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Lopategui DM, Porto JG, Bhatia A, Titus R, Marcovich R, Shah HN. Letter Re: 'Ejaculatory function following transperineal laser ablation vs TURP for benign prostatic obstruction: a randomized trial'. BJU Int 2024. [PMID: 38403752 DOI: 10.1111/bju.16309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
- Diana M Lopategui
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Joao G Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ansh Bhatia
- Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Renil Titus
- Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
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Lopategui DM, Bhatia A, Porto JG, Marcovich R, Shah HN. Decoding the complexity of benign prostatic hyperplasia therapies in the PARTEM trial. Lancet Reg Health Eur 2024; 37:100820. [PMID: 38362556 PMCID: PMC10866918 DOI: 10.1016/j.lanepe.2023.100820] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/29/2023] [Indexed: 02/17/2024]
Affiliation(s)
- Diana M. Lopategui
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ansh Bhatia
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Joao G. Porto
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Robert Marcovich
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Hemendra N. Shah
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Porto JG, Titus R, Camargo F, Bhatia A, Ahie N, Blachman-Braun R, Malpani A, Lopategui DM, Herrmann TRW, Marcovich R, Shah HN. Minimally invasive techniques in quest of Holy Grail of surgical management of enlarged prostates: a narrative review. World J Urol 2024; 42:35. [PMID: 38217727 DOI: 10.1007/s00345-023-04747-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/05/2023] [Indexed: 01/15/2024] Open
Abstract
PURPOSE Past decade has seen a renewed interest in minimally invasive surgical techniques (MISTs) for management of enlarged prostate. This narrative review aims to explore newer MIST for benign prostatic hyperplasia (BPH) which are not yet integrated into established societal guidelines. METHODS We conducted a literature search across PubMed, Google Scholar, and FDA ClinicalTrials.gov databases on June 1st, 2023, to identify studies published within the past decade exploring various MISTs for BPH. Additionally, we gathered insights from abstracts presented in meetings of professional associations and corporate websites. We broadly classified these procedures into three distinct categories: energy-based, balloon dilation, and implant/stent treatments. We collected detail information about the device, procedure details, its inclusion and exclusion criteria, and outcome. RESULTS Our review reveals that newer energy-based MISTs include Transperineal Laser Ablation, Transurethral Ultrasound Ablation, and High-Intensity Focused Ultrasound. In the sphere of balloon dilation, Transurethral Columnar Balloon Dilation and the Optilume BPH Catheter System were gaining momentum. The noteworthy implants/stents that are on horizon include Butterfly Prostatic Retraction Device, Urocross Expander System, Zenflow Spring System, and ProVee Urethral Expander System. CONCLUSION The exploration of various MISTs reflects ongoing efforts to enhance patient care and address limitations of existing treatments. This review provides a bird-eye view and valuable insights for urologists and researchers seeking to navigate the dynamic landscape of MISTs in the quest for effective and minimally invasive solutions for enlarged prostates.
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Affiliation(s)
- Joao G Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Renil Titus
- Seth GS Medical College, KEM Hospital, Mumbai, India
| | - Feres Camargo
- Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ansh Bhatia
- Seth GS Medical College, KEM Hospital, Mumbai, India
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Nehizena Ahie
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ankur Malpani
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Diana M Lopategui
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA.
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Porto J, Suarez Arbelaez MC, Zarli M, Ahumada M, Schard RC, Loftus T, Swain S, Marcovich R, Shah HN. Correction: Exploring the Legal Implications of Benign Prostatic Hyperplasia Surgeries in the United States: A Comprehensive Analysis of Two Decades of Lawsuits. Cureus 2024; 16:c157. [PMID: 38304645 PMCID: PMC10834023 DOI: 10.7759/cureus.c157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
[This corrects the article DOI: 10.7759/cureus.39335.].
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Affiliation(s)
- Joao Porto
- Desai Sethi Urology Institute, University of Miami, Miami, USA
| | | | - Mohamadhusni Zarli
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Mariam Ahumada
- Desai Sethi Urology Institute, University of Miami, Miami, USA
| | | | - Timothy Loftus
- Department of Public Health Sciences, School of Medicine, University of Miami, Miami, USA
- School of Law, University of Miami, Miami, USA
| | - Sanjaya Swain
- Desai Sethi Urology Institute, University of Miami, Miami, USA
| | | | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miami, USA
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Lopategui DM, Porto JG, Marcovich R, Shah HN. Comparison Between Holmium:YAG Laser With MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score-Matched Analysis From the FLEXible Ureteroscopy Outcomes Registry. Letter. J Urol 2023; 210:840-841. [PMID: 37782933 DOI: 10.1097/ju.0000000000003725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Diana M Lopategui
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Joao G Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, Florida
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Suarez Arbelaez MC, Nackeeran S, Shah K, Blachman-Braun R, Bronson I, Towe M, Bhat A, Marcovich R, Ramasamy R, Shah HN. Association between body mass index, metabolic syndrome and common urologic conditions: a cross-sectional study using a large multi-institutional database from the United States. Ann Med 2023; 55:2197293. [PMID: 37036830 PMCID: PMC10088970 DOI: 10.1080/07853890.2023.2197293] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/25/2023] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION The study aims to determine whether body mass index (BMI), metabolic syndrome (MS) or its individual components (primary hypertension, type 2 diabetes mellitus and dyslipidemias) are risk factors for common urological diseases. MATERIALS AND METHODS Cross-sectional study with data collected on February 28, 2022 from the TriNetX Research Network. Patients were divided in cohorts according to their BMI, presence of MS (BMI > 30 kg/m2, type 2 diabetes mellitus, primary hypertension and disorders of lipoprotein metabolism) and its individual components and its association with common urological conditions was determined. For each analysis, odds ratio (OR) with 95% confidence intervals were calculated. Statistical significance was assessed at p < .05. RESULTS BMI > 30 kg/m2 was associated with increased risk of lithiasis, kidney cancer, overactive bladder, male hypogonadism, benign prostatic hyperplasia, and erectile dysfunction (p < .05). On the contrary, BMI was inversely associated with ureteral, bladder and prostate cancer (p < .05). In all urological diseases, MS was the strongest risk factor, with prostate cancer (OR = 2.53) showing the weakest and male hypogonadism the strongest (OR = 13.00) associations. CONCLUSIONS MS and its individual components were significant risk factors for common urological conditions. Hence holistic approaches with lifestyle modification might prevent common urological disease.Key messagesOverall, metabolic syndrome is the strongest risk factor for all the analysed urological diseases.Abnormally high body mass index can be a risk or protective factor depending on the threshold and urological disease that are being evaluated.Metabolic syndrome and increased BMI should be considered important factors associated to the prevalence of common urological diseases.
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Affiliation(s)
| | - Sirpi Nackeeran
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Khushi Shah
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Isaac Bronson
- UMass Chann Medical School, University of Massachusetts, Amherst, MA, USA
| | - Maxwell Towe
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Abhishek Bhat
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hemendra N. Shah
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Porto JG, Blachman-Braun R, Delgado C, Zarli M, Chen R, Ajami T, Marcovich R, Shah HN. Is Holmium Laser Enucleation of the Prostate Truly Size-Independent? A Critical Evaluation at the Extreme Ends of the Spectrum. Urology 2023; 182:204-210. [PMID: 37716456 DOI: 10.1016/j.urology.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To assess the outcomes of holmium laser enucleation of the prostate (HoLEP) at the extremes of the size spectrum, comparing whether the results are consistent for very large and small prostates. METHODS A retrospective review of 402 patient charts was conducted to compare the outcomes of HoLEP in patients with prostate size ≤40 g (group 1), 41-200 g (group 2), and >200 g (group 3). Various preoperative, perioperative, and postoperative variables were collected. RESULTS HoLEP showed comparable voiding outcomes among all 3 groups, although patients with small prostates had a higher International Prostate Symptom Score during follow-up (P = .022). We noted a higher rate of perioperative blood transfusion in patients with very large prostates (P = .019) and a higher rate of transient acute urinary retention (AUR) in group 1 when compared to group 3 (P = .048). Patients with smaller prostates had a higher rate of bladder neck stenosis and urethral strictures, but the differences were not found to be statistically significant. The incidence of other complications, length of hospital stay, and catheterization duration did not differ significantly among the groups. CONCLUSION HoLEP has consistent and safe outcomes across a wide range of prostate sizes. Although, the risk of blood transfusion is higher in patients with very large prostates and the risk of transient AUR is greater in patients with small glands, the overall efficacy and safety of HoLEP are not significantly influenced by prostate size.
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Affiliation(s)
- Joao G Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Carlos Delgado
- School of Medicine and Health Sciences, Tecnologico de Monterrey, Monterrey, Mexico
| | - Mohamadhusni Zarli
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
| | - Ryan Chen
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Tarek Ajami
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL.
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Suarez Arbelaez MC, Monshine J, Porto JG, Shah K, Singh PK, Roy S, Amin K, Marcovich R, Herrmann TRW, Shah HN. The emerging role of the urinary microbiome in benign noninfectious urological conditions: an up-to-date systematic review. World J Urol 2023; 41:2933-2948. [PMID: 37737900 DOI: 10.1007/s00345-023-04588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
PURPOSE The goal of this systematic review was to examine the current literature on the urinary microbiome and its associations with noninfectious, nonmalignant, urologic diseases. Secondarily, we aimed to describe the most common bioinformatics used to analyze the urinary microbiome. METHODS A comprehensive literature search of Ovid MEDLINE using the keywords "microbiota" AND "prostatic hyperplasia," "microbiota" AND "urinary bladder, overactive," "microbiota" AND "pelvic pain," and "microbiota" AND "urolithiasis" OR "nephrolithiasis" OR "urinary calculi" AND "calcium oxalate" was performed to identify relevant clinical microbiome studies associated with noninfectious benign urological conditions published from 2010 to 2022. We included human studies that evaluated the urinary, stone, or semen microbiota, or any combination of the above-mentioned locations. RESULTS A total of 25 human studies met the inclusion criteria: 4 on benign prostatic hyperplasia (BPH), 9 on overactive bladder (OAB), 8 on calcium oxalate stones, and 4 on chronic pelvic pain syndrome (CPPS). Specific taxonomic profiles in the urine microbiome were associated with each pathology, and evaluation of alpha- and beta-diversity and relative abundance was accounted for most of the studies. Symptom prevalence and severity were also analyzed and showed associations with specific microbes. CONCLUSION The study of the urogenital microbiome is rapidly expanding in urology. Noninfectious benign urogenital diseases, such as BPH, calcium oxalate stones, CPPS, and OAB were found to be associated with specific microbial taxonomies. Further research with larger study populations is necessary to solidify the knowledge of the urine microbiome in these conditions and to facilitate the creation of microbiome-based diagnostic and therapeutic approaches.
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Affiliation(s)
| | - Joshua Monshine
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joao G Porto
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Khushi Shah
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Praveen K Singh
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sabita Roy
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katherine Amin
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
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Porto JG, Arbelaez MCS, Pena B, Khandekar A, Malpani A, Nahar B, Punnen S, Ritch CR, Gonzalgo ML, Parekh DJ, Marcovich R, Shah HN. The Influence of the Microbiome on Urological Malignancies: A Systematic Review. Cancers (Basel) 2023; 15:4984. [PMID: 37894351 PMCID: PMC10605095 DOI: 10.3390/cancers15204984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
The microbiome, once considered peripheral, is emerging as a relevant player in the intricate web of factors contributing to cancer development and progression. These often overlooked microorganisms, in the context of urological malignancies, have been investigated primarily focusing on the gut microbiome, while exploration of urogenital microorganisms remains limited. Considering this, our systematic review delves into the complex role of these understudied actors in various neoplastic conditions, including prostate, bladder, kidney, penile, and testicular cancers. Our analysis found a total of 37 studies (prostate cancer 12, bladder cancer 20, kidney cancer 4, penile/testicular cancer 1), revealing distinct associations specific to each condition and hinting at potential therapeutic avenues and future biomarker discoveries. It becomes evident that further research is imperative to unravel the complexities of this domain and provide a more comprehensive understanding.
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Affiliation(s)
- Joao G. Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | | | - Brandon Pena
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
- Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Archan Khandekar
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Ankur Malpani
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Bruno Nahar
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Chad R. Ritch
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Mark L. Gonzalgo
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Dipen J. Parekh
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Hemendra N. Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
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Porto JG, Arbelaez MCS, Blachman-Braun R, Bhatia A, Bhatia S, Satyanarayana R, Marcovich R, Shah HN. Complications associated with minimally invasive surgical therapies (MIST) for surgical management of benign prostatic hyperplasia: a Manufacturer and User Facility Device Experience (MAUDE) database review. World J Urol 2023; 41:1975-1982. [PMID: 37222779 DOI: 10.1007/s00345-023-04440-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023] Open
Abstract
PURPOSE MAUDE database houses medical device reports of suspected device-related complications received by Food and Drug Administration. In the present study we aim to evaluate the MAUDE database for reported complications of MIST procedures. METHODS The database was queried using keywords: rezum, urolift, prostate embolization (PAE), transurethral needle ablation (TUNA), transurethral microwave therapy (TUMT), prostate stent and Temporarily Implanted Nitinol Device (iTIND) on 10/1/22 to extract information regarding device problems and procedure-related complications. Gupta classification system was used to stratify complications. Statistical analysis was performed to compare frequency of complications among MIST procedures. RESULTS We found a total of 692 reports (Rezum-358, urolift-226, PAE-53, TUNA-31, TUMT-19, prostatic stent-4, and iTIND-1). Most complications related to device or users were minor (level 1 and 2) and there was no significant difference among various MIST procedures. The screen/system error was responsible for 93% and 83% aborted cases in Rezum and TUNA, respectively, and PAE showed 40% of device component detachment/fracture. Overall Urolift and TUMT were associated with statistically significant higher incidence of major (level 3 and 4) complications (23% and 21%, respectively) as compared with Rezum (7%). Most major complications needing hospitalization after Urolift included hematoma and hematuria with clots and those after Rezum included urinary tract infection and sepsis. Thirteen deaths were reported, mostly due to cardiovascular events, which were classified as not associated with the proposed treatment. CONCLUSION MIST for BPH can occasionally cause significant morbidity. Our data should assist urologists and patients in shared decision-making process.
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Affiliation(s)
- Joao G Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Coral Gables, USA
| | | | - Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Coral Gables, USA
| | - Ansh Bhatia
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Coral Gables, USA
| | - Ramgopal Satyanarayana
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Coral Gables, USA
| | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Coral Gables, USA
| | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Coral Gables, USA.
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11
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Porto J, Suarez Arbelaez MC, Zarli M, Ahumada M, Swain S, Marcovich R, Shah HN. Exploring the Legal Implications of Benign Prostatic Hyperplasia Surgeries in the United States: A Comprehensive Analysis of Two Decades of Lawsuits. Cureus 2023; 15:e39335. [PMID: 37351225 PMCID: PMC10284091 DOI: 10.7759/cureus.39335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE The United States (US) currently faces a medical malpractice crisis, and a survey done in 2006 informed that 63% of urologists faced an average of 2.1 medical malpractice lawsuits. Surgery for benign prostatic hyperplasia (BPH) is performed by 95% of US urologists. Hence, we postulated that these procedures might be responsible for a substantial number of medical malpractice lawsuits. We examined claims related to BPH surgery in various US courts. MATERIALS AND METHODS Data were collected from Westlaw and LexisNexis databases using the keywords "benign prostatic hyperplasia," "enlarged prostate," "surgery," and "malpractice" to search for cases from the entire US from January 2000 to December 2021. We extracted details such as the type of procedure, the plaintiff and defendant, the nature of the allegation, the alleged complications, the verdict, and the compensation amount. RESULTS We found 30 cases in which the most common procedure was transurethral resection of the prostate (37%), with inadequate postoperative care as the most frequent reason for claims (33%). Urologists were the most frequently processed professionals (57%). The postsurgical outcomes that resulted in lawsuits were urinary incontinence (23%), erectile dysfunction (13%), and urinary retention (13%). Interestingly, 43% of the patients were inmates. Plaintiffs won only two (7%) cases: colon perforation after interstitial laser coagulation with Indigo laser and recto-urethral fistula after transurethral microwave therapy. CONCLUSION Most lawsuits were related to postoperative incontinence and erectile dysfunction, with the verdict favoring the defendant in most cases. Inmates were the plaintiffs in a relatively high percentage of cases. Only two cases resulted in a plaintiff victory, wherein both cases presented unexpected and serious postsurgical complications.
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Affiliation(s)
- Joao Porto
- Desai Sethi Urology Institute, University of Miami, Miami, USA
| | | | - Mohamadhusni Zarli
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Mariam Ahumada
- Desai Sethi Urology Institute, University of Miami, Miami, USA
| | - Sanjaya Swain
- Desai Sethi Urology Institute, University of Miami, Miami, USA
| | | | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miami, USA
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Heard JR, Wyant WA, Loeb S, Marcovich R, Dubin JM. AUTHOR REPLY. Urology 2022; 164:73. [PMID: 35710178 DOI: 10.1016/j.urology.2021.08.044] [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: 03/30/2021] [Accepted: 08/01/2021] [Indexed: 11/27/2022]
Affiliation(s)
- John R Heard
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - W Austin Wyant
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Stacy Loeb
- Departments of Urology and Population Health, New York University School of Medicine and the Manhattan Veterans Affairs, New York, NY
| | - Robert Marcovich
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Justin M Dubin
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
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Abstract
PURPOSE OF REVIEW The coronavirus disease 2019 (COVID-19) pandemic led to a drastic change in healthcare priorities, availability of resources and accommodation of different needs and scenarios. We sought to review the effect of the pandemic on different aspects of nephrolithiasis. RECENT FINDINGS The pandemic resulted in a significant impact on management of patients with nephrolithiasis around the world. A significant decrease in patient presentation and differences in strategies of management to truncate exposure and surgery time and expedite patient discharge deferring definitive management has been noted. Moreover, new safety measures such as COVID-19 PCR testing prior to surgery and limiting any intervention for COVID-19 positive patients to only life-saving scenarios has been implemented. Different emergency triaging proposals are being used, mainly including high risk patients with septic shock or complete obstruction/renal injury. Moreover, the emergence of telehealth has changed outpatient practice dramatically with a significant adoption to minimize exposure. Lastly, the effect of COVID-19 on renal physiology has been described with significant potential to cause morbidity from immediate or delayed acute kidney. No physiological effect on stone formation has yet been described, and transmission through urine is rare. SUMMARY The COVID-19 pandemic has markedly shifted the treatment of nephrolithiasis in many ways, including emergency triage, outpatient care, and definitive management. Although various approaches and algorithms proposed are meant to optimize management in the time of the pandemic, further studies are required for validation.
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Affiliation(s)
- Mohammad Hout
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Heard JR, Wyant WA, Loeb S, Marcovich R, Dubin JM. Perspectives of Residency Applicants and Program Directors on the Role of Social Media in the 2021 Urology Residency Match. Urology 2021; 164:68-73. [PMID: 34606880 DOI: 10.1016/j.urology.2021.08.041] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/13/2021] [Accepted: 08/01/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To perform a survey assessing the use of, attitudes towards, and perceived utility of social media (SoMe) in the 2021 urology residency match. METHODS We distributed surveys to urology residency applicants and program directors (PDs) via the Urology Match 2021 Google Spreadsheet and email. The survey collected demographic information as well as SoMe activity, perceived pressure to use SoMe, match results, and attitudes regarding the utility of SoMe in the match process. RESULTS A total of 108/528 (20%) applicants registered for the 2021 match and 61/142 (43%) PDs completed the survey. More applicants than PDs felt that SoMe helped them gain better insight into residency programs or applicants, respectively. Fewer applicants than PDs felt that SoMe activity provided a benefit to them in the match process. No significant relationship was found between SoMe viewing frequency, posting frequency, or tweetorial use with match outcomes. The majority of PDs believed that SoMe played a more important role in the 2021 match process than previous years while 15% and 12% reported that an applicant's SoMe activity helped or hurt the chances of matching to their program respectively. CONCLUSIONS SoMe, particularly Twitter, was widely used in the 2021 match by both applicants and PDs. A majority of applicants and PDs believed that SoMe use aided them in some way in the match process, yet there was no relationship between the volume or type of applicant SoMe activity and match outcomes.
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Affiliation(s)
- John R Heard
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY.
| | - W Austin Wyant
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Stacy Loeb
- Departments of Urology and Population Health, New York University School of Medicine and the Manhattan Veterans Affairs, New York, NY
| | - Robert Marcovich
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Justin M Dubin
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
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15
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Banerjee I, Katz JE, Bhattu AS, Soodana NP, Deane LA, Marcovich R, Shah HN. Durability of Digital Flexible Ureteroscope in University Hospital and Ambulatory Surgical Center: Is It Time to Rethink? J Endourol 2021; 35:289-295. [PMID: 32998577 DOI: 10.1089/end.2020.0709] [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] [Indexed: 11/13/2022] Open
Abstract
Introduction and Objectives: Published literature on damages to a digital flexible ureteroscope (DFU) examines a limited number of ureteroscopes and shows wide variation in its durability. The aim of this study was to compare the primary damage location, causes of DFU damages, and the durability of Karl Storz Flex-Xc digital ureteroscope between University Hospital (UH) and Ambulatory Care Surgery Center (ASC). We also evaluated the available literature on the durability of DFU. Methods: Each damaged DFU prospectively underwent a manufacturer's evaluation to determine the reason for return and primary site of damage. Hospital data on the number of ureteroscopic procedures and damaged DFUs over 3 years were retrospectively reviewed. The possible reason for the damage was classified as either intraoperative or between the procedures. The durability of DFUs, type, and cause of damage were compared between the UH and nonteaching ASC. A chi-square test was utilized for categorical variables. When cell frequencies were <5, Fisher's exact test was used. Results: During the study period, 1211 ureteroscopies were performed and 143 ureteroscopes were returned to the manufacturer. The mean number of uses was 7.45 at the UH and 16.5 at the ASC. The location and cause of damage were similar at both locations. The most common locations of primary damage were at the angle cover (70.6%) and instrument channel (19.2%). Most damage occurred during the handling of the ureteroscopes between surgical procedures (78%). On review of the literature, we found that DFUs were 6 times more durable in a nonteaching hospital. Conclusions: The DFU was more than two times as durable in the ASC as in the UH. Most incidents occurred during handling between surgical procedures. Future research is needed to examine the impact of training and certification of support staff on durability of DFUs.
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Affiliation(s)
- Indraneel Banerjee
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jonathan E Katz
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Amit S Bhattu
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Nachiketh P Soodana
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Leslie A Deane
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Robert Marcovich
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Lokeshwar SD, Randall V A, Dykes TE, Klaassen Z, Neal DE, Terris MK, Marcovich R. Dr. Alexander Randall III and the Discovery of Randall's Plaques. Urology 2020; 146:15-18. [PMID: 32991912 DOI: 10.1016/j.urology.2020.09.023] [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: 08/18/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Soum D Lokeshwar
- Yale University School of Medicine, Department of Urology, New Haven, CT.
| | | | - Thomas E Dykes
- Department of Surgery, Section of Urology, Medical College of Georgia, Augusta, GA
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Medical College of Georgia, Augusta, GA
| | - Durwood E Neal
- Department of Surgery, Section of Urology, Medical College of Georgia, Augusta, GA
| | - Martha K Terris
- Department of Surgery, Section of Urology, Medical College of Georgia, Augusta, GA
| | - Robert Marcovich
- University of Miami Miller School of Medicine, Department of Urology, Miami, FL
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17
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Nackeeran S, Katz J, Ramasamy R, Marcovich R. Association between sex hormones and kidney stones: analysis of the National Health and Nutrition Examination Survey. World J Urol 2020; 39:1269-1275. [PMID: 32504317 DOI: 10.1007/s00345-020-03286-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Increasing age, male gender, and metabolic syndrome are associated with kidney stone formation. As sex hormones change with age, gender, and metabolic syndrome, we hypothesized that sex hormones may underlie the physiologic changes affecting stone formation. METHODS We analyzed the relationships between testosterone, estradiol, and history of kidney stones using data from 10,193 participants in the Continuous National Health and Nutrition Examination Survey (NHANES) database from 2013-2016. We performed logistic regression analysis to analyze the predictive value of low testosterone and low estradiol on the history of kidney stones in both males and females. Self-reported history of kidney stone diagnosis was the outcome. RESULTS After adjusting for risk factors known to be associated with nephrolithiasis such as age, race, BMI, and medical comorbidities including: gout, angina, coronary disease, stroke, asthma, hypertension, and diabetes, multiple regression analysis demonstrated that there is no independent association between sex hormones (testosterone and estradiol) and history of kidney stones in either males or females. CONCLUSIONS There appears to be no association between sex hormones and history of kidney stones. Whether there is a more complex interaction of sex hormone levels and the shared association with factors such as metabolic syndrome requires additional investigation. Further studies matching menopausal status for women are necessary to further investigate the potential relationship between estrogen and kidney stones.
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Affiliation(s)
| | - Jonathan Katz
- Department of Urology, University of Miami, Miami, FL, USA
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18
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Masterson TA, Nackeeran S, Rainer Q, Hauser N, Marcovich R, Ramasamy R. Survey of Microsurgery Training Availability in US Urology Residency Programs. World J Mens Health 2020; 39:376-380. [PMID: 32648382 PMCID: PMC7994659 DOI: 10.5534/wjmh.190162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/19/2020] [Accepted: 03/02/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose The Accreditation Council of Graduate Medical Education (ACGME) establishes surgical minimum numbers of cases for urologic training. Currently there is not a requirement for microsurgery, likely from a belief that programs do not offer exposure. In an effort to evaluate the availability of microsurgery training among urology residency programs we surveyed the programs. Materials and Methods We obtained a list of the 138 ACGME-accredited urology residencies and contact information the American Urology Association (AUA). We contacted the residency programs by phone and e-mail. For programs that did not reply, we performed a search of the program website. We answered 3-questions to assess resident subspecialty training in microsurgery and used penile implant and artificial urinary sphincters as a comparison. Data are reported as frequencies. Results We obtained data from 134 programs (97.1%). A total of 104 programs (77.6%) had fellowship-trained physicians for training in microsurgery, 86.6% for penile implants, and 88.8% for artificial urinary sphincters. The percentage of fellowship-trained microsurgeons per program did not vary significantly when comparing the different sections of the AUA. The northeast and southeast sections had the lowest percentage (67% and 68%). Conclusions Nearly 80% of urology residency programs have a fellowship-trained microsurgeon on faculty, we therefore believe that microsurgery should be added as part of the ACGME minimums. In order to provide an equal exposure to all graduating urology residents, urology residency programs that lack microsurgery should identify potential faculty with fellowship training.
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Affiliation(s)
- Thomas A Masterson
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Sirpi Nackeeran
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Quinn Rainer
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nicholas Hauser
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert Marcovich
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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19
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Kava BR, Andrade AD, Marcovich R, Idress T, Ruiz JG. Communication Skills Assessment Using Human Avatars: Piloting a Virtual World Objective Structured Clinical Examination. Urol Pract 2017; 4:76-84. [PMID: 37592593 DOI: 10.1016/j.urpr.2016.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Proficiency in communication skills is a core competency of residency training. We evaluated the feasibility, acceptability and applicability of a virtual world objective structured clinical examination that enables practice based learning and assessment of resident communication skills. METHODS A virtual clinical encounter situated in 2 practice settings was developed that uses a human avatar physician and a standardized patient. Following an online tutorial house staff participated in 4 communication tasks, including shared decision making, delivering bad news, obtaining informed consent and disclosing a medical error. Validated instruments and semistructured interviews were used to assess house staff acceptability and applicability of the platform. Three faculty members used ACS (Affective Competency Scale) and communication specific assessment instruments to evaluate house staff performance. RESULTS A total of 12 urology house staff completed the simulation. Direct costs were approximately $1,000. The virtual world was easy to use and immersive. Applicability directly correlated with presence (Pearson r = 0.67, p = 0.01) and co-presence (Pearson r = 0.8, p = 0.002). House staff identified problems with 1) limited nonverbal cues, 2) too much information presented and 3) a lack of immediate feedback. The ICC (intraclass correlation) of faculty assessments was high for ACS at 0.53 (95% CI 0.36-0.69) for single measures, 0.77 (95% CI 0.63-0.86) for average measures and less for other assessment instruments. CONCLUSIONS A virtual world objective structured clinical examination is a feasible, acceptable and applicable method of communication skills assessment. Improving nonverbal cues, focusing on individual skill sets and providing immediate feedback are measures to be adopted in future iterations of this platform.
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Affiliation(s)
- Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Allen D Andrade
- Geriatric Research Education and Clinical Centers, James J. Peters Veterans Affairs Medical Center, Bronx, New York
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Marcovich
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Thaer Idress
- Laboratory of E-learning and Multimedia Research, Geriatric Research Education and Clinical Centers, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida
| | - Jorge G Ruiz
- Laboratory of E-learning and Multimedia Research, Geriatric Research Education and Clinical Centers, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida
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20
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Mezzarobba S, Bortolato S, Giacomazzi A, Fancellu G, Marcovich R, Valentini R. Percutaneous repair of Achilles tendon ruptures with Tenolig: quantitative analysis of postural control and gait pattern. Foot (Edinb) 2012; 22:303-9. [PMID: 23102510 DOI: 10.1016/j.foot.2012.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 09/06/2012] [Accepted: 09/10/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical approach in Achilles tendon's rupture involved during the last years has becoming safer and less invasive as possible. Lots of study investigate the outcomes of the mini-invasive technique with Tenolig proving its good results, but never in the long-term. OBJECTIVES Our study want to emphasize the effectiveness of this treatment exploring the postural and gait patterns in a 24-month follow up. METHOD Patients did self-training exercises without specific supervision, instead of a particular postoperative rehabilitation protocol. We compared 21 patients to a control group of 19 health subjects using a clinical examination, a podobarometric and an optokinetic analysis. RESULTS Data shows no differences in time-distance parameters, despite a reduction of propulsion phase data, confirmed also by kinetic analysis. Podobarometric results show only a decrease in the anterior pressure of the injured limb (p=0.09). In standing an increase of anterior-posterior oscillation of the COP (center of pressure) (p=0.03). CONCLUSIONS The results underline the long-term outcome effectiveness of the technique but some functional alterations remain. This could be the reason of the weakness, which always affected the patients. Reduction of the triceps elongation and restoration of strength during the propulsion phase should be the key points in postoperative physiotherapy.
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Affiliation(s)
- S Mezzarobba
- Physiotherapy Degree, University of Trieste, Azienda Ospedaliero-Universitaria di Cattinara, Italy
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21
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Matsuda T, Keeley F, Marcovich R, Paterson R, Patel A, Tiselius HG, Bach T, Michel M, Lee DI, Ukimura O. Survey of Endourology. J Endourol 2010. [DOI: 10.1089/end.2009.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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22
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Fukuda RG, Marcovich R. IMPACT OF SELECTIVE CT PARAMETERS SKIN TO STONE DISTANCE AND ATTENUATION VALUE ON THE TREATMENT OF INTRARENAL CALCULI. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61641-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Finas D, Huszar M, Agic A, Dogan S, Kiefel H, Riedle S, Gast D, Marcovich R, Noack F, Altevogt P, Fogel M, Hornung D. L1 cell adhesion molecule (L1CAM) as a pathogenetic factor in endometriosis. Hum Reprod 2008; 23:1053-62. [DOI: 10.1093/humrep/den044] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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24
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Paterson RF, Matsuda T, Marcovich R, Patel A, Tiselius HG, Keeley, Jr. FX, Michel MS, Lee DI. Survey of Endourology. J Endourol 2008. [DOI: 10.1089/end.2007.9848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Van Cangh P, Smith AD, NG CS, Ost MC, Marcovich R, Wong M, Joyce AD, Desai RA, Assimos DG. Management of Difficult Kidney Stones. J Endourol 2007; 21:478-89. [PMID: 17523899 DOI: 10.1089/end.2007.9965] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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French DB, Marcovich R. Fibrin sealant for retrograde ureteroscopic closure of urine leak after partial nephrectomy. Urology 2006; 67:1085.e1-3. [PMID: 16698381 DOI: 10.1016/j.urology.2005.11.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [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: 07/28/2005] [Revised: 10/20/2005] [Accepted: 11/09/2005] [Indexed: 01/01/2023]
Abstract
We present a case of a prolonged urine leak after partial nephrectomy successfully treated by retrograde ureteroscopic injection of fibrin sealant. The technical aspects of retrograde instillation of sealant into the lower renal pole and outcome are discussed.
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Affiliation(s)
- Dan B French
- Department of Urology, University of Texas Health Science Center, San Antonio, Texas 78229-3900, USA
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27
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Stallman KJ, Marcovich R, Glickman RD, Teichman JM. 1542: Holmium:Yag Lithotripsy Fiber Performance as a Function of Chemical Environment. J Urol 2006. [DOI: 10.1016/s0022-5347(18)33746-7] [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: 10/17/2022]
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Abstract
BACKGROUND AND PURPOSE Long strictures of the proximal ureter are difficult to manage, and circumferential replacement with various natural and synthetic materials has been unsuccessful. We sought to use cultured autologous cells seeded onto graft material for proximal-ureteral replacement. Additionally, we wished to determine if urothelial cell-seeded de-epithelialized small bowel would generate adequate ureteral replacement. MATERIALS AND METHODS Three sets of experiments were performed. First, autologous pig-bladder smooth-muscle and urothelial cells were expanded in culture on large sheets of multilayer small-intestinal submucosa (SIS). These sheets were then tubularized and used to replace a 5-cm segment of proximal ureter in pigs. Second, autologous cells harvested from the bladders of Beagle dogs were cultured and seeded on porcine ureteral acellular matrix, which was used to replace a 3-cm segment of ureter in dogs. Segments were wrapped in omentum to enhance vascularity. Third, a de-epithelialized small-bowel segment seeded with autologous bladder-epithelial cells was transversally retubularized (Monti) into a 4-cm ureteral replacement. Follow-up studies consisted of retrograde pyelography, serum chemistry assays, hematoxylin/eosin studies, and immunohistopathologic examination using antibodies against alpha-smooth-muscle actin and pancytokeratin AE1-AE3. RESULTS Coculture of urinary-tract cells on large segments of SIS failed to create adequate ureteral replacement. All grafts were contracted and stenotic, with complete obstruction of the ipsilateral renal unit. Similar results were seen in the Beagles. Despite clinical obstruction and gross contraction of the graft, a circumferential muscular ureteral wall lined with multilayer transitional epithelium was present. Urotheliumseeded de-epithelialized Monti bowel segments resulted in patent ureteral replacement without hydroureteronephrosis and with normal renal function, serum electrolytes, and acid-base balance. However, bowel mucosa fully regenerated, with multilayer transitional epithelium growing adluminally in continuity with the proximal and distal anastomotic sites. CONCLUSIONS Seeding of ureteral grafts with autologous bladder cells does not promote success in two largeanimal models using different xenogenic acellular matrices. However, muscle and urothelium regeneration occurs with ureteral acellular matrix in the dog. Urothelium-seeded de-epithelialized Monti bowel segments may be an acceptable substitute for long proximal ureteral segments. Further technical refinements are required to replace the bowel mucosa completely with normal urothelium.
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Affiliation(s)
- Assaad El-Hakim
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
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Tan BJ, Rastinehad AR, Marcovich R, Smith AD, Lee BR. Trends in ureteropelvic junction obstruction management among urologists in the United States. Urology 2005; 65:260-4. [PMID: 15708034 DOI: 10.1016/j.urology.2004.09.051] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [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: 06/14/2004] [Accepted: 09/23/2004] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To determine current practice patterns in the surgical treatment of ureteropelvic junction obstruction (UPJO) among urologists in the United States. METHODS Using the American Urological Association directory, an electronic mail survey regarding the surgical management of UPJO was sent to 1040 urologists in the United States with an electronic mail address listed in the roster. RESULTS The response rate was 37.6%. Of the respondents, 67.4% were in community practice and 32.6% in academic practice. Nearly 53% of the respondents would perform a workup for a crossing vessel before definitive therapy; if no crossing vessel was found, 43.5% would consider Acucise endopyelotomy as the first-line procedure. However, if a crossing vessel was found, 57.4% would perform open pyeloplasty and 34.3% would choose laparoscopic pyeloplasty as their first-line procedure. If pyeloplasty was chosen, community urologists preferred open pyeloplasty (77.6%), and academic urologists preferred laparoscopic pyeloplasty (66.9%). The surgeon's training and experience was the most influential factor in choosing between laparoscopic and open pyeloplasty. If the patient had a failed endopyelotomy in the past, most respondents (90.8%) would perform pyeloplasty for definitive treatment of the UPJO. CONCLUSIONS Demonstration of a crossing vessel remains an important factor in determining the course of management of a UPJO. During the past 5 years, a growing number of urologists in both academic and nonacademic practices have been performing laparoscopic pyeloplasty for the management of UPJO in adults. Several factors, especially the surgeon's training, have an impact on the choice of procedure. Open pyeloplasty is still performed by a significant number of urologists. These data may be useful in designing physician education programs and/or future investigations to help define standard treatment practices for UPJO.
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Affiliation(s)
- Beng Jit Tan
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040-1496, USA
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Affiliation(s)
- Robert Marcovich
- Department of Urology, University of Texas Health Sciences Center, San Antonio, Texas 78229-3900, USA.
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Abstract
BACKGROUND AND PURPOSE The optimal postoperative drainage system for patients undergoing percutaneous nephrolithotomy (PCNL) has not yet been determined. Each of the different tubes available has theoretical advantages and disadvantages. The objective of this study was to determine if any one system of post-PCNL drainage has any significant advantage over the others. PATIENTS AND METHODS Sixty patients were randomized to either a 24F Re-entry tube (Group 1), an 8F pigtail catheter (Group 2), or a double-J stent (Group 3) (N = 20 for all groups). The double-J stent patients also had an 18F Councill catheter as a nephrostomy tube, which was removed on the morning of postoperative day 1. The three groups were well-matched for age, stone size, operative time, and mean number of percutaneous tracts (P > 0.05 for all). Data collected included intraoperative findings, postoperative analog pain scores and narcotic usage, presence of extravasation on postoperative nephrostogram, presence of perinephric fluid on postoperative ultrasound scans, length of stay, and whether leakage from the nephrostomy site persisted more than 48 hours after tube removal. RESULTS There were no statistically significant differences among the three groups in terms of change in hematocrit or number of patients requiring blood transfusion; in the incidence of tube blockage, extravasation, or presence of perinephritic fluid; or in complication rates, length of hospital stay, or persistent leakage after tube removal. There was a strong trend to less postoperative leakage with the 8F pigtail than the Reentry tube (P = 0.05). Postoperative analog pain scores and narcotic usage were equivalent for all three groups. Patients Groups 1 and 2 were free of all tubes sooner than patients in Group 3 (P < 0.001). CONCLUSIONS This study did not demonstrate an overwhelming advantage of any one drainage system over the others. All three systems were equally tolerated by patients. There may be less chance of prolonged nephrostomy-site leakage with an 8F pigtail catheter.
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Affiliation(s)
- R Marcovich
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040-1496, USA
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32
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Lee BR, Marcovich R, Smith AD. Editorial comment. Urology 2004. [DOI: 10.1016/j.urology.2004.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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El-Hakim A, Cai Y, Marcovich R, Pinto P, Lee BR. Effect of Endo-GIA vascular staple size on laparoscopic vessel sealing in a porcine model. Surg Endosc 2004; 18:961-3. [PMID: 15108116 DOI: 10.1007/s00464-003-8546-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2003] [Accepted: 01/13/2004] [Indexed: 11/27/2022]
Abstract
BACKGROUND Two sizes of endoscopic gastrointestinal anastomosis (Endo-GIA) staples are currently available for vascular control. The purpose of this study was to compare the Endo-GIA 30-2.0 mm with the Endo-GIA 30-2.5 mm vascular staple. METHODS The renal blood vessels, aorta, and vena cava were divided laparoscopically using the Endo-GIA 30-2.0 and 30-2.5 mm in four pigs, respectively. The arterial and venous segments were harvested en bloc for ex vivo burst pressure studies. RESULTS Both 2.0-mm and 2.5-mm staples achieved vessel sealing at supraphysiologic mean burst pressures (> or =310 mmHg). There were no statistical differences between mean burst pressures of vessels stapled by 2.0-mm compared to 2.5-mm staples. Both staples sealed arteries up to 17 mm and veins up to 22 mm in diameter. CONCLUSION Endo-GIA 30-2.0 mm and 30-2.5 mm vascular staples are equivalent in sealing vessels at supraphysiologic mean burst pressures.
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Affiliation(s)
- A El-Hakim
- Department of Urology, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040-1496, USA.
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Lee BR, Marcovich R, Chiu KY, Smith AD. V685: Laparoscopic Distal Ureterectomy and Boari Flap for Transitional Cell Carcinoma of the Ureter: The Video. J Urol 2004. [DOI: 10.1016/s0022-5347(18)39227-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee BR, Marcovich R, Chiu KY, Smith AD. V1687: Laparoscopic Monti Procedure for Strictures of the Proximal Ureter- the Video. J Urol 2004. [DOI: 10.1016/s0022-5347(18)39199-7] [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: 10/17/2022]
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Marcovich R, Rastinehad A, El-Hakim A, Smith AD, Lee BR. 476: Medical Malpractice Trends in Contemporary Urological Laparoscopy: Results of an Internet Survey. J Urol 2004. [DOI: 10.1016/s0022-5347(18)37738-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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El-Hakim A, Chertin B, Marcovich R, Lee BR, Weiss GH, Smith AD. 1760: Adjuvant Bacillus Calmette-Guérin Therapy after Endoscopic Treatment of Upper Tract Transitional Cell Carcinoma: First Proof of Efficacy. J Urol 2004. [DOI: 10.1016/s0022-5347(18)38952-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Marcovich R, Atala A, Chiu KY, El-Hakim A, Aldana JP, Jacobson AI, Lee BR, Smith AD. 19: Ureteral Segmental Replacement Revisited. J Urol 2004. [DOI: 10.1016/s0022-5347(18)37281-1] [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: 10/17/2022]
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Affiliation(s)
- B R Lee
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, NY, USA.
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Abstract
OBJECTIVE To compare two newly designed flexible ureteroscopes with their respective predecessors, to determine whether design advances have overcome the limitation of tip deflection, which may interfere with diagnosis and treatment of lower pole renal pathology. MATERIALS AND METHODS Two new-generation flexible ureteroscopes, the DUR-8 Elite (ACMI, Southborough, MA, USA) and 11278AU (Karl Storz Endoscopy, Culver City, CA, USA) were compared with their previous models, the ACMI DUR-8 and the Storz 11274AAU. Active tip deflection and irrigation flow rates with and without various endoscopic tools were assessed. Specifications, purchase prices and repair costs were obtained from each manufacturer. The field of view and screen image size of each ureteroscope were also compared. RESULTS The ACMI DUR-8 Elite and the Storz 11278AU had improvements of 79 degrees and 144 degrees, respectively, from their respective older models. Although the tip deflection of all ureteroscopes was compromised by inserting different endoscopic tools, these new instruments were less affected. With a 3 F basket inside the working channel, the ACMI DUR-8 Elite and the Storz 11278AU had only 0.7% and 2.8% loss of upward tip deflection, compared with their older models, at 9.6% and 5.0%, respectively. However, the flow rates of these new instruments were decreased. CONCLUSION The new flexible ureteroscopes have significantly better active tip deflection than previous models, both with and without endoscopic instrumentation inserted. However, improved flexibility is at the expense of decreased flow rates and higher purchase costs.
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Affiliation(s)
- K-Y Chiu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan.
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Affiliation(s)
- E M Paul
- Long Island Jewish Medical Center, Department of Urology, NY, USA.
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Marcovich R, Aldana JPA, Morgenstern N, Jacobson AI, Smith AD, Lee BR. Optimal lesion assessment following acute radio frequency ablation of porcine kidney: cellular viability or histopathology? J Urol 2003; 170:1370-4. [PMID: 14501771 DOI: 10.1097/01.ju.0000073846.32015.45] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Radio frequency ablation (RFA) has been used as a minimally invasive alternative to nephrectomy for small renal tumors. Questions have arisen regarding the accuracy of cell viability determination on standard hematoxylin and eosin (H & E) staining. We investigated and compared the histological characteristics of RF ablated renal tissue using nicotinamide adenine dinucleotide (NADH) and H & E staining. MATERIALS AND METHODS Ten porcine kidneys underwent laparoscopic RFA of the upper and lower poles using a 2 (8) or 3 cm (2) protocol with 2 cycles of 90 W, target temperature 105C and treatment time 5.5 minutes per cycle. Following tract ablation the kidneys were immediately harvested, gross lesion size was measured and tissue was processed for standard H & E and NADH staining. RESULTS H & E staining of ablated tissue revealed a number of alterations in renal tubular histology. However, all of these findings were focal with areas of parenchyma that appeared well preserved. Corresponding areas on NADH processed sections showed the complete absence of staining, indicating the lack of cellular viability. There were no skip areas noted on NADH processed sections and treated portions demonstrated a well demarcated border of ablation. CONCLUSIONS While RFA produces discernible histological changes acutely on H & E, these alterations are variable and patchy, and they alternate with areas of well preserved tissue. Therefore, NADH staining should always be used to assess and verify cellular death in RFA lesions. In this study no skip areas of viable cells were noted within areas of ablated tissue on NADH staining.
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Affiliation(s)
- Robert Marcovich
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York, USA
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Abstract
OBJECTIVES New designs have improved the ability of flexible ureteroscopes to assess the upper urinary tract. However, limitations of tip deflection may interfere with diagnosis and treatment of lower pole renal pathologic features and smaller working channels may impair irrigant flow. Our purpose was to compare the new flexible ureteroscopes with prior models to determine whether engineering advances have overcome these problems. METHODS Two newly released flexible ureteroscopes, the ACMI DUR-8 Elite and the Storz 11278AU, were compared with four other ureteroscopes, the ACMI DUR-8, Storz 11274AAU, Olympus URF-P3, and Wolf 9F. Active tip deflection, irrigation flow rates, and intraluminal pressures with and without various endoscopic tools were assessed. The specifications, purchase prices, and repair costs were obtained from the individual manufacturers. Also, the field of view and screen image size of each scope were compared. RESULTS The ACMI DUR-8 Elite and Storz 11278AU had improved tip deflection of 79 degrees and 144 degrees, respectively, from previous ureteroscopes. Although the tip deflections of all ureteroscopes were compromised by the insertion of endoscopic tools, new ureteroscopes were less affected. With a 3F basket within the working channel, the ACMI DUR-8 Elite and the Storz 11278AU had a loss of downward deflection of only 0.7% and 2.8% compared with a loss of 9.6% and 5.0% for their older models, respectively. However, the flow rate of these new instruments was decreased. CONCLUSIONS The new flexible ureteroscopes have significantly better active tip deflection than previous models, both with and without endoscopic instrumentation inserted. However, improved flexibility comes at the expense of a decreased flow rate.
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Affiliation(s)
- Kun-Yuan Chiu
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
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Abstract
OBJECTIVE To evaluate the attachment and proliferation of cultured human urinary tract cells to culture plates surface-modified by photochemical immobilization of extracellular matrix (ECM) proteins. MATERIALS AND METHODS Human uroepithelial (UEC) and smooth muscle (SMC) cells were harvested from ureter and expanded in culture; 24-well culture plates surface-modified by photochemical covalent immobilization of ECM proteins were then seeded with UEC or SMC. To characterize cellular attachment, cells were incubated on surface-modified plates for 30 and 90 min. For proliferation assays the cells were incubated for 3-12 days. Standard tissue culture plates with no surface modification and sham-modified plates served as controls. Differential attachment and proliferation on the various surfaces were assessed using analysis of variance with Fisher's posthoc test for multiple comparisons. RESULTS Attachment at 30 and 90 min of both UEC and SMC on plates surface-modified with ECM proteins was significantly greater than in control plates. Surface-modification with collagen resulted in significantly greater cellular attachment than with either laminin or fibronectin. UEC proliferation was also significantly greater than in control plates by surface-modification with collagen and fibronectin, but not with laminin. SMC proliferation was significantly better after surface modification than on sham- modified plates, but was no better than standard plates. CONCLUSIONS Covalent photochemical immobilization of ECM proteins to potential growth surfaces enhances the attachment of cultured UEC and SMC and the proliferation of UEC. This technique might be useful in modifying surface properties of synthetic polymer-based materials in a controlled and defined manner, giving them the capacity to promote and sustain the growth of urinary tract cells. This may lead to development of alternative methods of tissue engineering in the urinary tract.
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Affiliation(s)
- R Marcovich
- Urology Service, Department of Veterans Affairs Medical Center, University of Michigan Health System, Ann Arbor, MI, USA.
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Aldana JPA, Lee BR, Lee WJ, El-Hakim A, Marcovich R, Smith AD. Residual Air Persists in the Renal Collecting System following Percutaneous Nephrolithotomy. J Laparoendosc Adv Surg Tech A 2003; 13:317-9. [PMID: 14617390 DOI: 10.1089/109264203769681709] [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] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine the presence or absence of air in the renal collecting system 48 hours following percutaneous nephrolithotomy (PCNL). METHODS The study was based on a review of the records of the last 100 consecutive patients undergoing PCNL for stone extraction. Two urologists and a uroradiologist reviewed post-PCNL nephrostogram films and determined the presence or absence of air in the urinary tract. RESULTS Nephrostography was routinely performed 48 hours after PCNL, and all films of the 100 patients were reviewed. Gas was detected in 98 (98%) of the 100 cases that appeared as gas pyelograms outlining the renal calyces. Of the 98 cases, 33 (34%) demonstrated gas in the upper calyx, 10 (10%) in the middle calyx, 12 (13%) in the lower calyx, and 43 (44%) in more than one calyx. Gas was not detected in the renal parenchyma or perirenal areas. CONCLUSIONS Gas is present within the renal collecting system 48 hours after a percutaneous procedure. Prospective studies should be performed to document the amount of time needed for complete resolution of gas from the collecting system.
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Affiliation(s)
- Joel Patrick A Aldana
- Department of Urology, Albert Einstein College of Medicine, Long Island Jewish Medical Center Campus, New Hyde Park, New York 11040, USA
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Jacobson AI, Amukele SA, Marcovich R, Shapiro O, Shetty R, Aldana JP, Lee BR, Smith AD, Siegel DN. Efficacy and morbidity of therapeutic renal embolization in the spectrum of urologic disease. J Endourol 2003; 17:385-91. [PMID: 12965064 DOI: 10.1089/089277903767923164] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We report the largest series of renal embolizations performed for a variety of indications. PATIENTS AND METHODS A retrospective analysis was performed on embolizations performed in our institution from 1997 to 2002 encompassing 36 patients who underwent 44 procedures. RESULTS Embolization was successful on the first attempt in 87% of the patients. A second embolization was performed in four of the five unsuccessful cases, three successfully, increasing the success rate to 95%. The mean postoperative narcotic use was 27.2 mg of morphine equivalent, and 10 mg or less was required by 45% of the patients. In the 14 patients who had not also undergone a surgical procedure, the mean narcotic use was 21 mg, and 64% required 10 mg or less. Only 15% of the patients developed fever, which resolved within 2 days in all cases. Leukocytosis was seen in 47%. Follow-up creatinine and hypertension information was available in 16 and 18 patients, respectively. After a mean follow-up of 269 days, only one patient had a clinically significant rise in the creatinine concentration. After a mean follow-up of 496 days, two patients had new-onset hypertension. There was no statistically significant difference in the success rate, narcotic use, complications, creatinine concentrations, or the likelihood of fever, leukocytosis, or hypertension according to the indication for embolization or the agent used. Use of a microcatheter was associated with less parenchymal loss, and decreased parenchymal loss was associated with a significant reduction of narcotic use. CONCLUSIONS Renal embolization is a highly effective and well-tolerated procedure in a variety of urologic conditions. The indications and material used did not have a significant effect on the outcome. Reducing parenchymal loss can significantly reduce morbidity.
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Affiliation(s)
- Avi I Jacobson
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
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Marcovich R, Jacobson AI, Aldana JPA, Lee BR, Smith AD. Practice trends in contemporary management of adult ureteropelvic junction obstruction. Urology 2003; 62:22-5; discussion 25-6. [PMID: 12837413 DOI: 10.1016/s0090-4295(03)00346-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine current practice patterns in the surgical treatment of ureteropelvic junction obstruction in the United States and Canada. METHODS An e-mail survey was sent to 56 academic endourologists regarding the number of procedures performed in the previous year for ureteropelvic junction obstruction, factors considered in the choice of procedure, and whether community urologists in their area were performing laparoscopic pyeloplasty or endopyelotomy. RESULTS The response rate was 66% (37 of 56). More respondents were performing endopyelotomy (91%) than laparoscopic pyeloplasty (51%), and nearly one half were performing open pyeloplasty. The mean number of procedures performed by respondents in the previous year was 9.5 endopyelotomies, 4 laparoscopic pyeloplasties, and 2.5 open pyeloplasties. A number of factors had an impact on the practitioners' choice of procedure, including the presence of a crossing vessel and massive hydronephrosis, secondary ureteropelvic junction obstruction, the surgeon's training, procedure cost, operative time, expected success rate, degree of invasiveness, and patient preference. Nearly one fifth of respondents said they would choose laparoscopic pyeloplasty as first-line therapy regardless of anatomic considerations. Seventy-eight percent stated that community urologists in their area were performing endopyelotomy routinely or occasionally compared with only 3% who stated community urologists in their area were performing laparoscopic pyeloplasty. CONCLUSIONS Laparoscopic pyeloplasty is still in its early stages. Although laparoscopic pyeloplasty has a greater success rate, endopyelotomy continues to be more commonly performed in academic centers. Laparoscopic pyeloplasty has not yet made significant inroads into community practice. Several factors, especially the surgeons' training, have an impact on the choice of procedure. Open pyeloplasty is still performed by a significant number of academic endourologists.
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Affiliation(s)
- Robert Marcovich
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040-1496, USA
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Abstract
BACKGROUND AND PURPOSE Laparoscopic bowel injuries are rare but potentially fatal if recognition is delayed. Unlike the situation after open surgery, patients with unrecognized bowel injury after laparoscopy do not present with the typical "acute surgical abdomen." We investigated monocyte, neutrophil, and lymphocyte apoptosis as indicators of the immune response and whether this response is stimulated or suppressed by laparoscopic bowel injury compared with bowel injury induced during open surgery. MATERIALS AND METHODS After an animal protocol was approved, laparoscopy was performed in a rabbit model. A total of 44 animals were divided into four groups of 11 rabbits each. Laparoscopic bowel injury was created using 30-W electrocautery at 0 (control), 1, and 5 hours after induction of pneumoperitoneum. Bowel injury was created in the fourth group during open laparotomy. Animals were euthanized at 0, 1 day, 1 week, or 2 weeks after surgery. Apoptosis was assessed by staining the nuclei of blood cells with H-33342 dye. RESULTS At 1 week, neutrophil, monocyte, and lymphocyte apoptosis levels were 2.4- to 5-fold lower after laparoscopy (1-hour pneumoperitoneum) compared with open surgery. However, at 2 weeks, the percentage of apoptosis had equalized in the two groups. Interestingly, with longer laparoscopic procedures (5 hours), the percentage of apoptosis at 0 and 1 day more closely approached that seen after open surgery. At 2 weeks, there was a significant difference in apoptosis levels in all cell types between the experimental groups compared with controls (P < 0.001). No animals undergoing a 5-hour open procedure survived to 2 weeks after bowel injury. CONCLUSIONS Open surgery resulted in a significant increase in programmed cell death compared with controls in the immediate postoperative period following bowel injury. Laparoscopic surgery produced a delayed response and after 2 weeks with bowel perforation approached open surgery levels. The difference in the degree of cellular death may be secondary to a smaller degree of stimulation of the immune response in laparoscopic surgery.
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Affiliation(s)
- Joel Patrick A Aldana
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York, USA
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Cai Y, Jacobson A, Marcovich R, Lowe D, El-Hakim A, Shah DK, Smith AD, Lee BR. Electrical prostate morcellator: an alternative to manual morcellation for laparoscopic nephrectomy specimens? An in vitro study. Urology 2003; 61:1113-7; discussion 1117. [PMID: 12809874 DOI: 10.1016/s0090-4295(03)00149-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To compare the safety and efficacy of morcellation with the electrical prostate morcellator (EPM) or manual morcellation of the kidney, using an internal view within the morcellation sac. METHODS Thirty porcine kidneys, mean renal mass 174.5 g, were divided into three groups of 10. All morcellations were performed inside the LapSac. Groups 1 and 2 underwent morcellation using the EPM, monitored inside the LapSac using the nephroscope and outside the LapSac with the laparoscope, respectively. Group 3 underwent manual morcellation with ring forceps. The groups were assessed for morcellation time, fragment size, and LapSac integrity. RESULTS In group 1, one pinhole perforation occurred; in group 2, nine perforations occurred (five large and four pinhole). No perforations occurred (P <0.001) in group 3 (manual morcellation). The mean morcellation time for groups 1 through 3 was, respectively, 86.9, 47.1, and 15.1 minutes (P <0.0001). The corresponding mean fragment size was 0.011, 0.015, and 1.36 g. The difference in mean fragment size was significantly different between the manual morcellation group and the EPM groups (P <0.001), but not between the two EPM groups (P = 0.12). CONCLUSIONS Manual morcellation was safe, fast, and superior to morcellation with the EPM monitored either inside or outside the LapSac. The high rate of LapSac perforation precludes the use of EPM after laparoscopic radical nephrectomy in the clinical forum.
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Affiliation(s)
- Yi Cai
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
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Marcovich R, Smith AD. Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy. Int Braz J Urol 2003; 29:195-207. [PMID: 15745522 DOI: 10.1590/s1677-55382003000300002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2002] [Accepted: 10/10/2002] [Indexed: 11/22/2022] Open
Abstract
Introduction of minimally invasive techniques has revolutionized the surgical management of renal calculi. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are now both well-established procedures. Each modality has advantages and disadvantages, and the application of each should be based on well-defined factors. These variables include stone factors such as number, size, and composition; factors related to the stone's environment, including the stone's location, spatial anatomy of the renal collecting system, presence of hydronephrosis, and other anatomic variables, such as the presence of calyceal diverticula and renal anomalies; and clinical or patient factors like morbid obesity, the presence of a solitary kidney, and renal insufficiency. The morbidity of each procedure in relation to its efficacy should be taken in to account. This article will review current knowledge and suggest an algorithm for the rational management of renal calculi with shock wave lithotripsy and percutaneous nephrolithotomy.
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Affiliation(s)
- Robert Marcovich
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040-1496, USA.
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