1
|
Pfail J, Packiam VT, Ghodoussipour S. Editorial Comment. J Urol 2024:101097JU0000000000003995. [PMID: 38701231 DOI: 10.1097/ju.0000000000003995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Affiliation(s)
- John Pfail
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Vignesh T Packiam
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Saum Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| |
Collapse
|
2
|
Passarelli R, Pfail J, Kaldany A, Chua K, Lichtbroun B, Patel HV, Srivastava A, Golombos D, Jang TL, Packiam VT, Ghodoussipour S. The Association Between Duration of Antibiotics and Infectious Complications Following Radical Cystectomy: Analysis of the 2019-2021 NSQIP Database. Urology 2024:S0090-4295(24)00263-2. [PMID: 38648953 DOI: 10.1016/j.urology.2024.04.006] [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: 01/20/2024] [Revised: 03/21/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES To identify the impact of the duration of peri-operative antibiotics on infectious complications following radical cystectomy. METHODS The National Surgical Quality Improvement Project (NSQIP) targeted database was queried for patients undergoing radical cystectomy from 2019 to 2021. Baseline patient characteristics were collected. Antibiotic duration was classified as <24 hours (short), 24-72 hours (intermediate) or >72 hours (long). Infectious complication data were collected including surgical site infection (SSI), urinary tract infection (UTI), organ space infection, pneumonia, sepsis, and clostridium difficile infection up to 30 days after surgery. Univariate and multivariable analyses were performed to compare duration of antibiotic therapy to infectious outcomes. RESULTS Of the 4363 patients who underwent radical cystectomy, 3250 (74%), 827 (19%) and 286 (6.6%) received short, intermediate, and long duration of peri-operative antibiotics, respectively. Infectious complication occurred in 954 (22%) patients, including 227 (5.2%) SSI, 280 (6.4%) UTI, 268(6.1%) organ space infection, 87 (2%) pneumonia, and 378 (8.7%) sepsis. Clostridium difficile infection occurred in 89 (2%) patients. On multivariable analysis, there was no significant difference in overall infectious complication rates with long-duration antibiotics. However, intermediate duration of antibiotics in open surgery was associated with a decreased risk of SSI (OR 0.58; 95%CI 0.37-0.91) compared to those treated with short-term antibiotics. CONCLUSION Despite guideline recommendations, 26% of patients in this database received >24 hours of peri-operative antibiotics without decreased risk of overall infectious complication. An intermediate course of antibiotics decreased risk of SSI in open surgery compared to the guideline recommend <24-hour course. Greater education regarding antibiotic stewardship and further studies investigating infectious complications are warranted.
Collapse
Affiliation(s)
- Rachel Passarelli
- Division of Urology, Rutgers Robert Wood Johnson, New Brunswick, NJ.
| | - John Pfail
- Division of Urology, Rutgers Robert Wood Johnson, New Brunswick, NJ
| | - Alain Kaldany
- Division of Urology, Rutgers Robert Wood Johnson, New Brunswick, NJ
| | - Kevin Chua
- Division of Urology, Rutgers Robert Wood Johnson, New Brunswick, NJ
| | | | - Hiren V Patel
- Department of Urology, University of California at San Francisco, San Francisco, CA
| | - Arnav Srivastava
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor MI
| | - David Golombos
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Vignesh T Packiam
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Saum Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| |
Collapse
|
3
|
Sodagum L, Passarelli R, Pfail J, Patel HV, Chua K, Doppalapudi SK, Golombos D, Elsamra SE, Singer EA, Jang TL, Srivastava A, Ghodoussipour S. Pelvic lymphadenectomy: Evaluating nodal stage migration and will rogers effect in bladder cancer. Urol Oncol 2024; 42:21.e9-21.e20. [PMID: 37953186 PMCID: PMC10842630 DOI: 10.1016/j.urolonc.2023.09.009] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/28/2023] [Accepted: 09/19/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Pelvic lymphadenectomy (PLND) alongside radical cystectomy (RC), provides crucial diagnostic and therapeutic value in patients with bladder cancer. With the advent of neoadjuvant chemotherapy and prospective data supporting standard PLND, controversy remains regarding the optimal PLND extent and patient selection. Nearly 40% of patients may not receive adequate PLND, even though 25% of patients have positive lymph nodes (LN) at time of RC. We hypothesized that PLND still remains an important facet of bladder cancer treatment. To clarify the prognostic importance of nodal yield, we performed a retrospective investigation of a heterogenous population (pTanyNx/0M0) of patients undergoing RC. METHODS From the Surveillance, Epidemiology, and End Results (SEER) program, we identified pTanyNx/0M0 bladder cancer patients undergoing RC from 2004 to 2015. Kaplan Meier curves and Cox proportional hazards models assessed cancer-specific survival. Patients were analyzed with PLND performed as the primary covariate. Survival analysis then stratified patients undergoing PLND by LN yield, both as a continuous and categorial variable (≤10, 11-20, 21-30, and >30), and T stage. RESULTS The final cohort included pTanyNx/0M0 patients with urothelial bladder cancer (n = 12,096); median follow up was 39 (IQR: 17-77) months. PLND was performed in 81.45% of patients with a median LN yield of 14 (IQR: 7-23). Most commonly, patients had T2 disease (44.68%). After controlling for age and T stage, patients receiving PLND had improved CSS (HR = 0.56, [95% CI: 0.51-0.62]) compared to those that did not receive PLND. When grouping patients by LN yield, survival improved in a "dose dependent" manner (>30 LN: HR = 0.76, [95% CI: 0.66-0.87]). We noted similar results when stratifying patients into non-muscle-invasive (NMIBC) and muscle-invasive bladder cancer (MIBC). CONCLUSIONS In a large contemporary series of pTanyNx/0M0 bladder cancer patients, we found a significant oncologic benefit to PLND. Higher LN yield correlated to improved CSS in non-muscle-invasive and muscle-invasive disease. Our data support the possibility of occult micrometastasis even in non-muscle-invasive disease. Additionally, in light of recent advances in adjuvant immunotherapy, our results emphasize the importance of adequate nodal yield for accurate staging and optimal treatment.
Collapse
Affiliation(s)
- Lohit Sodagum
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Rachel Passarelli
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - John Pfail
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Hiren V Patel
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Kevin Chua
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Sai Krishnaraya Doppalapudi
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - David Golombos
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Sammy E Elsamra
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Eric A Singer
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Thomas L Jang
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Arnav Srivastava
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ.
| | - Saum Ghodoussipour
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| |
Collapse
|
4
|
Ranti D, Pfail J, Garcia M, Razdan S, Bieber C, Rosenzweig S, Waingankar N, Hosseini A, Radros J, Mehrazin R, Lavallée E, Wiklund PN, Sfakianos JP. Neobladder creation in patients with chronic kidney disease: A viable diversion strategy. Urol Oncol 2022; 40:168.e21-168.e27. [PMID: 35039217 DOI: 10.1016/j.urolonc.2021.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/01/2021] [Accepted: 11/26/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Renal function impairment is often cited as a contraindication to continent diversion strategies. There is little evidence exploring renal function changes between continent and incontinent surgery in patients with preoperative chronic kidney disease (CKD), in particular CKD3B. METHODS This was a retrospective review of two high-volume centers performing robotic assisted radical cystectomy (RARC) with orthotopic neobladder (ONB) or ileal conduit (IC) between 2014 to 2020. Patients were stratified based on CKD estimated glomerular filtration (eGFR) stage, which was estimated via the CKD-EPI equation. Postoperative renal function was compared for up to 60 months postoperative. Surgical, post-surgical, complications, and readmission data were gathered and compared between all patients RESULTS: 522 cystectomy patients, 430 with IC and 125 with ONB, were included. eGFR decline was statistically significant in a matched cohort of IC and ONB patients only at 3 months. There were no statistically significant differences between readmission rates, time to readmission, or complications. 34.6% of stage 3B patients had hydronephrosis on imaging prior to surgery, compared to 11.4%, 22.1% and 21.8% of CKD stage 1, 2, and 3A patients. CKD stage 3B had statistically and clinically improved eGFR through 24 months. CONCLUSION ONB surgery may be a viable diversion strategy in patients previously thought to be contraindicated due to low renal function.
Collapse
Affiliation(s)
- Daniel Ranti
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - John Pfail
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mariely Garcia
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shirin Razdan
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Christine Bieber
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shoshana Rosenzweig
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nikhil Waingankar
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Abolfazl Hosseini
- Dept of Molecular Medicine and Surgery section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Jari Radros
- Dept of Molecular Medicine and Surgery section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Reza Mehrazin
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Etienne Lavallée
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter N Wiklund
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; Dept of Molecular Medicine and Surgery section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - John P Sfakianos
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
5
|
Dovey Z, Pfail J, Martini A, Steineck G, Dey L, Renström L, Hosseini A, Sfakianos JP, Wiklund P. Bladder Cancer (NMIBC) in a population-based cohort from Stockholm County with long-term follow-up; A comparative analysis of prediction models for recurrence and progression, including external validation of the updated 2021 E.A.U. model. Urol Oncol 2021; 40:106.e1-106.e10. [PMID: 34840075 DOI: 10.1016/j.urolonc.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 09/26/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Non muscle invasive bladder cancer (NMIBC) has recurrence and progression rates of approximately 55-75% and 5-45% respectively. After diagnosis, risk stratification guides management decisions regarding surveillance, intravesical therapy or surgery. This prospective cohort of patients from Stockholm County is ideal for external validation of the current risk stratification models used in clinical practice. PATIENTS & METHODS The cohort consisted of 395 patients diagnosed with bladder cancer across all the hospitals in Stockholm County between the years 1995-96, with up to 25 years follow up. All patients with pathologic Ta or T1 disease were included. Patients with muscle invasive disease (MIBC) referred for radical treatment at diagnosis were excluded. External validation of EORTC, CUETO and updated EAU Sylvester et al. (2021) models was done and multivariate Cox regression analysis was performed to generate hazard ratios for covariables of interest using both WHO '73 and WHO '04/16 pathological grade classifications. RESULTS Overall Harrel's C-indices (CIs) for EORTC and CUETO models for recurrence were 0.66 and 0.63 respectively. The CIs for the EORTC, CUETO and EAU Sylvester et al. (2021) WHO '73 and '04/16 models for progression were higher at 0.82, 0.84, 0.83 and 0.83 respectively. All models tended to underestimate both recurrence and progression rates at 1 and 5 yrs. A simplified model devised to include only multifocality, tumor stage, size and grade performed with similar accuracy to all models for both recurrence and progression. CONCLUSION Current risk stratification models are clinically useful but only moderately accurate across different patient populations, and the results of this study suggest a model using fewer variables is of similar accuracy to all models tested. In the future, research into the use of genomic classifiers will hopefully contribute to more accurate, modern risk stratification models.
Collapse
Affiliation(s)
- Zachary Dovey
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, U.S.A
| | - John Pfail
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, U.S.A
| | - Alberto Martini
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Gunnar Steineck
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Linda Dey
- Department of Urology, Karolinska University Hospital Solna, Sweden
| | - Lotta Renström
- Department of Urology, Karolinska University Hospital Solna, Sweden
| | | | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, U.S.A..
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, U.S.A.; Department of Urology, Karolinska University Hospital Solna, Sweden
| |
Collapse
|
6
|
Razdan S, Sljivich M, Pfail J, Wiklund PK, Sfakianos JP, Waingankar N. Predicting morbidity and mortality after radical cystectomy using risk calculators: A comprehensive review of the literature. Urol Oncol 2020; 39:109-120. [PMID: 33223369 DOI: 10.1016/j.urolonc.2020.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/02/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Radical cystectomy (RC) with urinary diversion is associated with significant perioperative morbidity and mortality, varying between 30% and 70% and between 0.3% and 10.6%, respectively. Risk calculators have been extensively studied in the general surgery literature to predict 30- and 90-day postoperative morbidity and mortality but have not been widely accepted in the RC literature. MATERIALS AND METHODS We performed a search of MEDLINE and Embase databases during May 2020 to identify all relevant studies using the following keywords: radical cystectomy, surgical complication predictive model, surgical complication predictive equation, surgical complication predictive nomogram, surgical risk calculator, morbidity, and mortality. We determined the existing surgical predictive nomograms, calculators, and indices and their accuracy in predicting morbidity, mortality, and major complications after RC. RESULTS National Surgical Quality Improvement Program had poor accuracy at predicting 30-day morbidity at mortality (AUC 0.5-0.6). LACE index showed good discrimination at predicting 90-day mortality (AUC 0.7). The various frailty and sarcopenia indices have shown poor to fair accuracy at predicting (AUC 0.5-0.7). The Isbarn and Aziz nomograms have equivalent accuracy at predicting 90-day mortality (AUC 0.7) but are limited by inclusion of tumor histology and presence of metastatic disease as variables. POSSUM and P-POSSUM have poor ability at predicting morbidity and mortality (AUC 0.5) and are cumbersome calculators. The surgical Apgar score has been able to predict 30-day morbidity and mortality but can only be used in the postoperative setting. DISCUSSION The currently available surgical risk calculators have either poor accuracy at predicting post-RC morbidity and mortality or are limited by types of variables included. An ideal risk calculator would be comprised of preoperative factors only and have a high accuracy to serve as a tool for preoperative patient counseling prior to surgery. CONCLUSION There exists a strong need to develop a comprehensive and accurate preoperative risk calculator that predicts morbidity and mortality after RC.
Collapse
Affiliation(s)
- Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Michaela Sljivich
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - John Pfail
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Peter K Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Nikhil Waingankar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
| |
Collapse
|
7
|
Paranjpe I, Tsao N, Judy R, Paranjpe M, Chaudhary K, Klarin D, Forrest I, O'Hagan R, Kapoor A, Pfail J, Jaladanki S, Chaudhry F, Vaid A, Duy PQ, He JC, Glicksberg BS, Coca SG, Gupta M, Do R, Damrauer SM, Nadkarni GN. Derivation and validation of genome-wide polygenic score for urinary tract stone diagnosis. Kidney Int 2020; 98:1323-1330. [PMID: 32540406 PMCID: PMC7606592 DOI: 10.1016/j.kint.2020.04.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/30/2020] [Accepted: 04/16/2020] [Indexed: 11/25/2022]
Abstract
Urinary tract stones have high heritability indicating a strong genetic component. However, genome-wide association studies (GWAS) have uncovered only a few genome wide significant single nucleotide polymorphisms (SNPs). Polygenic risk scores (PRS) sum cumulative effect of many SNPs and shed light on underlying genetic architecture. Using GWAS summary statistics from 361,141 participants in the United Kingdom Biobank, we generated a PRS and determined association with stone diagnosis in 28,877 participants in the Mount Sinai BioMe Biobank. In BioMe (1,071 cases and 27,806 controls), for every standard deviation increase, we observed a significant increment in adjusted odds ratio of a factor of 1.2 (95% confidence interval 1.13-1.26). In comparison, a risk score comprised of GWAS significant SNPs was not significantly associated with diagnosis. After stratifying individuals into low and high-risk categories on clinical risk factors, there was a significant increment in adjusted odds ratio of 1.3 (1.12-1.6) in the low- and 1.2 (1.1-1.2) in the high-risk group for every standard deviation increment in PRS. In a 14,348-participant validation cohort (Penn Medicine Biobank), every standard deviation increment was associated with a significant adjusted odds ratio of 1.1 (1.03 - 1.2). Thus, a genome-wide PRS is associated with urinary tract stones overall and in the absence of known clinical risk factors and illustrates their complex polygenic architecture.
Collapse
Affiliation(s)
- Ishan Paranjpe
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Noah Tsao
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Renae Judy
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Manish Paranjpe
- Division of Health Sciences and Technology, Harvard Medical School, Boston, Massachusetts, USA
| | - Kumardeep Chaudhary
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Derek Klarin
- Malcolm Randall Veterans Affairs Medical Center, Gainesville, Florida, USA; Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Florida, USA; Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Iain Forrest
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ross O'Hagan
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arjun Kapoor
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Pfail
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Suraj Jaladanki
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fayzan Chaudhry
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Akhil Vaid
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Phan Q Duy
- Medical Scientist Training Program, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John Cijiang He
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Renal Program, James J Peters Veterans Affairs Medical Center at Bronx, New York, New York, USA
| | - Benjamin S Glicksberg
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Steven G Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ron Do
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott M Damrauer
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Girish N Nadkarni
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Renal Program, James J Peters Veterans Affairs Medical Center at Bronx, New York, New York, USA.
| |
Collapse
|
8
|
Ravivarapu KT, Omidele O, Pfail J, Tomer N, Small AC, Palese MA. Robotic-assisted simple prostatectomy versus open simple prostatectomy: a New York statewide analysis of early adoption and outcomes between 2009 and 2017. J Robot Surg 2020; 15:627-633. [PMID: 33009988 DOI: 10.1007/s11701-020-01152-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/04/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022]
Abstract
The factors driving early adoption of robotic-assisted simple prostatectomy (RASP) for large gland BPH have not yet been identified. This study aims to determine the patient, provider, and facility level differences and predictors in undergoing RASP versus OSP. This population-based cohort study used data from the all-payer New York State Statewide Planning and Research Cooperative System (SPARCS) database. Patient, provider, and facility characteristics for each cohort were analyzed, and a multivariate analysis was conducted to identify predictive factors associated with undergoing RASP versus OSP. From 2009 to 2017, 1881 OSP and 216 RASP cases were identified. RASP utilization increased from 2.6% of all cases in 2009 to 16.8% in 2017. Patient demographics were similar between both cohorts. Median length of stay was shorter for RASP patients (3 vs. 4 days, p < 0.001), and OSP was associated with a long length of stay (> 7 days) (p < 0.001). There were no significant differences in 30- and 90-day readmission rates or 1-year mortality. More OSP patients were discharged to continued care facilities than RASP patients (p = 0.049), and more RASP patients were discharged to home compared to OSP patients (p = 0.035). Positive predictors for undergoing RASP included teaching hospital status, medium and high hospital bed volume, high hospital operative volume, high surgeon volume, and surgeons that graduated within 15 years of surgery. As RASP shows favorable perioperative outcomes, the diffusion of robotic technology and newer graduates entering the workforce may augment the upward trend of RASP utilization.
Collapse
Affiliation(s)
- Krishna T Ravivarapu
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Olamide Omidele
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - John Pfail
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Nir Tomer
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Alexander C Small
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Michael A Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA.
| |
Collapse
|
9
|
Marco B, Martini A, Pfail J, Gandaglia G, Fossati N, Scuderi S, Fallara G, Barletta F, Robesti D, Rizzo A, Basile G, Bravi C, Rosiello G, Nocera L, Stabile A, Gallina A, Salonia A, Montorsi F, Briganti A, Galsky M, Oh W. Surrogate endpoints for overall survival for patients with metastatic hormone-sensitive prostate cancer in the CHAARTED trial. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35564-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
10
|
Sorce G, Martini A, Pfail J, Falgario U, Waingankar N, Gandaglia G, Fossati N, Fallara G, Barletta F, Scuderi S, Robesti D, Cannoletta D, Cignoli D, Basile G, Nocera L, Rosiello G, Mazzone E, Bravi C, Necchi A, Montorsi F, Briganti A, Galsky M, Sfakianos J. Neoadjuvant versus adjuvant chemotherapy for upper tract urothelial carcinoma: results from the national cancer database. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35620-2] [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: 11/29/2022] Open
|
11
|
Martini A, Pfail J, Falagario U, Waingankar N, Gandaglia G, Fossati N, Fallara G, Barletta F, Scuderi S, Robesti D, Cannoletta D, Necchi A, Montorsi F, Briganti A, Daza J, Treacy P, Galsky M, Sfakianos J. Neoadjuvant versus adjuvant chemotherapy for upper tract urothelial carcinoma: Results from the national cancer database. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32774-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
12
|
Martini A, Pfail J, Montorsi F, Galsky MD, Oh WK. Surrogate endpoints for overall survival for patients with metastatic hormone-sensitive prostate cancer in the CHAARTED trial. Prostate Cancer Prostatic Dis 2020; 23:638-645. [DOI: 10.1038/s41391-020-0231-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/20/2020] [Accepted: 03/31/2020] [Indexed: 01/22/2023]
|
13
|
Falagario UG, Martini A, Pfail J, Treacy PJ, Okhawere KE, Dayal BD, Sfakianos JP, Abaza R, Eun DD, Bhandari A, Porter JR, Hemal AK, Badani KK. Does race impact functional outcomes in patients undergoing robotic partial nephrectomy? Transl Androl Urol 2020; 9:863-869. [PMID: 32420201 PMCID: PMC7214979 DOI: 10.21037/tau.2019.09.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The role of race on functional outcomes after robotic partial nephrectomy (RPN) is still a matter of debate. We aimed to evaluate the clinical and pathologic characteristics of African American (AA) and Caucasian patients who underwent RPN and analyzed the association between race and functional outcomes. Methods Data was obtained from a multi-institutional database of patients who underwent RPN in 6 institutions in the USA. We identified 999 patients with complete clinical data. Sixty-three patients (6.3%) were AA, and each patient was matched (1:3) to Caucasian patients by age at surgery, gender, Charlson Comorbidity Index (CCI) and renal score. Bivariate and multivariate logistic regression analyses were used to evaluate predictors of acute kidney injury (AKI). Kaplan-Meier method and multivariable semiparametric Cox regression analyses were performed to assess prevalence and predictors of significant eGFR reduction during follow-up. Results Overall, 252 patients were included. AA were more likely to have hypertension (58.7% vs. 35.4%, P=0.001), even after 1:3 match. Overall 42 patients (16.7%) developed AKI after surgery and 35 patients (13.9%) developed significant eGFR reduction between 3 and 15 months after RAPN. On multivariate analysis, AA race did not emerge as a significant factor for predicting AKI (OR 1.10, P=0.8). On Cox multivariable analysis, only AKI was found to be associated with significant eGFR reduction between 3 and 15 months after RAPN (HR 2.49, P=0.019). Conclusions Although African American patients were more likely to have hypertension, renal function outcomes of robotic partial nephrectomies were not significantly different when stratified by race. However, future studies with larger cohorts are necessary to validate these findings.
Collapse
Affiliation(s)
- Ugo G Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Urology, University of Foggia, Foggia, Italy
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - John Pfail
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bheesham D Dayal
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ronney Abaza
- Robotic Urologic Surgery, Ohio Health Dublin Methodist Hospital, Columbus, OH, USA
| | - Daniel D Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Akshay Bhandari
- Division of Urology, Columbia University at Mount Sinai, Miami Beach, FL, USA
| | | | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
14
|
Pike LRG, Wu J, Chen MH, Loffredo M, Renshaw AA, Pfail J, Kantoff PW, D'Amico AV. Time to PSA nadir and the risk of death from prostate cancer following radiation and androgen deprivation therapy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4 Background: Whether the time to PSA nadir (TTN) has differential prognostic value in men who reach an undetectable versus detectable PSA nadir remains unknown. Methods: Two-hundred and four men from a prospective randomized controlled trial (RCT) involving radiation therapy with or without 6 months of androgen deprivation therapy (ADT) in unfavorable risk CaP at academic or community based centers in Massachusetts, enrolled between 1995 and 2001. Adjusted hazard ratios (AHR) of the risk of CaP-specific mortality (PCSM) calculated using Fine and Gray competing risk regression. Results: After a median follow-up of 18.17 years, 160 men died; 30 (18.75%) of CaP. Amongst men with a PSA nadir ≥ 0.2 ng/ml, a TTN < median (12 months) was significantly associated with an increased PCSM-risk versus the median or more (AHR 5.07, 95% CI 2.10-12.23, p<0.001); whereas this association was not observed among men with a PSA nadir of <0.2 ng/ml, (AHR 9.9, 95% CI 0.23-433.8, p=0.23). Conclusions: Men with both a short TTN and detectable PSA nadir could be considered for entry on RCTs at a novel entry point prior to PSA failure at the time of PSA nadir to complete planned conventional ADT versus that plus agent(s) shown to improve outcomes in men with or at high risk of having castrate-resistant CaP.
Collapse
Affiliation(s)
| | - Jing Wu
- University of Rhode Island, Kingston, RI
| | | | - Marian Loffredo
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA
| | | | - John Pfail
- Mount Sinai Icahn School of Medicine, New York, NY
| | | | | |
Collapse
|
15
|
Audenet F, Attalla K, Giordano M, Pfail J, Lubin MA, Waingankar N, Gainsburg D, Badani KK, Sim A, Sfakianos JP. Prospective implementation of a nonopioid protocol for patients undergoing robot-assisted radical cystectomy with extracorporeal urinary diversion. Urol Oncol 2019; 37:300.e17-300.e23. [PMID: 30777392 DOI: 10.1016/j.urolonc.2019.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/14/2018] [Accepted: 02/05/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the feasibility and outcomes of a nonopioid (NOP) perioperative pain management protocol for patients undergoing robot-assisted radical cystectomy (RARC). MATERIALS AND METHODS We prospectively included 52 consecutive patients undergoing RARC at our institution for bladder cancer. Patients received a multimodal pain management protocol, including a combination of nonopioid pain medications and regional anesthesia. For comparison, we retrospectively included 41 consecutive patients who received the same procedure before implementation of the NOP protocol. RESULTS There was no significant difference in demographic and perioperative characteristics between the two groups. Patients included in the NOP protocol received a much lower dose of postoperative morphine milligram equivalents (2.5 [IQR: 0-23] vs. 44 [14.5-128], P < 0.001), with no difference in pain scores. In the NOP protocol, the median time to regular diet was significantly shorter (4days [IQR: 3-5] vs. 5days [IQR: 4-8], P = 0.002) and the length of stay was 2days shorter compared to the control group (5days [IQR: 4-7] vs. 7days [IQR: 6-11], P < 0.001). When evaluating the direct costs within 30days after initial surgery, the NOP protocol was associated with an 8.6% reduction as compared to the control group (P = 0.032). In multivariate analysis, the receipt of the NOP protocol was a significant predictor of a length of stay <7days after RARC (OR: 12.09; 95% CI: 1.70-140; P = 0.023). CONCLUSIONS The prospective implementation of a NOP protocol for patients undergoing RARC is feasible, allowing for minimal narcotic usage and provides benefits to patients, institutions, and population.
Collapse
Affiliation(s)
- François Audenet
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kyrollis Attalla
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Morgane Giordano
- Department of Anesthesia, Perioperative and Pain Medicine, Icahn school of Medicine at Mount Sinai, New York, NY
| | - John Pfail
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marc A Lubin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nikhil Waingankar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel Gainsburg
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Anesthesia, Perioperative and Pain Medicine, Icahn school of Medicine at Mount Sinai, New York, NY
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alan Sim
- Department of Anesthesia, Perioperative and Pain Medicine, Icahn school of Medicine at Mount Sinai, New York, NY
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
| |
Collapse
|
16
|
Pike LRG, Wu J, Chen MH, Loffredo M, Renshaw AA, Pfail J, Kantoff PW, D'Amico AV. Time to Prostate-specific Antigen Nadir and the Risk of Death From Prostate Cancer Following Radiation and Androgen Deprivation Therapy. Urology 2019; 126:145-151. [PMID: 30664895 DOI: 10.1016/j.urology.2018.11.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/25/2018] [Accepted: 11/20/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether the time to prostate-specific antigen (PSA) nadir (TTN) has differential prognostic value in men who reach an undetectable vs detectable PSA nadir. METHODS Two hundred and four men from a prospective randomized controlled trial involving radiation therapy with or without 6 months of androgen deprivation therapy in unfavorable risk Prostate cancer (CaP) at academic or community based centers in Massachusetts, enrolled between 1995 and 2001. Adjusted hazard ratios (AHR) of the risk of CaP-specific mortality calculated using Fine and Gray competing risk regression. RESULTS After a median follow-up of 18.17years, 160 men died; 30 (18.75%) of CaP. Among men with a PSA nadir ≥ 0.2ng/ml, a TTN < median (12 months) was significantly associated with an increased CaP-specific mortality-risk vs the median or more (AHR 5.07, 95% CI 2.10-12.23, P <.001); whereas this association was not observed among men with a PSA nadir of < 0.2ng/mL, (AHR 9.9, 95% CI 0.23-433.8, P = .23). CONCLUSION Men with both a short TTN and detectable PSA nadir could be considered for entry on randomized controlled trials at a novel entry point prior to PSA failure at the time of PSA nadir to completeplanned conventional androgen deprivation therapy vs that plus agent(s) shown to improve outcomes in men with or at high risk of having castrate-resistant CaP.
Collapse
Affiliation(s)
- Luke R G Pike
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA.
| | - Jing Wu
- Department of Computer Science and Statistics, University of Rhode Island, South Kingstown, RI
| | - Ming-Hui Chen
- Department of Statistics, University of Connecticut, Storrs, CT
| | - Marian Loffredo
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - Andrew A Renshaw
- Department of Pathology, Baptist Hospital and Miami Cancer Institute, Miami, Florida
| | - John Pfail
- Mount Sinai School of Medicine, New York, NY
| | - Philip W Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anthony V D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| |
Collapse
|
17
|
Pentyala S, Whyard T, Pentyala S, Muller J, Pfail J, Parmar S, Helguero CG, Khan S. Prostate cancer markers: An update. Biomed Rep 2016; 4:263-268. [PMID: 26998261 DOI: 10.3892/br.2016.586] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 01/22/2016] [Indexed: 12/17/2022] Open
Abstract
As the most common noncutaneous malignancy in American men, prostate cancer currently accounts for 29% of all diagnosed cancers, and ranks second as the cause of cancer fatality in American men. Prostatic cancer is rarely symptomatic early in its course and therefore disease presentation often implies local extension or even metastatic disease. Thus, it is extremely critical to detect and diagnose prostate cancer in its earliest stages, often prior to the presentation of symptoms. Three of the most common techniques used to detect prostate cancer are the digital rectal exam, the transrectal ultrasound, and the use of biomarkers. This review presents an update regarding the field of prostate cancer biomarkers and comments on future biomarkers. Although there is not a lack of research in the field of prostate cancer biomarkers, the discovery of a novel biomarker that may have the advantage of being more specific and effective warrants future scientific inquiry.
Collapse
Affiliation(s)
- Srinivas Pentyala
- Department of Anesthesiology, Stony Brook Medical Center, Stony Brook, NY 11794, USA; Department of Urology, Stony Brook Medical Center, Stony Brook, NY 11794, USA; Department of Health Sciences, Stony Brook Medical Center, Stony Brook, NY 11794, USA; Department of Physiology, Stony Brook Medical Center, Stony Brook, NY 11794, USA
| | - Terry Whyard
- Department of Urology, Stony Brook Medical Center, Stony Brook, NY 11794, USA
| | - Sahana Pentyala
- Department of Anesthesiology, Stony Brook Medical Center, Stony Brook, NY 11794, USA
| | - John Muller
- Department of Anesthesiology, Stony Brook Medical Center, Stony Brook, NY 11794, USA
| | - John Pfail
- Department of Anesthesiology, Stony Brook Medical Center, Stony Brook, NY 11794, USA
| | - Sunjit Parmar
- Department of Anesthesiology, Stony Brook Medical Center, Stony Brook, NY 11794, USA
| | - Carlos G Helguero
- Department of Anesthesiology, Stony Brook Medical Center, Stony Brook, NY 11794, USA
| | - Sardar Khan
- Department of Urology, Stony Brook Medical Center, Stony Brook, NY 11794, USA; Department of Physiology, Stony Brook Medical Center, Stony Brook, NY 11794, USA
| |
Collapse
|
18
|
Lehrer S, Montazem A, Ramanathan L, Pessin-Minsley M, Pfail J, Stock RG, Kogan R. Bisphosphonate-Induced Osteonecrosis of the Jaws, Bone Markers, and a Hypothesized Candidate Gene. J Oral Maxillofac Surg 2009; 67:159-61. [DOI: 10.1016/j.joms.2008.09.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 09/06/2008] [Indexed: 11/28/2022]
|
19
|
Lehrer S, Montazem A, Ramanathan L, Pessin-Minsley M, Pfail J, Stock RG, Kogan R. Normal serum bone markers in bisphosphonate-induced osteonecrosis of the jaws. ACTA ACUST UNITED AC 2008; 106:389-91. [DOI: 10.1016/j.tripleo.2008.01.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 12/21/2007] [Accepted: 01/20/2008] [Indexed: 10/21/2022]
|