of Urology, Mater Misericordiae University Hospital, Dublin 7
| | - K Keane
- Department of Plastic Surgery, Mater Misericordiae University Hospital, Dublin 7
| | - G J Nason
- Department of Urology, Mater Misericordiae University Hospital, Dublin 7
| | - R H Caulfield
- Department of Plastic Surgery, Mater Misericordiae University Hospital, Dublin 7
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O'Connor EM, Nason GJ, Kiely EA. Urological Management of Extramural Malignant Ureteric Obstruction: A Survey of Irish Urologists. Curr Urol 2018; 11:21-25. [PMID: 29463973 DOI: 10.1159/000447190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 02/20/2017] [Accepted: 04/28/2017] [Indexed: 12/15/2022] Open
Abstract
Introduction The absence of guidelines in the management of extramural malignant ureteric obstruction leads to confusion in decision making and in the interaction between urology and other clinical disciplines. In this study, we surveyed consultant urologists with the goal of achieving a better consensus on optimal management options. Methods A multiple choice survey was sent via the online survey tool "SurveyMonkey" to all consultant urologists practicing in the Republic of Ireland. Results There was a response rate of 57.5% (n = 23). Twenty-two (96%) consultants consider the use of percutaneous nephrostomy with placement of antegrade ureteric stent but only 22% (n = 5) would consider using a metallic stent. Eleven (48%) respondents favor retrograde stenting in the first instance with an equal proportion choosing an antegrade method. Nine (39%) consultants perform the initial stent change at 4-6 months, 8 (35%) at 2-4 months, and 1 at < 2 months and 6-10 months respectively. Total 59% (n = 13) of respondents felt that the duration of expected patient survival influenced their decision and agreement to stent with 42% (n = 8) saying this survival would need to be > 6 months and 82% (n = 18) were generally happy with the level of ongoing communication between urology and the primary service managing the patient. Conclusion There is a lack of consensus regarding the management of this challenging problem, particularly with regard to timing of first stent change and whether to initially use an antegrade or retrograde approach. This reflects the heterogeneous patient cohort and the important factors of life expectancy and patient co-morbidities.
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Affiliation(s)
| | - Gregory J Nason
- Department of Urology, Cork University Hospital, Wilton, Ireland
| | - Eamon A Kiely
- Department of Urology, Cork University Hospital, Wilton, Ireland
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O'Connor EM, Nason GJ, Manecksha RP. An Analysis of Gender Diversity in Urology in the UK and Ireland. Ir Med J 2017; 110:648. [PMID: 29465838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Traditionally, surgery and certain surgical sub-specialities in particular have been predominantly male orientated. In recent years, there has been an increased proportion of female medical graduates which will ultimately have an effect on speciality choices. The aim of this study was to assess the gender diversity among urologists in the UK and Ireland. The total number and gender breakdown of consultant urologists and trainees in the UK and Ireland was obtained from the British Association of Urological Surgeons (BAUS) and the Irish Society of Urology (ISU) membership offices. The total number and gender breakdown of medical school entrants and graduates in 2015 was obtained from the six medical schools in the Republic of Ireland. There are a total of 1,012 consultant urologists in the UK and Ireland. In the UK, 141 (14.6%) are female compared to four (8.2%) in Ireland, p= 0.531. There was a significant increase in the number of females between consultant urologists and trainees in both the UK (p=0.0001) and Ireland (p=0.015). In recent years, there has been a significant change in the percentage of female trainees in the UK and Ireland (22.8% (n=75) in 2011 vs 31.7% (n=93) in 2014, p=0.019. Between the six medical schools in Ireland, there were significantly more female entrants (n=726, 56.5%) than female graduates (n=521, 51.2%) in 2015, p=0.013.There has been a significant shift in gender diversity in urology in the UK and Ireland. Efforts to increase diversity should be pursued to attract further trainees to urology.
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Affiliation(s)
- E M O'Connor
- Department of Urology, Cork University Hospital, Cork, Ireland
| | - G J Nason
- Department of Urology, Cork University Hospital, Cork, Ireland
| | - R P Manecksha
- Department of Urology, St James' Hospital, Dublin 8, Ireland
- Department of Urology, Tallaght Hospital, Dublin 24, Ireland
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Ariffin NA, Nason GJ, Omer SI, Considine SW, Sweeney P, Power DG. Post-Chemotherapy Retroperitoneal Lymph Node Dissection in Patients with Non-Seminomatous Germ Cell Tumour (NSGCT). Ir Med J 2017; 110:647. [PMID: 29465837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Diabetic retinopathy is a significant complication of diabetes, and the most common cause of blindness in people under the age of 65. The National Diabetic Retinal Screening Programme (Diabetic RetinaScreen) was established to detect sight threatening retinopathies. The purpose of this cross-sectional study is to determine the barriers to the uptake of Diabetic RetinaScreen, to investigate discrepancies in attendance, if any, between patients whose diabetes care is delivered in a large tertiary referral hospital out-patient setting or in general practice, and to evaluate general practitioner's satisfaction with the service. Older age (OR 1.023, 95% CI 1.001 to 1.046) and complications of diabetes, excluding ocular complications, (OR 2.741, 95% CI 1.158 to 6.489) were associated with increased attendance at Diabetic RetinaScreen. Online referral is now available and the preferred method of referral. Efforts to encourage younger patients who do not yet have complications of diabetes may be beneficial.
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Affiliation(s)
- N A Ariffin
- Department of Urology, Mercy University Hospital, Cork, Ireland
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
| | - G J Nason
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - S I Omer
- Department of Urology, Mercy University Hospital, Cork, IrelandHospital
| | - S W Considine
- Department of Urology, Mercy University Hospital, Cork, IrelandHospital
| | - P Sweeney
- Department of Urology, Mercy University Hospital, Cork, IrelandHospital
| | - D G Power
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
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O'Kelly F, Nason GJ, Manecksha RP, Cascio S, Quinn FJ, Leonard M, Koyle MA, Farhat W, Leveridge MJ. The effect of social media (#SoMe) on journal impact factor and parental awareness in paediatric urology. J Pediatr Urol 2017; 13:513.e1-513.e7. [PMID: 28483467 DOI: 10.1016/j.jpurol.2017.03.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Social media (SoMe) comprises a number of internet-based applications that have the capability to disseminate multimodal media and allow for unprecedented inter-user connectivity. The role of Twitter has been studied in conferences and education; moreover, there is increasing evidence that patients are more likely to use social media for their own health education. OBJECTIVE The aim of this study was to assess the impact of social media platforms on the impact factor of both urological and paediatric journals that publish on paediatric urology, and to assess parental awareness of social media in paediatric urology. STUDY DESIGN A filtered Journal of Citation Reports (JCR) search was performed for the period 2012-16 for journals that published articles on paediatric urology. Journals were ranked according to impact factor, and each individual journal website was accessed to assess for the presence of social media. Parents in paediatric urology clinics and non-paediatric urology patients also filled out a questionnaire to assess for awareness and attitudes to social media. All statistical analysis was performed using Prism 6 software (Prism 6, GraphPad Software, California, USA). RESULTS Overall, there were 50 urological journals and 39 paediatric journals with a mean impact factor of 2.303 and 1.766, respectively. There was an overall average increase in impact factor across all urological journals between 2012 and 16. The presence of a Twitter feed was statistically significant for a rise in impact factor over the 4 years (P = 0.017). The cohort of parents was statistically more likely to have completed post-secondary education, to have and access to a social media profile, use it for health education, and use it to access journal/physician/hospital social media accounts. DISCUSSION This study examined, for the first time, the role of social media in paediatric urology, and demonstrated that SoMe use is associated with a positive influence in impact factor, but also a parental appetite for it. Limitations included a non-externally validated questionnaire. There may also have been bias in larger journals that generate and maintain social media platforms such as Twitter, which may then in turn have an influence on impact factor. CONCLUSIONS Social media use within paediatric urology was associated with a higher impact factor, which remained significant after 4 years of analysis. Parents were more likely to use a wide variety of social media to search for conditions and physicians/healthcare providers; therefore, journals and institutions need to embrace and endorse SoMe as a potential source of important clinical information.
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Affiliation(s)
- F O'Kelly
- Department of Paediatric Urology, Our Lady's Children' Hospital, Dublin, Ireland.
| | - G J Nason
- Department of Paediatric Urology, Our Lady's Children' Hospital, Dublin, Ireland
| | - R P Manecksha
- Department of Urological Surgery, Tallaght Hospital (AMNCH), Dublin, Ireland
| | - S Cascio
- Department of Paediatric Urology, Our Lady's Children' Hospital, Dublin, Ireland
| | - F J Quinn
- Department of Paediatric Urology, Our Lady's Children' Hospital, Dublin, Ireland
| | - M Leonard
- Division of Paediatric Urology, Childrens' Hospital of Eastern Ontario, Ottawa, Canada
| | - M A Koyle
- Department of Paediatric Urology, The Hospital for Sick Children, Toronto, Canada
| | - W Farhat
- Department of Paediatric Urology, The Hospital for Sick Children, Toronto, Canada
| | - M J Leveridge
- Department of Urological Surgery, Kingston General Hospital, Ontario, Canada
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O'Connor EM, Nason GJ, O'Kelly F, Manecksha RP, Loeb S. Newsworthiness vs scientific impact: are the most highly cited urology papers the most widely disseminated in the media? BJU Int 2017; 120:441-454. [PMID: 28418091 DOI: 10.1111/bju.13881] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess whether a correlation exists between newsworthiness (Altmetric score) and scientific impact markers, such as citation analysis, impact factors, and levels of evidence. METHODS The top five most cited articles for the year 2014 and 2015 from the top 10 ranking urology journals (Scientific Impact Group) were identified. The top 50 articles each in 2014 and 2015 were identified from Altmetric support based on media activity (Media Impact Group). We determined the number of citations that these articles received in the scientific literature, and calculated correlations between citations with Altmetric scores. RESULTS In the Scientific Impact Group, the mean number of citations per article was 37.6, and the most highly cited articles were oncology guidelines. The mean Altmetric score in these articles was 14.8. There was a weak positive correlation between citations and Altmetric score (rs = 0.35, 95% confidence interval 0.16-0.52, P < 0.001). In the Media Impact Group, the mean Altmetric score was 121.1 and most widely shared articles all related to sexual medicine. In this group, the mean number of citations was 9.7 and there was a weak negative correlation between Altmetric score and citations (rs = -0.20, P = 0.046). CONCLUSION The top articles based on Altmetric scores were not highly cited, suggesting that publications receiving the most media attention may not be the most scientifically rigorous, or that this audience places greater value on different subjects than the scientific community.
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Affiliation(s)
- Eabhann M O'Connor
- Department of Urology, St Vincent's University Hospital, Dublin, Ireland
| | - Gregory J Nason
- Department of Urology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Fardod O'Kelly
- Department of Urology, Our Lady's Childrens' Hospital, Crumlin, Dublin, Ireland
| | - Rustom P Manecksha
- Department of Urology, Tallaght Hospital, Dublin, Ireland.,Department of Urology, St James' Hospital, Dublin, Ireland
| | - Stacy Loeb
- Department of Urology, Population Health, and Laura & Isaac Perlmutter Cancer Center, New York University, New York, NY, USA
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Nason GJ, Abdelsadek AH, Foran AT, O'Malley KJ. Multidisciplinary emergent removal of a metal penoscrotal constriction device. Ir Med J 2017; 110:536. [PMID: 28657249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Strangulation of the genital organs is a rare presentation to the emergency department which requires urgent intervention to avoid long term complications. Penoscrotal constriction devices are either used for autoerotic stimulus or to increase sexual performance by maintaining an erection for a longer period. We report a case of a man who presented with penile strangulation following the application of a titanium penoscrotal constriction ring during sexual intercourse seven hours previously. The Fire Brigade department attended with an electric operated angle grinder to facilitate removal of the ring as standard medical equipment (orthopaedic saws, bolt and bone cutters) were insufficient. Fully functional recovery was achieved.
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Affiliation(s)
- G J Nason
- Department of Urology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - A H Abdelsadek
- Emergency Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - A T Foran
- Department of Urology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - K J O'Malley
- Department of Urology, Mater Misericordiae University Hospital, Dublin 7, Ireland
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Nason GJ, O'Connor EM, O'Neill C, Izzeldin O, Considine SW, O'Brien MF. The impact of day of surgery on the length of stay for major urological procedures. Can Urol Assoc J 2016; 10:E367-E371. [PMID: 28096920 DOI: 10.5489/cuaj.3777] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Surgery performed later in the week has been associated with longer length of stay (LOS). The aim of this study was to assess if the day of the surgery impacted the LOS for two major urological procedures in a tertiary referral university teaching hospital. METHODS A retrospective review was performed of two major urological procedures consecutively performed by a single surgeon in our unit from March 2012 to December 2015. Patient demographics, histopathological characteristics, operative details, and LOS were obtained from the patients' medical records. Procedures performed on Monday or Tuesday were defined as early in the week and procedures performed on Wednesday, Thursday, or Friday were defined as late in the week. RESULTS During the study period, 140 open radical prostatectomy (ORP) and 42 open partial nephrectomy (OPN) procedures were performed. There was a significant difference in median LOS for major urological procedures performed early in the week compared to late in the week (3 [3-4] days vs. 4 [4-5] days; p= 0.0001). There was a significant difference in median LOS for ORP performed early in the week compared to late in the week (3 [3-4] days vs. 4 [4-5] days; p= 0.0004). There was a similar significant difference in OPN performed early in the week compared to late in the week (4 [3-5.5] days vs. 5 [4-5] days; p= 0.029). CONCLUSIONS The day of surgery impacts LOS for major urological procedures. Major procedures should be performed early in the week, when it is feasible to facilitate prompt safe discharge and better use of hospital resources.
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Affiliation(s)
- Gregory J Nason
- Department of Urology, Cork University Hospital, Cork, Ireland
| | | | | | - Omer Izzeldin
- Department of Urology, Cork University Hospital, Cork, Ireland
| | | | - M Frank O'Brien
- Department of Urology, Cork University Hospital, Cork, Ireland
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Nason GJ, Aslam A, Giri SK. Predictive Ability of Preoperative CT Scan in Determining Whether the Adrenal Gland is Spared at Radical Nephrectomy. Curr Urol 2016; 9:143-147. [PMID: 27867332 DOI: 10.1159/000442869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/09/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The aim of this study was to assess whether preoperative multiple detector computed tomography (MDCT) accurately predicts adrenal involvement for patients undergoing non-adrenal sparing radical nephrectomy for renal cell carcinoma. METHODS AND MATERIALS A retrospective observational study based on a composite patient population of two university teaching hospitals who underwent radical nephrectomy. Sensitivity, specificity, overall accuracy, positive and negative predictive values and likelihood ratios were calculated from radiological reports. RESULTS Total 579 patients underwent radical nephrectomy, of which 199 (34.4%) patients underwent a non-adrenal sparing radical nephrectomy, in which 128 (64.3%) were male and 118 (59.3%) were left side tumors. Mean tumor size was 8.2 cm (range 1.4-20cm). MDCT was found to have a sensitivity of 100% and specificity of 95.2% for identifying adrenal invasion. Total 179 patients (89.9%) had a radiographically normal ipsilateral adrenal gland, of which none were found to have adrenal involvement. Therefore, the negative predictive value of preoperative cross-sectional imaging for identification of adrenal involvement was 100%. CONCLUSION Cross- sectional MDCT imaging accurately predicts adrenal involvement and the decision to remove or spare the adrenal gland should be made preoperative planning regardless of tumour size or location at the time of multi-disciplinary discussion unless there is intraoperative evidence of adrenal invasion.
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Affiliation(s)
- Gregory J Nason
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - Asadullah Aslam
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - Subhasis K Giri
- Department of Urology, University Hospital Limerick, Limerick, Ireland
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Kelly BS, Redmond CE, Nason GJ, Healy GM, Horgan NA, Heffernan EJ. The Use of Twitter by Radiology Journals: An Analysis of Twitter Activity and Impact Factor. J Am Coll Radiol 2016; 13:1391-1396. [PMID: 27577594 DOI: 10.1016/j.jacr.2016.06.041] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [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: 04/04/2016] [Revised: 06/06/2016] [Accepted: 06/13/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Medical journals use social media as a means to disseminate new research and interact with readers. The microblogging site Twitter is one such platform. The aim of this study was to analyze the recent use of Twitter by the leading radiology journals. METHODS The top 50 journals by Impact Factor were included. Twitter profiles associated with these journals, or their corresponding societies, were identified. Whether each journal used other social media platforms was also recorded. Each Twitter profile was analyzed over a one-year period, with data collected via Twitonomy software. Klout scores of social media influence were calculated. Results were analyzed in SPSS using Student's t test, Fisher contingency tables, and Pearson correlations to identify any association between social media interaction and Impact Factors of journals. RESULTS Fourteen journals (28%) had dedicated Twitter profiles. Of the 36 journals without dedicated Twitter profiles, 25 (50%) were associated with societies that had profiles, leaving 11 (22%) journals without a presence on Twitter. The mean Impact Factor of all journals was 3.1 ± 1.41 (range, 1.7-6.9). Journals with Twitter profiles had higher Impact Factors than those without (mean, 3.37 vs 2.14; P < .001). There was no statistically significant difference between the Impact Factors of the journals with dedicated Twitter profiles and those associated with affiliated societies (P = .47). Since joining Twitter, 7 of the 11 journals (64%) experienced increases in Impact Factor. A greater number of Twitter followers was correlated with higher journal Impact Factor (R2 = 0.581, P = .029). CONCLUSIONS The investigators assessed the prevalence and activity of the leading radiology journals on Twitter. Radiology journals with Twitter profiles have higher Impact Factors than those without profiles, and the number of followers of a journal's Twitter profile is positively associated with Impact Factor.
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Affiliation(s)
- Brendan S Kelly
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland.
| | - Ciaran E Redmond
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Gregory J Nason
- Department of Urology, Cork University Hospital, Cork, Ireland
| | - Gerard M Healy
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | | | - Eric J Heffernan
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
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O'Connor EM, Nason GJ, O'Brien MF. Ireland's contribution to urology and nephrology research in the new millennium: a bibliometric analysis. Ir J Med Sci 2016; 186:371-377. [PMID: 27485350 DOI: 10.1007/s11845-016-1485-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Bibliometrics is the statistical analysis of written publications. Bibliometric analyses have been performed across a range of biomedical disciplines. The aim of this study was to provide a comprehensive qualitative and quantitative analysis of Irish urology and nephrology research and to analyse how this compares internationally. METHODS We performed a retrospective bibliometric analysis of the top 20 ranking journals in the field of "Urology and Nephrology" based on their 5 years impact factor, as obtained from the ISI Journal Citation Report database over the 15-year study period, 2000-2015. Utilising the Pubmed database, a search phrase was constructed using country of affiliation, year of publication and journal title. The abstracts of the Irish publications identified were analysed for their institution of origin, article theme and content. RESULTS A total of 67,740 article abstracts were analysed over the 15 years study period. As anticipated, the USA accounted for the largest number of publications by a country [28,206 (41.64 % of all articles)]. Ireland contributed 347 articles in total (0.51 % of all articles); however, ranking according to population per million was 13th worldwide. Ireland's contribution to urology and nephrology research was highest in the BJUI-British Journal of Urology International [76 articles (21.90 % of Irish total)]. CONCLUSION We believe this study to be the largest bibliometric analysis in the field of urology and nephrology internationally. This study provides a novel overview of the current Irish urology- and nephrology-related research, and examines how our results compare within the international community.
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Affiliation(s)
- E M O'Connor
- Department of Urology, Cork University Hospital, Wilton, Cork, Ireland.
| | - G J Nason
- Department of Urology, Cork University Hospital, Wilton, Cork, Ireland
| | - M F O'Brien
- Department of Urology, Cork University Hospital, Wilton, Cork, Ireland
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Quinlan CS, Collins AM, Nason GJ, Dempsey M. The use of social media by plastic surgery journals. J Plast Reconstr Aesthet Surg 2016; 69:1009-11. [DOI: 10.1016/j.bjps.2016.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/23/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022]
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Nason GJ, McNamara F, Twyford M, O'Kelly F, White S, Dunne E, Durkan GC, Giri SK, Smyth GP, Power RE. Efficacy of vacuum erectile devices (VEDs) after radical prostatectomy: the initial Irish experience of a dedicated VED clinic. Int J Impot Res 2016; 28:205-208. [PMID: 27225711 DOI: 10.1038/ijir.2016.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/15/2016] [Accepted: 04/24/2016] [Indexed: 01/07/2023]
Abstract
Controversy exists regarding optimal penile rehabilitation program following radical prostatectomy (RP). Vacuum erectile devices (VEDs) have become an important component of penile rehabilitation protocols. The aim of this study was to assess the efficacy and patient satisfaction of a dedicated VED clinic. A voluntary telephone questionnaire was performed of all patients who attended a VED clinic to date in two university teaching hospitals. Patient demographics, histopathological characteristics and functional status (International Index of Erectile Function (IIEF) scores) were obtained from a retrospective review of a prospectively maintained database. Sixty-five men attended the dedicated VED clinic in the two university teaching hospitals. Forty-men (76.3%) men purchased a VED following the dedicated clinic. There was significant differences noted between the mean preoperative and the 3-month postoperative IIEF scores (22.08±3.16 vs 11.3±3.08, P=0.0001) and between the 3-month postoperative IIEF score and the post-VED use IIEF score (11.3±3.08 vs 16.74±2.62, P=0.0001). Despite VED use, there was a significant reduction in erectile function from presurgery status (22.08±3.16 vs 16.74±2.62, P=0.0001). All patients reported that the dedicated VED was helpful and would recommend it to other patients. Our study demonstrates that, despite a reduction in erectile function after RP, successful erections are attainable with a VED. There is potential and need for the development of a standard penile rehabilitation program and treatment of ED after RP internationally.
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Affiliation(s)
- G J Nason
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | - F McNamara
- Department of Urology, Beaumont Hospital, Dublin, Ireland.,Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - M Twyford
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | - F O'Kelly
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | - S White
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | - E Dunne
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | - G C Durkan
- Department of Urology, University Hospital Limerick, Limerick, Ireland.,Department of Urology, University College Hospital Galway, Galway, Ireland
| | - S K Giri
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - G P Smyth
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | - R E Power
- Department of Urology, Beaumont Hospital, Dublin, Ireland
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Kelly ME, Heeney A, Redmond CE, Costelloe J, Nason GJ, Ryan J, Brophy D, Winter DC. Incidental findings detected on emergency abdominal CT scans: a 1-year review. ACTA ACUST UNITED AC 2016; 40:1853-7. [PMID: 25576049 DOI: 10.1007/s00261-015-0349-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION In recent years, there has been a substantial rise in the use of computed tomography (CT) in the emergency medicine setting. Accordingly, with increased CT usage there has been an upsurge in incidental pathology detection. METHODS A retrospective review of all emergency CT abdominal scans performed at a university teaching hospital was examined. The frequency of incidental findings, their clinical significance and workload effect for the radiology department was assessed. RESULTS 1155 patients had an emergency abdominal CT scan of which 700 had incidental findings detected. Of the incidental findings, 143 were deemed indeterminate requiring urgent investigations. Twenty-four occult neoplasms were confirmed subsequently. Additionally, 259 patients were recommended for additional diagnostics. The cumulative effect of the initial emergency abdominal CT was 15,015 relative value units (RVU). Subsequent imaging of incidental findings resulted in another 1674 RVU workload for radiology. CONCLUSION Incidental findings cause considerable debate and concern over which patients require significant follow-up, investigations, and/or surveillance. This exerts significant pressures on sub-specialties for their expert input, with increased workload and implications on healthcare service provision.
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Affiliation(s)
- M E Kelly
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland,
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50
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Freeman CM, Kelly ME, Nason GJ, McGuire BB, Kilcoyne A, Ryan J, Lennon G, Galvin D, Quinlan D, Mulvin D. Renal Trauma: The Rugby Factor. Curr Urol 2016; 8:133-7. [PMID: 26889132 DOI: 10.1159/000365704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/01/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Renal trauma accounts for 5% of all trauma cases. Rare mechanisms of injuries including sports participation are increasingly common. Rugby-related trauma poses a conundrum for physicians and players due to the absence of clear guidelines and a paucity of evidence. Our series highlights traumatic rugby-related renal injuries in our institution, and emphasize the need for international guidelines on management. METHODS A retrospective review of all abdominal traumas between January 2006 and April 2013, specifically assessing for renal related trauma that were secondary to rugby injuries was performed. All patients' demographics, computerized tomography results, hematological and biochemical results and subsequent management were recorded. RESULTS Five male patients presented with rugby-related injuries. Mean age was 21 years old. All patients were hemodynamically stable and managed conservatively in acute setting. One patient was detected to have an unknown pre-existing atrophic kidney that had been subsequently injured, and was booked for an elective nephrectomy an 8-week interval. CONCLUSION Rugby-related trauma has generated essential attention. This paper serves to highlight this type of injury and the need for defined guidelines on role of imaging and international consensus on timing of return to contact sport, in both professional and amateur settings.
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Affiliation(s)
- Catherine M Freeman
- Department of Urology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Michael E Kelly
- Department of Urology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Gregory J Nason
- Department of Urology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Barry B McGuire
- Department of Urology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Aoife Kilcoyne
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - John Ryan
- Emergency Department, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Gerald Lennon
- Department of Urology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - David Galvin
- Department of Urology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - David Quinlan
- Department of Urology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - David Mulvin
- Department of Urology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
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