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Lopategui DM, Porto JG, Bhatia A, Titus R, Marcovich R, Shah HN. Comment on: "Initial Postoperative Prostate Specific Antigen and PSA Velocity Are Important Indicators of Underlying Malignancy After Simple Prostatectomy" by Livingston et al.. J Endourol 2024. [PMID: 38545770 DOI: 10.1089/end.2024.0111] [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: 04/17/2024] Open
Affiliation(s)
- Diana M Lopategui
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Joao G Porto
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ansh Bhatia
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Renil Titus
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Robert Marcovich
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Hemendra N Shah
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Lopategui DM, Shah HN, Herrmann TRW. Antegrade ejaculation preservation in surgical treatment for benign prostatic hyperplasia: quest for balance between voiding and sexual function. Curr Opin Urol 2024:00042307-990000000-00152. [PMID: 38595170 DOI: 10.1097/mou.0000000000001178] [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: 04/11/2024]
Abstract
PURPOSE OF REVIEW Surgical treatment of benign prostatic hyperplasia (BPH) carries a significant risk of ejaculation dysfunction. Preservation of antegrade ejaculation while providing effective, well tolerated, and durable treatment of BPH is a paramount component of physical and sexual well being for significant number of men. We reviewed available literature with an aim of providing status on antegrade ejaculation preserving BPH surgical therapies. RECENT FINDINGS Minimally invasive surgical therapies for BPH have been developed over the last decade, with significant marketing emphasis on their potential for preservation of antegrade ejaculation. However, the question about durability of relief of bladder outlet obstruction remains. Parallel to this technological development, the understanding of anatomical structures involved in ejaculation have resulted in technical modifications of well established surgical treatments modalities like transurethral resection of prostate, endoscopic enucleation of prostate and simple prostatectomy, thereby providing safe and durable relief of bladder outlet obstruction secondary to BPH with a satisfactory preservation of antegrade ejaculation. SUMMARY Preservation of antegrade ejaculation is an important goal for significant number of men needing BPH surgery. Novel minimally invasive surgical technologies have been developed for this purpose; but understanding of the anatomical structures essential for antegrade ejaculation have allowed technical modification of existing surgical techniques with excellent preservation of antegrade ejaculation.
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Affiliation(s)
- Diana M Lopategui
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Hemendra N Shah
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Stellenbosch, South Africa
- Hannover Medical School, Hannover, Germany
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Lopategui DM, Porto JG, Bhatia A, Titus R, Marcovich R, Shah HN. Letter Re: 'Ejaculatory function following transperineal laser ablation vs TURP for benign prostatic obstruction: a randomized trial'. BJU Int 2024. [PMID: 38403752 DOI: 10.1111/bju.16309] [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: 02/27/2024]
Affiliation(s)
- Diana M Lopategui
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Joao G Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ansh Bhatia
- Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Renil Titus
- Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
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Lopategui DM, Bhatia A, Porto JG, Marcovich R, Shah HN. Decoding the complexity of benign prostatic hyperplasia therapies in the PARTEM trial. Lancet Reg Health Eur 2024; 37:100820. [PMID: 38362556 PMCID: PMC10866918 DOI: 10.1016/j.lanepe.2023.100820] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/29/2023] [Indexed: 02/17/2024]
Affiliation(s)
- Diana M. Lopategui
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ansh Bhatia
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Joao G. Porto
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Robert Marcovich
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Hemendra N. Shah
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Porto JG, Titus R, Camargo F, Bhatia A, Ahie N, Blachman-Braun R, Malpani A, Lopategui DM, Herrmann TRW, Marcovich R, Shah HN. Minimally invasive techniques in quest of Holy Grail of surgical management of enlarged prostates: a narrative review. World J Urol 2024; 42:35. [PMID: 38217727 DOI: 10.1007/s00345-023-04747-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/05/2023] [Indexed: 01/15/2024] Open
Abstract
PURPOSE Past decade has seen a renewed interest in minimally invasive surgical techniques (MISTs) for management of enlarged prostate. This narrative review aims to explore newer MIST for benign prostatic hyperplasia (BPH) which are not yet integrated into established societal guidelines. METHODS We conducted a literature search across PubMed, Google Scholar, and FDA ClinicalTrials.gov databases on June 1st, 2023, to identify studies published within the past decade exploring various MISTs for BPH. Additionally, we gathered insights from abstracts presented in meetings of professional associations and corporate websites. We broadly classified these procedures into three distinct categories: energy-based, balloon dilation, and implant/stent treatments. We collected detail information about the device, procedure details, its inclusion and exclusion criteria, and outcome. RESULTS Our review reveals that newer energy-based MISTs include Transperineal Laser Ablation, Transurethral Ultrasound Ablation, and High-Intensity Focused Ultrasound. In the sphere of balloon dilation, Transurethral Columnar Balloon Dilation and the Optilume BPH Catheter System were gaining momentum. The noteworthy implants/stents that are on horizon include Butterfly Prostatic Retraction Device, Urocross Expander System, Zenflow Spring System, and ProVee Urethral Expander System. CONCLUSION The exploration of various MISTs reflects ongoing efforts to enhance patient care and address limitations of existing treatments. This review provides a bird-eye view and valuable insights for urologists and researchers seeking to navigate the dynamic landscape of MISTs in the quest for effective and minimally invasive solutions for enlarged prostates.
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Affiliation(s)
- Joao G Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Renil Titus
- Seth GS Medical College, KEM Hospital, Mumbai, India
| | - Feres Camargo
- Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ansh Bhatia
- Seth GS Medical College, KEM Hospital, Mumbai, India
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Nehizena Ahie
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ankur Malpani
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Diana M Lopategui
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA.
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Porto J, Suarez Arbelaez MC, Zarli M, Ahumada M, Schard RC, Loftus T, Swain S, Marcovich R, Shah HN. Correction: Exploring the Legal Implications of Benign Prostatic Hyperplasia Surgeries in the United States: A Comprehensive Analysis of Two Decades of Lawsuits. Cureus 2024; 16:c157. [PMID: 38304645 PMCID: PMC10834023 DOI: 10.7759/cureus.c157] [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: 02/03/2024] Open
Abstract
[This corrects the article DOI: 10.7759/cureus.39335.].
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Affiliation(s)
- Joao Porto
- Desai Sethi Urology Institute, University of Miami, Miami, USA
| | | | - Mohamadhusni Zarli
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Mariam Ahumada
- Desai Sethi Urology Institute, University of Miami, Miami, USA
| | | | - Timothy Loftus
- Department of Public Health Sciences, School of Medicine, University of Miami, Miami, USA
- School of Law, University of Miami, Miami, USA
| | - Sanjaya Swain
- Desai Sethi Urology Institute, University of Miami, Miami, USA
| | | | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miami, USA
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Lopategui DM, Porto JG, Marcovich R, Shah HN. Comparison Between Holmium:YAG Laser With MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score-Matched Analysis From the FLEXible Ureteroscopy Outcomes Registry. Letter. J Urol 2023; 210:840-841. [PMID: 37782933 DOI: 10.1097/ju.0000000000003725] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Diana M Lopategui
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Joao G Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, Florida
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Suarez Arbelaez MC, Nackeeran S, Shah K, Blachman-Braun R, Bronson I, Towe M, Bhat A, Marcovich R, Ramasamy R, Shah HN. Association between body mass index, metabolic syndrome and common urologic conditions: a cross-sectional study using a large multi-institutional database from the United States. Ann Med 2023; 55:2197293. [PMID: 37036830 PMCID: PMC10088970 DOI: 10.1080/07853890.2023.2197293] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/25/2023] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION The study aims to determine whether body mass index (BMI), metabolic syndrome (MS) or its individual components (primary hypertension, type 2 diabetes mellitus and dyslipidemias) are risk factors for common urological diseases. MATERIALS AND METHODS Cross-sectional study with data collected on February 28, 2022 from the TriNetX Research Network. Patients were divided in cohorts according to their BMI, presence of MS (BMI > 30 kg/m2, type 2 diabetes mellitus, primary hypertension and disorders of lipoprotein metabolism) and its individual components and its association with common urological conditions was determined. For each analysis, odds ratio (OR) with 95% confidence intervals were calculated. Statistical significance was assessed at p < .05. RESULTS BMI > 30 kg/m2 was associated with increased risk of lithiasis, kidney cancer, overactive bladder, male hypogonadism, benign prostatic hyperplasia, and erectile dysfunction (p < .05). On the contrary, BMI was inversely associated with ureteral, bladder and prostate cancer (p < .05). In all urological diseases, MS was the strongest risk factor, with prostate cancer (OR = 2.53) showing the weakest and male hypogonadism the strongest (OR = 13.00) associations. CONCLUSIONS MS and its individual components were significant risk factors for common urological conditions. Hence holistic approaches with lifestyle modification might prevent common urological disease.Key messagesOverall, metabolic syndrome is the strongest risk factor for all the analysed urological diseases.Abnormally high body mass index can be a risk or protective factor depending on the threshold and urological disease that are being evaluated.Metabolic syndrome and increased BMI should be considered important factors associated to the prevalence of common urological diseases.
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Affiliation(s)
| | - Sirpi Nackeeran
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Khushi Shah
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Isaac Bronson
- UMass Chann Medical School, University of Massachusetts, Amherst, MA, USA
| | - Maxwell Towe
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Abhishek Bhat
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hemendra N. Shah
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Porto JG, Blachman-Braun R, Delgado C, Zarli M, Chen R, Ajami T, Marcovich R, Shah HN. Is Holmium Laser Enucleation of the Prostate Truly Size-Independent? A Critical Evaluation at the Extreme Ends of the Spectrum. Urology 2023; 182:204-210. [PMID: 37716456 DOI: 10.1016/j.urology.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To assess the outcomes of holmium laser enucleation of the prostate (HoLEP) at the extremes of the size spectrum, comparing whether the results are consistent for very large and small prostates. METHODS A retrospective review of 402 patient charts was conducted to compare the outcomes of HoLEP in patients with prostate size ≤40 g (group 1), 41-200 g (group 2), and >200 g (group 3). Various preoperative, perioperative, and postoperative variables were collected. RESULTS HoLEP showed comparable voiding outcomes among all 3 groups, although patients with small prostates had a higher International Prostate Symptom Score during follow-up (P = .022). We noted a higher rate of perioperative blood transfusion in patients with very large prostates (P = .019) and a higher rate of transient acute urinary retention (AUR) in group 1 when compared to group 3 (P = .048). Patients with smaller prostates had a higher rate of bladder neck stenosis and urethral strictures, but the differences were not found to be statistically significant. The incidence of other complications, length of hospital stay, and catheterization duration did not differ significantly among the groups. CONCLUSION HoLEP has consistent and safe outcomes across a wide range of prostate sizes. Although, the risk of blood transfusion is higher in patients with very large prostates and the risk of transient AUR is greater in patients with small glands, the overall efficacy and safety of HoLEP are not significantly influenced by prostate size.
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Affiliation(s)
- Joao G Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Carlos Delgado
- School of Medicine and Health Sciences, Tecnologico de Monterrey, Monterrey, Mexico
| | - Mohamadhusni Zarli
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
| | - Ryan Chen
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Tarek Ajami
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL.
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Suarez Arbelaez MC, Monshine J, Porto JG, Shah K, Singh PK, Roy S, Amin K, Marcovich R, Herrmann TRW, Shah HN. The emerging role of the urinary microbiome in benign noninfectious urological conditions: an up-to-date systematic review. World J Urol 2023; 41:2933-2948. [PMID: 37737900 DOI: 10.1007/s00345-023-04588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
PURPOSE The goal of this systematic review was to examine the current literature on the urinary microbiome and its associations with noninfectious, nonmalignant, urologic diseases. Secondarily, we aimed to describe the most common bioinformatics used to analyze the urinary microbiome. METHODS A comprehensive literature search of Ovid MEDLINE using the keywords "microbiota" AND "prostatic hyperplasia," "microbiota" AND "urinary bladder, overactive," "microbiota" AND "pelvic pain," and "microbiota" AND "urolithiasis" OR "nephrolithiasis" OR "urinary calculi" AND "calcium oxalate" was performed to identify relevant clinical microbiome studies associated with noninfectious benign urological conditions published from 2010 to 2022. We included human studies that evaluated the urinary, stone, or semen microbiota, or any combination of the above-mentioned locations. RESULTS A total of 25 human studies met the inclusion criteria: 4 on benign prostatic hyperplasia (BPH), 9 on overactive bladder (OAB), 8 on calcium oxalate stones, and 4 on chronic pelvic pain syndrome (CPPS). Specific taxonomic profiles in the urine microbiome were associated with each pathology, and evaluation of alpha- and beta-diversity and relative abundance was accounted for most of the studies. Symptom prevalence and severity were also analyzed and showed associations with specific microbes. CONCLUSION The study of the urogenital microbiome is rapidly expanding in urology. Noninfectious benign urogenital diseases, such as BPH, calcium oxalate stones, CPPS, and OAB were found to be associated with specific microbial taxonomies. Further research with larger study populations is necessary to solidify the knowledge of the urine microbiome in these conditions and to facilitate the creation of microbiome-based diagnostic and therapeutic approaches.
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Affiliation(s)
| | - Joshua Monshine
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joao G Porto
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Khushi Shah
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Praveen K Singh
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sabita Roy
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katherine Amin
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
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Porto JG, Arbelaez MCS, Pena B, Khandekar A, Malpani A, Nahar B, Punnen S, Ritch CR, Gonzalgo ML, Parekh DJ, Marcovich R, Shah HN. The Influence of the Microbiome on Urological Malignancies: A Systematic Review. Cancers (Basel) 2023; 15:4984. [PMID: 37894351 PMCID: PMC10605095 DOI: 10.3390/cancers15204984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
The microbiome, once considered peripheral, is emerging as a relevant player in the intricate web of factors contributing to cancer development and progression. These often overlooked microorganisms, in the context of urological malignancies, have been investigated primarily focusing on the gut microbiome, while exploration of urogenital microorganisms remains limited. Considering this, our systematic review delves into the complex role of these understudied actors in various neoplastic conditions, including prostate, bladder, kidney, penile, and testicular cancers. Our analysis found a total of 37 studies (prostate cancer 12, bladder cancer 20, kidney cancer 4, penile/testicular cancer 1), revealing distinct associations specific to each condition and hinting at potential therapeutic avenues and future biomarker discoveries. It becomes evident that further research is imperative to unravel the complexities of this domain and provide a more comprehensive understanding.
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Affiliation(s)
- Joao G. Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | | | - Brandon Pena
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
- Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Archan Khandekar
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Ankur Malpani
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Bruno Nahar
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Chad R. Ritch
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Mark L. Gonzalgo
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Dipen J. Parekh
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Hemendra N. Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
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Mason MM, Nackeeran S, Lokeshwar S, Carino Mason MR, Kohn T, Shah HN, Ramasamy R. A comparison of adverse pregnancy events between ureteral stents and percutaneous nephrostomy tubes in the treatment of nephrolithiasis during pregnancy: A propensity score-matched analysis of a large multi-institutional research network. World J Urol 2023; 41:1721-1726. [PMID: 35909212 DOI: 10.1007/s00345-022-04111-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/18/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To investigate rates of adverse pregnancy events associated with the use of percutaneous nephrostomy tubes (PCN) versus ureteral stents in the treatment of nephrolithiasis during pregnancy. METHODS We queried the TriNetX Diamond Network database to evaluate pregnant women (ICD-10 Z34, O09) with a history of nephrolithiasis (N20-23) who underwent a PCN (CPT 50432) or ureteral stent (52332) placement up to 6 months before delivery (O80-82). We controlled for the following potentially confounding variables through propensity score matching: age, race, ethnicity, acute pyelonephritis (N10), infections of the genitourinary tract in pregnancy (O23.0), and other sepsis (A41) at the time of stent or PCN placement. RESULTS We identified 2,999 pregnant women who underwent ureteral stent placement and 321 who underwent PCN. Following propensity score matching, we found there to be no significant difference in the rate of premature labor or delivery (aOR 1.08, 95% CI 0.735-1.588), premature rupture of membranes (0.889, 0.453-1.743), intrauterine infection (0.906, 0.379-2.165), or c-Sect. (0.825, 0.408-1.667). Within 6 months of their initial procedure, women with a ureteral stent experienced a significantly decreased rate of subsequent urinary tract infection (UTI) or pyelonephritis (0.52, 0.38-0.71), inpatient hospital stay (0.40, 0.26-0.64), emergency department visit (0.65, 0.48-0.89), and repeat exchange procedure (0.70, 0.51-0.96). CONCLUSION In the treatment of nephrolithiasis during pregnancy, PCN versus ureteral stent placement does not confer a significant difference in rates of adverse pregnancy events. However, ureteral stent placement was associated with a lower incidence of hospital admissions, emergency department visits, exchange procedures, and new UTIs or pyelonephritis.
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Affiliation(s)
- Matthew M Mason
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sirpi Nackeeran
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Soum Lokeshwar
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | | | - Taylor Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hemendra N Shah
- Department of Urology, Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, Room 1560, Miami, FL, 33136, USA
| | - Ranjith Ramasamy
- Department of Urology, Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, Room 1560, Miami, FL, 33136, USA.
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Porto JG, Arbelaez MCS, Blachman-Braun R, Bhatia A, Bhatia S, Satyanarayana R, Marcovich R, Shah HN. Complications associated with minimally invasive surgical therapies (MIST) for surgical management of benign prostatic hyperplasia: a Manufacturer and User Facility Device Experience (MAUDE) database review. World J Urol 2023; 41:1975-1982. [PMID: 37222779 DOI: 10.1007/s00345-023-04440-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 01/30/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023] Open
Abstract
PURPOSE MAUDE database houses medical device reports of suspected device-related complications received by Food and Drug Administration. In the present study we aim to evaluate the MAUDE database for reported complications of MIST procedures. METHODS The database was queried using keywords: rezum, urolift, prostate embolization (PAE), transurethral needle ablation (TUNA), transurethral microwave therapy (TUMT), prostate stent and Temporarily Implanted Nitinol Device (iTIND) on 10/1/22 to extract information regarding device problems and procedure-related complications. Gupta classification system was used to stratify complications. Statistical analysis was performed to compare frequency of complications among MIST procedures. RESULTS We found a total of 692 reports (Rezum-358, urolift-226, PAE-53, TUNA-31, TUMT-19, prostatic stent-4, and iTIND-1). Most complications related to device or users were minor (level 1 and 2) and there was no significant difference among various MIST procedures. The screen/system error was responsible for 93% and 83% aborted cases in Rezum and TUNA, respectively, and PAE showed 40% of device component detachment/fracture. Overall Urolift and TUMT were associated with statistically significant higher incidence of major (level 3 and 4) complications (23% and 21%, respectively) as compared with Rezum (7%). Most major complications needing hospitalization after Urolift included hematoma and hematuria with clots and those after Rezum included urinary tract infection and sepsis. Thirteen deaths were reported, mostly due to cardiovascular events, which were classified as not associated with the proposed treatment. CONCLUSION MIST for BPH can occasionally cause significant morbidity. Our data should assist urologists and patients in shared decision-making process.
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Affiliation(s)
- Joao G Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Coral Gables, USA
| | | | - Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Coral Gables, USA
| | - Ansh Bhatia
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Coral Gables, USA
| | - Ramgopal Satyanarayana
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Coral Gables, USA
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Coral Gables, USA
| | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Coral Gables, USA.
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Porto J, Suarez Arbelaez MC, Zarli M, Ahumada M, Swain S, Marcovich R, Shah HN. Exploring the Legal Implications of Benign Prostatic Hyperplasia Surgeries in the United States: A Comprehensive Analysis of Two Decades of Lawsuits. Cureus 2023; 15:e39335. [PMID: 37351225 PMCID: PMC10284091 DOI: 10.7759/cureus.39335] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE The United States (US) currently faces a medical malpractice crisis, and a survey done in 2006 informed that 63% of urologists faced an average of 2.1 medical malpractice lawsuits. Surgery for benign prostatic hyperplasia (BPH) is performed by 95% of US urologists. Hence, we postulated that these procedures might be responsible for a substantial number of medical malpractice lawsuits. We examined claims related to BPH surgery in various US courts. MATERIALS AND METHODS Data were collected from Westlaw and LexisNexis databases using the keywords "benign prostatic hyperplasia," "enlarged prostate," "surgery," and "malpractice" to search for cases from the entire US from January 2000 to December 2021. We extracted details such as the type of procedure, the plaintiff and defendant, the nature of the allegation, the alleged complications, the verdict, and the compensation amount. RESULTS We found 30 cases in which the most common procedure was transurethral resection of the prostate (37%), with inadequate postoperative care as the most frequent reason for claims (33%). Urologists were the most frequently processed professionals (57%). The postsurgical outcomes that resulted in lawsuits were urinary incontinence (23%), erectile dysfunction (13%), and urinary retention (13%). Interestingly, 43% of the patients were inmates. Plaintiffs won only two (7%) cases: colon perforation after interstitial laser coagulation with Indigo laser and recto-urethral fistula after transurethral microwave therapy. CONCLUSION Most lawsuits were related to postoperative incontinence and erectile dysfunction, with the verdict favoring the defendant in most cases. Inmates were the plaintiffs in a relatively high percentage of cases. Only two cases resulted in a plaintiff victory, wherein both cases presented unexpected and serious postsurgical complications.
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Affiliation(s)
- Joao Porto
- Desai Sethi Urology Institute, University of Miami, Miami, USA
| | | | - Mohamadhusni Zarli
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Mariam Ahumada
- Desai Sethi Urology Institute, University of Miami, Miami, USA
| | - Sanjaya Swain
- Desai Sethi Urology Institute, University of Miami, Miami, USA
| | | | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miami, USA
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15
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Hout M, Gurayah A, Arbelaez MCS, Blachman-Braun R, Shah K, Herrmann TRW, Shah HN. Incidence and risk factors for postoperative urinary incontinence after various prostate enucleation procedures: systemic review and meta-analysis of PubMed literature from 2000 to 2021. World J Urol 2022; 40:2731-2745. [PMID: 36194286 DOI: 10.1007/s00345-022-04174-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the risk of urinary incontinence (UI) after various prostate enucleation procedures (PEP). METHODS PubMed was searched from January 2000 to July 2021 for studies investigating UI after PEP. The articles were divided into 5 subgroups: holmium, thulium, greenlight laser, electrocautery, and simple prostatectomy. Meta-analysis was performed to examine rate of stress (SUI), urge (UUI) or unspecified UI at short (< 3 months), intermediate (3-6 months), and long-term (> 6 months). The impact of age, prostate size, surgery time, laser time, postoperative nadir PSA level and technical modifications on UI was analyzed. RESULTS Most (69.4%) of 49 articles included employed holmium laser. There was no significant difference in incidence of short-, intermediate-, and long-term UI, SUI and UUI between five sub-groups and within different technical modifications. Although not statistically significant, the incidence of UI was higher (15%) at short-term with green-light and simple prostatectomy (95% CI 9-23 and 1-84), and higher (4%) at intermediate-term with holmium laser (95% CI 2-8). SUI was more prevalent at short-term with holmium laser (4%; 95% CI 2-5%), and at intermediate term with simple prostatectomy (3%; 95% CI 1-14). UUI was higher in the thulium group (10%, 95% CI 7-16). Increased age, surgery time, laser time and prostate size up to 80 cc were associated with higher UI. There was no correlation between postoperative PSA and UI. CONCLUSIONS There is no significant difference in incidence of UI, SUI and UUI after various PEP. Patients age, prostate size, surgery and laser time are linearly associated with UI.
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Affiliation(s)
- Mohammad Hout
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Aaron Gurayah
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Maria Camila Suarez Arbelaez
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Ruben Blachman-Braun
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Khushi Shah
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | | | - Hemendra N Shah
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA.
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16
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Becerra MF, Smith N, Bhat A, Shah HN. Endoscopic management of adolescent closed Cowper's gland syringocele with holmium:YAG laser. Asian J Urol 2022; 9:340-342. [PMID: 36035349 PMCID: PMC9399538 DOI: 10.1016/j.ajur.2021.06.008] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Maria F Becerra
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Nicholas Smith
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Abhishek Bhat
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Hemendra N Shah
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
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Bhat A, Katz JE, Acharya VK, Shah K, Blachman Braun R, Anthony Smith N, Castillo RP, Shah HN. Morphometric Analysis of Prostate Zonal Anatomy After Transurethral Resection of Prostate and Holmium Laser Enucleation of Prostate Using Magnetic Resonance Imaging: A Pilot Study. Turk J Urol 2022; 48:201-208. [PMID: 35634938 PMCID: PMC9730261 DOI: 10.5152/tud.2022.21326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The primary purpose was to compare the completeness of adenomectomy and zonal anatomy of prostate on magnetic resonance imaging prostate after transurethral resection of prostate and Holmium enucleation of prostate. The secondary purpose was to investigate the relationship between preoperative total prostate volume and postoperative transition zone and peripheral zone volume after both procedures. MATERIAL AND METHODS A retrospective review of all patients who underwent transurethral resection of pros- tate or Holmium enucleation of prostate over 3 years (2017-2020) and had at least 1 postoperative magnetic resonance imaging prostate was performed. Volume estimations of the prostate and individual zones were per- formed, and statistical comparisons were made to evaluate morphometric changes between the 2 procedures. RESULTS A total of 9 patients (mean age, 71.8 years) underwent transurethral resection of prostate and 12 patients (mean age, 66.9 years) underwent Holmium enucleation of prostate. The median pre-operative prostate volume in the Holmium enucleation of prostate group was higher than the transurethral resection of prostate group (101.5 g vs. 62 g; P =.102). However, there was a significant difference in the resected tissue weight favoring Holmium enucleation of prostate over transurethral resection of prostate (P value=.004). The postoperative transition zone and peripheral zone volume as calculated by magnetic resonance imaging remained relatively constant in both procedures. The peripheral zone volume on postoperative magnetic res- onance imaging was found to be independent of transition zone volume even for very large-sized prostates. CONCLUSION A well-performed transurethral resection of prostate or Holmium enucleation of prostate cannearly completely eliminate the transition zone volume, irrespective of the size of the prostate as confirmed by magnetic resonance imaging prostate. Additionally, the peripheral zone volume is consistent across the entire spectrum of the prostate size.
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Affiliation(s)
- Abhishek Bhat
- Department of Urology, Jackson Health System, Miami, FL
| | - Jonathan E. Katz
- Department of Urology, University of Miami Miller Faculty of Medicine, Miami, FL
| | - Vedant K. Acharya
- Department of Urology, University of Miami Miller Faculty of Medicine, Miami, FL
| | - Khushi Shah
- Department of Urology, University of Miami Miller Faculty of Medicine, Miami, FL
| | - Ruben Blachman Braun
- Department of Urology, University of Miami Miller Faculty of Medicine, Miami, FL
| | | | - R. Patricia Castillo
- Department of Radiology, University of Miami Miller Faculty of Medicine, Miami, FL
| | - Hemendra N. Shah
- Department of Urology, University of Miami Miller Faculty of Medicine, Miami, FL
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18
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Banerjee I, Bhat A, Katz JE, Shah RH, Smith NA, Shah HN. Bilateral same session flexible ureterorenoscopy for endoscopic management of bilateral renal calculi is noninferior to unilateral flexible ureterorenoscopy for management of multiple unilateral renal calculi: outcomes of a prospective comparative study. Scand J Urol 2022; 56:244-250. [PMID: 35384790 DOI: 10.1080/21681805.2022.2058606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the study was to prospectively evaluate safety and efficacy of bilateral same session ureterorenoscopy (BSS-FURS) for management of bilateral renal calculi. METHODS A prospective comparative study was designed to compare the results of BSS-FURS with unilateral flexible ureterorenoscopy (U-FURS) for management of renal calculi between June 2003 and May 2016. A sample size of 55 patients in each arm was calculated considering a 20% increase in the incidence of complications with BSS-FURS over 15% complication rate in U-FURS (alpha = 0.05; Beta = 0.90). Patient demographics, stone burden, total operative time, postoperative creatinine level, duration of hospital stay, perioperative complications and stone free rate (SFR) were compared in both the groups. The literature pertaining to BSS-FURS was reviewed. RESULTS Although the study group patients had higher overall stone burden (18.60 ± 7.70 mm vs. 13.32 ± 6.43 mm) and significantly longer operative time (48.30 ± 16.71 min vs. 32.95 ± 13.05 min; p < 0.05) as compared to the control group, the length of hospital stay, SFR (67.85% vs. 78.5%; p = 0.436) and perioperative complications were comparable in both the groups. Most patients who developed postoperative fever from both groups had struvite stones. CONCLUSION BSS-FURS is a safe and efficient procedure for the management of bilateral renal calculi in the hands of an experienced endourologist. It has comparable SFR and morbidity compared to U-FURS. Caution should be exercised in patients with struvite stones, as they are more likely to develop postoperative fever.
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Affiliation(s)
- Indraneel Banerjee
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Abhishek Bhat
- Department of Urology, Jackson Health System, Miami, FL, USA
| | - Jonathan E Katz
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Rashmi H Shah
- Urolap Superspeciality Clinic and S. L. Raheja, Fortis Associate Hospital, Mumbai, India
| | | | - Hemendra N Shah
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
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19
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Katz JE, Soodana-Prakash N, Jain A, Parmar M, Smith N, Kryvenko O, Austin GW, Shah HN. Influence of Age and Geography on Chemical Composition of 98043 Urinary Stones from the USA. EUR UROL SUPPL 2021; 34:19-26. [PMID: 34934963 PMCID: PMC8655393 DOI: 10.1016/j.euros.2021.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background Urolithiasis is a growing issue globally, but it is heterogeneous, with a different epidemiology and pathophysiology for each different stone composition. Objective The purpose of this study is to describe the incidence of urinary stones in the USA from 2016 to 2019 by chemical composition and to investigate the influence of age and geography on these stone types. Design, setting, and participants We obtained compositional analyses for all urinary stones submitted to a national laboratory over an approximately 3-yr period. Outcome measurements and statistical analysis Data collected included the chemical constituents of a stone, patient age, and geographical origin. We describe the incidence of each stone type by frequency. Statistical testing was performed to determine the influence of age and geographical region on overall incidence of each stone composition. Results and limitations In total, 99 908 specimens were analyzed. When pure stones were ordered by frequency, we found that the most common stone type was calcium oxalate (CaOx) (79.2%), followed by uric acid (UA; 14.3%), calcium phosphate (CaPO4; 3.7%), cystine (0.51%), drug induced (0.12%), and magnesium ammonium phosphate (0.04%). CaOx, UA, and CaPO4 were often mixed with one another. Among CaOx stones, the plurality (28.0%) was made of pure calcium oxalate monohydrate (COM), and only 0.002% was pure calcium oxalate dihydrate. There was an overall association between stone composition and both geographical distribution and age (p < 0.001). Conclusions CaOx stones comprise the majority of urinary stones in the USA, of which almost 28% were pure COM. Additionally, age and geographical region are significantly associated with variations in stone composition. Patient summary We evaluated the incidence of urinary stones in the USA based on their chemical composition. The most common stone type was calcium oxalate, the majority of which was pure calcium oxalate monohydrate. We also found age and geographical region to be significantly associated with variations in stone composition.
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Affiliation(s)
- Jonathan E. Katz
- Department of Urology, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | | | - Anika Jain
- Department of Urology, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Madhumita Parmar
- Department of Urology, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Nicholas Smith
- Department of Urology, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Oleksandr Kryvenko
- Department of Urology, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
- Department of Pathology, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | | | - Hemendra N. Shah
- Department of Urology, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
- Corresponding author. Department of Urology, Miller School of Medicine, University of Miami, Coral Gables, FL, USA. Tel. +1 3059158344.
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Abstract
Percutaneous nephrolithotomy (PCNL) remains the treatment of choice for large and complex renal stones. The technological advances over the past several decades gave birth to different varieties of minimally invasive PCNLs, including the mini-PCNL, ultra-mini PCNL, super mini-PCNL, and micro-PCNL, with indications being extended to stones even larger than 20 mm. This article provides an update of all these available techniques of miniaturized PCNL along with its anatomic and physiologic impact. This should assist urologists in providing a personalized approach to the patient based on various patient- and stone-related factors to provide the best of all available technology for treatment.
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Affiliation(s)
- Janak Desai
- Department of Urology, Samved Hospital, 2nd Floor, Navrangpura, Ahmedabad 380009, India.
| | - Hemendra N Shah
- Department of Urology, University of Miami Miller School of Medicine, 1150 NW 14(th) street, Suite 309, Miami, FL 33136, USA
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21
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Bhat A, Katz JE, Smith NA, Shah HN. Unilateral diaphragmatic paresis following supracostal post-percutaneous nephrolithotomy. J Postgrad Med 2021; 68:176-178. [PMID: 34708699 DOI: 10.4103/jpgm.jpgm_13_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Unilateral acquired diaphragmatic paresis is a known complication of thoracic surgeries. Direct mechanical injury to the phrenic nerve during surgery results in this complication. However its occurrence post-percutaneous nephrolithotomy (PCNL) has not been described. We report a 43-year-old man who underwent prone PCNL for endourological management of left complete staghorn calculus. Access via the 10th left intercostal space, under fluoroscopy, was carried out to remove the calculus. Post-operative, the routine chest radiograph revealed left hemidiaphragmatic blunting. Computerized tomography of the chest confirmed left hemidiaphragmatic elevation, suggesting unilateral diaphragmatic paresis. He did not have any respiratory symptoms, was managed conservatively with chest physiotherapy and incentive spirometry and responded extremely well. The absence of reported cases of diaphragmatic paresis post PCNL lends to a dearth in knowledge regarding recognition and management. This case report aims to acquaint urologists with this rare complication associated with supracostal PCNL and provide a rational management plan.
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Affiliation(s)
- A Bhat
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - J E Katz
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - N A Smith
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - H N Shah
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
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22
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Smith NA, Katz JE, Shah HN. Enbloc laser enucleation of prostate after prostatic artery embolization. Urology Video Journal 2021. [DOI: 10.1016/j.urolvj.2021.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Shah HN. Is there still a role of nephrectomy in management of emphysematous pyelonephritis in today's era? J Postgrad Med 2021; 67:130-131. [PMID: 34427277 PMCID: PMC8445115 DOI: 10.4103/jpgm.jpgm_337_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- H N Shah
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, United States
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Madhusoodanan V, Katz JE, Bhat A, Shah HN. Endourological management of osteitis pubis secondary to a calcified prostate ossifying into the pubic symphysis. BMJ Case Rep 2021; 14:14/5/e242009. [PMID: 34016634 DOI: 10.1136/bcr-2021-242009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Osteitis pubis is a rare but known complication of multiple urological procedures including transurethral resection of the prostate, prostate cryotherapy, photovaporisation of the prostate, high-intensity focused ultrasound treatment of the prostate, prostatectomy and cystectomy, especially in the context of salvage therapy for prostate cancer. Patients can present with significant often intractable pain secondary to this condition. We report a case of a patient with a history of radiation therapy and salvage cryoablation who presented with osteitis pubis, calcification of the prostatic tissue bed which was inseparable from the pubic symphysis. Treatment with salvage holmium laser enucleation of the prostate and holmium lithotripsy was demonstrated to be effective for palliative management of osteitis pubis from prostatic calcification ossifying into the pubic symphysis.
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Affiliation(s)
| | - Jonathan E Katz
- Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Abhishek Bhat
- Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hemendra N Shah
- Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Blachman-Braun R, Ory J, Shah HN, Ramasamy R. Is Sexual Function Impacted After Minimally Invasive Surgery for Benign Prostatic Obstruction? Eur Urol 2021; 80:188-189. [PMID: 34023163 DOI: 10.1016/j.eururo.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ruben Blachman-Braun
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jesse Ory
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Hemendra N Shah
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA.
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Smith NA, Katz JE, Shah HN. Salvage Enbloc Thulium Fiber Laser Enucleation of Prostate for Giant Prostatomegaly After Prostatic Urethral Lift. Urology 2021; 154:342-343. [PMID: 33971190 DOI: 10.1016/j.urology.2021.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To demonstrate technique of salvage thylium fiber laser enucleation of prostate in men with history of prior prostatic urethral lift (PUL) implant. PUL is an accepted treatment modality for benign prostatic hyperplasia (BPH) and is currently recommended for surgical management of prostates <80 g in size.1 However, in reality some patients with prostate >80 g also receive PUL.2 A substantial number of these patients may requirement re-treatment for recurrent or persistent lower urinary tract symptoms after PUL.3-5 Patients with larger prostates who fail PUL might be better managed with endoscopic enucleation which is a size-independent modality for treatment of BPH.1,6 Endoscopic enucleation can be accomplished via a variety of energy sources. Thulium fiber laser is a new addition to urologist armamentarium for endoscopic enucleation of prostate. We hereby present a video demonstrating salvage thulium fiber laser enucleation of 198 cc prostate in a men with history of prior PUL. METHODS A 66-year-old male presented with a history of recurrent urine retention after prior PUL done 2 years prior at an outside institution. Pre-operative international prostate symptom score was 13, maximum uroflow rate was 6.1 ml/sec, residual urine was 26 ml despite maximal medical management. MRI demonstrated a 198 g prostate and PSA was 13.4 ng/dl with negative prostate biopsy. After a detailed discussion of options, he elected endoscopic enucleation. We employed a 550-micron Soltive superpulsed laser fiber set at 2 J and 30 Hz to perform en-bloc enucleation of prostate, and morcellation was performed with the VersaCut Morcellator. We edited the video to demonstrate the technical nuances of this procedure. RESULTS Surgery was uneventful with enucleation time of 70 minutes and morcellation time of 142 minutes. Implants encountered during enucleation were easily separated with the thulium fiber laser. No attempt was made to remove implants segments extending beyond the plane of enucleation. Morcellation was challenging, with evidence of damage to morcellation probes requiring replacement of 3 morcellator probes. The patient was discharged on post-operative day one after successful voiding trial. At six-week follow up, his international prostate symptom score of 3 with maximum urinary flow rate of 50 mL/sec. He reported no urinary incontinence and his pathology demonstrated BPH. CONCLUSION This video demonstrates the feasibility of thulium fiber laser enucleation of prostate after PUL, however the findings need to be reproduced in cohort studies. It also demonstrates difficulties encountered during morcellation. For smaller prostates, vaporization may be preferable, thereby avoiding difficulties associated with morcellation.
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Affiliation(s)
- Nicholas A Smith
- University of Miami, Department of Urology, Miller School of Medicine-1400 NW 12th Ave, Miami, FL 33136
| | - Jonathan E Katz
- University of Miami, Department of Urology, Miller School of Medicine-1400 NW 12th Ave, Miami, FL 33136
| | - Hemendra N Shah
- University of Miami, Department of Urology, Miller School of Medicine-1400 NW 12th Ave, Miami, FL 33136.
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Bhat A, Katz JE, Smith N, Shah HN. Nephropleural fistula after supracostal approach for PCNL: report of two cases with review of literature. BMJ Case Rep 2021; 14:14/4/e241360. [PMID: 33795284 DOI: 10.1136/bcr-2020-241360] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Nephropleural fistula is a rarely encountered complication of percutaneous nephrolithotomy (PCNL). Only 11 cases have been reported in literature to date. Often associated with supracostal punctures, the presentation is frequently delayed. Diagnosis is based on imaging, mainly X-rays and CT along with retrograde pyelography that establishes the fistulous connection. A difficult to diagnose condition, any patient with a supracostal access PCNL who presents with delayed symptoms of breathlessness and has leucocytosis with fluid in the lungs on chest imaging should be suspected to have a nephropleural fistula. The management involves intercostal tube thoracostomy to relieve symptoms and drainage of the operated kidney by double-J stent placement, if not placed already. Prompt recognition and management results in excellent recovery with no sequelae. We present our experience with two such cases and our aim was to familiarise the practising urologist regarding the diagnosis and management of this infrequent condition.
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Affiliation(s)
- Abhishek Bhat
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jonathan E Katz
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nicholas Smith
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hemendra N Shah
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Bitran JN, Katz JE, Bhat A, Shah HN. Endourological management of multiple large bladder calculi over eroded mesh in an adult with augmented bladder and catheterisable continent appendicovesicostomy. BMJ Case Rep 2021; 14:e241514. [PMID: 33758052 PMCID: PMC7993306 DOI: 10.1136/bcr-2020-241514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/04/2022] Open
Abstract
Migration of abdominal wall mesh in an augmented bladder is a rarely encountered complication leading to formation of bladder stones causing recurrent urinary tract symptoms. The usual management of this condition involves either open surgical or a percutaneous approach for removal of the stone and migrated portion of mesh. Diagnosis of a migrated mesh is usually made intraoperatively during cystolitholapaxy. Appropriate management results in symptomatic improvement. Endoscopic management through catheterisable continent appendicovesicostomy has not been described to manage this challenging condition. To the best of our knowledge, we describe herewith the first report of endoscopic management of a large bladder stone formed over migrated mesh which involved removal of migrated mesh with holmium laser via a Mitrafanoff.
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Affiliation(s)
- Joshua Nissim Bitran
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jonathan E Katz
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Abhishek Bhat
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hemendra N Shah
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Bhat A, Katz JE, Banerjee I, Blachman-Braun R, Alter K, Shah RH, Smith NA, Shah HN. A prospective evaluation of high- and low-power holmium laser settings for transurethral lithotripsy in the management of adults with large bladder calculi. World J Urol 2021; 39:3481-3488. [PMID: 33624144 DOI: 10.1007/s00345-021-03617-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To prospectively investigate the efficacy and safety of high-power (100 W) vs low-power (20 W) laser settings for transurethral laser lithotripsy in the management large vesical calculi (> 4 cm). METHODS All patients with vesical calculi > 4 cm in the maximum dimension and scheduled for transurethral holmium laser lithotripsy were invited to participate in the study. Every alternate patient was treated with either the low- or high-power laser settings. We used a continuous irrigation resectoscope with laser bridge or a laser working element (Karl Storz) for laser lithotripsy of bladder stones. We compared the operative time, intra-operative/post-operative complications (up to 1 year), and stone-free rates between the treatment groups using IBM SPSS Statistics 24 software. Comparisons between treatment groups for continuous variables were assessed using the Welch test, while categorical variables were compared with either the Chi-square or Fisher's exact test. A p value < 0.05 was considered statistically significant. RESULTS Twenty patients with ten in each cohort were recruited. Preoperative data and mean bladder stone size were comparable in both groups. The duration of surgery was significantly reduced from 70.80 ± 25.28 min in low-power cohort to 40.90 ± 15.01 min in the high-power group (p = 0.005). There were no significant intra-operative complications in either group. All patients were stone-free following the procedure. CONCLUSION High-power laser setting of up to 100 W results in a significant reduction in duration of surgery without any increase in the complication rate for treatment of large bladder stones.
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Affiliation(s)
- Abhishek Bhat
- Department of Urology, Miller School of Medicine, University of Miami, Miami, USA
| | - Jonathan E Katz
- Department of Urology, Miller School of Medicine, University of Miami, Miami, USA
| | - Indraneel Banerjee
- Department of Urology, Miller School of Medicine, University of Miami, Miami, USA
| | - Ruben Blachman-Braun
- Department of Urology, Miller School of Medicine, University of Miami, Miami, USA
| | - Kevin Alter
- Department of Urology, Miller School of Medicine, University of Miami, Miami, USA
| | - Rashmi H Shah
- Urolap Superspeciality Clinic and S. L. Raheja (Fortis Associate Hospital), Mumbai, India
| | | | - Hemendra N Shah
- Department of Urology, Miller School of Medicine, University of Miami, Miami, USA.
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Martos M, Katz JE, Parmar M, Jain A, Soodana‐Prakash N, Punnen S, Gonzalgo ML, Miao F, Reis IM, Smith N, Shah HN. Impact of perioperative factors on nadir serum prostate‐specific antigen levels after holmium laser enucleation of prostate. BJUI Compass 2021; 2:202-210. [PMID: 35475131 PMCID: PMC8988639 DOI: 10.1002/bco2.68] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate the relationship of preoperative prostate size, urinary retention, positive urine culture, and histopathological evidence of prostatitis or incidental prostate cancer on baseline and 3‐month nadir prostate‐specific antigen (PSA) value after Holmium laser enucleation of prostate (HoLEP). Patients and methods Data from 90 patients who underwent a HoLEP by En‐bloc technique were analyzed. PSA values at baseline and at 3‐month follow‐up, preoperative urinary retention and urine culture status, weight of resected tissue, and histopathological evidence of prostatitis or prostate cancer were recorded. We performed univariable and multivariable gamma‐regression analyses to determine the impact of the aforementioned perioperative variables on preoperative PSA, 3‐month postoperative PSA, and change in PSA. Results Serum PSA reduced significantly at 3 months from 6.3 ± 5.9 ng/mL to 0.6 ± 0.6 ng/mL. On both univariable and multivariable analysis, 3‐month nadir level was independent of all preoperative factors examined, except preoperative urinary retention status. Although patients with smaller prostate (resected tissue weight <40 g) had less percentile reduction in PSA when compared with those with larger prostate (resected tissue weight >80 g) (77.67% vs 89.06%; P < .001), patients from both these groups noted a similar PSA nadir level after 3 months (0.54 vs 0.56 ng/dL). The drop in PSA level after HoLEP remained stable up to 1‐year follow‐up. Conclusions PSA nadir 3 months after HoLEP remains relatively consistent across patients, regardless of preoperative prostate size, PSA value, urine culture status, and histopathological evidence of prostatitis or incidental prostate cancer.
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Affiliation(s)
- Mary Martos
- Miller School of Medicine University of Miami Miami FL USA
| | - Jonathan E. Katz
- Department of Urology Miller School of Medicine University of Miami Miami FL USA
| | | | - Anika Jain
- Miller School of Medicine University of Miami Miami FL USA
| | | | - Sanoj Punnen
- Department of Urology Sylvester Comprehensive Cancer Center Miller School of Medicine University of Miami Miami FL USA
| | - Mark L. Gonzalgo
- Department of Urology Sylvester Comprehensive Cancer Center Miller School of Medicine University of Miami Miami FL USA
| | - Feng Miao
- Division of Biostatistics Department of Public Health Sciences Sylvester Biostatistics and Bioinformatics Shared Resource Miller School of Medicine University of Miami Miami FL USA
| | - Isildinha M. Reis
- Division of Biostatistics Department of Public Health Sciences Sylvester Biostatistics and Bioinformatics Shared Resource Miller School of Medicine University of Miami Miami FL USA
| | - Nicholas Smith
- Miller School of Medicine University of Miami Miami FL USA
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Shah HN, Etafy MH, Katz JE, Garcia Lopez EA, Shah RH. A randomized controlled trial comparing high and medium power settings for holmium laser enucleation of prostate. World J Urol 2021; 39:3005-3011. [PMID: 33398423 DOI: 10.1007/s00345-020-03535-y] [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] [Received: 09/10/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To report the results of a randomized controlled trial comparing outcomes between medium power (MP) and high power (HP) laser settings for HoLEPs. METHODS The primary objective was to compare the enucleation efficiency (EE) of HP- HoLEP (80-100 W) with MP-HoLEP (50 - 60 W). The secondary objectives were to compare treatment efficacy and safety between both groups. To show a 25% difference in EE, a sample size of 45 individuals per treatment arm was required (alpha = 0.05; Beta = 0.80). Patients demographic and perioperative factors were analyzed, including EE, hemoglobin drop, duration of catheterization, and length of hospital stay. The surgical outcome was evaluated with AUA symptom score, maximum flow rate, postvoid residual urine, and complications to assess differences between MP and HP HoLEP at baseline, 3 months, 1, and 5 years. Quantitative outcomes were compared with independent sample t tests (2-tailed) and qualitative outcomes were compared with chi-square tests. RESULTS Preoperative data with the exception of indication for surgery were comparable in both treatment arms. There was no statistically significant difference in enucleation efficiency between the HP-HoLEP and MP-HoLEP laser setting (0.97 ± 0.47 vs. 0.85 ± 0.47 gm/min, p = 0.209). MP laser settings did not increase perioperative or postoperative complications and resulted in durable outcome comparable with HP laser settings at 5-year follow-up. CONCLUSIONS MP-HoLEP is safe and efficient and does not compromise the outcome for HoLEPs when compared with HP-HoLEP.
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Affiliation(s)
- Hemendra N Shah
- Department of Urology, Miller School of Medicine, University of Miami, Miami, USA.
| | - Mohamed H Etafy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, USA
| | - Jonathan E Katz
- Department of Urology, Miller School of Medicine, University of Miami, Miami, USA
| | | | - Rashmi H Shah
- Urolap Superspeciality Clinic and S. L. Raheja (Fortis Associate Hospital), Mumbai, India
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Etafy MH, Katz JE, Gonzalgo MR, Garcia Lopez EA, Shah RH, Banerjee I, Smith N, Shah HN. Holmium Laser Enucleation of Prostate Within 6 Weeks of Transrectal Ultrasound Guided Prostate Biopsy is Safe and Effective. Urology 2020; 148:88-92. [PMID: 33227302 DOI: 10.1016/j.urology.2020.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of performing Holmium laser enucleation of the prostate (HoLEP) for the treatment of bladder outlet obstruction secondary to an enlarged prostate within 6-weeks of a transrectal ultrasound (TRUS) guided prostate biopsy. MATERIALS AND METHODS We performed a retrospective review of patients who underwent a HoLEP at our institution, excluding any patients with a confounding urologic history and compared patients who underwent a TRUS-guided 6- or 12-core prostate biopsy, and then underwent a HoLEP within 6 weeks (study group) with all other patients (control group). Our primary outcomes were enucleation efficiency (EE) and perioperative complication rate. Our secondary outcomes included postoperative drop in hemoglobin, duration of catheterization, length of hospital stay, voiding metrics at 1 and 6 months and rate of incidental prostate cancer diagnosed on histopathological examination of prostate specimens after HoLEP. To test for differences between the study and control groups, we performed independent sample t-test (2-tailed) and chi-square tests for quantitative and qualitative variables, respectively. P values of < 0.05 were considered statistically significant. RESULTS 552 patients met inclusion criteria and 84 patients underwent prostate biopsy within a period of 45 days prior to HoLEP. Enucleation efficiency was higher in the study group (P = 0.00). There was no significant difference between the 2 groups regarding perioperative complications, postoperative voiding outcomes, or rate of incidental prostate cancer detection. CONCLUSIONS TRUS prostate biopsy performed within 6 weeks of HoLEP does not negatively impact operative difficulty or treatment outcome.
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Affiliation(s)
| | | | - Mia R Gonzalgo
- Miller School of Medicine, University of Miami, Miami, FL
| | | | - Rashmi H Shah
- S. L. Raheja (Fortis Associate Hospital), Mumbai, India
| | | | - Nicholas Smith
- Miller School of Medicine, University of Miami, Miami, FL
| | - Hemendra N Shah
- Miller School of Medicine, University of Miami, Miami, FL; S. L. Raheja (Fortis Associate Hospital), Mumbai, India.
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Abstract
Background: Tamsulosin in a widely used drug in urology practice in treating lower urinary tract symptoms of benign prostatic hyperplasia, distal ureteral stones, and ureteral stent-related symptoms. Ischemic priapism is a rare but serious adverse effect of tamsulosin. We report two cases of tamsulosin-induced priapism and reviewed available literature citing priapism as a complication of tamsulosin. We also reviewed the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database to identify reported cases of tamsulosin-induced priapism. Case Presentation: First patient was a 61-year-old African American male with paraplegia of 30-year duration. He developed priapism after taking first dose of tamsulosin for lower urinary tract symptoms. He presented with 18 hours of painful erection and was treated with aspiration and irrigation, followed by phenylephrine injection. The patient maintained potency after treatment. The second patient was a 24-year-old male who received tamsulosin in the emergency department as medical expulsive therapy for 11 mm distal ureteral stone. Since he had intractable pain, he underwent emergency primary ureteroscopy with laser lithotripsy as definitive treatment of his ureteral calculus. He developed intraoperative priapism that subsided postoperatively. However, he was discharged with tamsulosin to reduce stent-related urinary symptoms. He returned back to the emergency department after 3 days with persistent priapism for 3 days and needed penoscrotal corporeal decompression to treat his priapism. At 6 weeks follow-up visit, the patient has lost his potency. Although there were only 4 case reports on review of the literature, we were able to identify 46 cases reported in the U.S. FAERS database. Conclusion: Priapism can be an adverse reaction to tamsulosin. Providers and patients should be aware about this complication to ensure early seeking of management to avoid devastating outcomes, particularly in young patients when tamsulosin is given as medical expulsive therapy for ureteral stone and stent-related symptoms.
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Affiliation(s)
- Usama Khater
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hemendra N Shah
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Bhat A, Gonzalgo ML, Shah HN. Re: The Role of Prostate Specific Antigen Monitoring after Holmium Laser Enucleation of the ProstateZain A. Abedali, Adam C. Calaway, Tim Large, James E. Lingeman, Matthew J. Mellon and Ronald S. Boris J Urol 2020; 203: 304-310. J Urol 2020; 205:342. [PMID: 33035144 DOI: 10.1097/ju.0000000000001418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Abhishek Bhat
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Hemendra N Shah
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
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Veloo ACM, Jean-Pierre H, Justesen US, Morris T, Urban E, Wybo I, Shah HN, Friedrich AW, Morris T, Shah HN, Jean-Pierre H, Justesen US, Nagy E, Urban E, Kostrzewa M, Veloo A, Friedrich AW. A multi-center ring trial for the identification of anaerobic bacteria using MALDI-TOF MS. Anaerobe 2017; 48:94-97. [PMID: 28797803 DOI: 10.1016/j.anaerobe.2017.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 06/20/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 11/15/2022]
Abstract
Inter-laboratory reproducibility of Matrix Assisted Laser Desorption Time-of-Flight Mass Spectrometry (MALDI-TOF MS) of anaerobic bacteria has not been shown before. Therefore, ten anonymized anaerobic strains were sent to seven participating laboratories, an initiative of the European Network for the Rapid Identification of Anaerobes (ENRIA). On arrival the strains were cultured and identified using MALDI-TOF MS. The spectra derived were compared with two different Biotyper MALDI-TOF MS databases, the db5627 and the db6903. The results obtained using the db5627 shows a reasonable variation between the different laboratories. However, when a more optimized database is used, the variation is less pronounced. In this study we show that an optimized database not only results in a higher number of strains which can be identified using MALDI-TOF MS, but also corrects for differences in performance between laboratories.
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Affiliation(s)
- A C M Veloo
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, The Netherlands.
| | - H Jean-Pierre
- Centre Hospitalier Universitaire de Montpellier, Hôpital Arnaud de Villeneuve, Laboratoire de Bactériologie, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France; Université Montpellier 1, UMR5119 ECOSYM, Equipe Pathogènes Hydriques Santé Environnements, UMR 5569 Hydrosciences, UFR Pharmacie, 15 avenue Charles Flahault, 34093 Montpellier Cedex 5, France
| | - U S Justesen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - T Morris
- UK Anaerobe Reference Unit, Public Health Wales Microbiology, Cardiff, UK
| | - E Urban
- Institute of Clinical Microbiology, University of Szeged, Hungary
| | - I Wybo
- Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - H N Shah
- Department of Natural Sciences, Middlesex University, London NW4 4BT, UK
| | - A W Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, The Netherlands
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Shah HN, Badlani GH. Genitourinary Tuberculosis; An Update. Curr Bladder Dysfunct Rep 2013. [DOI: 10.1007/s11884-013-0197-4] [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: 10/26/2022]
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Andonian S, Scoffone CM, Louie MK, Gross AJ, Grabe M, Daels FPJ, Shah HN, de la Rosette JJMCH. Does imaging modality used for percutaneous renal access make a difference? A matched case analysis. J Endourol 2012; 27:24-8. [PMID: 22834999 DOI: 10.1089/end.2012.0347] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess perioperative outcomes of percutaneous nephrolithotomy (PCNL) using ultrasound or fluoroscopic guidance for percutaneous access. METHODS A prospectively collected international Clinical Research Office of the Endourological Society (CROES) database containing 5806 patients treated with PCNL was used for the study. Patients were divided into two groups based on the methods of percutaneous access: ultrasound versus fluoroscopy. Patient characteristics, operative data, and postoperative outcomes were compared. RESULTS Percutaneous access was obtained using ultrasound guidance only in 453 patients (13.7%) and fluoroscopic guidance only in 2853 patients (86.3%). Comparisons were performed on a matched sample with 453 patients in each group. Frequency and pattern of Clavien complications did not differ between groups (p=0.333). However, postoperative hemorrhage and transfusions were significantly higher in the fluoroscopy group: 6.0 v 13.1% (p=0.001) and 3.8 v 11.1% (p=0.001), respectively. The mean access sheath size was significantly greater in the fluoroscopy group (22.6 v 29.5F; p<0.001). Multivariate analysis showed that when compared with an access sheath ≤ 18F, larger access sheaths of 24-26F were associated with 3.04 times increased odds of bleeding and access sheaths of 27-30F were associated with 4.91 times increased odds of bleeding (p<0.05). Multiple renal punctures were associated with a 2.6 odds of bleeding. There were no significant differences in stone-free rates classified by the imaging method used to check treatment success. However, mean hospitalization was significantly longer in the ultrasound group (5.3 v 3.5 days; p<0.001). CONCLUSIONS On univariate analysis, fluoroscopic-guided percutaneous access was found to be associated with a higher incidence of hemorrhage. However, on multivariate analysis, this was found to be related to a greater access sheath size (≥ 27F) and multiple punctures. Prospective randomized trials are needed to clarify this issue.
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Affiliation(s)
- Sero Andonian
- Department of Urology, McGill University Health Centre, Montreal, Canada
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Shah HN, Shah RH, Sodha HS, Khandkar AA, Gokhale A. A Randomized Control Trial Evaluating Efficacy of Nephrostomy Tract Infiltration with Bupivacaine After Tubeless Percutaneous Nephrolithotomy. J Endourol 2012; 26:478-83. [DOI: 10.1089/end.2011.0465] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hemendra N. Shah
- Department of Urology, S. L. Raheja (Fortis) Hospital, Mahim (West), Mumbai, India
- Department of Urology, R. G. Stone Urological Research Institute, Mumbai, India
| | - Rashmi H. Shah
- Minimal Access Surgery, R. G. Stone Urological Research Institute, Mumbai, India
| | - Hiren S. Sodha
- Minimal Access Surgery, R. G. Stone Urological Research Institute, Mumbai, India
| | - Amit A. Khandkar
- Department of Urology, R. G. Stone Urological Research Institute, Mumbai, India
| | - Aniruddha Gokhale
- Department of Urology, R. G. Stone Urological Research Institute, Mumbai, India
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Abstract
We reviewed the incidence, predisposing factors, presentation and management of complications related to the use of synthetic mesh in the management of stress urinary incontinence and pelvic organ prolapse repair. Immediate complications, such as bleeding, hematoma, injury to adjacent organs during placement of mesh and complication of voiding dysfunction are not discussed in this review, since they are primarily related to technique. A PubMed search of related articles published in English was done from April 2008 to March 2011. Key words used were urinary incontinence, mesh, complications, midurethral sling, anterior prolapse, anterior vaginal repair, pelvic organ prolapse, transvaginal mesh, vault prolapse, midurethral slings, female stress urinary incontinence, mesh erosion, vaginal mesh complications, and posterior vaginal wall prolapse. Since there were very few articles dealing with the management of mesh-related complications in the period covered in the search we extended the search from January 2005 onwards. Articles were selected to fit the scope of the topic. In addition, landmark publications and Manufacturer and User Facility Device Experience (MAUDE) data (FDA website) were included on the present topic. A total of 170 articles were identified. The use of synthetic mesh in sub-urethral sling procedures is now considered the standard for the surgical management of stress urinary incontinence. Synthetic mesh is being increasingly used in the management of pelvic organ prolapse. While the incidence of extrusion and erosion with mid-urethral sling is low, the extrusion rate in prolapse repair is somewhat higher and the use in posterior compartment remains controversial. When used through the abdominal approach the extrusion and erosion rates are lower. The management of mesh complication is an individualized approach. The choice of the technique should be based on the type of mesh complication, location of the extrusion and/or erosion, its magnitude, severity and potential recurrence of pelvic floor defect.
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Affiliation(s)
- Hemendra N. Shah
- Wake Forest University School of Medicine, Department of Urology, Medical Center Boulevard, Winston-Salem, NC, country USA
| | - Gopal H. Badlani
- Wake Forest University School of Medicine, Department of Urology, Medical Center Boulevard, Winston-Salem, NC, country USA
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Abstract
When confronted with a septic patient or dealing with an emerging epidemic, clinicians, infection control specialists and microbiologists have often felt an immense 'need for speed' while waiting for culture results. Various mass spectrometry (MS) applications are about to answer most of their demands. Matrix-assisted laser desorption ionization (MALDI) time-of-flight (TOF) MS of whole bacterial cells has already greatly shortened the time needed for identification of a positive culture in major diagnostic laboratories in Europe. MS is described in this article, with a special emphasis on the different systems currently commercially available for routine identification. MALDI-TOF MS remains, however, limited by the previous time-consuming culture steps, and is not suited for strain typing in epidemic contexts. These limitations can be overcome by other applications of MS in microbiology. MALDI-resequencing is a rapid method for genotyping, offering comparable results to multilocus sequence typing. New systems of broad-range PCR, associated with analyses of amplicons by electrospray ionization MS, might allow nearly full automation for the direct identification of pathogens in blood, thus bypassing the culture stage. This article describes various applications of MS methods in clinical microbiology, and provides a comparative table of these technologies.
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Affiliation(s)
- S Emonet
- Department of Internal Medicine, Geneva University Hospitals, Switzerland.
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Shah HN, Kharodawala S, Sodha HS, Khandkar AA, Hegde SS, Bansal MB. The management of renal matrix calculi: a single-centre experience over 5 years. BJU Int 2009; 103:810-4. [DOI: 10.1111/j.1464-410x.2008.08065.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shah HN, Sodha HS, Khandkar AA, Kharodawala S, Hegde SS, Bansal MB. A randomized trial evaluating type of nephrostomy drainage after percutaneous nephrolithotomy: small bore v tubeless. J Endourol 2008; 22:1433-9. [PMID: 18690809 DOI: 10.1089/end.2007.0350] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare the outcome of tubeless percutaneous nephrolithotomy (PCNL) with small-bore nephrostomy drainage after PCNL. PATIENTS AND METHODS We tested the hypothesis that tubeless PCNL is superior to small-bore nephrostomy drainage after PCNL in terms of postoperative pain, analgesic requirement, and hospital stay. To show a 10% difference in these parameters, a sample size of 30 persons per group would be needed. All patients undergoing PCNL from September 2005 to May 2006 were included in the study. Patients meeting the inclusion and exclusion criteria were then randomized to either a tubeless approach with insertion of a ureteral stent or placement of an 8F nephrostomy tube without insertion of a ureteral stent. The perioperative outcomes of patients in the two groups were compared. RESULTS Tubeless PCNL was performed in 33 patients, and an 8F nephrostomy tube was placed in 32 patients. The two groups had comparable demographic data. The hemoglobin drop and complication rate between the two groups were comparable. Patients undergoing tubeless PCNL experienced less postoperative pain (P = 0.001), needed less analgesia (P = 0.006), and were discharged 9 hours earlier than patients in the other group. Complete stone clearance was achieved in 87.87% patients in the tubeless group and 87.5% patients in the nephrostomy group. In the tubeless group, 39.4% of patients had bothersome stent-related symptoms, of whom 61.5% needed analgesics and/or antispasmodic agents. CONCLUSIONS Tubeless PCNL offers the potential advantages of decreased postoperative pain, analgesic requirement, and hospital stay without increasing the complications. It was associated with stent-related discomfort in 39% of patients.
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Affiliation(s)
- Hemendra N Shah
- Department of Urology, R. G. Stone Urological Research Institute, Mumbai, India.
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Shah HN, Sodha H, Khandkar AA, Kharodawala S, Hegde SS, Bansal M. Endoscopic management of adult orthotopic ureterocele and associated calculi with holmium laser: experience with 16 patients over 4 years and review of literature. J Endourol 2008; 22:489-96. [PMID: 18271717 DOI: 10.1089/end.2007.0312] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To retrospectively evaluate the safety and effectiveness of holmium laser endoscopic incision and laser lithotripsy in adults with orthotopic ureterocele and associated calculi. PATIENTS AND METHODS From May 2003 to August 2007 at our center, 16 adults underwent transurethral incision of an ureterocele and intracorporeal holmium laser lithotripsy for associated calculi. The perioperative data of these patients were retrospectively analyzed. The literature was reviewed to identify all the reported options for management of this relatively rare condition. RESULTS Ureterocele was associated with a single system in 13 patients. Two patients had bilateral ureteroceles. Four patients had associated upper tract stones. The procedure was uneventful in all patients. The average postoperative hospital stay was 19.3 hours. All patients were stone free after the procedure. Eleven patients were available for follow-up at 3 and 6 months. None of these patients had any evidence of residual ureterocele and/or hydronephrosis when evaluated with intravenous urography at 3 months. Micturating cystourethrography (MCU) at 3 months revealed low-grade vesicoureteral reflux (VUR) in four patients; no reflux was found with MCU at 6 months. CONCLUSIONS Laser endoscopic management of adult orthotopic ureterocele and associated calculi effectively decompressed ureterocele and removed stones in all patients without any significant postoperative morbidity. Low-grade VUR that may occur postoperatively resolved at 6 months. A literature review suggests that the ability of the holmium laser to manage both ureterocele and calculi simultaneously should make holmium laser management a procedure of choice at centers that possess the equipment.
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Affiliation(s)
- Hemendra N Shah
- Department of Urology, R.G. Stone Urological Research Institute, Mumbai, India.
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Shah HN, Sodha HS, Kharodawala SJ, Khandkar AA, Hegde SS, Bansal MB. Influence of prostate size on the outcome of holmium laser enucleation of the prostate. BJU Int 2008; 101:1536-41. [DOI: 10.1111/j.1464-410x.2007.07434.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Shah HN, Sodha HS, Khandkar AA, Kharodawala SS, Hegde SS, Bansal MB. A RANDOMIZED CONTROL TRIAL EVALUATING EFFICACY OF NEPHROSTOMY TRACT INFILTRATION WITH BUPIVACAINE AFTER TUBELESS PERCUTANEOUS NEPHROLITHOTOMY (PCNL). J Urol 2008. [DOI: 10.1016/s0022-5347(08)61271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Shah HN, Kharodawala SS, Khandkar AA, Sodha HS, Hegde SS, Bansal MB. PERCUTANEOUS NEPHROLITHOTOMY (PCNL) FOR RENAL MATRIX CALCULI: SINGLE CENTRE EXPERIENCE WITH 12 PATIENTS. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61483-4] [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: 11/30/2022]
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Shah HN, Khandkar AA, Hegde SS, Bansal MB. HOLMIUM LASER ENUCLEATION OF THE PROSTATE IN PATIENTS ON ANTICOAGULANT THERAPY AND WITH BLEEDING DISORDERS. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61968-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Shah HN, Mahajan AP, Hegde SS, Bansal M. Tubeless Percutaneous Nephrolithotomy in Patients with Previous Ipsilateral Open Renal Surgery: A Feasibility Study with Review of Literature. J Endourol 2008; 22:19-24. [DOI: 10.1089/end.2006.0480] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hemendra N. Shah
- Department of Urology, R.G. Stone Urological Research Institute, Mumbai, India
| | - Amol P. Mahajan
- Department of Urology, R.G. Stone Urological Research Institute, Mumbai, India
| | - Sunil S. Hegde
- Department of Anesthesia, R.G. Stone Urological Research Institute, Mumbai, India
| | - Manish Bansal
- Department of Urology, R.G. Stone Urological Research Institute, Mumbai, India
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Jacinto RC, Gomes BPFA, Desai M, Rajendram D, Shah HN. Bacterial examination of endodontic infections by clonal analysis in concert with denaturing high-performance liquid chromatography. ACTA ACUST UNITED AC 2007; 22:403-10. [PMID: 17949344 DOI: 10.1111/j.1399-302x.2007.00378.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIMS The aim of this study was to examine the diversity of bacterial species in the infected root canals of teeth associated with endodontic abscesses by cloning and sequencing techniques in concert with denaturing high-performance liquid chromatography. METHODS Samples collected from five infected root canals were subjected to polymerase chain reaction (PCR) with universal 16S ribosomal DNA primers. Products of these PCRs were cloned and sequenced. Denaturing high-performance liquid chromatography (DHPLC) was used as a screening method to reduce the number of clones necessary for DNA sequencing. RESULTS All samples were positive for the presence of bacteria and a range of 7-13 different bacteria were found per root canal sample. In total, 48 different oral clones were detected among the five root canal samples. Olsenella profusa was the only species present in all samples. Porphyromonas gingivalis, Dialister pneumosintes, Dialister invisus, Lachnospiraceae oral clone, Staphylococcus aureus, Pseudoramibacter alactolyticus, Peptostreptococcus micros and Enterococcus faecalis were found in two of the five samples. The majority of the taxa were present in only one sample, for example Tannerella forsythia, Shuttleworthia satelles and Filifactor alocis. Some facultative anaerobes that are frequently isolated from endodontic infections such as E. faecalis, Streptococcus anginosus and Lactobacillus spp. were also found in this study. CONCLUSION Clonal analysis of the microflora associated with endodontic infections revealed a wide diversity of oral species.
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Affiliation(s)
- R C Jacinto
- Department of Restorative Dentistry, Endodontic Area, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, SP, Brazil
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