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Hebert KJ, Findlay BL, Yang DY, Houlihan MD, Bole R, Avant RA, Andrews JR, Jimbo M, Ziegelmann MJ, Helo S, Köhler TS. Incidence of Venous Thromboembolism and Safety of Perioperative Subcutaneous Heparin During Inflatable Penile Prosthesis Surgery. Urology 2021; 157:155-160. [PMID: 34411598 DOI: 10.1016/j.urology.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/14/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify the incidence of venous thromboembolism (VTE) risk factors, postoperative VTE, and to assess the morbidity of perioperative pharmacologic VTE prophylaxis in men undergoing inflatable penile prosthesis (IPP) surgery. METHODS We retrospectively reviewed 215 patients undergoing IPP surgery between July 2017 and June 2019. Univariate and multivariate statistical analyzes were performed to assess pre-operative Caprini risk score and compare post-operative day 0 scrotal drain output, scrotal hematoma formation, and VTE in men who received subcutaneous heparin (SqH) vs those who did not receive SqH. RESULTS Of 215 IPP patients, 84% were classified as high or highest risk for VTE utilizing the Caprini risk score. A total of 119 (55%) received perioperative SqH with or without additional anti-thrombotics. Post-operative day 0 scrotal drain output was higher in those who received SqH compared to those who did not receive SqH, 99.9 mL vs 75.6 mL, respectively (P = .001). Minor scrotal hematomas occurred in similar rates in patients who received perioperative SqH vs those who did not, 3.8% vs 6.3%, respectively (P = .38). Similar results were found on subgroup analysis when eliminating patients who received SqH concurrently with other anti-thrombotics. The overall rate of postoperative VTE was 0.9%. No post-operative infections occurred. CONCLUSION Patients undergoing IPP surgery are at elevated risk for VTE. To our knowledge, this is the first study showing SqH use in the perioperative IPP surgery setting is safe when used in conjunction with a scrotal drain. Preoperative VTE risk stratification may be performed and can be used to guide clinical decision making regarding pharmacologic prophylaxis.
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Affiliation(s)
| | | | - David Y Yang
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Raevti Bole
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Ross A Avant
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Masaya Jimbo
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Sevan Helo
- Department of Urology, Mayo Clinic, Rochester, MN
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Stroie FA, Houlihan MD, Kohler TS. Sexual function in the penile cancer survivor: a narrative review. Transl Androl Urol 2021; 10:2544-2553. [PMID: 34295742 PMCID: PMC8261429 DOI: 10.21037/tau-20-1228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/02/2021] [Indexed: 11/06/2022] Open
Abstract
Squamous cell carcinoma of the penis is a rare malignancy among men in North America and Europe with an incidence of <1 per 100,00 men. Of all genitourinary cancers, penile carcinoma has the potential to jeopardize sexual function the most. The treatment modalities of penile carcinoma span the gamut from organ-sparing treatments such as topical therapy, laser therapy, radiotherapy, glansectomy, wide-local excision and partial or total penectomy. There is a relative paucity of data in the medical literature describing the impact of penile cancer treatment on sexual function. The majority of available studies use retrospective data from small samples utilizing heterogeneous study tools such as patient interviews and non-validated questionnaires. The most commonly used validated instrument to evaluate sexual outcomes is the International Index of Erectile Function Questionnaire (IIEF), but is limited in that it does not assess patients who perform self-stimulation or achieve sexual stimulation by any means other than penetrative intercourse. Though advances in clinical research continue; large, well-designed comparative studies using validated instruments are elusive. The sexual outcomes after penile cancer are reviewed from the available published data to better assist the patient and the treating physician with medical decision making. With a detailed assessment of sexual outcomes, the physician is better equipped in providing patient centered care to achieve outcomes meaningful for each patient.
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Affiliation(s)
- Florian A Stroie
- Department of Surgery, Division of Urology, Cook County Health, Chicago, IL, USA
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Fakhoury MQ, Ghorayeb AM, Houlihan MD, Powers RJ, Hurley S, Wille MA, Freeman VL, Kim K, Psutka SP, Vidal P, Hollowell CM. Predictive Risk Factors for Continued Smoking after the Diagnosis of a Genitourinary Malignancy. Urology 2020; 147:178-185. [PMID: 32663556 DOI: 10.1016/j.urology.2020.05.089] [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: 03/28/2020] [Revised: 05/09/2020] [Accepted: 05/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine risk factors for continued smoking following a diagnosis of a genitourinary (GU) malignancy. Smoking is a well established risk factor in the development of cancers involving the GU tract. Unfortunately, a large percentage of patients continue to smoke or relapse after cancer diagnosis; by doing so, there is an increased risk of recurrence, poor survival rates, treatment complications, secondary primary cancers, and other chronic smoking related illnesses. MATERIALS AND METHODS Two hundred and five patients who presented to a Urologic Oncology clinic at a single tertiary treatment center were given smoking cessation counseling and pharmacotherapy, as well as a questionnaire which was used to identify smoking status, demographics, and behavioral/psychosocial characteristics. Patients were followed for a minimum of 1 year with a median length of follow up for 13 months. RESULTS 91% of patients enrolled in the study continued smoking at survey completion. After accounting for age, ethnicity, education and cigarettes consumed/day, 5 variables were independently associated with an increased risk of continued smoking: smoking 20 or more cigarettes per day, less than 2 prior quit attempts, anxiety and/or depression, fear of cancer recurrence, and home secondhand smoke exposure. CONCLUSION The role of the urologist is imperative for encouraging smoking cessation. While every patient should receive adequate counseling regarding smoking at the time of a GU malignancy diagnosis, identifying patients with the risk factors noted in this study and augmenting smoking cessation efforts may result in stronger efforts to quit and prevention of long-term complications.
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Affiliation(s)
- Mathew Q Fakhoury
- Division of Urology, Cook County Hospital, Cook County Health and Hospitals System, Chicago, IL
| | - Antoine M Ghorayeb
- Division of Urology, Cook County Hospital, Cook County Health and Hospitals System, Chicago, IL.
| | - Matthew D Houlihan
- Division of Urology, Cook County Hospital, Cook County Health and Hospitals System, Chicago, IL
| | - Ryan J Powers
- Division of Urology, Cook County Hospital, Cook County Health and Hospitals System, Chicago, IL
| | - Stephen Hurley
- Division of Urology, Cook County Hospital, Cook County Health and Hospitals System, Chicago, IL
| | - Mark A Wille
- Division of Urology, Cook County Hospital, Cook County Health and Hospitals System, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Vincent L Freeman
- School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Kyeezu Kim
- School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Sarah P Psutka
- Division of Urology, Cook County Hospital, Cook County Health and Hospitals System, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Patricia Vidal
- Division of Urology, Cook County Hospital, Cook County Health and Hospitals System, Chicago, IL
| | - Courtney Mp Hollowell
- Division of Urology, Cook County Hospital, Cook County Health and Hospitals System, Chicago, IL
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Stroie FA, Hasan OM, Houlihan MD, McArdle BJ, Hollowell CMP, Blumetti J, Vidal PP, Psutka SP. Low diagnostic sensitivity of cystoscopy and cystography of surgically confirmed vesicoenteric fistulae. Int Urol Nephrol 2020; 52:1203-1208. [PMID: 32100206 DOI: 10.1007/s11255-020-02409-x] [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: 11/27/2019] [Accepted: 02/09/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The objective of this study was to assess the accuracy of cystoscopy and cystography, as compared to other diagnostic studies, in identifying vesicoenteric fistulae (VEF) in a contemporary series of patients with surgically confirmed VEF. METHODS With institutional review board approval, we performed a single-center retrospective review of surgically confirmed VEF between 2002 and 2018. Demographic data, comorbidities, symptoms, and diagnostic evaluation were reviewed. The sensitivity, specificity, and accuracy of cystoscopy in diagnosis of VEF were compared to cross-sectional imaging. RESULTS The study cohort consisted of 51 patients with surgically confirmed VEF secondary to diverticular disease. Diagnostic evaluation included cross-sectional imaging with CT (94%), colonoscopy (82%), cystoscopy (75%), cystography (53%), and barium enema (26%). Cystoscopic evaluation definitively demonstrated evidence of VEF in 34% of patients, while 55% of patients had nonspecific urothelial changes on cystoscopy without definitively demonstrating VEF. Comparatively, the sensitivity of VEF was 25% for cystography and 84% for CT. CONCLUSIONS In clinical practice, the diagnostic work-up of VEF is variable. In the modern era of managed care, inclusion of cystoscopy and cystography in the evaluation of VEF does not contribute a substantial additive benefit over standard cross-sectional imaging. Cystoscopy and cystography could potentially be eliminated from the diagnostic evaluation of VEF, in the absence of a concern for malignancy, in an effort to minimize unnecessary invasive testing as well as health care expenditures.
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Affiliation(s)
- Florian A Stroie
- Division of Urology, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Osamah M Hasan
- Division of Urology, Cook County Health and Hospitals System, Chicago, IL, USA. .,Midwestern University Chicago College of Medicine, 555 31st Street, Downers Grove, IL, USA.
| | - Matthew D Houlihan
- Division of Urology, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Brian J McArdle
- Division of Urology, Cook County Health and Hospitals System, Chicago, IL, USA
| | | | - Jennifer Blumetti
- Division of Colorectal Surgery, Department of Surgery, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Patricia P Vidal
- Division of Urology, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Sarah P Psutka
- Division of Urology, Cook County Health and Hospitals System, Chicago, IL, USA.,Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Houlihan MD, Köhler TS, Wilson SK, Hatzichristodoulou G. Penoscrotal approach for IPP: still up-to-date after more than 40 years? Int J Impot Res 2019; 32:2-9. [DOI: 10.1038/s41443-019-0206-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/10/2019] [Accepted: 08/13/2019] [Indexed: 11/09/2022]
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Houlihan MD, Bowyer BA, Barclay RL. Resolution of pancreatico-pleural fistula with endoscopic ultrasound-guided therapy. Respir Med Case Rep 2013; 9:30-3. [PMID: 26029626 PMCID: PMC3949552 DOI: 10.1016/j.rmcr.2013.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 05/01/2013] [Accepted: 05/06/2013] [Indexed: 01/10/2023] Open
Abstract
Pancreatico-pleural fistula is an uncommon cause of recurrent pleural effusion. Delayed diagnosis may occur if fluid amylase level is not obtained early in the clinical course. As most cases of pancreatico-pleural effusion are due to chronic pancreatitis, endoscopic therapy may be effective if pancreatic fluid secretion can be diverted to a more physiologic pathway. However, when severe pancreatitis leads to disconnection of the pancreatic duct, it precludes conventional endoscopic treatment via transpapillary stenting of the pancreatic duct. We describe a patient with a chronic, refractory pancreatico-pleural fistula arising from chronic pancreatitis with a disconnected pancreatic duct syndrome, which resolved following endoscopic ultrasound-guided therapy.
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Affiliation(s)
- M D Houlihan
- University of Illinois College of Medicine at Rockford, USA
| | - B A Bowyer
- University of Illinois College of Medicine at Rockford, USA ; Rockford Gastroenterology Associates, Ltd., 401 Roxbury Road, Rockford, IL 61107-5078, USA
| | - R L Barclay
- University of Illinois College of Medicine at Rockford, USA ; Rockford Gastroenterology Associates, Ltd., 401 Roxbury Road, Rockford, IL 61107-5078, USA
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