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Hemo O, Dotan A, Shvero A, Kleinmann N, Dotan ZA, Zilberman DE. High ambient temperature impact on the pattern of emergency-room visits due to renal colic in the Middle East. Urolithiasis 2024; 52:54. [PMID: 38564058 DOI: 10.1007/s00240-024-01560-9] [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: 12/26/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
Urolithiasis has a seasonal pattern, with an established increase in incidence during the summer months. This study aims to assess the impact of high ambient temperatures on emergency room (ER) visits related to renal colic (RC) in a Middle Eastern country over the past decade. Population data were extracted using the MDClone Big Data platform. We recorded demographic and clinical data on all RC-associated ER visits from January 2012 to April 2023 and calculated the heat index (HI) that combines daily average coastal plane temperatures and humidity percentages. There was a total of 12,770 ER visits (median age 48 years, 9,236 (72%) males). The number of visits increased during the hottest months (July-October), with the highest numbers recorded during August. The number of visits remained stable throughout the study. We identified a linear association between humidity and the incidence of ER visits (p = 0.002), and a non-linear association between ambient temperature (p < 0.0001) and HI (p < 0.0001). There was a direct relationship between high temperatures and ER visits on the same day (risk ratio [RR]: 1.75, p = 0.036), with a 2-day lag (RR: 1.123, p = 0.024). In Conclusion, there is a significant relationship between temperature, humidity, HI, and the number of ER visits due to RC. Adjusted resource allocation and healthcare workforce availability are essential for managing additional cases during heat waves. Clinical implications: Increased demand is expected during heatwaves and within a 2-day lag, emphasizing the importance of proactive strategies to effectively manage RC patients.
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Affiliation(s)
- Orel Hemo
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel.
| | - Arad Dotan
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Asaf Shvero
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel
| | - Nir Kleinmann
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel
| | - Zohar A Dotan
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel
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Carmona O, Kleinmann N, Zilberman DE, Dotan ZA, Shvero A. Do Urine Cytology and FISH Analysis Have a Role in the Follow-Up Protocol of Upper Tract Urothelial Carcinoma? Clin Genitourin Cancer 2024; 22:98-105. [PMID: 37996271 DOI: 10.1016/j.clgc.2023.10.010] [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: 07/08/2023] [Revised: 10/24/2023] [Accepted: 10/29/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Current guidelines recommend a stringent follow-up regimen that includes interval cystoureteronephscopy, CT urography, and selective urine cytology sampling for upper tract urothelial carcinoma (UTUC) patients undergoing endoscopic treatment and management. There are no recommendations regarding FISH analysis. Our purpose was to assess the efficacy of cytology and FISH as part of the follow-up protocol and its significance to clinical decision-making in this scenario. METHODS The medical records of all patients who managed endoscopically for UTUC at our institute between 2014 and 2022 were retrospectively analyzed. Demographic and clinical data, histology, cytology, and FISH results were collected. FISH analysis was considered malignant according to Paris criteria. RESULTS During the study period, 62 patients underwent 561 ureteroscopies as part of the treatment and follow-up regimen of low-grade UTUC. Urine from the affected upper tract was sampled for cytology in 377 procedures, and FISH analyses were performed in 273. In 75.4% of FISH analyses, the result was different from the cytology results: FISH found malignant aberrations in 15.5% of cases where cytology was benign. Furthermore, FISH classified all the cells defined as atypical via cytology as either benign or malignant. In only one case (0.17%), the urinary cytology report changed the follow-up regimen. CONCLUSION Cytology may be omitted from the follow-up protocol of low-grade UTUC. In the handful of cases cytology does assist the diagnosis of UTUC, there is an additional benefit to performing FISH analysis, particularly when cellular atypia is reported in the cytology results.
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Affiliation(s)
- Orel Carmona
- The Department of Urology, Sheba Medical Center, Ramat Gan, Israel; The School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Nir Kleinmann
- The Department of Urology, Sheba Medical Center, Ramat Gan, Israel; The School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- The Department of Urology, Sheba Medical Center, Ramat Gan, Israel; The School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar A Dotan
- The Department of Urology, Sheba Medical Center, Ramat Gan, Israel; The School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Shvero
- The Department of Urology, Sheba Medical Center, Ramat Gan, Israel; The School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lazarovich A, Haramaty R, Shvero A, Zilberman DE, Dotan ZA, Winkler H, Kleimann N. Primary Ureteroscopy without Pre-Stenting for Proximal Ureteral Stones-Is It Feasible? Life (Basel) 2023; 13:2019. [PMID: 37895401 PMCID: PMC10608335 DOI: 10.3390/life13102019] [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: 09/11/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Primary ureteroscopy with laser lithotripsy is the treatment of choice for distal ureteral stones. However, in cases of proximal ureteral stones, some urologists recommend the preliminary insertion of a ureteral stent and deferred ureteroscopy. We aimed to evaluate the necessity of preliminary ureteral stent insertion in the management of proximal ureteral stones by comparing the surgical outcomes of patients undergoing primary ureteroscopy with laser lithotripsy for proximal vs. distal ureteral stones. METHODS Medical records of patients who underwent ureteroscopy between 2016 and 2017 in our institution were retrospectively reviewed. Data collected included demographic data, stone size, renal function, intra- and post-operative complications, and stone-free rate (SFR). Patients were divided into two groups: proximal ureteral stones and distal ureteral stones. RESULTS The cohort included 241 patients who underwent ureteroscopy. Among them, 106 had a proximal ureteral stone. The median age was 51 (IQR 41-65) years. Patients who underwent ureteroscopy for proximal ureteral stones were significantly older (p = 0.007). The median stone's maximal diameter was 7 (5-10) mm. The complication rate and stone-free rate (SFR) were similar in both groups (p = 0.657 and p = 1, respectively). The prevalence of post-procedural ureteral stent insertion was higher among patients who underwent ureteroscopy for proximal ureteral stones: 92.5% vs. 79.3% (p = 0.004). CONCLUSIONS Our study concludes that primary ureteroscopy with laser lithotripsy for proximal ureteral stones is a valid and feasible treatment with a similar surgical outcome compared to distal ureteral stones. Preliminary ureteral stent insertion seems to be unnecessary.
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Affiliation(s)
- Alon Lazarovich
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel; (R.H.); (A.S.); (D.E.Z.); (Z.A.D.); (H.W.); (N.K.)
- The School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Rennen Haramaty
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel; (R.H.); (A.S.); (D.E.Z.); (Z.A.D.); (H.W.); (N.K.)
- The School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Asaf Shvero
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel; (R.H.); (A.S.); (D.E.Z.); (Z.A.D.); (H.W.); (N.K.)
- The School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dorit E. Zilberman
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel; (R.H.); (A.S.); (D.E.Z.); (Z.A.D.); (H.W.); (N.K.)
- The School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Zohar A. Dotan
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel; (R.H.); (A.S.); (D.E.Z.); (Z.A.D.); (H.W.); (N.K.)
- The School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Harry Winkler
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel; (R.H.); (A.S.); (D.E.Z.); (Z.A.D.); (H.W.); (N.K.)
- The School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nir Kleimann
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel; (R.H.); (A.S.); (D.E.Z.); (Z.A.D.); (H.W.); (N.K.)
- The School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Lazarovich A, Drori T, Zilberman DE, Portnoy O, Dotan ZA, Rosenzweig B. The Added Value of Systematic Sampling in In-Bore Magnetic Resonance Imaging-Guided Prostate Biopsy. J Pers Med 2023; 13:1373. [PMID: 37763141 PMCID: PMC10532510 DOI: 10.3390/jpm13091373] [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: 08/09/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
We sought to quantify the additive value of systematic biopsy (SB) using in-bore magnetic resonance (MR)-guided prostate biopsy (IBMRGpB) by retrospectively reviewing the records of 189 patients who underwent IBMRGpB for suspected prostate cancer or as part of the surveillance protocol for previously diagnosed prostate cancer. The endpoints included clinically significant and non-clinically significant cancer diagnosis. SB detected clinically significant disease in 67 (35.5%) patients. Five (2.65%) patients whose targeted biopsies indicated benign or non-clinically significant disease had clinically significant disease based on SB. SB from the lobe contralateral to the lesion detected clinically significant disease in 15 (12%) patients. The size of the prostate was larger and the percentage of lesions located in the peripheral zone of the prostate was higher in patients with SB-detected clinically significant disease. The location of the main lesion in the peripheral zone of the prostate was a predictor for clinically significant disease in the multivariate analysis (OR = 8.26, p = 0.04), a finding supported by a subgroup analysis of biopsy-naïve patients (OR = 10.52, p = 0.034). The addition of SB during IBMRGpB increased the diagnosis of clinically significant as well as non-clinically significant prostate cancer. The location of the main lesion in the peripheral zone emerged as a positive predictive factor for clinically significant disease based on SB. These findings may enhance patient-tailored management.
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Affiliation(s)
- Alon Lazarovich
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel; (A.L.); (T.D.); (D.E.Z.); (Z.A.D.)
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Tomer Drori
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel; (A.L.); (T.D.); (D.E.Z.); (Z.A.D.)
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Dorit E. Zilberman
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel; (A.L.); (T.D.); (D.E.Z.); (Z.A.D.)
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Orith Portnoy
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel
| | - Zohar A. Dotan
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel; (A.L.); (T.D.); (D.E.Z.); (Z.A.D.)
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Barak Rosenzweig
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel; (A.L.); (T.D.); (D.E.Z.); (Z.A.D.)
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
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Carmona O, Shvero A, Zilberman DE, Dotan ZA, Kleinmann N. Unveiling the Challenges in Tandem Ureteral Stent Management for Malignant Ureteral Obstruction: Failure Rate, Risk Factors, and Durability of Their Replacement. J Clin Med 2023; 12:5251. [PMID: 37629293 PMCID: PMC10455996 DOI: 10.3390/jcm12165251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Malignant ureteral obstruction (MUO) is a sequela of advanced malignant disease that requires renal drainage, with tandem ureteral stents (TUSs) being a viable option. This study aimed to evaluate the TUS failure rate, associated risk factors, and the feasibility of replacing failed TUSs with a new pair of stents. METHODS A retrospective analysis of MUO patients treated with TUS insertion from 2014 to 2022 was conducted. TUS failure was defined as urosepsis, recurrent urinary tract infections, acute kidney failure, or new hydronephrosis on imaging. Cox proportional hazard regression analysis identified the independent predictors of TUS failure. RESULTS A total of 240 procedures were performed on 186 patients, with TUS drainage failing in 67 patients (36%). The median time to failure was 7 months. Multivariate analysis revealed female gender (OR = 3.46, p = 0.002), pelvic mass (OR = 1.75, p = 0.001), and distal ureteral obstruction (OR = 2.27, p = 0.04) as significant risk factors for TUS failure. Of the failure group, 42 patients (22.6%) underwent TUS replacement for a new pair. Yet, 24 (57.2%) experienced a second failure, with a median time of 4.5 months. The risk factors for TUS second failure included a stricture longer than 30 mm (OR = 11.8, p = 0.04), replacement with TUSs of the same diameter (OR = 43, p = 0.003), and initial TUS failure within 6 months (OR = 19.2, p = 0.006). CONCLUSIONS TUS insertion for the treatment of MUO is feasible and has good outcomes with a relatively low failure rate. Primary pelvic mass and distal ureteral obstruction pose higher risks for TUS failure. Replacing failed TUSs with a new pair has a success rate of 42.8%. Consideration should be given to placing larger diameter stents when replacing failed TUS.
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Affiliation(s)
- Orel Carmona
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel (N.K.)
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Asaf Shvero
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel (N.K.)
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dorit E. Zilberman
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel (N.K.)
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Zohar A. Dotan
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel (N.K.)
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nir Kleinmann
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel (N.K.)
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Shvero A, Carmona O, Zilberman DE, Dotan ZA, Haifler M, Kleinmann N. Strategies of Endoscopic Management of Upper Tract Urothelial Carcinoma among Endourologists: A Global Survey. J Pers Med 2023; 13:jpm13040591. [PMID: 37108977 PMCID: PMC10143047 DOI: 10.3390/jpm13040591] [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: 02/21/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Up-to-date guidelines on the management of upper tract urothelial carcinoma (UTUC) are continuously published. We aim to assess the variability of diagnosis and treatment strategies in the endoscopic management of UTUC and adherence to European Association of Urology and National Comprehensive Cancer Network guidelines. A 15-question survey was designed to query practitioners on approaches to clinical practice and knowledge about endoscopic treatment indications and techniques. It was emailed to all members of the Endourologic Society through the society’s office, and to all Israeli non-member endourologists. Eighty-eight urologists participated in the survey. Adherence to guidelines on indications for endoscopic management was only 51%. Most of the survey respondents (87.5%) use holmium laser for tumor ablation, and ~50% use forceps for biopsy while the other half use baskets. Only 50% stated that they would use Jelmyto® for specific indications. Most (80%) indicated that they repeat the ureteroscopy 3 months after the first one, and 52.3% continue with follow-up ureteroscopy every 3 months during the first year after diagnosis. There is vast variability among endourologists in the technical aspects of UTUC, the indications for endoscopic management, and adherence to the available guidelines for managing UTUC.
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Affiliation(s)
- Asaf Shvero
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel; (O.C.); (D.E.Z.); (Z.A.D.); (M.H.); (N.K.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-3-5303893
| | - Orel Carmona
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel; (O.C.); (D.E.Z.); (Z.A.D.); (M.H.); (N.K.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dorit E. Zilberman
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel; (O.C.); (D.E.Z.); (Z.A.D.); (M.H.); (N.K.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Zohar A. Dotan
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel; (O.C.); (D.E.Z.); (Z.A.D.); (M.H.); (N.K.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Miki Haifler
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel; (O.C.); (D.E.Z.); (Z.A.D.); (M.H.); (N.K.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nir Kleinmann
- The Department of Urology, Sheba Medical Center, Ramat Gan 5262000, Israel; (O.C.); (D.E.Z.); (Z.A.D.); (M.H.); (N.K.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Amir I, Golan S, Frumer M, Sternberg IA, Gildor OS, Hoffman A, Shashar R, Mano R, Savin Z, Haifler M, Zilberman DE, Dotan ZA, Rosenzweig B. Association between COVID-19 Burden, Population Vaccination Status, and Urologic Oncology Surgery Volume: A National Multicenter Cross-Sectional Study. J Clin Med 2022; 11:jcm11237071. [PMID: 36498646 PMCID: PMC9738532 DOI: 10.3390/jcm11237071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022] Open
Abstract
Initial deleterious effects of the COVID-19 pandemic on urologic oncology surgeries are well described, but the possible influence of vaccination efforts and those of pandemic conditions on surgical volumes is unclear. Our aim was to examine the association between changing vaccination status and COVID-19 burden throughout the pandemic and the volume of urologic oncology surgeries in Israel. This multi-center cross-sectional study included data collected from five tertiary centers between January 2019 and December 2021. All 7327 urologic oncology surgeries were included. Epidemiological data were obtained from the Israeli Ministry of Health database. A rising trend in total urologic oncology surgery volumes was observed with ensuing COVID-19 wave peaks over time (X2 = 13.184, df = 3, p = 0.004). Total monthly surgical volumes correlated with total monthly hospitalizations due to COVID-19 (R = -0.36, p = 0.015), as well as with the monthly average Oxford Stringency Index (R = -0.31, p = 0.035). The cumulative percent of vaccinations and of new COVID-19 cases per month did not correlate with total monthly urologic surgery volumes. Our study demonstrates the gradual acclimation of the Israeli healthcare system to the COVID-19 pandemic. However, hospitalizations due to COVID-19, as well as restriction stringency, correlate with lower volumes of urologic oncological surgeries, regardless of the population's vaccination status.
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Affiliation(s)
- Ido Amir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shay Golan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Section of Urology, Rabin Medical Center, Petah Tikva 4941492, Israel
- Israeli Urologic Oncology Collaboration (IUOC)
| | - Michael Frumer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Section of Urology, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Itay A. Sternberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Israeli Urologic Oncology Collaboration (IUOC)
- Department of Urology, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Omri Schwarztuch Gildor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Urology, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Azik Hoffman
- Israeli Urologic Oncology Collaboration (IUOC)
- Department of Urology, Rambam Health Center, Haifa 3109601, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Reut Shashar
- Department of Urology, Rambam Health Center, Haifa 3109601, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Roy Mano
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Israeli Urologic Oncology Collaboration (IUOC)
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Ziv Savin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Miki Haifler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Israeli Urologic Oncology Collaboration (IUOC)
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5262000, Israel
| | - Dorit E. Zilberman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5262000, Israel
| | - Zohar A. Dotan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5262000, Israel
| | - Barak Rosenzweig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Israeli Urologic Oncology Collaboration (IUOC)
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5262000, Israel
- Correspondence: or ; Tel.: +972-3-5302221
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Carmona O, Dotan ZA, Haifler M, Rosenzweig B, Zilberman DE. Laparoscopic Versus Robot-Assisted Pyeloplasty in Adults-A Single-Center Experience. J Pers Med 2022; 12:jpm12101586. [PMID: 36294723 PMCID: PMC9604574 DOI: 10.3390/jpm12101586] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/29/2022] [Accepted: 09/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Laparoscopic (LP) and robot-assisted pyeloplasty (RAP) are minimally invasive techniques for correcting uretero-pelvic junction obstruction (UPJO). We retrospectively compared the clinical outcomes of all adults who underwent RAP (n = 41) to those who underwent LP (n = 24) for UPJO at our institution between 2003−2022. Methods: Age, sex, body mass index, surgical side, past abdominal/endoscopic surgeries, pre- and postoperative renal scans, pre- and postoperative serum creatinine levels, operative time (OT), presence of crossing vessels, estimated blood loss, postoperative complications, length of hospital stay, time to JJ stent removal, follow-up length, and postoperative hydronephrosis were analyzed. Results: The groups were demographically comparable. The mean total and skin-to-skin OTs (minutes) were significantly longer in the RAP group than in the LP group (242.4 ± 55 vs. 161.4 ± 40 p < 0.001; 163.7 ± 41.8 vs. 124.3 ± 30.3 p = 0.006, respectively). Hospital stay (days) was shorter in the RAP group (3.3 ± 2.1 vs. 7.3 ± 2.5 p < 0.001). Postoperative complication rates were identical for both groups. The LP group had a significantly longer follow-up period (85.2 ± 73 vs. 19 ± 14 months p < 0.001). The success rates for the LP and RAP groups were 87.5% and 90.6% (p = 0.708). Conclusions: RAP achieves equivalent results to LP, in adult patients. A longer OT may be expected with the robotic system since it can handle more complicated cases.
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Haifler M, Kleinmann N, Haramaty R, Zilberman DE. A machine learning model for predicting surgical intervention in renal colic due to ureteral stone(s) < 5 mm. Sci Rep 2022; 12:11788. [PMID: 35821517 PMCID: PMC9276693 DOI: 10.1038/s41598-022-16128-z] [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: 11/23/2021] [Accepted: 07/05/2022] [Indexed: 11/09/2022] Open
Abstract
A 75-89% expulsion rate is reported for ureteric stones ≤ 5 mm. We explored which parameters predict justified surgical intervention in cases of pain caused by < 5 mm ureteral stones. We retrospectively reviewed all patients with renal colic caused by ureteral stone < 5 mm admitted to our urology department between 2016 and 2021. Data on age, sex, body mass index, the presence of associated hydronephrosis/stranding on images, ureteral side, stone location, medical history, serum blood count, creatinine, C-reactive protein, and vital signs were obtained upon admission. XGboost (XG), a machine learning model has been implemented to predict the need for intervention. A total of 471 patients (median age 49, 83% males) were reviewed. 74% of the stones were located in the distal ureter. 160 (34%) patients who sustained persistent pain underwent surgical intervention. The operated patients had proximal stone location (56% vs. 10%, p < 0.001) larger stones (4 mm vs. 3 mm, p < 0.001), longer length of stay (3.5 vs. 3 days, p < 0.001) and more emergency-room (ER) visits prior to index admission (2 vs. 1, p = 0.007) compared to those who had no surgical intervention. The model accuracy was 0.8. Larger stone size and proximal location were the most important features in predicting the need for intervention. Altogether with pulse and ER visits, they contributed 73% of the final prediction for each patient. Although a high expulsion rate is expected for ureteral stones < 5 mm, some may be painful and drawn out in spontaneous passage. Decision-making for surgical intervention can be facilitated by the use of the present prediction model.
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Affiliation(s)
- Miki Haifler
- Department of Urology, Chaim Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel.,Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nir Kleinmann
- Department of Urology, Chaim Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel.,Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Rennen Haramaty
- Department of Urology, Chaim Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel.,Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel. .,Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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10
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Rosenzweig B, Drori T, Raz O, Goldinger G, Shlomai G, Zilberman DE, Shechtman M, Ramon J, Dotan ZA, Portnoy O. The urologist's learning curve of "in-bore" magnetic resonance-guided prostate biopsy. BMC Urol 2021; 21:169. [PMID: 34872545 PMCID: PMC8650564 DOI: 10.1186/s12894-021-00936-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background The combination of multi-parametric MRI to locate and define suspected lesions together with their being targeted by an MRI-guided prostate biopsy has succeeded in increasing the detection rate of clinically significant disease and lowering the detection rate of non-significant prostate cancer. In this work we investigate the urologist’s learning curve of in-bore MRI-guided prostate biopsy which is considered to be a superior biopsy technique. Materials and methods Following Helsinki approval by The Chaim Sheba Medical Center ethics committee in accordance with The Sheba Medical Center institutional guidelines (5366-28-SMC) we retrospectively reviewed 110 IB-MRGpBs performed from 6/2016 to 1/2019 in a single tertiary center. All patients had a prostate multi-parametric MRI finding of at least 1 target lesion (prostate imaging reporting and data system [PI-RADS] score ≥ 3). We analyzed biopsy duration and clinically significant prostate cancer detection of targeted sampling in 2 groups of 55 patients each, once by a urologist highly trained in IB-MRGpBs and again by a urologist untrained in IB-MRGpBs. These two parameters were compared according to operating urologist and chronologic order. Results The patients’ median age was 68 years (interquartile range 62–72). The mean prostate-specific antigen level and prostate size were 8.6 ± 9.1 ng/d and 53 ± 27 cc, respectively. The mean number of target lesions was 1.47 ± 0.6. Baseline parameters did not differ significantly between the 2 urologists’ cohorts. Overall detection rates of clinically significant prostate cancer were 19%, 55%, and 69% for PI-RADS 3, 4 and 5, respectively. Clinically significant cancer detection rates did not differ significantly along the timeline or between the 2 urologists. The average duration of IB-MRGpB targeted sampling was 28 ± 15.8 min, correlating with the number of target lesions (p < 0.0001), and independent of the urologist’s expertise. Eighteen cases defined the cutoff for the procedure duration learning curve (p < 0.05). Conclusions Our data suggest a very short learning curve for IB-MRGpB-targeted sampling duration, and that clinically significant cancer detection rates are not influenced by the learning curve of this technique.
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Affiliation(s)
- Barak Rosenzweig
- Department of Urology, Chaim Sheba Medical Center, 5262080, Ramat Gan, Israel. .,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,The Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
| | - Tomer Drori
- Department of Urology, Chaim Sheba Medical Center, 5262080, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Raz
- Assuta Ashdod University Hospital, Ashdod, Israel
| | - Gil Goldinger
- Department of Urology, Chaim Sheba Medical Center, 5262080, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gadi Shlomai
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Department of Internal Medicine D and the Hypertension Unit, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, 5262080, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Shechtman
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Anesthesiology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Jacob Ramon
- Department of Urology, Chaim Sheba Medical Center, 5262080, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Chaim Sheba Medical Center, 5262080, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orith Portnoy
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel
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11
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Orr Y, Zilberman DE, Abu Ghanem Y, Dotan ZA, Rosenzweig B. [FOCAL TREATMENT OF PROSTATE CANCER - LEADING AND FUTURE TECHNIQUES, OUTCOMES AND COMPLICATIONS]. Harefuah 2021; 160:608-614. [PMID: 34482675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Focal treatment for prostate cancer has been proposed as an innovative strategy that aims to achieve oncological benefit while reducing treatment-related morbidity. This treatment is suitable for patients with low and intermediate risk, organ-confined disease. Focal therapy can be categorized as follows: unifocal index lesion ablation, multifocal ablation, hemi-gland ablation or subtotal gland ablation. Different types of energies are applied in focal therapy including high intensity focal ultrasound (HIFU), cryotherapy, focal laser ablation (FLA), irreversible electroporation (IRE) and Photodynamic therapy (PDT). In this review we will briefly present a summary of leading techniques and the available data regarding their oncological outcomes and adverse events. Whole-gland therapies were excluded from this review.
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Affiliation(s)
- Yam Orr
- Urology Department, The Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Dorit E Zilberman
- Urology Department, The Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Yasmin Abu Ghanem
- Urology Department, The Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Zohar A Dotan
- Urology Department, The Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Barak Rosenzweig
- Urology Department, The Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Sackler Faculty of Medicine, Tel-Aviv University, Israel
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12
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Carmona O, Abu-Ghanem Y, Rosenzweig B, Zilberman DE, Dotan ZA. [CLINICAL OUTCOMES FOLLOWING ROBOT-ASSISTED PARTIAL NEPHRECTOMY (RAPN)]. Harefuah 2021; 160:598-602. [PMID: 34482673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Partial nephrectomy is the gold standard treatment for renal tumors less than 7 cm. OBJECTIVES To describe surgical techniques and trends of treating renal tumors less than 7 cm at our department and present the clinical outcomes of our experience with Robot-Assisted Partial Nephrectomy (RAPN). METHODS Out of an established prospective RAPN database, we retrieved demographic, clinical, surgical and pathological parameters. Operation length was defined as the time between the first surgical incision and the last suture (skin to skin). Warm ischemia time (WIT) was defined as the time between the renal artery clamping and clamp releasing. Data is presented as mean (range, standard deviation) or numeric value (%). RESULTS Overall, 250 RAPN cases were recorded between the years 2013-2020. Mean tumor size was 32 mm. Mean operation length was 153 minutes. Mean warm ischemia time was 17.5 minutes. Intra-operative complication rates, including converting the surgery to an open approach or to radical nephrectomy, was low. Mean estimated blood loss was 359 cc. An increase in the utilization of the robotic approach has been recorded throughout the years, with a concurrent decrease in the open and laparoscopic approaches. CONCLUSIONS RAPN is associated with lower complication rates and superior perioperative outcomes, therefore considered a good alternative to the open and laparoscopic approaches. Thus, RAPN is the gold standard treatment for renal tumors less than 7 cm at our institute.
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Affiliation(s)
- Orel Carmona
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Barak Rosenzweig
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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13
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Shvero A, Laufer M, Zilberman DE, Winkler H, Dotan ZA, Kleinmann N. [UPPER TRACT UROTHELIAL CARCINOMA]. Harefuah 2021; 160:619-624. [PMID: 34482677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Upper tract urothelial carcinoma is a relatively rare malignancy, but with an increasing prevalence. The main risk factor for the disease is smoking. The most common presentation is hematuria or flank pain. Workup is made by imaging of the upper tract - CTU/MRU (Computed Tomography-Urography/Magnetic resonance (MR) urography) and diagnostic uretero-nephroscopy with biopsy. In the past several years there is major advancement in our understanding of the disease and how to treat it, mainly in nephron-sparing treatments. A risk-stratification is usually conducted according to parameters such as tumor size, distribution, and pathologic diagnosis. The low-risk group is usually offered nephron-sparing treatments such as segmental ureterectomy, endoscopic treatments, and lately - local chemotherapy. The high-risk group is usually offered radical resection of the kidney and ureter, with the possible addition of new-adjuvant and adjuvant treatments. In this article we will review the epidemiology, risk factors, diagnosis, and treatment of this malignancy, with a distinction between the risk groups.
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Affiliation(s)
- Asaf Shvero
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Menachem Laufer
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Harry Winkler
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Kleinmann
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lazarovich A, Abu-Ghanem Y, Rosenzweig B, Dotan ZA, Zilberman DE. [FACTORS PREDICTING FULL URINARY CONTINENCE FOLLOWING ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (RALP)]. Harefuah 2021; 160:594-597. [PMID: 34482672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Urinary Incontinence (UI) following Robot-Assisted Laparoscopic-Radical Prostatectomy (RALP) adversely affects patients' quality of life. OBJECTIVES To find parameters that predict full urinary continence (FUC) following RALP. METHODS Out of an established prospective RALP database, we retrieved and analyzed parameters that potentially predict FUC: age, Body Mass Index, American Anesthesiology Association (ASA) score, previous abdominal surgeries, pre-operative IPSS (International Prostate-Symptom Score), operative time (OT), estimated blood loss (EBL), peritoneum closure and prostate weight. FUC has been defined as 0 pads/day. Univariate analysis has been executed for comparison between patient groups, whereas multivariate analysis has been implemented for the detection of predicting factors for FUC. Data are presented as median (interquartile range) or numeric value (%). RESULTS A total of 431 RALP cases were recorded between the years 2010-2019. Final analysis included 364 patients with full medical records; 81% gained FUC within 15 weeks (8-28); 96% gained FUC or used 1 pad/day within 17.5 weeks (8-36). Among those who gained FUC, smaller prostates (p=0.028) and low EBL (p=0.025) have been observed. On multivariate analysis EBL has been associated with UI (OR=0.9). CONCLUSIONS Most patients gained FUC following RALP. EBL was found as risk factor for UI.
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Affiliation(s)
- Alon Lazarovich
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yasim Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, IsraelDepartment of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Barak Rosenzweig
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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15
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Yacobi Y, Abu-Ghanem Y, Dotan ZA, Kleinmann N, Mor Y, Zilberman DE. [ROBOT ASSISTED PYELOPLASTY IN ADULTS WITH URETERO-PELVIC JUNCTION OBSTRUCTION (UPJO)]. Harefuah 2021; 160:570-575. [PMID: 34482668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Robotic-pyeloplasty (RP) for uretero-pelvic-junction-obstruction (UPJO) has been performed in our institution since 2013. OBJECTIVES To summarize the outcomes of RP in adults over 18 years of age. METHODS Adult RP cases have been prospectively documented. Analysis included demographic data such as age, sex, American Association of Anesthesiology-ASA Score, surgical-side, pre-operative imaging. Operative time (OT), estimated blood loss (EBL), length of stay (LOS) and short-term complications were also recorded. In all cases a JJ-stent has been left in place and subsequently taken out. Complications were classified in accordance with the Clavien-Dindo classification criteria. Patients were seen periodically with repeat imaging. The renal scan was performed at least once during the post-operative follow-up. Results are given as median (inter-quartile range) or numeric values (%). RESULTS A total of 32 patients aged 33.5 years (21-45.2) had RP between the years 2013-2020, among which 53% were females and 59% right sided. An ASA score of 1-2 has been observed in 87.5% of all cases. Skin-to-skin OT was 163 min (136-185), and EBL was 5 ml (0-30). Short-term post-operative complications were hematuria (3.1%), urinary leak/urinoma (12.5%), body temperature>38.30C (12.5%). In 2 cases (6.2%) the JJ-stent had been re-positioned in the operating-theater (Clavien-Dindo 3b). LOS was 3 days (2-4) and JJ-stent had been taken out 39 days (31.7-45.2) post-operatively. Median length of follow-up was 19.5 months (9.5-26.7). In 92.3% of cases an improvement in hydronephrosis has been observed in post-operative imaging. The renal scan did not demonstrate renal function deterioration. CONCLUSIONS Adult robotic pyeloplasty for UPJO is safe and effective. Low complication rates and over 90% success rates have been observed. These findings are in line with those found in previous studies.
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Affiliation(s)
- Yonatan Yacobi
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Kleinmann
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoram Mor
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Zilberman DE, Drori T, Shvero A, Mor Y, Winkler HZ, Kleinmann N. A single day fasting may increase emergency room visits due to renal colic. Sci Rep 2021; 11:6578. [PMID: 33753858 PMCID: PMC7985495 DOI: 10.1038/s41598-021-86254-7] [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: 08/26/2020] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
We aimed to explore whether a single-day of fasting (SDF) increase emergency room (ER) visits due to renal colic (RC). We elected to concentrate on Yom-Kippur (i.e.: SDF), the holiest day in Judaism. Food and liquid consumption is prohibited during this day for 25 h, and an estimated 50–70% fasting rate is observed. SDF always takes place between mid-September and mid-October during which the temperature in the Middle-East ranges between 19 and 30 °C. ER visits for RC between 01/2012 and 11/2019 were reviewed, and the Gregorian days on which SDF occurred were retrieved. The number of ER visits for RC was compared between SDF and the surrounding days/months as well as to another single-day "standard" holiday (SDSH) that precedes SDF in 10 days and is not associated with fasting. Of 11,717 ER visits for RC, 8775 (74.9%) were males. Male:Female ratio was 3:1. The mean daily number of ER visits for RC during the 3 days following SDF was 6.66 ± 2.49, significantly higher compared with the mean annual daily visits (4.1 ± 2.27, p < 0.001), the mean daily visits during the week prior to SDF (5.27 ± 2.656, p = 0.032), and the mean daily visits during September (5.06 ± 2.659, p = 0.005), and October (4.78 ± 2.23, p < 0.001). The mean number of ER daily visits for RC during the 3 days following SDSH, 5.79 ± 2.84, did not differ compared with the mean daily visits during September and October (p = 0.207; p = 0.13, respectively). It was lower compared to SDF, however statistically insignificant (p = 0.285). A single-day fasting may increase ER visits for RC. The mechanism underlying this phenomenon is unknown.
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Affiliation(s)
- Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Ramat-Gan, 52621, Tel-Aviv, Israel.
| | - Tomer Drori
- Department of Urology, Chaim Sheba Medical Center, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Ramat-Gan, 52621, Tel-Aviv, Israel
| | - Asaf Shvero
- Department of Urology, Chaim Sheba Medical Center, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Ramat-Gan, 52621, Tel-Aviv, Israel
| | - Yoram Mor
- Department of Urology, Chaim Sheba Medical Center, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Ramat-Gan, 52621, Tel-Aviv, Israel
| | - Harry Z Winkler
- Department of Urology, Chaim Sheba Medical Center, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Ramat-Gan, 52621, Tel-Aviv, Israel
| | - Nir Kleinmann
- Department of Urology, Chaim Sheba Medical Center, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Ramat-Gan, 52621, Tel-Aviv, Israel
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Zilberman DE, Abu-Ghanem Y, Raviv G, Rosenzweig B, Fridman E, Portnoy O, Dotan ZA. Oncologic Outcomes Following Robot-Assisted Radical Prostatectomy for Clinical T3 Prostate Disease. Isr Med Assoc J 2021; 23:111-115. [PMID: 33595217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Little is known about oncologic outcomes following robot-assisted-radical-prostatectomy (RALP) for clinical T3 (cT3) prostate cancer. OBJECTIVES To investigate oncologic outcomes of patients with cT3 prostate cancer treated by RALP. METHODS Medical records of patients who underwent RALP from 2010 to 2018 were retrieved. cT3 cases were reviewed. Demographic and pre/postoperative pathology data were analyzed. Patients were followed in 3-6 month intervals with repeat PSA analyses. Adjuvant/salvage treatments were monitored. Biochemical recurrence (BCR) meant PSA levels of ≥ 0.2 ng/ml. RESULTS Seventy-nine patients met inclusion criteria. Median age at surgery was 64 years. Preoperative PSA level was 7.14 ng/dl, median prostate weight was 54 grams, and 23 cases (29.1%) were down-staged to pathological stage T2. Positive surgical margin rate was 42%. Five patients were lost to follow-up. Median follow-up time for the remaining 74 patients was 24 months. Postoperative relapse in PSA levels occurred in 31 patients (42%), and BCR in 28 (38%). Median time to BCR was 9 months. The overall 5-year BCR-free survival rate was 61%. Predicting factors for BCR were age (hazard-ratio [HR] 0.85, 95% confidence interval [95%CI] 0.74-0.97, P = 0.017) and prostate weight (HR 1.04, 95%CI 1.01-1.08, P = 0.021). Twenty-six patients (35%) received adjuvant/salvage treatments. Three patients died from metastatic prostate cancer 31, 52, and 78 months post-surgery. Another patient died 6 months post-surgery of unknown reasons. The 5-year cancer-specific survival rate was 92. CONCLUSIONS RALP is an oncologic effective procedure for cT3 prostate cancer. Adjuvant/salvage treatment is needed to achieve optimal disease-control.
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Affiliation(s)
- Dorit E Zilberman
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yasmin Abu-Ghanem
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Raviv
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Rosenzweig
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eddie Fridman
- Department of Pathology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orith Portnoy
- Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Abu-Ghanem Y, Kleinmann N, Erlich T, Winkler HZ, Zilberman DE. The Impact of Dietary Modifications and Medical Management on 24-Hour Urinary Metabolic Profiles and the Status of Renal Stone Disease in Recurrent Stone Formers. Isr Med Assoc J 2021; 23:12-16. [PMID: 33443336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Dietary modifications and patient-tailored medical management are significant in controlling renal stone disease. Nevertheless, the literature regarding effectiveness is sparse. OBJECTIVES To explore the impact of dietary modifications and medical management on 24-hour urinary metabolic profiles (UMP) and renal stone status in recurrent kidney stone formers. METHODS We reviewed our prospective registry database of patients treated for nephrolithiasis. Data included age, sex, 24-hour UMP, and stone burden before treatment. Under individual treatment, patients were followed at 6-8 month intervals with repeat 24-hour UMP and radiographic images. Nephrolithiasis-related events (e.g., surgery, renal colic) were also recorded. We included patients with established long-term follow-up prior to the initiation of designated treatment, comparing individual nephrolithiasis status before and after treatment initiation. RESULTS Inclusion criteria were met by 44 patients. Median age at treatment start was 60.5 (50.2-70.2) years. Male:Female ratio was 3.9:1. Median follow-up was 10 (6-25) years and 5 (3-6) years before and after initiation of medical and dietary treatment, respectively. Metabolic abnormalities detected included: hypocitraturia (95.5%), low urine volume (56.8%), hypercalciuria (45.5%), hyperoxaluria (40.9%), and hyperuricosuria (13.6%). Repeat 24-hour UMP under appropriate diet and medical treatment revealed a progressive increase in citrate levels compared to baseline and significantly decreased calcium levels (P = 0.001 and 0.03, respectively). A significant decrease was observed in stone burden (P = 0.001) and overall nephrolithiasis-related events. CONCLUSIONS Dietary modifications and medical management significantly aid in correcting urinary metabolic abnormalities. Consequently, reduced nehprolithiasis-related events and better stone burden control is expected.
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Affiliation(s)
- Yasmin Abu-Ghanem
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Kleinmann
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Erlich
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Harry Z Winkler
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shvero A, Zilberman DE, Dotan ZA, Laufer M, Fridman E, Winkler H, Kleinmann N. Endoscopic management of upper tract urothelial carcinoma-tips and tricks. Transl Androl Urol 2020; 9:1815-1820. [PMID: 32944545 PMCID: PMC7475684 DOI: 10.21037/tau.2020.01.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Ureteroscopic methods have been rapidly evolving in the last several decades. With advances in flexible devices, optics and laser technologies, the endourologic surgeon has now the tools to treat high-volume tumors, in difficult locations, with good oncologic outcome. This makes radical nephroureterectomy unnecessary in some cases. Endoscopy in the setting of UTUC will surely continue to evolve and become applicable to a wider selection of patients. In this review we describe the surgical technique and provide tips and tricks which we use in our practice of endoscopic retrograde treatment of upper-tract urothelial carcinoma.
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Affiliation(s)
- Asaf Shvero
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maneham Laufer
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eddie Fridman
- Department of Pathology, Sheba Medical Center, Ramat Gan, Israel Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Harry Winkler
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Kleinmann
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rosenzweig B, Laitman Y, Zilberman DE, Raz O, Ramon J, Dotan ZA, Portnoy O. Effects of "real life" prostate MRI inter-observer variability on total needle samples and indication for biopsy. Urol Oncol 2020; 38:793.e13-793.e18. [PMID: 32303407 DOI: 10.1016/j.urolonc.2020.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/07/2020] [Accepted: 03/19/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Prostate multiparametric magnetic resonance imaging (mpMRI) improves diagnosis of clinically significant cancer and reduces over-detection of nonsignificant cancer. Disagreement in the interpretation of mpMRI readings is well-known, with a reported discrepancy rate of 10% to 42%. We report the clinical repercussions of this variability on prostate biopsy candidates. MATERIALS AND METHODS Medical records of patients referred from 11 medical centers for MR-guided prostate biopsy (MRGpB) between October, 2017 and January, 2019 were retrospectively analyzed. Patients with at least one prostate imaging reporting and data system (PI-RADS) 3 or greater prostate lesion were selected, and the mpMRI studies (all read by others) were reviewed by our prostate mpMRI reader. Outcomes included changes in PI-RADS score and the subsequent effect on total needle samples and indication for biopsy. RESULTS Eighty-two patients with 128 lesions were suitable for analysis (mean age 66.5 ± 7.1 years, mean PSA 6.8 ± 8.5 ng/ml). Nine (11%) patients had suspicious rectal exams (T2a). Following our prostate mpMRI reader's imaging revisions, the PI-RADS score was downgraded in 66 (52%) lesions, upgraded in 15 (12%), and unchanged in 47 (37%), leaving a total of 84 suspected lesions (kappa = 0.17). Biopsy was deferred in 22 (27%) patients, and an estimated 136.4 (34.4%) samples were avoided (P = 0.0001 for both). There was a trend toward prostate size to correlate with imaging revision and abortion of biopsy (P = 0.06) while enrollment in active surveillance correlated with proof from such outcome (P = 0.007). CONCLUSION These data suggest that high interobserver disagreement in prostate mpMRIs from diverse institutes significantly affects prostate biopsy practice. The clinical consequences of this discord are significant.
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Affiliation(s)
- Barak Rosenzweig
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
| | - Yael Laitman
- Oncogenetics Unit, Institute of Human Genetics, and Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Orit Raz
- Assuta Ashdod University Hospital, Ashdod, Israel
| | - Jacob Ramon
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Orith Portnoy
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel
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Horesh N, Abu-Ghanem Y, Erlich T, Rosin D, Gutman M, Zilberman DE, Ramon J, Dotan ZA. Management of Pancreatic Injuries Following Nephrectomy. Isr Med Assoc J 2020; 22:244-248. [PMID: 32286029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Pancreatic injuries during nephrectomy are rare, despite the relatively close anatomic relation between the kidneys and the pancreas. The data regarding the incidence and outcome of pancreatic injuries are scarce. OBJECTIVES To assess the frequency and the clinical significance of pancreatic injuries during nephrectomy. METHODS A retrospective analysis was conducted of all patients who underwent nephrectomy over a period of 30 years (1987-2016) in a large tertiary medical center. Demographic, clinical, and surgical data were collected and analyzed. RESULTS A total of 1674 patients underwent nephrectomy during the study period. Of those, 553 (33%) and 294 patients (17.5%) underwent left nephrectomy and radical left nephrectomy, respectively. Among those, four patients (0.2% of the total group, 0.7% of the left nephrectomy group, and 1.36% of the radical left nephrectomy) experienced iatrogenic injuries to the pancreas. None of the injuries were recognized intraoperatively. All patients were treated with drains in an attempt to control the pancreatic leak and one patient required additional surgical interventions. Average length of stay was 65 days (range 15-190 days). Mean follow-up was 23.3 months (range 7.7-115 months). CONCLUSIONS Pancreatic injuries during nephrectomy are rare and carry a significant risk for postoperative morbidity.
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Affiliation(s)
- Nir Horesh
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yasmin Abu-Ghanem
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Erlich
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Ramon
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shvero A, Zilberman DE, Laufer M, Dotan ZA, Ramon J, Winkler HZ, Kleinmann N. [THE EFFICACY OF ENDOSCOPIC DUAL LASER TREATMENT FOR LOW GRADE UPPER TRACT UROTHELIAL CARCINOMA]. Harefuah 2020; 159:170-174. [PMID: 32186786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Until recently, radical nephroureterectomy was considered the gold standard treatment for upper tract urothelial carcinoma (UTUC). Post-operative complications, long-term adverse effects of nephrectomy as well as the risk of contralateral recurrence have led to the development of nephron-sparing techniques. OBJECTIVES To evaluate the safety, complication rate, and oncologic outcomes of ureteroscopic nephron-sparing treatment for low-grade UTUC utilizing a hybrid laser system that incorporates two types of lasers: Nd:YAG and Ho:YAG. METHODS We reviewed the files of patients who underwent ureteroscopic treatment for UTUC with the hybrid laser system between the years 2014-2018. Only cases of low-grade UTUC and follow-up time of at least 6 months were included in the present study. The following were analyzed: demographic data, tumor histologic characteristics, peri-operative complications, histologic upgrade, oncologic outcomes (i.e: local recurrence, local spread, metastatic progression). RESULTS A total of 38 patients, who underwent 74 ureteroscopies, met inclusion criteria. Mean tumor size was 16.2 mm. No intra-operative complications were recorded. Two post-operative complications were recorded in one patient - hematuria and retroperitoneal bleeding - both had been treated conservatively. Mean follow-up time was 21.8 months. Local recurrence rate was 73%. Histologic upgrade has been observed in two patients. Four patients (10.5%) were referred to radical nephroureterectomy. There were no cases of local spread, distant metastases or death during the follow-up period. DISCUSSION Endoscopic dual-laser treatment for low-grade UTUC is safe, surgically feasible and associated with good short-term oncologic outcome. Patient selection and strict follow-up are mandatory.
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Affiliation(s)
- Asaf Shvero
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Menahem Laufer
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Ramon
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Harry Z Winkler
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Kleinmann
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Drori T, Abu-Ghanem Y, Kleinmann N, Shvero A, Winkler HZ, Zilberman DE. [A COMPARISON BETWEEN TWO POTASSIUM CITRATE REGIMENS FOR THE TREATMENT OF NEPHROLITHIASIS]. Harefuah 2019; 158:774-777. [PMID: 31823528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND UROCIT-K is a potassium-citrate regimen prescribed for the prevention of kidney stone formation. In 2013, K-CITEK was introduced to the local market as a new potassium-citrate regimen that reduces kidney stone formation in a declared rate of 93. OBJECTIVES We sought to explore the efficacy of K-CITEK versus UROCIT-K. METHODS A prospective database of patients treated with potassium-citrate regimens for nephrolithiasis has been reviewed. Patients were divided into two groups: those who were treated with UROCIT-K only (Group 1) and those who were treated with K-CITEK only (Group 2). The two groups were compared as regards to demographics, length of follow-up, urinary citrate level and stone burden changes, as well as the number of stone events (i.e: colic, surgery) throughout the follow-up period. In a separate analysis another group (Group 3) was checked. This group consisted of patients who were initially treated with UROCIT-K and later on were switched to K-CITEK. RESULTS The study group consisted of 104 patients: 54 patients in Group 1, 38 in group 2 and 12 in group 3. The latter was omitted from analysis due to the small size. Groups 1 and 2 resembled in their demographic data and medical comorbidities. No statistically significant differences were found in terms of change in urinary citrate levels, stone burden or recurrent stone events. CONCLUSIONS K-CITEK for the treatment of kidney stone prevention was found to be as equally effective as UROCIT-K in terms of increasing urinary citrate levels, reducing stone burden and maintaining the intervals between kidney stone events.
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Affiliation(s)
- Tomer Drori
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nir Kleinmann
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Asaf Shvero
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Harry Z Winkler
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Anis O, Rimon U, Ramon J, Khaitovich B, Zilberman DE, Portnoy O, Dotan ZA. Selective Arterial Embolization for Large or Symptomatic Renal Angiomyolipoma: 10 Years of Follow-up. Urology 2019; 135:82-87. [PMID: 31618658 DOI: 10.1016/j.urology.2019.09.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/25/2019] [Accepted: 09/29/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess long-term outcome after selective arterial embolization (SAE) as first-line treatment for large or symptomatic AML. DESIGN, SETTING, AND PARTICIPANTS Data from a prospectively maintained database on 71 patients who underwent SAE for large or symptomatic AML were reviewed. Patients with sporadic and tuberous-sclerosis-complex (TSC) were included. OUTCOME MEASUREMENTS The main endpoints were re-embolization rates, occurrence of clinical events related to AML, size of AML, and renal function. RESULTS Thirteen (19.1%) patients reported at least 1 major clinical event. Major complications affected 2 patients (2.9%), both ending in complete loss of renal unit function. Four renal units (5.9%) were eventually treated surgically. The re-embolization rate was 41.1%, with an average time from the initial to a repeat SAE of 2.18 years (range 0.31-10.65 years). The size of the tumor prior to SAE and after 5 and 10 years of follow-up were 8.9 cm (7-12), 6.5 cm (4-7.5), 7 cm (4-7.8), respectively [median (IQR)]. These results are translated to a size reduction of 27% in 10 years follow-up. Patients with TSC had larger tumors on long-term follow-up (77.8 vs 41.3 mm, P = .045). The long-term follow-up estimated average glomerular filtration rate was 81.97 (range 26-196). No patient needed renal replacement therapy, and disease-specific survival was 100%. CONCLUSIONS SAE is a safe treatment option for patients with symptomatic or large AML. It represents a minimally invasive intervention with good long-term outcome. SAE may be offered as first-line treatment in most cases, though, it is associated with high retreatment rates.
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Affiliation(s)
- Omer Anis
- Departments of Urology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Uri Rimon
- Departments of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Ramon
- Departments of Urology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Boris Khaitovich
- Departments of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dorit E Zilberman
- Departments of Urology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Orith Portnoy
- Departments of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zohar A Dotan
- Departments of Urology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Nissenkorn A, Erlich T, Zilberman DE, Sarouk I, Krauthammer A, Kitrey ND, Heimer G, BenZeev B, Mor Y. Secondary enuresis and urological manifestations in children with ataxia telangiectasia. Eur J Paediatr Neurol 2018; 22:1118-1123. [PMID: 30100180 DOI: 10.1016/j.ejpn.2018.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/11/2018] [Accepted: 07/18/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ataxia telangiectasia (AT) is a neurodegenerative cerebellar disorder, caused by mutations in the ATM gene, involved in DNA repair. Radiosensitivity, progressive ataxia, immune deficiency and malignancies, are well known symptoms, but urological manifestations are scarcely described. OBJECTIVE To characterize urologic manifestations in a large cohort of AT patients. METHODS Retrospective cross-sectional chart study comprising 52 AT patients followed at a National AT Center. RESULTS 25% of the cohort (13 patients/8 males) had urologic symptoms, which presented at 11 ± 4.3 years. The most common symptom was secondary enuresis affecting 15% of the patients (8 children/4 males). Incontinence appeared at 8 ± 6.2 years of age, and resolved spontaneously within 15 ± 8.3 months in 6 patients. It preceded loss of ambulatory capacity by 1-2 years in 7 patients. Lumbosacral MRI were normal (4 children) and urine cultures (all) were negative. Urodynamic evaluation that was performed in only one patient revealed overactive bladder. Additional manifestations were macroscopic hematuria due to bladder telangiectasia in a 12-year-old, and renal cell carcinoma in a 22-year-old. Other manifestations unrelated to AT were neprolithiasis, vesico-ureteral reflux and scrotal pain, each in 1 patient. DISCUSSION Transient secondary enuresis is a frequent finding in AT patients, heralding loss of ambulatory capacity, tough it's pathophysiological mechanism is largely no understood.
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Affiliation(s)
- Andreea Nissenkorn
- Service for Rare Disorders, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Tomer Erlich
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Ifat Sarouk
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; National AT Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Pediatric Pulmonology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Alexander Krauthammer
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Noam D Kitrey
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Gali Heimer
- Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bruria BenZeev
- Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoram Mor
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Service of Pediatric Urology, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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Abu-Ghanem Y, Shvero A, Kleinmann N, Winkler HZ, Zilberman DE. 24-h urine metabolic profile: is it necessary in all kidney stone formers? Int Urol Nephrol 2018; 50:1243-1247. [PMID: 29876775 DOI: 10.1007/s11255-018-1902-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 05/23/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE A 24-h urine metabolic profile (24-UMP) is an integral part of nephrolithiasis work-up. We aimed to explore whether it can be waived under certain circumstances. MATERIALS AND METHODS We reviewed our prospective registry database of patients seen at our outpatient clinic for nephrolithiasis between the years 2010 and 2017. Data included: gender, age at first stone, body mass index (BMI), self-reported comorbidities and family history of nephrolithiasis. A 24-UMP was obtained from each patient under random diet. The following were recorded: urine volume, urinary levels of sodium, calcium, uric acid, oxalate and citrate. Presence of at least one comorbidity (i.e., hypertension/diabetes/hyperlipidemia) was defined as "associated comorbidities" (AC). Their absence was defined as "no comorbidities" (NC). Subjects were divided into two subgroups: first-time and recurrent stone formers, which were further divided into two subgroups: 1st + AC; 1st + NC; recurrent + AC; recurrent + NC. 24-UMPs have been compared between the four groups. RESULTS Four hundred and fifty-seven patients were included in the study. In the AC groups, patients demonstrated higher BMI levels (p = 0.001), and were statistically significantly obese (BMI > 30, p = 0.001) and older at first stone event (p = 0.001). First formers, either with AC or NC were more likely to have low urine volume (LUV) compared with recurrent formers (72.5 vs. 59.5%, p = 0.005). In the remaining metabolic abnormalities, no such differences were observed. CONCLUSIONS First-time stone formers, either with or without AC are likely to demonstrate LUV as their primary metabolic abnormality in 24-UMP. Therefore, 24-UMP may be postponed until recurrent stone event.
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Affiliation(s)
- Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel. .,Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Asaf Shvero
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Kleinmann
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Harry Z Winkler
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Haifler M, Mor Y, Dotan Z, Ramon J, Zilberman DE. Prophylactic antibiotic treatment following laparoscopic robot-assisted radical prostatectomy for the prevention of catheter-associated urinary tract infections: did the AUA guidelines make a difference? J Robot Surg 2016; 11:367-371. [DOI: 10.1007/s11701-016-0667-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
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Abu-Ghanem Y, Kleinmann N, Winkler HZ, Zilberman DE. Nephrolithiasis in Israel: Epidemiological Characteristics of Return Patients in a Tertiary Care Center. Isr Med Assoc J 2016; 18:725-728. [PMID: 28457074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The prevalence and etiology of nephrolithiasis vary, depending on geography, gender and ethnicity. OBJECTIVES To analyze the demographic data of return nephrolithiasis patients in a tertiary care center. METHODS We retrospectively reviewed our prospective registry database of return patients seen at our outpatient clinic for nephrolithiasis. Data included gender, age at first visit, age at first stone event, body mass index (BMI), self-reported hypertension, diabetes mellitus (DM), and hyperlipidemia. All patients were seen at least twice and had undergone a metabolic workup. RESULTS A total of 260 return patients were seen during the period 2010-2015. The male:female ratio was 3.1:1. Mean age at the first stone event was 44.1 years. Median time elapsed since the first stone event to medical evaluation was 5 years (interquartile range 1-12 years). Hypertension was reported by 33.1% of the patients, DM by 23.5% and hyperlipidemia by 30.4%. All three diseases were reported by 11.5% of patients. The metabolic abnormalities detected were hypocitraturia (60%), low urine volume (LUV) (60%), hypercalciuria (40.8%), hyperoxaluria (24.2%), hyperuricosuria (16.5%) and hyperuricemia (13.5%). Stone compositions from most to least frequent were calcium-oxalate (81%), calcium-phosphate (11.9%) and uric acid (7.1%). We also found that 24.6% were obese (BMI ≥ 30 kg/m2) and showed higher rates of hypertension, DM, hyperlipidemia, hyperuricemia and hyperuricosuria compared with non-obese patients. Significantly higher rates of obesity and LUV were detected in females compared with males. Patients over age 45 had lower rates of hyperuricemia compared with patients ≥ 45 years old (P = 0.038). CONCLUSIONS Factors related to nephrolithiasis can potentially differ among populations and countries. Our findings emphasize the significance of individualized national health programs to address local issues.
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Affiliation(s)
- Yasmin Abu-Ghanem
- Department of Urology, Sheba Medical Center, Tel Hashomer, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Kleinmann
- Department of Urology, Sheba Medical Center, Tel Hashomer, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Harry Z Winkler
- Department of Urology, Sheba Medical Center, Tel Hashomer, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Sheba Medical Center, Tel Hashomer, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abu-Ghanem Y, Dotan Z, Kaver I, Zilberman DE, Ramon J. The use of Haemostatic Agents does not impact the rate of hemorrhagic complications in patients undergoing partial nephrectomy for renal masses. Sci Rep 2016; 6:32376. [PMID: 27572274 PMCID: PMC5004111 DOI: 10.1038/srep32376] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/02/2016] [Indexed: 11/16/2022] Open
Abstract
Hemostatic agents(HAs) have gained increasing popularity as interventions to improve perioperative haemostasis and diminish the need for allogeneic red cell transfusion(PBT) despite a paucity of data supporting the practice. The aim of the current study is to examine the efficacy of HAs in reducing the rate of hemorrhagic complications during partial nephrectomy(PN). Data on 657 patients, who underwent elective PN between 2004–2013, were analyzed. The impact of HAs and SURGICEL was evaluated by comparing four sequential groups of patients: Group1 = Sutures alone, Group2 = sutures and HA, Group3 = sutures and SURGICEL, Group4 = both HA and SURGICEL. Complications included post-operative urinary leak(UL), PBT rate, delayed bleeding and post-operative renal failure. Results showed that the use of HAs did not engender a statistically significant difference in overall complications rate. Specifically, the addition of HAs did not reduce the rate of PBT, delayed bleeding or UL. Further analysis revealed that patients who received SURGICEL had significantly higher PBT rate and higher prevalence of UL cases. Addition of HAs to SURGICEL had no effect on the rate of these complications. In the current study, the use of HAs during open and laparoscopic PN did not reduce the rate of negative outcomes. Adequate suture renorrhaphy may be sufficient to prevent hemorrhagic complications.
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Affiliation(s)
- Yasmin Abu-Ghanem
- Dept. of Urology, Sheba Medical Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israe
| | - Zohar Dotan
- Dept. of Urology, Sheba Medical Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israe
| | - Issac Kaver
- Dept. of Urology, Sheba Medical Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israe
| | - Dorit E Zilberman
- Dept. of Urology, Sheba Medical Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israe
| | - Jacob Ramon
- Dept. of Urology, Sheba Medical Center, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israe
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Abu-Ghanem Y, Dotan Z, Kaver I, Zilberman DE, Ramon J. PD48-01 THE IMPACT OF PERIOPERATIVE BLOOD TRANSFUSION ON CANCER RECURRENCE AND SURVIVAL FOLLOWING NEPHRECTOMY FOR NON-METASTATIC RENAL CELL CARCINOMA (RCC). J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2723] [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: 11/30/2022]
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Zilberman DE, Mor Y, Fridman E, Ramon J. Mesenteric Fibromatosis Mimicking Tumor Recurrence Following Radical Cystectomy and Bladder Replacement. Urol Case Rep 2016; 3:40-1. [PMID: 26793495 PMCID: PMC4714273 DOI: 10.1016/j.eucr.2014.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 11/25/2022] Open
Abstract
We report an unusual case of benign tumor mimicking tumor recurrence following radical cystectomy and bladder replacement for high grade urothelial carcinoma.
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Affiliation(s)
- Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; Tel-Aviv University, Sackler School of Medicine, Israel
| | - Yoram Mor
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; Tel-Aviv University, Sackler School of Medicine, Israel
| | - Edward Fridman
- Department of Pathology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Tel-Aviv University, Sackler School of Medicine, Israel
| | - Jacob Ramon
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; Tel-Aviv University, Sackler School of Medicine, Israel
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Zilberman DE, Rimon U, Morag R, Winkler HZ, Ramon J, Mor Y. Non-surgical treatment of latrogenic postoperatively diagnosed ureteral injuries. Isr Med Assoc J 2015; 17:227-230. [PMID: 26040048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND latrogenic ureteral injury may be seen following abdominopelvic surgeries. While ureteral injuries identified during surgery should be immediately and surgically repaired, those that are postoperatively diagnosed may be treated non-surgically by draining the ipsilateral kidney. Data regarding the outcome of this approach are still missing. OBJECTIVES To evaluate the success rates of non-surgical management of ureteral injuries diagnosed following abdominopelvic surgeries. METHODS We retrospectively reviewed the files of all patients treated for iatrogenic ureteral injuries diagnosed following abdominopelvic surgeries. Patients' ipsilateral kidney was percutaneously drained following diagnosis of injury by either nephrostomy tube (NT)/nephro-ureteral stent (NUS) or double-J stent (DJS) inserted retrogradely. The tube was left in place until a pyelogram confirmed healing or a conservative approach was abandoned due to failure. RESULTS Twenty-nine patients were identified as having ureteral injury following abdominopelvic surgery. Median time from injury to renal drainage was 9 days, interquartile range (IQR) 4-17 days. Seven cases (24%) had surgical repair. Among the other 22 patients, in 2 oncology patients the conservative approach was maintained although renal drainage failed to resolve the injury. In the remaining 20, median drainage length was 60 days (IQR 43.5-85). Calculated overall success rates following renal drainage was 69% (18/29), and with NUS approached 78.5%. CONCLUSIONS Ureteral injuries diagnosed following abdominopelvic surgeries can be treated conservatively. Ipsilateral renal drainage should be the first line of treatment before surgical repair, and NUS may be the preferred drainage to obtain spontaneous ureteral healing.
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Rosenzweig B, Mor Y, Zilberman DE, Rimon U, Garniek A. Bagless nephron-ephroureterostomy for bilateral ureteral obstruction: a simple modification to improve patients' quality of life. J Vasc Interv Radiol 2013; 24:295-6. [PMID: 23369563 DOI: 10.1016/j.jvir.2012.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/06/2012] [Accepted: 10/09/2012] [Indexed: 11/16/2022] Open
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Zilberman DE, Golomb J, Kitrey ND, Inbar Y, Heyman Z, Kleinnbaum Y, Mor Y. Long-term urinary bladder function following unilateral refluxing low loop cutaneous ureterostomy. Korean J Urol 2012; 53:355-9. [PMID: 22670196 PMCID: PMC3364476 DOI: 10.4111/kju.2012.53.5.355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 02/10/2012] [Indexed: 11/29/2022] Open
Abstract
Purpose Unilateral low loop cutaneous ureterostomy (LLCU) has been offered as the preferred method of temporary urinary diversion in cases of massively dilated and refluxing ureters. We sought to explore whether LLCU is effective in preserving urinary bladder function in the long term. Materials and Methods The charts of all patients who had undergone temporary unilateral LLCU as newborns in the presence of massive vesico-ureteric reflux were retrospectively reviewed. Demographic data, follow-up length, and presence of incontinence were recorded. Patients were interviewed regarding lower urinary tract symptoms (LUTS), and their urination patterns were recorded by using uroflow and post-void residual (PVR) measurements. Results Between 1972 and 2003, a total of 24 patients underwent unilateral LLCU in the presence of massively refluxing ureters. Eight patients were included in the final analysis. The median age at diversion was 12 days, the median time to closure was 22.5 months, and the median follow-up was 12.5 years. Urinary bladders showed normal contour, normal capacities, and minimal PVRs in most cases. None of the patients required augmentation cystoplasty. One patient suffered from urinary leakage and few demonstrated minimal LUTS. Conclusions Unilateral refluxing LLCU is an effective method of urinary diversion that preserves urinary bladder function for the long term. Larger studies are required to confirm this finding.
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Affiliation(s)
- Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel-Ha'shomer, 52621 Ramat-Gan, Israel
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Tsivian M, Zilberman DE, Ferrandino MN, Madden JF, Mouraviev V, Albala DM. Apical Surgical Margins Status in Robot-Assisted Laparoscopic Radical Prostatectomy Does Not Depend on Disease Characteristics. J Endourol 2012; 26:361-5. [DOI: 10.1089/end.2011.0336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Matvey Tsivian
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Dorit E. Zilberman
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael N. Ferrandino
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - John F. Madden
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Vladimir Mouraviev
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Zilberman DE, Luthringer T, Young D, Albala DM. Societal Changes and the Etiology of Stone Disease. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_113] [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: 10/27/2022]
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Zilberman DE, Lipkin ME, Ferrandino MN, Simmons WN, Mancini JG, Raymundo ME, Zhong P, Preminger GM. The digital flexible ureteroscope: in vitro assessment of optical characteristics. Int Braz J Urol 2011. [DOI: 10.1590/s1677-55382011000300015] [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: 11/22/2022] Open
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Zilberman DE, Tsivian M, Yong D, Albala DM. Surgical Steps That Elongate Operative Time in Robot-Assisted Radical Prostatectomy Among the Obese Population. J Endourol 2011; 25:793-6. [DOI: 10.1089/end.2010.0428] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dorit E. Zilberman
- Department of Surgery, Urology Division, Duke University Medical Center, Durham, North Carolina
| | - Matvey Tsivian
- Department of Surgery, Urology Division, Duke University Medical Center, Durham, North Carolina
| | - Daniel Yong
- Department of Surgery, Urology Division, Duke University Medical Center, Durham, North Carolina
| | - David M. Albala
- Department of Surgery, Urology Division, Duke University Medical Center, Durham, North Carolina
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Lipkin ME, Mancini JG, Zilberman DE, Raymundo ME, Yong D, Ferrandino MN, Miller MJ, Yoshizumi TT, Preminger GM. Reduced radiation exposure with the use of an air retrograde pyelogram during fluoroscopic access for percutaneous nephrolithotomy. J Endourol 2011; 25:563-7. [PMID: 21426236 DOI: 10.1089/end.2010.0431] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Fluoroscopy with retrograde pyelogram is commonly used to obtain access for percutaneous nephrolithotomy (PNL). Our practice uses room air for retrograde identification of calyceal anatomy. Herein we explore whether an air pyelogram was associated with a decrease in radiation exposure compared with standard retrograde pyelogram. METHODS We retrospectively reviewed all PNL procedures performed at our institution over the past 2 years. Of the 260 PNL procedures performed during the study period, 96 had information on radiation dosage required for analysis. The effective dose (ED) was calculated using accepted conversion tables. Multivariable linear regression was used to determine the association between ED and the use of air pyelogram controlling for factors thought to affect radiation exposure. RESULTS Of the 96 PNL procedures included in the study, 60 (63%) were performed with an air retrograde pyelogram (AP) and 36 (37%) used contrast retrograde pyelogram (CP). Both groups were matched in terms of age, body mass index, stone burden, and number of access tracts. Multivariable linear regression showed significantly lower radiation exposure in the AP group than in the CP group (p = 0.001). There was no difference in fluoroscopy time between the two groups. Using an AP lowered the mean adjusted ED nearly twofold, from 7.67 (CI = 5.99-9.81) to 4.45 (CI = 3.68-5.38) mSv. CONCLUSIONS An air retrograde pyelogram is associated with decreased radiation exposure during PNL when compared with a contrast retrograde pyelogram.
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Affiliation(s)
- Michael E Lipkin
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Raymundo EM, Lipkin ME, Bañez LB, Mancini JG, Zilberman DE, Preminger GM, Inman BA. Third Prize: The Role of Endoscopic Nephron-Sparing Surgery in the Management of Upper Tract Urothelial Carcinoma. J Endourol 2011; 25:377-84. [DOI: 10.1089/end.2010.0276] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eliza M. Raymundo
- Department of Surgery-Urology, Duke University Medical Center, Durham, North Carolina
| | - Michael E. Lipkin
- Department of Surgery-Urology, Duke University Medical Center, Durham, North Carolina
| | - Lionel B. Bañez
- Department of Surgery-Urology, Duke University Medical Center, Durham, North Carolina
| | - John G. Mancini
- Department of Surgery-Urology, Duke University Medical Center, Durham, North Carolina
| | - Dorit E. Zilberman
- Department of Surgery-Urology, Duke University Medical Center, Durham, North Carolina
| | - Glenn M. Preminger
- Department of Surgery-Urology, Duke University Medical Center, Durham, North Carolina
| | - Brant A. Inman
- Department of Surgery-Urology, Duke University Medical Center, Durham, North Carolina
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Zilberman DE, Lipkin ME, Ferrandino MN, Simmons WN, Mancini JG, Raymundo ME, Zhong P, Preminger GM. The digital flexible ureteroscope: in vitro assessment of optical characteristics. J Endourol 2011; 25:519-22. [PMID: 21361823 DOI: 10.1089/end.2010.0206] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Recent advances in endoscope design have placed the charged coupled device chip on the tip of the endoscope. The image is instantly digitalized and converted into an electrical signal for transmission. Digital technology was first introduced into flexible cystoscopes/nephroscopes and subsequently into rigid and flexible ureteroscopes. Herein, we assess the image characteristics and advantages of a new generation of digital flexible ureteroscopes. METHODS The Olympus URF-V flexible digital ureteroscope and the Olympus URF-P3 fiberoptic ureteroscope were assessed in vitro for image resolution, distortion, color representation, grayscale imaging, field of view, and depth of field. RESULTS The digital ureteroscope had a higher resolution at 3, 5, 10, and 20 mm (25.2 lines/mm vs. 8.0, 14.1 vs. 5.0, 6.3 vs. 2.8, and 3.2 vs. 1.3), respectively. Distortion with the digital flexible ureteroscope was lower, though not statistically significant. Color representation was better with the digital ureteroscope, whereas contrast evaluation was comparable between both scopes. The digital flexlible ureteroscope produced a 5.3 times larger image size compared with the standard fiberoptic flexible uretersocpe with a narrower field of view. The depth of field was limited by light and not the optic or the camera for both ureteroscopes. CONCLUSIONS The development of digital flexible ureteroscopes represents a significant technological advance in urology. These devices offer significantly improved resolution and color reproduction as compared with traditional fiberoptic flexible ureteroscopes. Future clinical trials are warranted to ultimately determine the advantages of these innovative endoscopes.
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Affiliation(s)
- Dorit E Zilberman
- Division of Urologic Surgery, Comprehensive Kidney Stone Center, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Zilberman DE, Tsivian M, Lipkin ME, Ferrandino MN, Frush DP, Paulson EK, Preminger GM. Low dose computerized tomography for detection of urolithiasis--its effectiveness in the setting of the urology clinic. J Urol 2011; 185:910-4. [PMID: 21239024 DOI: 10.1016/j.juro.2010.10.052] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Indexed: 12/17/2022]
Abstract
PURPOSE Low dose noncontrast computerized tomography is becoming a common imaging tool to diagnose urolithiasis. We investigated its usefulness as a diagnostic tool in the outpatient setting. MATERIALS AND METHODS A total of 62 patients with suspected urolithiasis underwent standard renal stone protocol computerized tomography with a tube current of 160 mA. Images were modified by adding image noise to simulate tube currents of 70, 100 and 130 mA. Three urologists independently interpreted the original and simulated dose scans for stone number, location and associated signs of obstruction. In addition, the investigators rated the ease of interpreting the scans and their overall level of confidence. RESULTS There were no statistically significant differences in interobserver and intra-observer variability for stone detection or obstruction signs except significant interobserver variability in hydronephrosis and intra-observer variability in stranding categories. Each 1 mm increase in stone size increased the likelihood of a concordant response 3.55, 2.7 and 2-fold when reducing the tube current level by 19%, 38% and 56%, respectively (p=0.001, 0.008 and 0.021, respectively). Multiple stones or index stone location were not associated with agreement. The overall level of confidence decreased with lower simulated doses, particularly in the bony pelvis (p<0.02). CONCLUSIONS Low dose computerized tomography may serve as an effective tool in the setting of the urology clinic in patients with urolithiasis. This imaging tool can better assess urolithiasis and associated obstruction than plain abdominal radiographs, but it may be problematic with small stones (less than 2 mm) and evidence of distal ureteral obstruction. Its effectiveness as a long-term followup tool requires further prospective trials.
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Affiliation(s)
- Dorit E Zilberman
- Comprehensive Kidney Stone Center, Division of Urologic Surgery, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Yong DZ, Tsivian M, Zilberman DE, Ferrandino MN, Mouraviev V, Albala DM. Predictors of prolonged operative time during robot-assisted laparoscopic radical prostatectomy. BJU Int 2010; 107:280-2. [DOI: 10.1111/j.1464-410x.2010.09511.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zilberman DE, Preminger GM. Editorial comment. Urology 2009; 74:1221; author reply 1221-2. [PMID: 19962517 DOI: 10.1016/j.urology.2009.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 06/30/2009] [Accepted: 06/30/2009] [Indexed: 10/20/2022]
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Zilberman DE, Preminger GM. Long-Term Results of Percutaneous Nephrolithotomy: Does Prophylactic Medical Stone Management Make a Difference? J Endourol 2009; 23:1773-6. [DOI: 10.1089/end.2009.0118] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dorit E. Zilberman
- Division of Urologic Surgery, Comprehensive Kidney Stone Center, Duke University Medical Center, Durham, North Carolina
| | - Glenn M. Preminger
- Division of Urologic Surgery, Comprehensive Kidney Stone Center, Duke University Medical Center, Durham, North Carolina
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Zilberman DE, Cohen Y, Amariglio N, Fridman E, Ramon J, Rechavi G. AKT1 E17 K pleckstrin homology domain mutation in urothelial carcinoma. ACTA ACUST UNITED AC 2009; 191:34-7. [PMID: 19389506 DOI: 10.1016/j.cancergencyto.2009.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 01/16/2009] [Indexed: 10/20/2022]
Abstract
The PI3K/AKT pathway is frequently activated in human cancer. Recently, a G to A point mutation (E17K) was found in the pleckstrin homology domain of AKT1. We aimed to explore this mutation in cases of urothelial carcinoma. Using chip-based matrix-assisted laser desorption-time-of-flight (MALDI-TOF) mass spectrometer, AKT1 E17K mutation was searched in 26 total RNA samples obtained from 26 patients known to have urothelial carcinoma. Mutation was found in one out of 26 (3.8%) patients - a 46 year old female with a low grade transitional cell carcinoma located to the lamina propria (Ta disease). Our finding is in line with previous studies showing AKT1 E17K mutation to be rare. Yet, further studies are required to determine whether this mutation is indeed related to less aggressive disease and carries better prognosis.
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Affiliation(s)
- Dorit E Zilberman
- Department of Urology, The Chaim Sheba Medical Center, Tel-Ha'Shomer, Ramat-Gan, Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Robinson MR, Scales CD, Lack BD, Ferrandino MN, Zilberman DE, Preminger GM. DOES RISING URINE PH INCREASE THE STONE FORMATION RATE? J Urol 2009. [DOI: 10.1016/s0022-5347(09)61472-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Antonelli J, Ferrandino MN, Zilberman DE, Pierre SA, Albala DM, Preminger GM. TUBELESS-STENTLESS PERCUTANEOUS NEPHROLITHOTOMY: A FURTHER ADVANCE IN PERCUTANEOUS URINARY STONE MANAGEMENT. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61751-1] [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: 11/25/2022]
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Scales CD, Shea AM, Curtis LH, Ferrandino MN, Zilberman DE, Schulman KA, Preminger GM. VARIATION IN IMAGING UTILIZATION FOR URINARY LITHIASIS IN THE UNITED STATES. J Urol 2009. [DOI: 10.1016/s0022-5347(09)60213-5] [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: 11/24/2022]
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Zilberman DE, Safran M, Paz N, Amariglio N, Simon A, Fridman E, Kleinmann N, Ramon J, Rechavi G. Does RNA editing play a role in the development of urinary bladder cancer? Urol Oncol 2009; 29:21-6. [PMID: 19186082 DOI: 10.1016/j.urolonc.2008.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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: 09/08/2008] [Revised: 11/09/2008] [Accepted: 11/12/2008] [Indexed: 12/31/2022]
Abstract
PURPOSE A-to-I RNA editing is essential for the development of normal cells and is involved in a wide variety of biological pathways. Currently, limited information suggests linkage between changes in RNA editing levels and the development of cancer. We aimed to explore the possible linkage between altered RNA editing levels and the development of human urinary bladder neoplasms. MATERIALS AND METHODS Thirty-two patients underwent transurethral resection of bladder tumor. Normal and tumoral urinary bladder tissues were obtained from each patient during surgery. Total RNA was extracted from tissue cells and converted by RT-PCR reaction to cDNA molecules for further analysis. We explored known editing sites in RNA encoding for proteins (BLCAP, Cyfip2, FLNA, GluB Q/R) as well as in RNA transcribed from Alu elements in noncoding regions of the genes encoding for CARD11, FANCC, MDM4, BRCA1, and RBBP9 proteins. Editing levels were determined using Sequenom MassARRAY Compact Analyzer. RESULTS Eleven tumoral tissues obtained were low grade TCC, 14 high grade TCC, 1 CIS, and another 5 inflammation. One sample contained only normal tissue. We got a total number of 30 normal bladder tissue samples and overall 29 paired samples (i.e., normal and tumoral tissues obtained from the same patient). Statistical analysis revealed no significant changes in editing levels between normal and tumoral tissues. CONCLUSIONS Relying on the results obtained for 9 different editing sites, it can be determined that RNA editing is an epigenetic mechanism that does not participate in the evolution of urinary bladder cancer.
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Affiliation(s)
- Dorit E Zilberman
- Department of Urology, The Chaim Sheba Medical Center, Tel-Ha'Shomer, Ramat-Gan, Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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