1
|
Raheem OA, Alkassis M, Iwuala R. Comment on: current opinions on the management of prolonged ischemic priapism: does penoscrotal decompression outperform corporoglanular tunneling? Int J Impot Res 2024; 36:295-296. [PMID: 38514868 DOI: 10.1038/s41443-024-00876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Omer A Raheem
- The University of Chicago, Department of Surgery, Section of Urology, Chicago, IL, USA.
| | - Marwan Alkassis
- The University of Chicago, Department of Surgery, Section of Urology, Chicago, IL, USA
| | - Rosemary Iwuala
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| |
Collapse
|
2
|
Villota CK, Hou SW, Judge C, Eggener S, Paner G, Raheem OA. Ex-vivo microscopic oncotesticular sperm extraction: step-by-step surgical technique at time of radical orchiectomy. Fertil Steril 2024:S0015-0282(24)00125-0. [PMID: 38403108 DOI: 10.1016/j.fertnstert.2024.02.037] [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: 06/27/2023] [Revised: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To demonstrate the intraoperative surgical techniques required for simultaneous radical orchiectomy and microscopic oncotesticular sperm extraction (m-OncoTESE) in a step-by-step fashion. DESIGN Video presentation. SETTING University Hospital (University of Chicago). PATIENTS A 37-year-old man (status after right orchiectomy at another institution for stage II-C testicular seminoma with positive preoperative tumor markers) was referred for contralateral orchiectomy of multifocal left testis mass and fertility preservation. Semen analysis before, microscopic testicular sperm extraction during, and semen or testicular specimen analysis after the first orchiectomy were unable to identify any sperm. A postoperative analysis of the m-OncoTESE performed on the left testis resulted in the cryopreservation of 200,000 motile sperm for future assisted reproductive technology (i.e., in vitro fertilization or in vitro fertilization-intracytoplasmic sperm injection). INTERVENTIONS Left radical orchiectomy and left m-OncoTESE. MAIN OUTCOME MEASURES A comprehensive visual documentation of m-OncoTESE surgical techniques with concurrent commentary detailing the reasons behind each surgical step. A brief discussion on the background of m-OncoTESE and alternative fertility preservation methods accompanies the procedure. RESULTS This video provides a step-by-step guide to performing an m-OncoTESE (proceeding a radical orchiectomy in a patient with testicular cancer) as a means of fertility preservation in an azoospermic patient. Successful extraction and cryopreservation of testicular spermatozoa were achieved after targeted ex-vivo testicular microdissection. CONCLUSIONS Sperm extraction via m-OncoTESE is a viable option for azoospermic patients with testicular cancer undergoing radical orchiectomies. The use of preoperative imaging and microsurgical techniques facilitates and optimizes surgical dissection and sperm recovery.
Collapse
Affiliation(s)
| | - Sean W Hou
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Clark Judge
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| | - Scott Eggener
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| | - Gladell Paner
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Omer A Raheem
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| |
Collapse
|
3
|
Hyman MJ, Huang Z, Raheem OA. The percentage of men counseled by urologists who received a vasectomy mildly increased after the publication of the AUA vasectomy guideline. Int J Impot Res 2024:10.1038/s41443-024-00829-2. [PMID: 38291118 DOI: 10.1038/s41443-024-00829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
This retrospective cohort study explored whether the publication of the vasectomy guideline by the American Urological Association in December 2012 increased the percentage of men counseled by urologists who received a vasectomy. We used commercial health insurance claims between 2010 and 2015 to identify the initial sterilization counseling visit for men aged 18-64 and whether each of them received a vasectomy within six months of that visit. A difference-in-differences analysis isolated the effect of the guideline on the percentage of men counseled by urologists who received a vasectomy, exploiting suspected variation in guideline exposure and adherence between urologists and non-urologists. In total, 226 012 men had an initial sterilization counseling visit, of which 182 204 (80.6%) were counseled by urologists and 43 808 (19.4%) were counseled by non-urologists. The percentage of men counseled by urologists who received a vasectomy mildly increased by 1.5% (p = 0.002) after the publication of the guideline. Therefore, the percentage of men who receive a vasectomy may in part be explained by practice guidelines and clinicians' willingness to consider the procedure, and future research should investigate how clinicians arrive at their decisions to recommend a vasectomy and whether a standardized counseling protocol would ensure consistency.
Collapse
Affiliation(s)
- Max J Hyman
- The Center for Health and the Social Sciences, The University of Chicago, Chicago, IL, USA
| | - Zhong Huang
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Omer A Raheem
- Department of Surgery, Section of Urology, The University of Chicago Medical Center, Chicago, IL, USA.
| |
Collapse
|
4
|
Huang Z, Hyman MJ, Raheem OA. Trends in the Vasectomy Rate Among Privately Insured Men Aged 18-64 in the United States Between 2014 and 2021. Urology 2023; 179:80-86. [PMID: 37353084 DOI: 10.1016/j.urology.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To update trends in the vasectomy rate among privately insured men aged 18-64 in the United States (U.S.) between 2014 and 2021. MATERIALS AND METHODS We used commercial health insurance claims data between 2014 and 2021 to calculate the annual vasectomy rate in men aged 18-64 in the U.S. We performed these calculations nationally and by age group, marital status, maternal age of a wife, number of children, U.S. Census Bureau region, geography, geographical region, and state. We calculated the absolute and relative changes in these rates from 2014 to 2021 to study how much and how quickly they changed. RESULTS The vasectomy rate among privately insured men aged 18-64 in the U.S. increased by 0.11%-a 26% change-from 2014 (0.427%) to 2021 (0.537%). The absolute changes were greatest in men with 3 or more children (0.489%), with 2 children (0.295%), with a wife not of advanced maternal age (0.276%), and aged 35-44 (0.243%). The relative changes were greatest in men with no children (61%), with a wife of advanced maternal age (40.8%), who were single (40.6%), and aged 18-24 (36.7%). In every region except the Northeast, the absolute and relative changes were greater in rural geographies compared to urban geographies. CONCLUSIONS The vasectomy rate among privately insured men aged 18-64 in the U.S. increased between 2014 and 2021. Further investigation is needed to ensure demand for vasectomies may continue to be met.
Collapse
Affiliation(s)
- Zhong Huang
- Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | - Max J Hyman
- The Center for Health and the Social Sciences, The University of Chicago, Chicago, IL
| | - Omer A Raheem
- Department of Surgery, Section of Urology, The University of Chicago Medical Center, Chicago, IL.
| |
Collapse
|
5
|
Raheem OA, Xing MH, Cooper CA, Hyman MJ, Khera M, Modi PK. Reply by Authors. Urol Pract 2023; 10:326. [PMID: 37341370 DOI: 10.1097/upj.0000000000000402.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/07/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Omer A Raheem
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| | - Monica H Xing
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Caleb A Cooper
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| | - Max J Hyman
- The Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
| | - Mohit Khera
- Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Parth K Modi
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| |
Collapse
|
6
|
Raheem OA, Xing MH, Cooper CA, Hyman MJ, Khera M, Modi PK. Increasing Role of the Advanced Practice Provider in Men's Health Clinics: An Analysis of Medicare and Commercial Claims in the United States. Urol Pract 2023:101097UPJ0000000000000402. [PMID: 37167418 DOI: 10.1097/upj.0000000000000402] [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: 05/13/2023]
Abstract
INTRODUCTION As urologic care delivery in the U.S. continues to evolve to meet patient needs, we aim to clarify the role of Advanced Practice Providers (APPs) for publicly and privately insured patients in the treatment of male urologic conditions commonly encountered in men's health clinics. METHODS Medicare and commercial insurance claims from the Physician/Supplier Procedure Summary and Merative MarketScan Commercial Database, were queried for procedures submitted by APPs between 2010 and 2021. Common urologic conditions were identified using Current Procedural Terminology codes and grouped into 4 categories: testicular hypofunction, erectile dysfunction (ED) and Peyronie's disease (PD), benign prostatic hyperplasia (BPH), and scrotal pain. The proportion of procedures submitted by APPs was calculated for each year and category. RESULTS From 2010 to 2021, the proportion of APP submitted service counts for each condition within the MarketScan group increased up to 5-fold, with BPH representing the greatest growth. The proportion of APP submitted service counts within the Medicare group increased up to 8-fold, with ED/PD representing the greatest fold change. The proportion of claims submitted by APPs treating all 4 conditions were higher in 2021 than 2010 in both publicly and privately insured groups. CONCLUSIONS The role of APPs in men's urologic health is increasing for both privately and publicly insured patient populations. APPs play a critical role in urologic care and can help to improve access to men's health.
Collapse
Affiliation(s)
- Omer A Raheem
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| | - Monica H Xing
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Caleb A Cooper
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| | - Max J Hyman
- The Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
| | - Mohit Khera
- Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Parth K Modi
- Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois
| |
Collapse
|
7
|
Raheem OA, Faris S, Kocjancic E. Perspective on 1st International Symposium Advanced Genitourinary Reconstruction & Urologic Prosthesis course at the University of Chicago Medical Center. Int J Impot Res 2023:10.1038/s41443-023-00704-6. [PMID: 37185979 DOI: 10.1038/s41443-023-00704-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Omer A Raheem
- Department of Surgery, Section of Urology, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA.
| | - Sarah Faris
- Department of Surgery, Section of Urology, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Ervin Kocjancic
- Department of Surgery, Section of Urology, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| |
Collapse
|
8
|
Singh A, Cooper CA, Hou SW, Raheem OA. A Systematic Review of Partner Satisfaction After Penile Prosthesis with Special Emphasis on LGBTQ + Populations. Curr Urol Rep 2023; 24:105-115. [PMID: 36670232 DOI: 10.1007/s11934-022-01126-5] [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] [Accepted: 10/04/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Despite the current surgical advances and patients' satisfactions after penile prosthesis (PP) implantation, there has been paucity of data on reported partner satisfaction and their quality-of-life (QoL). Our objective was to summarize the current literature on partner satisfaction for both heterosexual and non-heterosexual populations, respectively. We specifically conducted a systematic review according to the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, and stratified studies into three tiers by methodological rigor. RECENT FINDINGS After an initial search of 172 articles, 33 studies met the inclusion criteria for the final review: 30 for heterosexual partner satisfaction, and 3 for LGBTQ patient satisfaction were included due to lack of published literature on partner satisfaction for LGBTQ patients. For heterosexual partner satisfaction, 10 studies were classified as Tier 1, 11 studies were classified as Tier 2, and 9 studies were classified as Tier 3. From an initial search of 13 records, three studies consisting of 272 patients met the inclusion criteria for our LGBTQ review. Across all the tiers, studies noted satisfaction rates between 50 and 90% and improved satisfaction and sexual QoL metrics compared to pre-surgery rates. That said, partner satisfaction rates were also consistently lower than patient satisfaction rates. Although the range of evidence quality varies, the available literature suggests significant improvements in and relatively high rates of partner satisfaction after PP implantation. Given the diversity of study designs and widespread use of non-validated or non-specific questionnaires in the current literature, future research should focus on prospective studies and/or data collection using validated, PP-specific questionnaires.
Collapse
Affiliation(s)
- Armaan Singh
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Caleb A Cooper
- Department of Surgery, Section of Urology, University of Chicago Medicine, Chicago, IL, USA
| | - Sean W Hou
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Omer A Raheem
- Department of Surgery, Section of Urology, University of Chicago Medicine, Chicago, IL, USA.
| |
Collapse
|
9
|
Xing MH, Hou SW, Raheem OA. Aesthetic Penile Augmentation Procedures: A Comprehensive and Current Perspective. Curr Urol Rep 2022; 23:355-361. [PMID: 36350528 DOI: 10.1007/s11934-022-01123-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW Some men experience small penis syndrome (SPS), a body dysmorphic disorder in which a patient believes their penis to be small even when it is clinically average. As cosmetic surgery becomes more widely accepted, management of SPS may present a challenge for urologists. We aim to provide an updated review of aesthetic penile augmentation procedures. RECENT FINDINGS Augmentation procedures range from invasive to noninvasive. Surgical solutions include grafts and flaps, suspensory ligament release, and suprapubic lipectomy. Minimally invasive solutions include injections of fillers (hyaluronic acid, polylactic acid, and polymethyl methacrylate). Noninvasive solutions include external devices such as vacuum pumps and traction devices. In the current climate, aesthetic penile augmentation is becoming a desirable option for many patients but remains clinically controversial. Our review summarizes recent and relevant studies and demonstrates the need for further research and consensus on penile augmentation procedures.
Collapse
Affiliation(s)
- Monica H Xing
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
| | - Sean W Hou
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Omer A Raheem
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL, USA
| |
Collapse
|
10
|
Mwamba RN, Ekwonu A, Guimaraes PVB, Raheem OA. The efficacy, safety, and outcomes of testosterone use among transgender men patients: A review of the literature. Neurourol Urodyn 2022. [DOI: 10.1002/nau.25094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/05/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Rimel N. Mwamba
- The Pritzker School of Medicine The University of Chicago Medical Center Chicago Illinois USA
| | - Adaora Ekwonu
- The Pritzker School of Medicine The University of Chicago Medical Center Chicago Illinois USA
| | - Paulo V. B. Guimaraes
- Department of Surgery, Section of Urology The University of Chicago Medical Center Chicago Illinois USA
| | - Omer A. Raheem
- The Pritzker School of Medicine The University of Chicago Medical Center Chicago Illinois USA
- Department of Surgery, Section of Urology The University of Chicago Medical Center Chicago Illinois USA
| |
Collapse
|
11
|
Nusbaum D, Sudhakar D, Raheem OA. Commentary on: Testosterone replacement therapy and cardiovascular disease. Int J Impot Res 2022; 34:691-692. [PMID: 36198810 DOI: 10.1038/s41443-022-00625-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 08/30/2022] [Accepted: 09/22/2022] [Indexed: 11/09/2022]
Affiliation(s)
- David Nusbaum
- Section of Urology, The University of Chicago, Chicago, IL, USA
| | | | - Omer A Raheem
- Section of Urology, The University of Chicago, Chicago, IL, USA.
| |
Collapse
|
12
|
Cooper CA, Sloan MJ, Singh A, Fantus RJ, Raheem OA. A Historical and Contemporary Review of Questionnaires Used in the Management of Post-Radical Prostatectomy Patients. Sex Med Rev 2022; 10:681-690. [PMID: 37051967 DOI: 10.1016/j.sxmr.2022.04.003] [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: 03/15/2022] [Revised: 04/20/2022] [Accepted: 04/23/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Patients undergoing radical prostatectomy (RP) face obstacles to recovery spanning the domains of erectile and sexual function; urinary function; and health-related quality of life (HRQoL). Numerous patient-directed questionnaires exist that serve to assist in the care of these men. AIM To describe patient-directed questionnaires of historical and contemporary relevance involving the evaluation and treatment of men after radical prostatectomy. METHODS A comprehensive review of peer-reviewed publications on the topic was performed. Using PubMed, the search terms used were: "radical prostatectomy; erectile function; lower urinary tract symptoms; sexual dysfunction; urinary incontinence; and health-related quality of life. MAIN OUTCOME MEASURE We aimed to summarize questionnaires and survey devices of historical and contemporary importance for the care of men after RP. RESULTS Many questionnaires have been developed specifically for, or conscripted for use in, the care of men after RP. Some of the oldest questionnaires relating to sexual function, urinary function, and general and cancer-specific QoL are important and still utilized in the routine clinical care of post-RP patients. However, recent devices that may offer clinicians a more comprehensive understanding to aid in the evaluation and care of these men. CONCLUSIONS Post-RP patients face numerous challenges that require a thoughtful approach, one that is broad enough to identify a variety of potential physical and emotional disturbances, yet granular enough to identify appropriate areas for intervention. While there is not a "best" questionnaire for this population, having an appropriate understanding of the current available instruments and what information they provide may help clinicians more thoroughly assess and treat these men. Castillo O, Chen IK, Amini E, et al. Male Sexual Health Related Complications Among Combat Veterans. Sex Med Rev 2022;XX:XXX-XXX.
Collapse
Affiliation(s)
- Caleb A Cooper
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Matthew J Sloan
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Armaan Singh
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Richard J Fantus
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA; Section of Urology, Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - Omer A Raheem
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
| |
Collapse
|
13
|
Xing M, Raheem OA. Commentary on "Penile augmentation with injectable hyaluronic acid gel: an alternative choice for small penis syndrome". Asian J Androl 2022; 24:677. [PMID: 35435335 PMCID: PMC9809485 DOI: 10.4103/aja202214] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Monica Xing
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL 60637, USA
| | - Omer A Raheem
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL 60637, USA,
Correspondence: Dr. O Raheem ()
| |
Collapse
|
14
|
Kohn TP, Nguyen HMT, Rajanahally S, Hellstrom W, Hsieh T, Raheem OA. Global Trends in Prevalence, Treatments, and Costs of Penile Prosthesis for Erectile Dysfunction in Men. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.243] [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: 10/18/2022]
|
15
|
Kohn TP, Rajanahally S, Hellstrom WJG, Hsieh TC, Raheem OA. Global Trends in Prevalence, Treatments, and Costs of Penile Prosthesis for Erectile Dysfunction in Men. Eur Urol Focus 2021; 8:803-813. [PMID: 34034995 DOI: 10.1016/j.euf.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)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 11/04/2022]
Abstract
CONTEXT Penile prosthesis is a durable and effective treatment for erectile dysfunction (ED). Even as other treatment options for ED have been brought to market, penile prosthetic surgery remains a mainstay for urologists treating ED. No systematic study has yet summarized the global trends in penile prosthetic surgery. OBJECTIVE To systematically review studies of trends in penile prosthetic surgery to determine global movements in implantation rates, malleable versus inflatable prosthetic surgery, inpatient versus outpatient implantation surgery, proportion of men with ED undergoing penile prosthetic surgery, and prosthetic cost. EVIDENCE ACQUISITION A systematic review of MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov was performed for studies assessing trends in penile prosthetic surgeries and costs associated with penile prosthetic device and inclusive surgical costs. EVIDENCE SYNTHESIS Twenty-seven studies were identified during the systematic review, comprising 447,204 penile prosthetic surgeries reported from 1988 to 2019. A trend analysis demonstrates that rates of penile prosthetic surgery declined dramatically in the late 1980s and early 1990s, but have demonstrated modest growth since the mid-2000s. Outpatient inflatable penile prosthetic surgery has strongly trended upward. Costs of penile prosthetic device have matched the rate of inflation, but inclusive surgical cost has radically outpaced inflation. Growth has mainly been seen in the USA, with a more modest global growth. CONCLUSIONS Penile prosthesis remains a viable option for the treatment of ED. Trends such as outpatient surgery and inflatable penile prosthesis placement may be driving the recent steady growth of penile prosthetic surgeries, but surging inclusive surgical cost may present a barrier for some patients without insurance coverage. PATIENT SUMMARY Penile prostheses continue to be an important treatment for erectile dysfunction. While the volume of penile prosthetic surgeries dropped when phosphidiesterase-5 inhibitors became available, prosthetic surgery is becoming more patient centric, as seen by increases in inflatable prosthetic placement and outpatient surgery.
Collapse
Affiliation(s)
- Taylor P Kohn
- Department of Urology, Johns Hopkins, Baltimore, MD, USA
| | | | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Tung-Chin Hsieh
- Department of Urology, University of California, San Diego, La Jolla, CA, USA
| | - Omer A Raheem
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
| |
Collapse
|
16
|
Brimley S, Natale C, Dick B, Pastuszak A, Khera M, Baum N, Raheem OA. The Emerging Critical Role of Telemedicine in the Urology Clinic: A Practical Guide. Sex Med Rev 2021; 9:289-295. [PMID: 33752994 PMCID: PMC9585225 DOI: 10.1016/j.sxmr.2020.12.002] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/30/2020] [Accepted: 12/10/2020] [Indexed: 01/23/2023]
Abstract
Introduction Although telemedicine (TM) has been available for several decades, the recent increase in its acceptance due to the COVID-19 pandemic has emerged as a valuable solution for the delivery of health care that provides easy, affordable, and convenient communication with urologic patients. Objectives The objective of this study was to highlight limiting factors and provide successful practical solutions to assist urologists in incorporating and maintaining TM in their practices. Methods A thorough literature review was conducted utilizing PubMed, Cochrane library, clinicaltrials.gov, Google Scholar, and Web of Science. Search terms and keywords included “telemedicine” and “urology.” Only articles written or translated into the English language were included. Results A total of 12 peer-reviewed articles were identified that discussed barriers for incorporation of TM in urology. Articles exclusive to the use of TM during the COVID-19 pandemic were also included, as well as American Urological Association and European Urological Association guidelines and Centers for Medicare & Medicaid Services statements and policies regarding TM pertinent to urological practice. Conclusion TM is currently a viable option and fills an unmet need for most practicing urologists, especially during the COVID-19 pandemic, offering insight to the relative ease of transition to online clinical practice. OA Raheem, S Brimley, C Natale, et al. The Emerging Critical Role of Telemedicine in the Urology Clinic: A Practical Guide. Sex Med Rev 2021;9:289–295.
Collapse
Affiliation(s)
- Scott Brimley
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Caleb Natale
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Brian Dick
- Department of Urology, Tulane University, New Orleans, LA, USA
| | | | - Mohit Khera
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Neil Baum
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Omer A Raheem
- Department of Urology, Tulane University, New Orleans, LA, USA.
| |
Collapse
|
17
|
Koller CR, Wang S, Sandoval V, Yousif A, Hsieh TC, Raheem OA. Self-Induced Trauma to the Genitalia: a Review of the Literature and Management Schemes. Curr Urol Rep 2021; 22:18. [PMID: 33534050 DOI: 10.1007/s11934-021-01034-0] [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: 01/04/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Self-induced genital trauma is rare, and prompt and evidence-based early intervention can improve the urinary and sexual function of these complex patients. This review has surveyed current literature and treatment trends to evaluate the clinical approach to managing genital trauma. RECENT FINDINGS A literature review was performed regarding self-induced genitalia trauma and trauma management between 2000 and 2019 using MEDLINE® database, the Cochrane Library® Central Search, Web of Science, and Google Scholar. In total, 42 articles were considered relevant and included in this review. Self-induced trauma can be appropriately managed with a multidisciplinary approach. Treatment goals are to preserve urinary, sexual, and reproductive function. Specific evaluation includes mechanism of injury, imaging, and determining the extent of injury and surgical repair, if indicated. Due to the rarity of these injuries and their emergent nature, much of the management is based on retrospective data. Further research is needed to improve long-term functional outcomes in trauma patients.
Collapse
Affiliation(s)
- Christopher R Koller
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Ave. 8642 Room 3514, New Orleans, LA, 70112, USA
| | - Shuhong Wang
- Department of Andrology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Victor Sandoval
- Department of Urology, Hospital Valentin Gomez Farias, Guadalajara, Mexico
| | - Ayad Yousif
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Ave. 8642 Room 3514, New Orleans, LA, 70112, USA
| | - Tung-Chin Hsieh
- Department of Urology, University of California San Diego Health, San Diego, California, USA
| | - Omer A Raheem
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Ave. 8642 Room 3514, New Orleans, LA, 70112, USA.
| |
Collapse
|
18
|
Natale C, Carlos C, Hong J, Khera M, Baum N, Raheem OA. Testosterone Therapy After Prostate Cancer Treatment: A Review of Literature. Sex Med Rev 2021; 9:393-405. [PMID: 33516741 DOI: 10.1016/j.sxmr.2020.12.003] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/07/2020] [Accepted: 12/13/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Although testosterone therapy (TTh) is the standard practice in otherwise healthy hypogonadal men, this therapy has historically been contraindicated in men with a history of prostate cancer. Recent evidence suggests that there is minimal or no prostate cancer growth in the setting of TTh administration in men definitively treated for non-metastatic prostate cancer. OBJECTIVE To review the evidence supporting the safety and efficacy of TTh in patients previously treated for localized prostate cancer. METHODS A literature review of the PubMed database was performed to identify studies evaluating the safety and efficacy of TTh in patients with a history of prostate cancer. Search terms included Testosterone Therapy, Testosterone Replacement Therapy and Radical Prostatectomy, Radiotherapy, External Beam Radiation Therapy, EBRT, Brachytherapy; Prostate Cancer and Hypogonadism, Low Testosterone; Bipolar Androgen Therapy. RESULTS Available literature provides evidence for the safe application of TTh in patients previously treated for prostate cancer with either radical prostatectomy or radiotherapy. Furthermore, there exists evidence that severely hypogonadal levels of testosterone may lead to worse oncological outcomes. More recent research has begun to elucidate the effectiveness of bipolar androgen deprivation therapy in the treatment of prostate cancer. This mechanism of action increases the level of evidence indicating that the traditional management of maintaining testosterone levels at low levels may no longer be standard of care. TTh likely has a role in improved erectile function and other quality-of-life concerns in patients developing testosterone deficiency after being treated for prostate cancer. CONCLUSIONS TTh should be offered to select hypogonadal patients who have a history of definitively treated prostate cancer. Adequately designed randomized controlled trials are necessary to confirm the safety and efficacy of TTh in this population. Natale C, Carlos C, Hong J, et al. Testosterone Replacement Therapy After Prostate Cancer Treatment: A Review of Literature. Sex Med Rev 2021;9:393-405.
Collapse
Affiliation(s)
- Caleb Natale
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Carmen Carlos
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Jennifer Hong
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Mohit Khera
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Neil Baum
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Omer A Raheem
- Department of Urology, Tulane University, New Orleans, LA, USA.
| |
Collapse
|
19
|
Hehemann MC, Raheem OA, Rajanahally S, Holt S, Chen T, Fustok JN, Song K, Rylander H, Chow E, Ostrowski KA, Muller CH, Walsh TJ. Evaluation of the impact of marijuana use on semen quality: a prospective analysis. Ther Adv Urol 2021; 13:17562872211032484. [PMID: 34367341 PMCID: PMC8299873 DOI: 10.1177/17562872211032484] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/25/2021] [Indexed: 11/23/2022] Open
Abstract
AIMS To assess if marijuana consumption - prevalent among men of reproductive age and becoming widespread due to decriminalization - is associated with changes in semen parameters. Marijuana's active metabolite, tetrahydrocannabinol, can alter signaling pathways within spermatozoa, affecting spermatogenesis and fertility. METHODS We prospectively evaluated semen analyses (SA) from men presenting for infertility evaluation at one institution from July 2017 to April 2018. Participants completed a reproductive health questionnaire including items regarding marijuana consumption. SA was performed in accordance with World Health Organization (WHO) 5th Edition criteria. SA parameters included volume (ml), concentration (million/ml), motility (%), progressive motility (%), and Tygerberg strict morphology (%). RESULTS A total of 409 patients completed the questionnaire; 174 (43%) men reported marijuana use (ever-users). Current and past users comprised 71 (17%) and 103 (25%), respectively. Compared with never-users, current and past users had a significantly higher likelihood of abnormal sperm strict morphology (33.1% versus 50.7% and 53.4%, respectively; p < 0.001). However, sperm motility was more likely to be less than WHO reference values in never-users than current and past-users (38.3% versus 21.1% and 27.2%, respectively; p = 0.01). In multivariate logistic regression analyses, current use was associated with increased odds of abnormal strict morphology [odds ratio (OR) 2.15, 95% confidence interval (CI): 1.21-3.79] and semen volume less than WHO reference value (OR 2.76, 95%CI: 1.19-6.42), while odds of less than WHO reference value sperm motility were reduced (OR 0.47, 95%CI: 0.25-0.91). CONCLUSION Marijuana use is common among men presenting for fertility evaluation, and may have a detrimental effect on semen quality, particularly morphology and volume, but may be protective against abnormal sperm motility. Large, prospective studies of both semen quality and fertility in this growing, at-risk population are warranted.
Collapse
Affiliation(s)
| | - Omer A. Raheem
- Department of Urology, Tulane University Medical Center, 1415 Tulane Avenue, 3rd Floor, New Orleans, LA 70112, USA
| | | | - Sarah Holt
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Tony Chen
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Judy N. Fustok
- Department of Urology, Tulane University, New Orleans, LA USA
| | - Kelly Song
- Male Fertility Lab, University of Washington, Seattle, WA, USA
| | | | - Emma Chow
- Male Fertility Lab, University of Washington, Seattle, WA, USA
| | | | - Charles H. Muller
- Department of Urology, University of Washington, Seattle, WA, USA Male Fertility Lab, University of Washington, Seattle, WA, USA
| | - Thomas J. Walsh
- Department of Urology, University of Washington, Seattle, WA, USA
| |
Collapse
|
20
|
Loftus CJ, Rajanahally S, Holt SK, Raheem OA, Ostrowski KA, Walsh TJ. Treatment Trends and Cost Associated With Peyronie's Disease. Sex Med 2020; 8:673-678. [PMID: 33036960 PMCID: PMC7691870 DOI: 10.1016/j.esxm.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/08/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Providers may use several treatment options for patients with Peyronie's disease; however, it is unclear whether practice patterns have evolved over recent years and if this has impacted cost. AIMS To investigate trends in the treatment of Peyronie's disease over time and the associated costs using a national, commercial insurance claims database. METHODS A retrospective cohort study was conducted using claims from the Truven MarketScan database from 2007 to 2018 for men with Peyronie's disease. Cost was estimated as either the sum of prescription oral or injectable treatment costs or as the single net cost associated with the operative procedure. MAIN OUTCOME MEASURES Frequency of use of various treatments for Peyronie's disease and associated costs were assessed as trends over the timeline by year. RESULTS The estimated annual incidence of Peyronie's disease in this population rose from 61 to 77 per 100,000 patients over the included years, and the percent annual treatment rate rose from 17.8% to 26.2%. Colchicine was the most commonly prescribed oral agent in 2007 used in 22% of treated individuals; by 2018, pentoxifylline was the most common prescribed oral agent used in 33%. In 2007, 11% of treated patients received intralesional verapamil; however, by 2018, 24% received injectable collagenase, whereas <1% received intralesional verapamil. The mean annual, per-individual cost of Peyronie's disease treatment increased from $1,531 in 2007 to $10,339 in 2018. The cost increase was greatest for injectable therapies, which rose from $811 per individual in 2007 to $16,184 in 2018, a 19-fold increase. CONCLUSIONS Diagnosis and treatment of Peyronie's disease is increasing over time. Pentoxifylline has become the most common oral prescription, whereas injectable collagenase has become most common injection. The mean cost associated with Peyronie's disease treatment increased more than 5 times from 2007 to 2018 corresponding with Federal Drug Administration's approval of injectable collagenase. Loftus CJ, Rajanahally S, Holt SK, et al. Treatment Trends and Cost Associated With Peyronie's Disease. Sex Med 2020;8:673-678.
Collapse
Affiliation(s)
| | | | - Sarah K Holt
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | - Omer A Raheem
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Kevin A Ostrowski
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | - Thomas J Walsh
- Department of Urology, University of Washington Medical Center, Seattle, WA
| |
Collapse
|
21
|
Shelton TM, Brimley SC, Nguyen HMT, Voznesensky I, Khalil MI, Machado B, Bhandari NR, Payakachat N, Davis R, Kamel MH, Raheem OA, Benson CR. Changing Trends in Management Following Artificial Urinary Sphincter Surgery for Male Stress Urinary Incontinence: An Analysis of the National Surgical Quality Improvement Program Database. Urology 2020; 147:287-293. [PMID: 33075382 DOI: 10.1016/j.urology.2020.07.090] [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: 06/01/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To characterize the safety and practice patterns of artificial urinary sphincter (AUS) placement on a population level. Increasingly AUS implantation has shifted to be an outpatient surgery; however, there is a lack of large-scale research evaluating factors associated with early (≤ 24 hours) versus late (>24 hours) discharges and complications in men following AUS placement. We utilized the National Surgical Quality Improvement Program (NSQIP) database to identify and compare factors and outcomes associated with each approach. METHODS NSQIP database was queried for men undergoing AUS placement between 2007 and 2016. Patients were classified as either early discharge (ED ≤ 24 hours) and late discharge (LD > 24 hours). Baseline demographics, operating time, and complications were compared between the 2 groups. Multivariate logistic regression evaluated factors associated with discharge timing and 30-day complications. RESULTS A total of 1176 patients were identified and were classified as ED in 232 and LD in 944 patients. Operative time was shorter in ED (83 minutes) compared to LD (95 minutes, P < .001). Hypertension was more prevalent among LD patients (60.3% vs 69.1% for ED and LD respectively, P < .001). The 30-day complication rate was similar in both groups (ED: 4.3% vs LD: 3.4%, P = .498). Multivariable analysis revealed that surgery after 2012 was associated with ED (OR = 3.66, P < .001). CONCLUSION At the national level, there are no differences in postoperative morbidity between early and late discharges. There is a trend toward more ED, specifically after 2012. A prospective study on the feasibility and safety of outpatient AUS is needed.
Collapse
Affiliation(s)
| | | | | | | | - Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR; Department of Urology, Ain Shams University, Cairo, Egypt
| | - Bruno Machado
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR; Department of Urology, Ain Shams University, Cairo, Egypt
| | - Naleen Raj Bhandari
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR; Department of Urology, Ain Shams University, Cairo, Egypt
| | - Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR; Department of Urology, Ain Shams University, Cairo, Egypt
| | - Omer A Raheem
- Department of Urology, Tulane University, New Orleans, LA
| | | |
Collapse
|
22
|
Dick B, Greenberg JW, Polchert M, Natale C, Hellstrom WJG, Raheem OA. A Systematic Review of Penile Prosthesis Surgery in Organ Transplant Recipients. Sex Med Rev 2020; 9:636-640. [PMID: 32641224 DOI: 10.1016/j.sxmr.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/08/2020] [Accepted: 05/17/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There is an increased prevalence of erectile dysfunction in patients with solid organ transplant (SOT) compared with the general population. Many of these patients may become refractory to medical treatment of erectile dysfunction and penile prosthesis (PP) is often recommended. Concerns regarding the safety of PP in patients with SOT are due to their immunosuppressed state. OBJECTIVE We aim to review all current literature on the outcomes of patients with SOT who have received PP. METHODS A PubMed search was performed to identify articles pertaining to the outcomes of PP in patients with SOT. RESULTS We identified and included 14 studies that report on outcomes of PP placement in 143 patients with SOT and 191 non-SOT controls from interval period from 1979 to 2019. Studies included retrospective cohort studies, case series, and case reports. Compared with non-SOT controls who had PP, aggregate analysis demonstrated that patients with SOT who had PP did not develop significantly increased overall complications. However, they were significantly more likely to experience future surgical complications. CONCLUSION Our aggregate analysis demonstrated that patients with SOT are not at a significantly increased risk of overall complications when receiving a PP. Nevertheless, there is an increased risk of experiencing PP injury during subsequent surgeries, which may be mitigated by the earlier involvement of a urologist. Given the lack of recent data, large studies are prerequisite to further evaluate the safety and overall outcome of PP surgery in patients with SOT. Dick B, Greenberg JW, Polchert M, et al. A Systematic Review of Penile Prosthesis Surgery in Organ Transplant Recipients. Sex Med Rev 2021;9:636-640.
Collapse
Affiliation(s)
- Brian Dick
- Department of Urology, Tulane University, New Orleans, LA, USA
| | | | | | - Caleb Natale
- Department of Urology, Tulane University, New Orleans, LA, USA
| | | | - Omer A Raheem
- Department of Urology, Tulane University, New Orleans, LA, USA.
| |
Collapse
|
23
|
Khalil MI, Bramwell AK, Bhandari NR, Payakachat N, Machado B, Davis R, Kamel MH, Safaan A, Raheem OA. Concurrent Penile Prosthesis and Artificial Urinary Sphincter versus Penile Prosthesis and Male Sling: A National Multi-Institutional Analysis of National Surgical Quality Improvement Program Database Comparing Postoperative Morbidity. World J Mens Health 2020; 39:75-82. [PMID: 32378369 PMCID: PMC7752517 DOI: 10.5534/wjmh.190172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose We aimed to assess the 30-day morbidity in patients undergoing combined insertion of penile prosthesis (PP) and artificial urinary sphincter (AUS) vs. PP and male sling (MS). Materials and Methods The National Surgical Quality Improvement Program database was queried to identify patients who underwent placement of AUS or MS combined with PP. Patient demographics, postoperative morbidity including complications, readmission and reoperation rates were recorded. Student t-test and chi-square or Fischer's exact test were used as appropriate. Results Forty-one patients met selection criteria between 2010 and 2016. Overall, 26 patients received PP and AUS vs. 15 that received PP and MS. Average age was similar in both groups (64.8±6.6 years vs. 62.3±6.3 years, p=0.254). Diabetes mellitus was more prevalent in PP+MS group compared to AUS+PP group (46.7% vs. 11.5%, p=0.022). Average length of stay was higher in PP+AUS group compared to PP+MS group (2.2±0.6 days vs. 1.8±0.4 days, p=0.017). Postoperative morbidity was reported in four patients in PP+AUS group. No reported complications in PP+MS group. In PP+AUS group, complications included one patient who developed urinary tract infection, one developed surgical site infection, readmission in two for postoperative infection, and one return to the operating room. No reported prosthesis explantation or revision in either groups. Conclusions Our results showed that 30-day morbidity was recorded in the PP+AUS group and none in the PP+MS group. The complication and readmission rates remain comparable to the previous reports in both groups.
Collapse
Affiliation(s)
- Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Urology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Austin K Bramwell
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Naleen Raj Bhandari
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bruno Machado
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Urology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Safaan
- Department of Urology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Omer A Raheem
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
| |
Collapse
|
24
|
Khalil MI, Bhandari NR, McKay S, Kamel MH, Safaan A, Davis R, Payakachat N, Raheem OA, Eltahawy E. Evaluation of factors and short-term postoperative morbidity associated with early versus late discharge following urethroplasty. Int Urol Nephrol 2020; 52:1279-1286. [DOI: 10.1007/s11255-020-02410-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
|
25
|
Yousif A, Raheem OA. RE: neurogenic bladder is an independent risk factor for complications associated with inflatable penile prosthesis implantation. Int J Impot Res 2020; 33:124-125. [PMID: 32071411 DOI: 10.1038/s41443-020-0240-x] [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: 01/15/2020] [Revised: 01/31/2020] [Accepted: 02/07/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Ayad Yousif
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Omer A Raheem
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
| |
Collapse
|
26
|
Khalil MI, Tourchi A, Langford BT, Bhandari NR, Payakachat N, Davis R, Safaan A, Raheem OA, Kamel MH. Early Postoperative Morbidity of Robotic Versus Open Radical Cystectomy in Obese Patients. J Endourol 2020; 34:461-468. [PMID: 31964189 DOI: 10.1089/end.2019.0560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: To compare the 30-day postoperative complications of robotic radical cystectomy (RRC) vs open radical cystectomy (ORC) in obese patients (body mass index ≥30) with bladder cancer (BC). Methods: The National Surgical Quality Improvement Program database was queried to identify obese BC patients who underwent RRC or ORC between 2005 and 2016. Patient demographics, postoperative mortality rate, morbidity, operating time (OPTIME), length of stay (LOS), readmission, and reoperation rates were recorded and compared between the two groups. Each RRC patient was matched with three ORC patients using a propensity score approach. Results: Four hundred forty-two RRC patients were matched with 1326 ORC patients. No difference in early postoperative mortality rate between RRC and ORC (0.7% vs 1.3%, relative risk, RR [95% confidence interval CI]: 0.27 [0.07-1.02]). Compared with ORC, the RRC group showed shorter mean OPTIME (364.7 [standard deviation, SD = 133.4] vs 387.8 [SD = 129.7] minutes, p = 0.001) and mean LOS (7.1 [SD = 5.6] vs 10.6 [SD = 6.6] days, p < 0.001). Compared with ORC, the RR of developing the following events in RRC group was lower: 30-day postoperative any complication (45%), any wound occurrence (64%), blood transfusion (70%), superficial surgical-site infection (78%), and wound disruption (77%). There was no difference in the RR of any-cause readmission (RR [95% CI]: 0.77 [0.57-1.05]) and reoperation (RR [95% CI]: 0.48 [0.22-1.04]) between the two groups. Conclusions: The study revealed that RRC for obese BC patients is associated with shorter OPTIME, shorter LOS, and lower risk of early postoperative complications when compared with a matched group of patients who received ORC. In addition, no difference in early postoperative mortality rate between RRC and ORC was observed.
Collapse
Affiliation(s)
- Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Ali Tourchi
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Brian T Langford
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Naleen Raj Bhandari
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ahmed Safaan
- Department of Urology, Ain Shams University, Cairo, Egypt
| | - Omer A Raheem
- Department of Urology, Tulane University, New Orleans, Louisiana, USA
| | - Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Department of Urology, Ain Shams University, Cairo, Egypt
| |
Collapse
|
27
|
Abstract
The field of prosthetic urology demonstrates the striking impact that simple devices can have on quality of life. Penile prosthesis and artificial urinary sphincter implantation are the cornerstone procedures on which this specialty focuses. Modern research largely concentrates on decreasing the rates of complication and infection, as the current devices offer superior rates of satisfaction when revision is not necessary. These techniques are also able to salvage sexual function and continence in more difficult patient populations including female-to-male transgender individuals, those with ischemic priapism, and those with erectile dysfunction and incontinence secondary to prostatectomy. This review summarizes modern techniques, outcomes, and complications in the field of prosthetic urology.
Collapse
Affiliation(s)
- Kole P Akula
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Avenue, 86-42, New Orleans, LA 70112-2699, USA
| | - Omer A Raheem
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Avenue, 86-42, New Orleans, LA 70112-2699, USA
| |
Collapse
|
28
|
Khalil MI, Bhandari NR, Payakachat N, Davis R, Raheem OA, Kamel MH. Perioperative mortality and morbidity of outpatient versus inpatient robot-assisted radical prostatectomy: A propensity matched analysis. Urol Oncol 2020; 38:3.e1-3.e6. [DOI: 10.1016/j.urolonc.2019.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
|
29
|
Khalil MI, Ubeda J, Soehner T, Bhandari NR, Payakachat N, Davis R, Raheem OA, Kamel MH. Contemporary Perioperative Morbidity and Mortality Rates of Minimally Invasive vs Open Partial Nephrectomy in Obese Patients with Kidney Cancer. J Endourol 2019; 33:920-927. [PMID: 31333072 DOI: 10.1089/end.2019.0310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: To compare early postoperative morbidity and mortality rates in obese patients (body mass index ≥30 kg/m2) who underwent minimally invasive partial nephrectomy (MIPN) vs open partial nephrectomy (OPN), utilizing the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods: The NSQIP database was queried to identify obese patients who underwent either MIPN or OPN between 2008 and 2016. Patient demographics, comorbidities, operative time (OT), length of stay (LOS), and 30-day postoperative complications, readmissions, and mortality rates were recorded and compared between the two groups. Multivariable logistic regression analysis was used to determine the adjusted odds of early postoperative complications in MIPN vs OPN. Results: A total of 6041 obese MIPN patients and 3064 obese OPN patients were identified. Mean OT (minutes ± standard deviation) was longer for MIPN vs OPN (197.2 ± 71.0 vs 189.6 ± 82.4, p < 0.001), while mean LOS (3.8 ± 2.8 days vs 5.8 ± 3.5 days, p < 0.001) and 30-day complications (8.5% vs 19.8%, p < 0.001) were lower. No difference in 30-day postoperative mortality rates between MIPN (0.4%) and OPN (0.5%) was observed (p = 0.426). In the adjusted analysis, the odds of any complication within 30 days in the MIPN group were 61% lower, blood transfusion 73% lower, pneumonia 38% lower, sepsis 70% lower, acute renal failure 64% lower, superficial surgical site infection 40% lower, and reoperation 47% lower, compared with OPN patients. Conclusions: When compared with OPN in obese patients, the likelihood of 30-day postoperative morbidity was significantly lower in MIPN patients. However, the odds of 30-day mortality rates were similar between the groups.
Collapse
Affiliation(s)
- Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Joel Ubeda
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Thomas Soehner
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Naleen Raj Bhandari
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Omer A Raheem
- Department of Urology, Tulane University, New Orleans, Louisiana
| | - Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Urology, Ain Shams University, Cairo, Egypt
| |
Collapse
|
30
|
Yim K, Bindayi A, McKay R, Mehrazin R, Raheem OA, Field C, Bloch A, Wake R, Ryan S, Patterson A, Derweesh IH. Rising Serum Uric Acid Level Is Negatively Associated with Survival in Renal Cell Carcinoma. Cancers (Basel) 2019; 11:cancers11040536. [PMID: 30991671 PMCID: PMC6520981 DOI: 10.3390/cancers11040536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 12/31/2022] Open
Abstract
Aim and Background: To investigate the association of serum uric acid (SUA) levels along with statin use in Renal Cell Carcinoma (RCC), as statins may be associated with improved outcomes in RCC and SUA elevation is associated with increased risk of chronic kidney disease (CKD). Methods: Retrospective study of patients undergoing surgery for RCC with preoperative/postoperative SUA levels between 8/2005–8/2018. Analysis was carried out between patients with increased postoperative SUA vs. patients with decreased/stable postoperative SUA. Kaplan-Meier analysis (KMA) calculated overall survival (OS) and recurrence free survival (RFS). Multivariable analysis (MVA) was performed to identify factors associated with increased SUA levels and all-cause mortality. The prognostic significance of variables for OS and RFS was analyzed by cox regression analysis. Results: Decreased/stable SUA levels were noted in 675 (74.6%) and increased SUA levels were noted in 230 (25.4%). A higher proportion of patients with decreased/stable SUA levels took statins (27.9% vs. 18.3%, p = 0.0039). KMA demonstrated improved 5- and 10-year OS (89% vs. 47% and 65% vs. 9%, p < 0.001) and RFS (94% vs. 45% and 93% vs. 34%, p < 0.001), favoring patients with decreased/stable SUA levels. MVA revealed that statin use (Odds ratio (OR) 0.106, p < 0.001), dyslipidemia (OR 2.661, p = 0.004), stage III and IV disease compared to stage I (OR 1.887, p = 0.015 and 10.779, p < 0.001, respectively), and postoperative de novo CKD stage III (OR 5.952, p < 0.001) were predictors for increased postoperative SUA levels. MVA for all-cause mortality showed that increasing BMI (OR 1.085, p = 0.002), increasing ASA score (OR 1.578, p = 0.014), increased SUA levels (OR 4.698, p < 0.001), stage IV disease compared to stage I (OR 7.702, p < 0.001), radical nephrectomy (RN) compared to partial nephrectomy (PN) (OR 1.620, p = 0.019), and de novo CKD stage III (OR 7.068, p < 0.001) were significant factors. Cox proportional hazard analysis for OS revealed that increasing age (HR 1.017, p = 0.004), increasing BMI (Hazard Ratio (HR) 1.099, p < 0.001), increasing SUA (HR 4.708, p < 0.001), stage III and IV compared to stage I (HR 1.537, p = 0.013 and 3.299, p < 0.001), RN vs. PN (HR 1.497, p = 0.029), and de novo CKD stage III (HR 1.684, p < 0.001) were significant factors. Cox proportional hazard analysis for RFS demonstrated that increasing ASA score (HR 1.239, p < 0.001, increasing SUA (HR 9.782, p < 0.001), and stage II, III, and IV disease compared to stage I (HR 2.497, p < 0.001 and 3.195, p < 0.001 and 6.911, p < 0.001) were significant factors. Conclusions: Increasing SUA was associated with poorer outcomes. Decreased SUA levels were associated with statin intake and lower stage disease as well as lack of progression to CKD and anemia. Further investigation is requisite.
Collapse
Affiliation(s)
- Kendrick Yim
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Ahmet Bindayi
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Rana McKay
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Reza Mehrazin
- Department of Urology, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA.
| | - Omer A Raheem
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Charles Field
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Aaron Bloch
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Robert Wake
- Department of Urology, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA.
| | - Stephen Ryan
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Anthony Patterson
- Department of Urology, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA.
| | - Ithaar H Derweesh
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| |
Collapse
|
31
|
Dai JC, Ahn JS, Cannon ST, Walsh TJ, Ostrowski K, Raheem OA, Sherman M, Lendvay TS. Acute Ischemic Priapism Management: An Educational and Simulation Curriculum. MedEdPORTAL 2018; 14:10731. [PMID: 30800931 PMCID: PMC6342429 DOI: 10.15766/mep_2374-8265.10731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/27/2018] [Indexed: 06/09/2023]
Abstract
Introduction Ischemic priapism is a urologic emergency managed by both urologic and nonurologic providers in the community. Given ischemic priapism's rare occurrence and the time-sensitive nature of treatment, effective provider education on management of this entity is imperative. We sought to develop a low-cost effective simulation model and curriculum to enhance trainee education. Methods A comprehensive didactic curriculum based on national urologic guidelines was developed, along with a low-cost, easily reproducible priapism simulator using hot dogs and Red Vines candy. The simulators cost $1.25 each, and assembly took 10 minutes. All materials were reviewed by three urology faculty members. The curriculum was piloted with two andrology fellowship-trained urology faculty among eight urology residents (PGY2-PGY4/U1-U2) and one medical student. Participants provided feedback regarding the overall course as well as the face and content validity of the simulator. Results Cognitive test scores significantly improved on average by 15.0% (p = .002), and confidence improved from baseline somewhat or very much among 88.9% of participants after completion of the curriculum. The task trainer was rated easy to use (average score: 4.78 out of 5), and 77.8% of participants though it was somewhat or very useful for training (average score: 4.00 out of 5). Additionally, 77.8% recommended its incorporation into resident training (average score: 4.00 out of 5). Discussion This simulation curriculum is effective, inexpensive, and easily reproducible, making it ideal for groups with limited resources. Expanding access to simulation-based curricula on priapism management may improve education of both urologic and nonurologic trainees.
Collapse
Affiliation(s)
- Jessica C. Dai
- Resident, Department of Urology, University of Washington School of Medicine
| | - Justin S. Ahn
- Resident, Department of Urology, University of Washington School of Medicine
| | - Shannon T. Cannon
- Resident, Department of Urology, University of Washington School of Medicine
| | - Thomas J. Walsh
- Associate Professor, Department of Urology, University of Washington School of Medicine
- Director of Men's Health Center, Department of Urology, University of Washington School of Medicine
| | - Kevin Ostrowski
- Assistant Professor, Department of Urology, University of Washington School of Medicine
| | - Omer A. Raheem
- Andrology Fellow, Department of Urology, University of Washington School of Medicine
| | - Megan Sherman
- Associate Director of Operations, The WWAMI Institute for Simulation in Healthcare (WISH), University of Washington School of Medicine
| | - Thomas S. Lendvay
- Associate Professor, Department of Urology, University of Washington School of Medicine
- Pediatric Urology Fellowship Director, Department of Urology, University of Washington School of Medicine
| |
Collapse
|
32
|
Abstract
Castrate-resistant prostate cancer is an incurable disease. It continues to be an area of intense research to save prostate cancer patients’ lives. We aim from this review to explore the new lines of treatment that aim at extending disease-specific survival. We conducted a PubMed research on available literature pertaining to key words alone and in combination: prostate cancer, castrate-resistant, immunotherapy, hormonal therapy, chemotherapy, radiation therapy, metastasis, survival and quality of life. We also reviewed the following guidelines on castrate-resistant prostate cancer: National Comprehensive Cancer Network (NCCN), American Urological Association (AUA), the National Institute for Health and Care Excellence (NICE) and the European Association of Urology (EAU). There are four new lines of treatment in castrate-resistant prostate cancer. An immunotherapy, sipuleucel T (Provenge); new hormonal therapies – in the form of a new androgen receptor blocker, enzalutamide (Xtandi) and new adrenal androgen synthesis inhibitor, abiraterone acetate (Zytiga); a new chemotherapy, cabazitaxel (Jevtana) and new radioactive agent, radium 223 (Xofigo). There is an agreement between guidelines that patients with M0 castrate-resistant prostate cancer should not be offered any of these treatments. Similarly, patients with castrate-resistant prostate cancer and poor performance status should be offered only palliative care. There are several new lines of treatment that can be used in castrate-resistant prostate cancer, and hopefully in the near future castrate-resistant prostate cancer will be changing from a lethal disease to more of a chronic disease.
Collapse
Affiliation(s)
- Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, USA
| | - Omer A Raheem
- Department of Urology, University of California San Diego, USA
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, USA
| |
Collapse
|
33
|
Khandwala YS, Raheem OA, Ali MA, Hsieh TC. Variation in Practice Pattern of Male Hypogonadism: A Comparative Analysis of Primary Care, Urology, Endocrinology, and HIV Specialists. Am J Mens Health 2018; 12:472-478. [PMID: 29183245 PMCID: PMC5818126 DOI: 10.1177/1557988317743152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/31/2017] [Accepted: 09/06/2017] [Indexed: 11/29/2022] Open
Abstract
The objective of the current study was to measure the adherence of guideline-based evaluation and treatment of hypogonadism by medical specialty. A retrospective review was performed analyzing patients from a single academic institution within the past 10 years. The cohort of 193 men was grouped according to medical specialty of the diagnosing physician (50 urology, 49 primary care, 44 endocrinology, and 50 HIV medicine). Adherence to guidelines was assessed using the Endocrine Society's criteria. Primary care patients were older compared to the rest of the cohort ( p < .001) but BMI and cardiovascular risk factors were similar ( p = .900). Patients treated by urologists and endocrinologists had the highest percentage of low testosterone findings at initial encounter at 72% ( p < .001). Sixty-two percent of urology patients had low LH or FSH compared to 63.6% for endocrinology and 16% for primary care ( p < .001). As for brain MRI findings, no urology patients had positive findings (0/9) while eight pituitary adenomas (40%) were found by endocrinologists. Forty-five percent of men treated by urologists received TRT without repeat confirmation, compared to 58% of endocrinologists, 77% of primary care, and 88% of HIV medicine ( p < .001). All urology patients had PSA checked before TRT compared to 77.5% of primary care and 61.2% of endocrinology patients ( p = .063). Adherence to the guidelines helps prevent undue over-diagnosis and over-treatment of hypogonadism. This study suggests that adherence to guideline-based screening is varied among specialties.
Collapse
Affiliation(s)
- Yash S. Khandwala
- Department of Urology, University of California San Diego, La Jolla, CA, USA
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Omer A. Raheem
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Mir Amaan Ali
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Tung-Chin Hsieh
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
34
|
Abstract
With the increased prevalence of Peyronie’s disease (PD) among men, there is also an up-rise of associated erectile dysfunction (ED) which can be devastating psychologically and sexually to most men. A wide range of therapies including medical and surgical procedures are available to satisfactorily address this condition. However when ED coexists, the gold standard treatment is penile prosthetic prosthesis (PP) with or without additional straightening procedures. We herein systematically review the contemporary literature addressing the role of the PP in the management of PD with concomitant ED with particular emphasis on patient’s satisfaction, outcomes and safety.
Collapse
Affiliation(s)
- Omer A Raheem
- Department of Urology, University of California San Diego Health, San Diego, California, USA
| | - Tung-Chin Hsieh
- Department of Urology, University of California San Diego Health, San Diego, California, USA
| |
Collapse
|
35
|
Raheem OA, Ana MS, Urol MC, Walsh TJ. Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios. Transl Androl Urol 2017; 6:S322-S323. [PMID: 29082131 PMCID: PMC5643700 DOI: 10.21037/tau.2017.08.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Omer A Raheem
- Department of Urology, University of Washington, Seattle, Washington, US.
| | - MSc Ana
- Department of Urology, University of Washington, Seattle, Washington, US.
| | - MCh Urol
- Department of Urology, University of Washington, Seattle, Washington, US.
| | - Thomas J Walsh
- Department of Urology, University of Washington, Seattle, Washington, US.
| |
Collapse
|
36
|
Raheem OA, Khandwala YS, Sur RL, Ghani KR, Denstedt JD. Burden of Urolithiasis: Trends in Prevalence, Treatments, and Costs. Eur Urol Focus 2017; 3:18-26. [PMID: 28720363 DOI: 10.1016/j.euf.2017.04.001] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/17/2017] [Accepted: 02/21/2017] [Indexed: 12/19/2022]
Abstract
CONTEXT The recent evolution of management options for urolithiasis has presented a unique dilemma for the modern urologist. A comprehensive understanding of epidemiological trends along with current provider preferences in treating urinary stones would be beneficial. OBJECTIVE To review trends in the prevalence, treatments, and costs of urolithiasis worldwide. EVIDENCE ACQUISITION A literature review was performed using the MEDLINE database, the Cochrane Library Central search facility, Web of Science, and Google Scholar between 1986 and 2016. Keywords used for the search were "urolithiasis" and "prevalence; treatment; and cost". EVIDENCE SYNTHESIS The incidence and prevalence of urinary stones are rising around the world, including regions that have historically had low rates of urolithiasis. Common theories explaining this trend involve climate warming, dietary changes, and obesity. Shockwave lithotripsy (SWL) has been the preferred mode of treatment since its introduction in the 1980s. However, ureteroscopy (URS) has become increasingly popular for small stones regardless of location because of lower recurrence rates and costs. Developing countries have been slower to adopt URS technology and continue to use percutaneous nephrolithotomy at a steady rate. CONCLUSIONS URS has recently challenged SWL as the treatment modality preferred for small upper urinary tract stones. In some cases it is less expensive but still highly effective. As the burden of stone disease increases worldwide, appropriate selection of stone removal therapies will continue to play an important role and will thus require further investigation. PATIENT SUMMARY Urinary stones are becoming more prevalent. Recent advances in technology have improved the management of this disease and have decreased costs.
Collapse
Affiliation(s)
- Omer A Raheem
- Department of Urology, University of California San Diego Health, San Diego, CA, USA
| | - Yash S Khandwala
- University of California San Diego School of Medicine, San Diego, CA, USA
| | - Roger L Sur
- Department of Urology, University of California San Diego Health, San Diego, CA, USA.
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - John D Denstedt
- Department of Surgery, Western University, London, ON, Canada
| |
Collapse
|
37
|
Hassan AER, Raheem OA, Berquist S, Beksac AT, Bloch A, Field C, Lee HJ, Mehrazin R, Holden M, McDonald M, Hamilton Z, Liss M, Derweesh IH. Comparison of laparoendoscopic single-site (LESS) and multiport laparoscopic radical nephrectomy for clinical T1b and T2a renal masses. Minerva Urol Nephrol 2017; 69:596-603. [PMID: 28281740 DOI: 10.23736/s0393-2249.17.02785-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to compare outcomes of laparoendoscopic single-site surgery (LESS) and multiport laparoscopic (MPL) radical nephrectomy (RN) for clinical T1b/T2a renal masses, as concerns continue regarding suitability and benefit of LESS for larger renal masses. METHODS Retrospective single-surgeon comparison of LESS- and MPL-RN between 7/2005 and 11/2014. Sixty-three patients underwent LESS-RN (44 cT1b/19 cT2a); 133 underwent MPL (83 cT1b/50 cT2a). All patients were managed with a standardized care pathway. Primary outcome was length of hospital stay (LOS). Secondary outcomes included operative time, estimated blood loss (EBL), complications, discharge pain score (visual analog pain, VAP), narcotic requirement (morphine equivalents, MSO4eq). RESULTS 130/133 MPL and 62/63 LESS were successfully performed. For MPL and LESS groups: mean tumor diameter (cm) for cT1b was 5.3 vs. 5.4 (P=0.689); and for cT2a was 8.2 vs. 8.3 (P=0.728); mean OR time (min) was 126.3 vs. 132.7 (P=0.314); mean EBL (mL) was 139.5 vs.127.8 (P=0.49). No significant differences in complications were noted (P=0.781). LESS was associated with significant reductions in LOS (2.14 vs. 2.45 days, P=0.043), discharge VAP (1.3 vs. 2.2, P<0.001), and narcotic use (5.9 vs. 10.7 MSO4eq, P<0.001). CONCLUSIONS LESS is comparable to MPL-RN for cT1b and T2a renal tumors in terms of perioperative parameters and may confer benefit with respect to LOS and analgesic requirement.
Collapse
Affiliation(s)
- Abd-El R Hassan
- Department of Urology, UC San Diego Health System, La Jolla, CA, USA
| | - Omer A Raheem
- Department of Urology, UC San Diego Health System, La Jolla, CA, USA
| | - Sean Berquist
- Department of Urology, UC San Diego Health System, La Jolla, CA, USA
| | - Alp T Beksac
- Department of Urology, UC San Diego Health System, La Jolla, CA, USA
| | - Aaron Bloch
- Department of Urology, UC San Diego Health System, La Jolla, CA, USA
| | - Charles Field
- Department of Urology, UC San Diego Health System, La Jolla, CA, USA
| | - Hak J Lee
- Department of Urology, UC San Diego Health System, La Jolla, CA, USA
| | - Reza Mehrazin
- Department of Urology, and University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marc Holden
- Department of Urology, UC San Diego Health System, La Jolla, CA, USA
| | - Michelle McDonald
- Department of Urology, UC San Diego Health System, La Jolla, CA, USA
| | - Zachary Hamilton
- Department of Urology, UC San Diego Health System, La Jolla, CA, USA
| | - Michael Liss
- Department of Urology, UC San Diego Health System, La Jolla, CA, USA
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego Health System, La Jolla, CA, USA -
| |
Collapse
|
38
|
Kamel MH, Barber A, Davis R, Raheem OA, Bissada N, Abdelmaksoud AEA, Eltahawy E. Reimbursements and frequency of tests in privately insured testicular cancer patients in the United States: Implications to national guidelines. Urol Ann 2017; 9:153-158. [PMID: 28479767 PMCID: PMC5405659 DOI: 10.4103/0974-7796.204180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objectives: The objective of this study was to assess the frequency of utilization and reimbursement of the common diagnostic tests and treatment modalities used in testicular cancer care. Methods: LifeLink™ (IMS Health, Danbury, CT, USA) Claims Database was used. We identified 877 subjects with a primary diagnosis of testicular cancer (ICD 186.9) between 2007 and 2012. Median reimbursement and frequency of the diagnostic/treatment modalities used were recorded. Results: The most common claim was a vein puncture with median reimbursement of $9.11. Tumor markers, alpha-fetoprotein and beta human chorionic gonadotropin, were ranked 6th and 7th with median reimbursement of $52.13 and $48.71, respectively. Chest X-ray and computerized tomography (CT) scan of the chest were ranked 9th and 13th with median reimbursement of $68.51 and $769, respectively. A contrast CT scan of abdomen and pelvis was the 11th most frequent claim with median reimbursement of $855.89. The three invasive treatment modalities, chemotherapy, radiation therapy, and retroperitoneal lymphadenectomy were ranked 8th, 15th, and 164th with median reimbursement of $2858.38, $3988.25, and $2009.67, respectively. Conclusions: Testicular cancer is not an inexpensive disease. Surgery is the less utilized than radiation and chemotherapy despite lower cost. This may have implications to national guidelines and training since these treatments often carry the same grade of recommendation.
Collapse
Affiliation(s)
- Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, Arkansas, USA.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Austin Barber
- Department of Urology, University of Arkansas for Medical Sciences, Arkansas, USA
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, Arkansas, USA
| | - Omer A Raheem
- Department of Urology, University of California, San Diego, California, USA
| | - Nabil Bissada
- Department of Urology, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Hospital, Houston, Texas, USA
| | | | - Ehab Eltahawy
- Department of Urology, University of Arkansas for Medical Sciences, Arkansas, USA.,Department of Urology, Ain Shams University, Cairo, Egypt
| |
Collapse
|
39
|
Ito T, Derweesh IH, Ginzburg S, Abbosh PH, Raheem OA, Mirheydar H, Hamilton Z, Chen DY, Smaldone MC, Greenberg RE, Viterbo R, Kutikov A, Uzzo RG. Perioperative Outcomes Following Partial Nephrectomy Performed on Patients Remaining on Antiplatelet Therapy. J Urol 2017; 197:31-36. [DOI: 10.1016/j.juro.2016.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Timothy Ito
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Ithaar H. Derweesh
- Department of Urology, University of California San Diego School of Medicine, San Diego, California
| | - Serge Ginzburg
- Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Philip H. Abbosh
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Omer A. Raheem
- Department of Urology, University of California San Diego School of Medicine, San Diego, California
| | - Hossein Mirheydar
- Department of Urology, University of California San Diego School of Medicine, San Diego, California
| | - Zachary Hamilton
- Department of Urology, University of California San Diego School of Medicine, San Diego, California
| | - David Y.T. Chen
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Marc C. Smaldone
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Richard E. Greenberg
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Rosalia Viterbo
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Alexander Kutikov
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Robert G. Uzzo
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| |
Collapse
|
40
|
Raheem OA, Patel SH, Sisul D, Furnish TJ, Hsieh TC. The Role of Testosterone Supplemental Therapy in Opioid-Induced Hypogonadism: A Retrospective Pilot Analysis. Am J Mens Health 2016. [PMID: 28625114 PMCID: PMC5675327 DOI: 10.1177/1557988316672396] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic opioid therapy for pain management is known to induce several endocrine changes. The authors examined the effect of testosterone supplemental therapy (TST) in patients with chronic, noncancer pain undergoing opioid therapy. It was hypothesized that treatment of opioid-induced hypogonadism (OIH) can reduce opioid requirements in patients suffering from chronic pain and approve their quality of life. Over 18 months period, patients with OIH were identified in a tertiary referral pain center, Numerical Rating Scale (NRS) pain scores and daily morphine equivalent dose (MED) were the primary outcomes measured. Data were collected and comparative analysis performed between men undergoing TST versus nontreatment group. Twenty-seven OIH patients (total testosterone <300 ng/dL) were identified during the study period. TST group consists of 11 patients, while non-TST group consists of 16 patients as control cohort. Mean patient age (55 and 54.4, p = .4) and basic metabolic index (28.5 and 31.9, p = .07) in TST and non-TST groups, respectively. Mean follow-up total testosterone (ng/dL) was significantly higher after TST compared with the non-TST group (497.5 vs. 242.4 ng/dL, p = .03). Median follow-up NRS was 0 and 2 in the TST and non-TST groups (p = .02). Mean MED (mg) decreased by 21 mg in TST group and increased by 2.5 mg in non-TST group (p < .05). This study reports that treatment of OIH with TST can reduce opioid requirements in men with chronic pain as quantified by MED. It also confirms previous reports on the potential effects of OIH and that TST is effective in correcting opioid-induced endocrine abnormalities.
Collapse
Affiliation(s)
- Omer A Raheem
- 1 Department of Urology, University of California San Diego Health, San Diego, CA, USA
| | - Sunil H Patel
- 1 Department of Urology, University of California San Diego Health, San Diego, CA, USA
| | - David Sisul
- 1 Department of Urology, University of California San Diego Health, San Diego, CA, USA
| | - Tim J Furnish
- 2 Center for Pain Medicine, University of California San Diego Health system, San Diego, CA, USA
| | - Tung-Chin Hsieh
- 1 Department of Urology, University of California San Diego Health, San Diego, CA, USA
| |
Collapse
|
41
|
Beksac AT, Rivera-Sanfeliz G, Dufour CA, Nseyo U, Hamilton Z, Berquist SW, Hassan AE, Raheem OA, Wang S, Wake RW, Gold RE, Derweesh IH. Impact of tumor histology and grade on treatment success of percutaneous renal cryoablation. World J Urol 2016; 35:633-640. [DOI: 10.1007/s00345-016-1911-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/27/2016] [Indexed: 01/20/2023] Open
|
42
|
Abstract
INTRODUCTION Mitomycin C offers a wide range of potential clinical uses in various disciplines, including urological diseases. As experimentally proven the effect of mitomycin C can be partly explained by its antifibrotic properties exerted on different target organs as well as its anticarcinogenic properties. We systematically reviewed the clinical applications of mitomycin C in the urological literature and comment on its safety, efficacy and long-term outcomes. METHODS We searched the MEDLINE® database, Cochrane Library® Central Search and Web of Science™ using the search terms mitomycin C and clinical applications. Peer reviewed clinical, experimental and review articles published in the English language that included mitomycin C and urological conditions were identified and screened between 2000 and 2014. RESULTS Our search resulted in 13 peer reviewed published articles that fit our criteria, including 2 randomized, controlled trials, 2 prospective studies, 3 retrospective studies, 1 meta-analysis, 3 reviews and 2 in vitro studies. The majority of studies detailed the clinical use of mitomycin C in various urological conditions. Information was extracted from studies that discussed the safety, efficacy and long-term outcomes of mitomycin C across each urological disease. CONCLUSIONS This systematic review details the different therapeutic applications of mitomycin C and comments on its safety, efficacy and long-term outcomes in urological diseases and conditions. This review also provides a useful guide for urologists to become familiar with the potential therapeutic roles of mitomycin C in the treatment of different urological diseases.
Collapse
Affiliation(s)
- Omer A Raheem
- Department of Urology, University of California San Diego Health, San Diego, California
- Department of Urology, University of Texas Health Science Center (MAL), San Antonio, Texas
| | - Michael A Liss
- Department of Urology, University of California San Diego Health, San Diego, California
- Department of Urology, University of Texas Health Science Center (MAL), San Antonio, Texas
| | - Jill C Buckley
- Department of Urology, University of California San Diego Health, San Diego, California
- Department of Urology, University of Texas Health Science Center (MAL), San Antonio, Texas
| |
Collapse
|
43
|
Raheem OA, Su JJ, Wilson JR, Hsieh TC. The Association of Erectile Dysfunction and Cardiovascular Disease: A Systematic Critical Review. Am J Mens Health 2016; 11:552-563. [PMID: 26846406 DOI: 10.1177/1557988316630305] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Despite strong association between erectile dysfunction (ED) and cardiovascular disease (CVD), there is a paucity of clear clinical guidelines detailing when and how to evaluate for ED in patients with known CVD, or vice versa. This systematic review discuss the role of cardiologists and urologists in the characterization of risk and management of CVD in the setting of ED, as well as contrasting the current evaluation of CVD and ED from the standpoint of published consensus statements. A comprehensive literature review utilizing MEDLINE®, the Cochrane Library® Central Search, and the Web of Science was performed to identify all published peer-reviewed articles in the English language describing ED and CVD across various disciplines. There is strong consensus that men with ED should be considered at high risk of CVD. Available risk assessment tools should be used to stratify the coronary risk score in each patient. The 2012 Princeton III Consensus Conference expanded on existing cardiovascular recommendations, proposing an approach to the evaluation and management of cardiovascular risk in men with ED and no known CVD. This systematic review highlights the similarities and differences of the existing clinical guidelines and recommendations regarding assessment and management of ED and CVD, as well as the pathophysiological linkage between ED and CVD, which may permit physicians, including urologists, to perform opportunistic screening and initiate secondary prophylaxis with regard to cardiovascular risk factors, particularly in young, nondiabetic men with ED.
Collapse
Affiliation(s)
- Omer A Raheem
- 1 University of California, San Diego, Department of Urology, San Diego, CA, USA
| | - Jeannie J Su
- 2 Yale School of Medicine, Department of Urology, New Haven, CT, USA
| | - Joel R Wilson
- 3 University of California, San Diego, Department of Medicine, Division of Cardiovascular Medicine, San Diego, CA, USA
| | - Tung-Chin Hsieh
- 1 University of California, San Diego, Department of Urology, San Diego, CA, USA
| |
Collapse
|
44
|
Bakare T, Raheem OA, Davis R, Heshmat S, Kamel MH. Percutaneous Management of Upper Tract Urothelial Carcinoma in a Transplant Kidney. Curr Urol 2015; 8:215-218. [DOI: 10.1159/000442841] [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] [Received: 02/25/2015] [Accepted: 03/02/2015] [Indexed: 11/19/2022] Open
|
45
|
Lacefield E, Raheem OA, Cox R, Davis R, Kamel MH. Composite Paraganglioma and Neuroblastoma of the Urinary Bladder: A Rare Histopathological Entity. Curr Urol 2015; 8:208-211. [PMID: 30263028 DOI: 10.1159/000365718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/26/2015] [Indexed: 11/19/2022] Open
Abstract
Paraganglioma of the urinary bladder is an uncommon clinical entity. Neuroblastoma of the urinary bladder is another rare tumor with only 7 reported cases, all in children. This report presents the case of a composite paraganglioma and neuroblastoma in a 45 year-old male who presented with dysuria and flank pain. On the computerized tomography scan, the bladder wall overlying the tumor was smooth and the mass had a large exophytic component. The initial diagnosis was paraganglioma on transurethral resection. Following partial cystectomy and bilateral pelvic lymph node dissection, pathology confirmed a composite tumor consisting of paraganglioma and neuroblastoma. To our knowledge, this is the first report of such a composite tumor involving the bladder.
Collapse
Affiliation(s)
| | - Omer A Raheem
- Department of Urology, University of California San Diego, La Jolla, Calif., USA
| | - Roni Cox
- Pathology, University of Arkansas for Medical Sciences, Little Rock, Ark, USA
| | | | | |
Collapse
|
46
|
Van Lierop D, Raheem OA, Siegel J, Lee HJ. A rare case of Epstein-Barr virus-associated leiomyosarcoma of the kidney in a patient with HIV. Actas Urol Esp 2015. [PMID: 26211573 DOI: 10.1016/j.acuro.2015.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- D Van Lierop
- Department of Urology, University of California, Irvine, Orange, CA, EE.UU
| | - O A Raheem
- Department of Urology, University of California, San Diego, La Jolla, CA, EE.UU
| | - J Siegel
- Department of Urology, University of California, Irvine, Orange, CA, EE.UU
| | - H J Lee
- Department of Urology, University of California, San Diego, La Jolla, CA, EE.UU..
| |
Collapse
|
47
|
Kamel MH, Elfaramawi M, Jadhav S, Saafan A, Raheem OA, Davis R. Insurance Status and Differences in Treatment and Survival of Testicular Cancer Patients. Urology 2015; 87:140-5. [PMID: 26477833 DOI: 10.1016/j.urology.2015.06.059] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/16/2015] [Accepted: 06/23/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore the relationship between insurance status and differences in treatment and survival of testicular cancer patients. The Surveillance, Epidemiology, and End Results (SEER) database was utilized for this study. MATERIALS AND METHODS Between 2007 and 2011, 5986 testicular cancer patients were included in the SEER database. Patients were classified into nonseminoma and seminoma groups. We compared mortality rates, metastasis (M+) at diagnosis, and rates of adjuvant treatments between the uninsured (UI) and insured (I) populations. RESULTS Overall, 2.64% of UI vs 1.36% of I died from testicular cancer (P = .025) and 16.73% of UI vs 10.52% of I had M+ at diagnosis (P <.0001). In the nonseminoma group, 4.19% of UI vs 2.79% of I died from testicular cancer (P = .326) and 25.92% of UI vs 18.46% of I had M+ at diagnosis (P = .0007). Also 17.28% of UI vs 20.88% of I had retroperitoneal lymph node dissection (RPLND; P = .1). In the seminoma group, 1.06% of UI vs 0.33% of I died from testicular cancer (P = .030) and 7.43% of UI vs 4.81% of I had M+ at diagnosis (P = .029). Also 34.75% of UI vs 48.4% of I received adjuvant radiation (P = .0083). The lack of health insurance predicted poor survival after adjusting for tumor stage, receiving adjuvant radiation or RPLND. CONCLUSION UI testicular cancer patients present with more advanced cancer stages and have higher mortality rates than I patients. UI seminoma patients received less adjuvant radiation. This may be related to lack of access to care or more advanced cancer stage at diagnosis.
Collapse
Affiliation(s)
- Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mohammed Elfaramawi
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Supriya Jadhav
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Ahmed Saafan
- Department of Urology, Aswan University, Aswan, Egypt
| | - Omer A Raheem
- Department of Urology, University of California, San Diego, San Diego, CA
| | - Rodney Davis
- Department of Urology, Ain Shams University, Cairo, Egypt.
| |
Collapse
|
48
|
Raheem OA, Mirheydar HS, Miller DL, Palazzi KL, Chang DC, Sur RL. Contemporary Trends in the Ambulatory Surgical Treatment of Urolithiasis: Population-Based Analysis. J Endourol 2015; 29:1189-92. [DOI: 10.1089/end.2015.0129] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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)
- Omer A. Raheem
- Department of Urology, University of California San Diego Health Care System, San Diego, California
| | - Hossein S. Mirheydar
- Department of Urology, University of California San Diego Health Care System, San Diego, California
| | - Daniel L. Miller
- Department of Urology, University of California San Diego Health Care System, San Diego, California
| | - Kerrin L. Palazzi
- Department of Urology, University of California San Diego Health Care System, San Diego, California
| | - David C. Chang
- Department of Urology, University of California San Diego Health Care System, San Diego, California
| | - Roger L. Sur
- Department of Urology, University of California San Diego Health Care System, San Diego, California
| |
Collapse
|
49
|
Raheem OA, Cohen SA, Parsons JK, Palazzi KL, Kane CJ. A Family History of Lethal Prostate Cancer and Risk of Aggressive Prostate Cancer in Patients Undergoing Radical Prostatectomy. Sci Rep 2015; 5:10544. [PMID: 26112134 PMCID: PMC4481640 DOI: 10.1038/srep10544] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/24/2015] [Indexed: 11/09/2022] Open
Abstract
We investigated whether a family history of lethal prostate cancer (PCa) was associated with high-risk disease or biochemical recurrence in patients undergoing radical prostatectomy. A cohort of radical prostatectomy patients was stratified into men with no family history of PCa (NFH); a first-degree relative with PCa (FH); and those with a first-degree relative who had died of PCa (FHD). Demographic, operative and pathologic outcomes were analyzed. Freedom from biochemical recurrence was examined using Kaplan-Meier log rank. A multivariate Cox logistic regression analysis was also performed. We analyzed 471 men who underwent radical prostatectomy at our institution with known family history. The three groups had: 355 patients (75%) in NFH; 97 patients (21%) in FH; and 19 patients (4%) in FHD. The prevalence of a Gleason score ≥8, higher pathologic T stage, and biochemical recurrence (BCR) rates did not significantly differ between groups. On Kaplan-Meier analysis there were no differences in short-term BCR rates (p = 0.212). In this cohort of patients undergoing radical prostatectomy, those with first-degree relatives who died of PCa did not have an increased likelihood of high-risk or aggressive PCa or shorter-term risk of BCR than those who did not.
Collapse
Affiliation(s)
- Omer A Raheem
- Department of Urology, UC San Diego Health System, San Diego, CA, United States
| | - Seth A Cohen
- Department of Urology, UC San Diego Health System, San Diego, CA, United States
| | - J Kellogg Parsons
- Department of Urology, UC San Diego Health System, San Diego, CA, United States
| | - Kerrin L Palazzi
- Department of Urology, UC San Diego Health System, San Diego, CA, United States
| | - Christopher J Kane
- Department of Urology, UC San Diego Health System, San Diego, CA, United States
| |
Collapse
|
50
|
Raheem OA, Mirheydar HS, Lee HJ, Patel ND, Godebu E, Sakamoto K. Does Listening to Music During Office-Based Flexible Cystoscopy Decrease Anxiety in Patients: A Prospective Randomized Trial. J Endourol 2015; 29:791-6. [PMID: 25630866 DOI: 10.1089/end.2015.0029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To validate the effect of listening to music on perceived anxiety and pain during office-based flexible cystoscopy using the State-Trait Anxiety Inventory (STAI) and the Visual Analog Scale (VAS), in a well-matched North American veteran patient population in a prospective, randomized fashion. PATIENTS AND METHODS A total of 137 veteran patients receiving routine urologic care in a North American Veterans Affairs (VA) healthcare system were recruited over a 2-year period (June 2011 to June 2013). All patients were prospectively randomized to undergo office-based flexible cystoscopy with or without music. The music group consisted of 73 patients who listened to the same excerpt of classical music at the time of flexible cystoscopy; the nonmusic group consisted of 64 patients. RESULTS The median postprocedural STAI anxiety scores between the music and nonmusic groups were statistically significantly different: 30 (range 23-39) and 35 (range 28-49), respectively (P=0.0017). The median postprocedural pain VAS score between the music and nonmusic groups reached statistical significance: 0 (range 0-1) and 2 (range 1-2), respectively (P<0.0001). The median delta STAI anxiety score was statistically significantly different between the music and nonmusic groups: 0 (range -3-0) and 2 (range 0-4), respectively (P<0.0001). CONCLUSIONS This study demonstrates that listening to music decreases anxiety and pain associated with flexible cystoscopy in a North American VA patient population. We recommend incorporating music as an effective adjunct to other maneuvers used at the time of flexible cystoscopy to reduce anxiety and pain.
Collapse
Affiliation(s)
- Omer A Raheem
- 1 Department of Urology, University of California (UC) San Diego Health System , San Diego, California
| | - Hossein S Mirheydar
- 1 Department of Urology, University of California (UC) San Diego Health System , San Diego, California
| | - Hak J Lee
- 1 Department of Urology, University of California (UC) San Diego Health System , San Diego, California
| | - Nishant D Patel
- 1 Department of Urology, University of California (UC) San Diego Health System , San Diego, California
| | - Elana Godebu
- 1 Department of Urology, University of California (UC) San Diego Health System , San Diego, California
| | - Kyoko Sakamoto
- 1 Department of Urology, University of California (UC) San Diego Health System , San Diego, California.,2 Urology Service, VA San Diego Healthcare System , San Diego, California
| |
Collapse
|