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Yoon D, Fast AM, Cipriano P, Shen B, Castillo JB, McCurdy CR, Mari Aparici C, Lum D, Biswal S. Sigma-1 Receptor Changes Observed in Chronic Pelvic Pain Patients: A Pilot PET/MRI Study. Front Pain Res 2021; 2:711748. [PMID: 35295458 PMCID: PMC8915714 DOI: 10.3389/fpain.2021.711748] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Chronic pelvic pain is a highly prevalent pain condition among women, but identifying the exact cause of pelvic pain remains a significant diagnostic challenge. In this study, we explored a new diagnostic approach with PET/MRI of the sigma-1 receptor, a chaperone protein modulating ion channels for activating nociceptive processes. Methods: Our approach is implemented by a simultaneous PET/MRI scan with a novel radioligand [18F]FTC-146, which is highly specific to the sigma-1 receptor. We recruited 5 chronic pelvic pain patients and 5 healthy volunteers and compared our PET/MRI findings between these two groups. Results: All five patients showed abnormally increased radioligand uptake on PET compared to healthy controls at various organs, including the uterus, vagina, pelvic bowel, gluteus maximus muscle, and liver. However, on MRI, only 2 patients showed abnormalities that could be potentially associated with the pain symptoms. For a subset of patients, the association of pain and the abnormally increased radioligand uptake was further validated by successful pain relief outcomes following surgery or trigger point injections to the identified abnormalities. Conclusion: In this preliminary study, sigma-1 receptor PET/MRI demonstrated potential for identifying abnormalities associated with chronic pelvic pain. Future studies will need to correlate samples with imaging findings to further validate the correlation between S1R distribution and pathologies of chronic pelvic pain. Trial Registration: The clinical trial registration date is June 2, 2018, and the registration number of the study is NCT03195270 (https://clinicaltrials.gov/ct2/show/NCT03556137).
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Affiliation(s)
- Daehyun Yoon
- Department of Radiology, School of Medicine, Stanford University, Stanford, CA, United States
| | - Angela M. Fast
- Diagnostic, Molecular and Interventional Radiology, The Mount Sinai Hospital, New York, NY, United States
| | - Peter Cipriano
- Department of Radiology, School of Medicine, Stanford University, Stanford, CA, United States
| | - Bin Shen
- Department of Radiology, School of Medicine, Stanford University, Stanford, CA, United States
| | - Jessa B. Castillo
- Department of Radiology, School of Medicine, Stanford University, Stanford, CA, United States
| | - Christopher R. McCurdy
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Carina Mari Aparici
- Department of Radiology, School of Medicine, Stanford University, Stanford, CA, United States
| | - Deirdre Lum
- Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, CA, United States
- *Correspondence: Sandip Biswal
| | - Sandip Biswal
- Department of Radiology, School of Medicine, Stanford University, Stanford, CA, United States
- Deirdre Lum
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Shaffer RK, Dobberfuhl AD, Vu KN, Fast AM, Dababou S, Marrocchio C, Lum DA, Hovsepian DM, Ghanouni P, Chen B. Are fibroid and bony pelvis characteristics associated with urinary and pelvic symptom severity? Am J Obstet Gynecol 2019; 220:471.e1-471.e11. [PMID: 30711512 DOI: 10.1016/j.ajog.2019.01.230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/08/2018] [Revised: 01/16/2019] [Accepted: 01/26/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Urinary and pelvic floor symptoms often are attributed to size and location of uterine fibroid tumors. However, direct supporting evidence that links increased size to worsening symptoms is scant and limited to ultrasound evaluation of fibroid tumors. Because management of fibroid tumors is targeted towards symptomatic relief, the identification of fibroid and pelvic characteristics that are associated with worse symptoms is vital to the optimization of therapies and prevention needless interventions. OBJECTIVE We examined the correlation between urinary, pelvic floor and fibroid symptoms, and fibroid size and location using precise uterine fibroid and bony pelvis characteristics that were obtained from magnetic resonance imaging. STUDY DESIGN A retrospective review (2013-2017) of a multidisciplinary fibroid clinic identified 338 women who had been examined via pelvic magnetic resonance imaging, Pelvic Floor Distress Inventory questionnaire (score 0-300), and a Uterine Fibroid Symptoms questionnaire (score 1-100). Multiple linear regression analysis was used to assess the influence of clinical factors and magnetic resonance imaging findings on scaled Pelvic Floor Distress Inventory and Uterine Fibroid Symptoms scores. Data were analyzed with statistical software. RESULTS Our cohort of 338 women had a median Pelvic Floor Distress Inventory of 72.7 (interquartile range, 41-112.3). Increased Pelvic Floor Distress Inventory score was associated with clinical factors of higher body mass index (P<.001), noncommercial insurance (P<.001), increased parity (P=.001), and a history of incontinence surgery (P=.003). Uterine volume, dominant fibroid volume, dimension and location, and fibroid tumor location relative to the bony pelvis structure did not reach significance when compared with pelvic floor symptom severity. The mean Uterine Fibroid Symptoms score was 52.0 (standard deviation, 23.5). An increased Uterine Fibroid Symptoms score was associated with dominant submucosal fibroid tumors (P=.011), body mass index (P<.0016), and a clinical history of anemia (P<.001) or any hormonal treatment for fibroid tumors (P=.009). CONCLUSION Contrary to common belief, in this cohort of women who sought fibroid care, size and position of fibroid tumors or uterus were not associated with pelvic floor symptom severity. Whereas, bleeding symptom severity was associated with dominant submucosal fibroid tumor and previous hormonal treatment. Careful attention to clinical factors such as body mass index and medical history is recommended when pelvic floor symptoms are evaluated in women with uterine fibroid tumors.
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Affiliation(s)
| | | | | | | | - Susan Dababou
- Department of Radiology, Sapienza University, Rome, Italy
| | | | | | | | | | - Bertha Chen
- Department of Obstetrics & Gynecology, Stanford, CA.
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Vu K, Fast AM, Shaffer RK, Rosenberg J, Dababou S, Marrocchio C, Vasanawala SS, Lum DA, Chen B, Hovsepian DM, Ghanouni P. Evaluation of the routine use of pelvic MRI in women presenting with symptomatic uterine fibroids: When is pelvic MRI useful? J Magn Reson Imaging 2019; 49:e271-e281. [DOI: 10.1002/jmri.26620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kim‐Nhien Vu
- Department of RadiologyStanford University Stanford California USA
- Department of RadiologyCentre hospitalier de l'Université de Montréal (CHUM) Québec Canada
| | - Angela M. Fast
- Department of RadiologyStanford University Stanford California USA
| | - Robyn K. Shaffer
- Department of Obstetrics and GynecologyStanford University Stanford California USA
| | | | - Susan Dababou
- Department of RadiologySapienza University Rome Italy
| | | | | | - Deirdre A. Lum
- Department of Obstetrics and GynecologyStanford University Stanford California USA
| | - Bertha Chen
- Department of Obstetrics and GynecologyStanford University Stanford California USA
| | | | - Pejman Ghanouni
- Department of RadiologyStanford University Stanford California USA
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Abstract
Extreme sports are growing in popularity, and physicians are becoming increasingly aware of injuries related to these activities. Imaging plays a key role in diagnosing and determining clinical management of many of these injuries. This article describes general imaging techniques and findings in various injuries specific to multiple extreme sports.
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Affiliation(s)
- Preeti Arun Sukerkar
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Angela M Fast
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Geoffrey Riley
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Van Batavia JP, Combs AJ, Fast AM, Glassberg KI. Overactive bladder (OAB): A symptom in search of a disease - Its relationship to specific lower urinary tract symptoms and conditions. J Pediatr Urol 2017; 13:277.e1-277.e4. [PMID: 28527720 DOI: 10.1016/j.jpurol.2017.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The ICCS defines OAB by the subjective symptom of urgency; detrusor overactivity (DO) is only implied. While no other symptom is required, OAB can also be associated with urinary frequency, decreased functional bladder capacity, and incontinence. OBJECTIVE We sought to determine how often these associated findings occur in OAB and what if any uroflow/EMG-defined conditions are found to be associated with it. METHODS The charts of 548 children (231M, 318F; mean age 9.0 years, range 3-20) who presented sequentially with urgency (OAB), over a period of 2 years, were reviewed paying particular attention to whether or not there was a history of frequency and/or daytime incontinence in addition to the urgency. All patients had been previously diagnosed with one of the following four lower urinary tract (LUT) conditions based on specific uroflow/EMG findings: 1. dysfunctional voiding (DV; active pelvic floor EMG during voiding); 2. idiopathic detrusor overactivity disorder (IDOD; OAB with a short EMG lag time (<2 s), and quiet pelvic floor EMG during voiding); 3. detrusor underutilization disorder (DUD; willful infrequent voiding with %EBC >125%, quiet EMG during voiding); and 4. primary bladder neck dysfunction (PBND; prolonged EMG lag time (>6 s), quiet EMG during voiding, and depressed uroflow curve). Mean %EBC was compared between patients with urgency alone and those with urgency plus other symptoms. Any association with gender was analyzed. RESULTS Urgency was accompanied by either frequency or daytime incontinence in 91% of the children (summary Table). Daytime incontinence was reported in 398 (72.6%) and frequency in 268 (48.9%). Mean %EBC was 80.9. Females were more likely to report daytime incontinence (76.7% vs. 66.7%, p = 0.02) and frequency was found more often in males (63.6% vs. 38.1%, p < 0.001). %EBC was less in males (70.0 vs. 88.8, p < 0.001). The majority of patients with urgency were diagnosed with IDOD (62%), while 15% had DV, 5% PBND, 3% DUD, and in 15%, the uroflow/EMG was not diagnostic. CONCLUSIONS %EBC was usually normal or mildly increased in OAB when urgency is the only symptom but significantly decreases with each additional LUTS. OAB is more common in girls and they tend to have a lower incidence of frequency, more incontinence, and >%EBC than boys. Because urgency in an anatomically and neurologically normal child is the only required criterion for diagnosing OAB, it must be realized that OAB can be associated with any of a number of objectively defined LUT conditions. Thus OAB appears to be a symptom, not a condition, that is often associated with other symptoms.
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Affiliation(s)
- Jason P Van Batavia
- Department of Urology, Columbia University Medical Center, College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, USA
| | - Andrew J Combs
- Department of Urology, Columbia University Medical Center, College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, USA
| | - Angela M Fast
- Department of Urology, Columbia University Medical Center, College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, USA
| | - Kenneth I Glassberg
- Department of Urology, Columbia University Medical Center, College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, USA.
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Van Batavia JP, Nees SN, Fast AM, Combs AJ, Glassberg KI. Outcomes of vesicoureteral reflux in children with non-neurogenic lower urinary tract dysfunction treated with dextranomer/hyaluronic acid copolymer (Deflux). J Pediatr Urol 2014; 10:482-7. [PMID: 24290224 DOI: 10.1016/j.jpurol.2013.10.017] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 10/16/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVE There has been hesitancy to use dextranomer/hyaluronic acid copolymer (DHXA, Deflux for vesicoureteral reflux (VUR) in the setting of lower urinary tract (LUT) dysfunction because of the limited number of published studies, the possibility of less success, and the manufacturer's recommendations contraindicating its use in patients with active LUT dysfunction. We report on our experience using DXHA in this subset of patients whose VUR persisted despite targeted therapy for their LUT condition. MATERIALS AND METHODS We reviewed patients diagnosed with both a LUT condition and VUR who underwent subureteric DXHA while still undergoing treatment for their LUT dysfunction. Persistence of VUR was confirmed by videourodynamic studies (VUDS)/VCUG (voiding cystourethrogram) and all patients were on targeted treatment (TT) and antibiotic prophylaxis prior to and during DXHA injection. VUR was reassessed post-injection. RESULTS Fifteen patients (22 ureters; 21F,1M) met inclusion criteria (mean age 6.1 years, range 4-12). Following one to three DXHA injections, VUR resolved in 17 ureters (77%) including eight of nine ureters in dysfunctional voiding (DV) patients, five of nine in idiopathic detrusor overactivity disorder (IDOD), and four of four in detrusor underutilization disorder (DUD) patients. CONCLUSIONS DXHA is safe and effective in resolving VUR in children with associated LUT dysfunction, even before their LUT condition has fully resolved. Highest resolution rates were noted in patients with either DV or DUD or who were least symptomatic prior to injection.
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Affiliation(s)
- Jason P Van Batavia
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
| | - Shannon N Nees
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Angela M Fast
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Andrew J Combs
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Kenneth I Glassberg
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
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Abstract
OBJECTIVE We previously described a lower urinary tract (LUT) condition (detrusor underutilization disorder, DUD) characterized by chronic or episodic willful deferment of voiding resulting in an expanded capacity in patients with LUT symptoms. We now further characterize these DUD patients. MATERIALS AND METHODS We reviewed our database identifying neurologically/anatomically normal children diagnosed with DUD. Bladder capacity had to be at least >125% EBC for age to be included. LUTS, diaries and uroflow/EMG findings were analyzed. RESULTS Fifty-five children (mean age 10.5 years, range 3.7-20.2; 34F, 19M) with LUTS were diagnosed with DUD. The most common reasons for presentation included incontinence (43.6%), history of urinary tract infection (UTI) (49.1%), and urgency (30.9%). Mean percent estimated bladder capacity for age was 1.67 and following treatment mean %EBC decreased to 1.10. CONCLUSIONS DUD patients typically present with infrequent voiding, incontinence, urgency, and UTIs. They have less bowel dysfunction and frequency, and larger bladder capacities than typically found in children with overactive bladder and dysfunctional voiding. Although the symptoms associated with DUD overlap in part with those considered by the International Children's Continence Society to be typical for "underactive bladder" and "voiding postponement", DUD, we feel, is a stand-alone diagnosis.
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Affiliation(s)
- Jason P Van Batavia
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York - Presbyterian, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
| | - Angela M Fast
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York - Presbyterian, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Andrew J Combs
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York - Presbyterian, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Kenneth I Glassberg
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York - Presbyterian, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
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Van Batavia JP, Combs AJ, Fast AM, Glassberg KI. Use of non-invasive uroflowmetry with simultaneous electromyography to monitor patient response to treatment for lower urinary tract conditions. J Pediatr Urol 2014; 10:532-7. [PMID: 24915869 DOI: 10.1016/j.jpurol.2013.11.015] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 11/25/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Non-invasive uroflowmetry with simultaneous electromyography (uroflow/EMG) has previously been reported as effective in triaging patients into four specific non-neurogenic lower urinary tract (LUT) conditions for targeted treatment. In this study we sought to determine if the same parameters would be useful for measuring response to treatment. MATERIAL AND METHODS We reviewed our database of normal children with LUT dysfunction, screened with uroflow/EMG, and diagnosed with a LUT condition: (1) dysfunctional voiding (DV); (2) idiopathic detrusor overactivity disorder (IDOD); (3) detrusor underutilization disorder (DUD); (4) primary bladder neck dysfunction (PBND). Pre- and on-treatment (minimum 3 months) uroflow/EMG parameters and subjective improvements were compared. RESULTS Of 159 children (71 boys, 88 girls; median age 7.0 years, range 3.5-18.0 years), median follow up was 13.1 months (range 3-43 months). On targeted treatment, DV patients showed relaxation of pelvic floor during voiding and significant decrease in PVR on biofeedback; IDOD patients had normalization of short lag time and increased capacity on antimuscarinics; DUD patients had a decrease in capacity on timed voiding; PBND patients on alpha-blocker therapy showed improved uroflow rates and a decrease in mean EMG lag time (all p < 0.05). CONCLUSION Non-invasive uroflow/EMG is useful not only for diagnosing specific LUT conditions, but also in objectively monitoring treatment efficacy. Subjective improvement on targeted therapy correlates well with objective improvements in uroflow/EMG parameters lending validation to this simplified approach to diagnosis.
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Affiliation(s)
- J P Van Batavia
- Division of Pediatric Urology, Department of Urology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York - Presbyterian, 3959 Broadway, CHN 1118, New York, NY 10032, USA.
| | - A J Combs
- Division of Pediatric Urology, Department of Urology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York - Presbyterian, 3959 Broadway, CHN 1118, New York, NY 10032, USA
| | - A M Fast
- Division of Pediatric Urology, Department of Urology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York - Presbyterian, 3959 Broadway, CHN 1118, New York, NY 10032, USA
| | - K I Glassberg
- Division of Pediatric Urology, Department of Urology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York - Presbyterian, 3959 Broadway, CHN 1118, New York, NY 10032, USA.
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Abstract
OBJECTIVE Varicoceles occur in 15% of adult and adolescent males and are generally considered to be an extratesticular phenomenon. However, an intratesticular component has been reported in up to 2% of adult and 2% of adolescent varicoceles. We sought to determine the incidence of intratesticular varicoceles (ITV) in adolescents in our practice, its significance, associated findings and response to treatment. MATERIALS AND METHODS We retrospectively reviewed 684 adolescent males who were diagnosed with varicoceles and had at least one Doppler ultrasound (DUS) prior to any surgery to identify those with an intratesticular component. Testicular volumes, maximum vein diameter (MVD) and peak retrograde flow (PRF) were determined by DUS and recorded. RESULTS A total of 6 (0.9%) patients were found to have an intratesticular component with a mean PRF of 43.7 cm/s, mean MVD of 3.3 mm and mean asymmetry of 20%. Mean PRF, MVD, and asymmetry of those without an intratesticular component who underwent surgery was 44.8 cm/s, 2.9 mm, and 21.8%, respectively (PNS for all parameters). Four of the 6 patients had 2 or more DUS, and all 4 had worsening testicular asymmetry and PRF over time. Five patients underwent laparoscopic varicocelectomy and all five had catch-up testicular growth. One patient refused surgical repair and has had subsequent worsening testicular asymmetry and softening of the testicle. CONCLUSIONS Our findings suggest that adolescents who present with an intratesticular varicocele in association with testicular asymmetry will develop worse asymmetry over time. Therefore, adolescents with intratesticular varicoceles and initial asymmetry should be scheduled for surgery rather than followed.
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Affiliation(s)
- Lara S MacLachlan
- Division of Pediatric Urology, Morgan-Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University College of Physicians and Surgeons, 3959 Broadway, CHN 1118, New York, NY 10032, USA
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Van Batavia JP, Ahn JJ, Fast AM, Combs AJ, Glassberg KI. Prevalence of Urinary Tract Infection and Vesicoureteral Reflux in Children with Lower Urinary Tract Dysfunction. J Urol 2013; 190:1495-9. [DOI: 10.1016/j.juro.2013.02.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Jason P. Van Batavia
- Divisions of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian and Columbia University Medical Center, New York, New York
| | - Jennifer J. Ahn
- Divisions of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian and Columbia University Medical Center, New York, New York
| | - Angela M. Fast
- Divisions of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian and Columbia University Medical Center, New York, New York
| | - Andrew J. Combs
- Divisions of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian and Columbia University Medical Center, New York, New York
| | - Kenneth I. Glassberg
- Divisions of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian and Columbia University Medical Center, New York, New York
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Van Batavia JP, Fast AM, Nees SN, Mercado MA, Gaselberti A, Glassberg KI. Incidence, significance and natural history of persistent retrograde venous flow after varicocelectomy in children and adolescents: correlation with catch-up growth. J Urol 2013; 190:689-95. [PMID: 23473906 DOI: 10.1016/j.juro.2013.02.3195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE Varying incidences and levels of persistent retrograde venous flow have been reported following adult and adolescent varicocelectomy but the significance remains unclear. We sought to determine the incidence and natural history of persistent flow and whether it had any effect on postoperative testicular catch-up growth. MATERIALS AND METHODS We retrospectively analyzed pre-varicocelectomy and post-varicocelectomy Doppler duplex ultrasound findings. Peak retrograde venous flow, maximum vein diameter, flow quality and varicocele grade were recorded at each visit. Catch-up growth was defined as less than 15% testicular asymmetry at final visit. RESULTS Of 330 patients (median age 15.4 years) undergoing varicocelectomy (laparoscopic in 247, open in 83) 145 had residual retrograde venous flow after Valsalva maneuver with a mean peak of 13.3 cm per second. Of 290 patients with repeat Doppler duplex ultrasound (median followup 2.6 years) 124 had initial peak retrograde venous flow less than 20 cm per second (43%) and only 17 (6%) had flow 20 cm per second or greater. Incidence of post-varicocelectomy retrograde venous flow at last visit (48%) was similar to that at initial postoperative visit (49%). Of 330 boys 20 had recurrence of palpable varicocele (grade 2 or 3), of whom 18 (90%) had initial retrograde venous flow. Catch-up growth was more likely in patients with no retrograde venous flow, and rates of catch-up growth decreased as peak retrograde venous flow increased. All 5 patients with initial testicular asymmetry and persistent retrograde venous flow at levels greater than 30 cm per second had continued testicular asymmetry (ie none had catch-up growth). CONCLUSIONS Retrograde venous flow is frequently present after varicocelectomy and is almost always associated with peak retrograde venous flow rates significantly lower than those seen in patients who are recommended for initial varicocelectomy. Retrograde venous flow tends to persist during followup at stable peak retrograde venous flow rates. Palpable recurrence and persistent testicular asymmetry are most often associated with postoperative peak retrograde venous flow rates 20 cm per second or greater.
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Affiliation(s)
- Jason P Van Batavia
- Division of Pediatric Urology, Department of Urology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, New York 10032, USA
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Fast AM, Nees SN, Van Batavia JP, Combs AJ, Glassberg KI. Outcomes of targeted treatment for vesicoureteral reflux in children with nonneurogenic lower urinary tract dysfunction. J Urol 2013; 190:1028-32. [PMID: 23473909 DOI: 10.1016/j.juro.2013.03.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/01/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE There is a known association between nonneurogenic lower urinary tract conditions and vesicoureteral reflux. Whether reflux is secondary to the lower urinary tract condition or coincidental is controversial. We determined the rate of reflux resolution in patients with lower urinary tract dysfunction using targeted treatment for the underlying condition. MATERIALS AND METHODS Patients diagnosed and treated for a lower urinary tract condition who had concomitant vesicoureteral reflux at or near the time of diagnosis were included. Patients underwent targeted treatment and antibiotic prophylaxis, and reflux was monitored with voiding cystourethrography or videourodynamics. RESULTS Vesicoureteral reflux was identified in 58 ureters in 36 females and 5 males with a mean age of 6.2 years. After a mean of 3.1 years of treatment reflux resolved with targeted treatment in 26 of 58 ureters (45%). All of these patients had a history of urinary tract infections before starting targeted treatment. Resolution rates of vesicoureteral reflux were similar for all reflux grades. Resolution or significant improvement of reflux was greater in the ureters of patients with dysfunctional voiding (70%) compared to those with idiopathic detrusor overactivity disorder (38%) or detrusor underutilization (40%). CONCLUSIONS Vesicoureteral reflux associated with lower urinary tract conditions resolved with targeted treatment and antibiotic prophylaxis in 45% of ureters. Unlike the resolution rates reported in patients with reflux without a coexisting lower urinary tract condition, we found that there were no differences in resolution rates among grades I to V reflux in patients with lower urinary tract conditions. Patients with dysfunctional voiding had the most improvement and greatest resolution of reflux. Additionally grade V reflux resolved in some patients.
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Affiliation(s)
- Angela M Fast
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA
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Fast AM, Deibert CM, Boyer C, Hruby GW, McKiernan JM. Partial nephrectomy online: a preliminary evaluation of the quality of health information on the Internet. BJU Int 2012; 110:E765-9. [DOI: 10.1111/j.1464-410x.2012.11626.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Angela M. Fast
- Department of Urology; Columbia University Medical Center; New York; NY; USA
| | | | - Celia Boyer
- Health On the Net Foundation; Geneva; Switzerland
| | | | - James M. McKiernan
- Department of Urology; Columbia University Medical Center; New York; NY; USA
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Holloway CJ, Dass S, Suttie JJ, Rider OJ, Cox P, Cochlin LE, Jackson H, Fast AM, Johnson AW, Karamitsos TD, Neubauer S, Clarke K. Exercise training in dilated cardiomyopathy improves rest and stress cardiac function without changes in cardiac high energy phosphate metabolism. Heart 2012; 98:1083-90. [DOI: 10.1136/heartjnl-2012-302145] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Van Batavia JP, Fast AM, Glassberg KI. 1530 ADOLESCENT HYDROCELECTOMY A SCROTAL OR INGUINAL APOPROACH? J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fast AM, Deibert CM, Hruby GW, Glassberg KI. 1531 EVALUATING QUALITY INTERNET HEALTH RESOURCES IN PEDIATRIC UROLOGY. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1299] [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: 10/28/2022]
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Fast AM, Motamedinia P, Lipsky MJ, Hruby GW, McKiernan JM. 711 THE IMPACT OF THE MINIMALLY INVASIVE CARE PATHWAY ON CONTEMPORARY OPEN PARTIAL NEPHRECTOMY. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.795] [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: 10/28/2022]
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Combs AJ, Van Batavia JP, Fast AM, Glassberg KI. 605 DYSFUNCTIONAL ELIMINATION SYNDROMES: ARE ENCOPRESIS AND CONSTIPATION ASSOCIATED WITH SPECIFIC LOWER URINARY TRACT CONDITIONS? J Urol 2012. [DOI: 10.1016/j.juro.2012.02.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee B, Fast AM, Zhu J, Cheng JX, Buhman KK. Intestine-specific expression of acyl CoA:diacylglycerol acyltransferase 1 reverses resistance to diet-induced hepatic steatosis and obesity in Dgat1-/- mice. J Lipid Res 2010; 51:1770-80. [PMID: 20147738 DOI: 10.1194/jlr.m002311] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mice deficient in acyl-CoA:diacylglycerol acyltransferase 1 (DGAT1), a key enzyme in triacylglycerol (TG) biosynthesis, are resistant to high-fat (HF) diet-induced hepatic steatosis and obesity. DGAT1-deficient (Dgat1-/-) mice have no defect in quantitative absorption of dietary fat; however, they have abnormally high levels of TG stored in the cytoplasm of enterocytes, and they have a reduced postprandial triglyceridemic response. We generated mice expressing DGAT1 only in the intestine (Dgat1IntONLY) to determine whether this phenotype contributes to resistance to HF diet-induced hepatic steatosis and obesity in Dgat1-/- mice. Despite lacking DGAT1 in liver and adipose tissue, we found that Dgat1IntONLY mice are not resistant to HF diet-induced hepatic steatosis or obesity. The results presented demonstrate that intestinal DGAT1 stimulates dietary fat secretion out of enterocytes and that altering this cellular function alters the fate of dietary fat in specific tissues.
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Affiliation(s)
- Bonggi Lee
- Department of Foods and Nutrition, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
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Fast AM, Lee B, Zhu J, Cheng J, Buhman KK. Intestine specific over‐expression of DGAT1 in mice alters triacylglycerol storage in enterocytes, but not body weight in response to a high fat diet. FASEB J 2009. [DOI: 10.1096/fasebj.23.1_supplement.721.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Ji‐Xin Cheng
- Weldon School of Biomedical Engineering
- ChemistryPurdue UniversityWest LafayetteIN
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