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Wagaskar VG, Zaytoun O, Bhardwaj S, Tewari A. 'Stealth' Prostate Tumors. Cancers (Basel) 2023; 15:3487. [PMID: 37444597 DOI: 10.3390/cancers15133487] [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: 02/25/2023] [Revised: 04/21/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The aim of this study was to determine the false negative rates of prebiopsy magnetic resonance imaging (MRI) and MRI-ultrasound (US) 12-core systematic prostate biopsy (PBx) by analyzing radical prostatectomy specimens. METHODS This retrospective study included 3600 prostate cancer (PCa) patients who underwent robot-assisted laparoscopic radical prostatectomy. Based on comparison of lobe-specific data on final pathology with preoperative biopsy and imaging data, the study population was subdivided into group I-contralateral (CL) benign PBx (n = 983), group II-CL and/or bilateral (BL) non-suspicious mpMRI (n = 2223) and group III-CL benign PBx + non-suspicious mpMRI (n = 688). This population was studied for the presence of PCa, clinically significant PCa (csPCa), extracapsular extension (ECE) (pathological stage pT3), positive frozen section and final positive surgical margin (PSM) in the CL lobe. Descriptive statistics were performed. RESULTS In subgroups I, II and III, PCa was respectively detected in 21.5%, 37.7% and 19.5% of cases, and csPCa in 11.3%, 16.3% and 10.3% of cases. CL pT3 disease was seen in 4.5%, 4% and 5.5%, and CL surgical margins and/or frozen section analysis were positive in 6%, 7% and 5% of cases in subgroups I, II and III, respectively. CONCLUSIONS There are still significant rates of false negatives in the standard care diagnostics of PCa. Further strategies are required to improve the accuracy of diagnosis and determination of tumor location.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
| | - Osama Zaytoun
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
- Urology Department, Alexandria University, Alexandria 21113, Egypt
| | - Swati Bhardwaj
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
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Wagaskar VG, Zaytoun O, Kale P, Pedraza A, Haines K, Tewari A. Robot-assisted simple prostatectomy for prostates greater than 100 g. World J Urol 2023; 41:1169-1174. [PMID: 36929409 DOI: 10.1007/s00345-023-04326-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/30/2022] [Indexed: 03/18/2023] Open
Abstract
PURPOSE Efforts are ongoing to treat severe benign prostatic hyperplasia as traditional endoscopic treatment options are often difficult to perform and associated with significant complications. This manuscript highlights our initial experience of robot-assisted simple prostatectomy [RASP] with minimum a year follow-up. We also compared our outcomes with published literature. METHODS After an Institution Review Board approval, we gathered data of 50 cases of RASP between Jan 2014 and May 2021. Patients with prostate volume > 100 cc [calculated from magnetic resonance imaging (MRI)] and prostate biopsy confirmed benign prostate were candidates for RASP. Patients underwent RASP via transperitoneal route either by suprapubic or trans-vesical approach. Preoperative demographics, peri-operative parameters and post-operative parameters such as hospital stay, catheter removal, urinary continence and uroflow were recorded in standard database and presented as descriptive statistics. RESULTS Patients presented with a baseline median International Prostate Symptom Score (IPSS) of 23 (inter-quartile range (IQR) 21,25) and a median PSA of 7.7 ng/ml (IQR 6.4,8.7). Median preoperative prostate volume was 167 ml (IQR, 136,198 ml). Median console time was 118 min, and median estimated blood loss was 148 ml (IQR 130, 167 ml). None of our cohort needed intraoperative transfusion, conversion to open surgery or developed any complications. Median time to Foley removal was 10 days (IQR 8,12). Significant drop in the IPSS score and improvement in Qmax was noted over the period of follow-up. CONCLUSION RASP is associated with considerable improvements in urinary symptoms. However, comparative studies with endoscopic treatment options of large prostatic adenomas are warranted and ideally include cost analysis of different procedures.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, 10029, USA
| | - Osama Zaytoun
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, 10029, USA.,Department of Urology, Alexandria, Egypt
| | - Priyanka Kale
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, 10029, USA
| | - Adriana Pedraza
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, 10029, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY, 10029, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, 10029, USA.
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Wagaskar VG, Levy M, Ratnani P, Sullimada S, Gerenia M, Schlussel K, Choudhury S, Gabriele M, Haas I, Haines K, Tewari A. Cover Image. Cancer Rep (Hoboken) 2023. [DOI: 10.1002/cnr2.1785] [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: 01/26/2023] Open
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Wagaskar VG, Lantz A, Sobotka S, Ratnani P, Parekh S, Falagario UG, Li L, Lewis S, Haines Iii K, Punnen S, Wiklund P, Tewari A. Development and External Validation of a Prediction Model to Identify Candidates for Prostate Biopsy. Urol J 2022; 19:379-385. [PMID: 34978065 DOI: 10.22037/uj.v18i.6852] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Prostate biopsies are associated with infectious complications and approximately 80% are either benign or clinically insignificant prostate cancer. Our aim is to develop and independently validate prediction model to avoid unnecessary prostate biopsies by predicting clinically significant prostate cancer (csPCa) Materials and Methods: Retrospective analysis of single-center cohort (Mount Sinai Hospital, NY) of 1632 men who underwent systematic or combined systematic and Magnetic Resonance Imaging (MRI)/ultrasound fusion targeted prostate biopsy between 2014-2020. External cohort (University of Miami) included 622 men that underwent biopsy. Outcome for predicting csPCa was defined as International Society of Urologic Pathology (ISUP) Gleason grade ≥ 2 on biopsy. Multivariable logistic regression analysis was performed to build nomogram using coefficients of logit function. Nomogram validation was performed in external cohort by plotting receiver operating characteristics (ROC). We also plotted decision curve analysis (DCA) and compared nomogram-predicted probabilities with actual rates of csPCa probabilities in external cohort. RESULTS Of 1632 men, 43% showed csPCa on biopsy. PSA density, prior negative biopsy, and Prostate Imaging and Reporting Data System (PI-RADS) scores 3, 4, and 5 were significant predictors for csPCa. ROC for prediction of csPCa was 0.88 in external cohort. There was agreement between predicted and actual rate of csPCa in external cohort. DCA demonstrated net benefit using the model. Using the prediction model at threshold of 30, 35% of biopsies and 46% of diagnosed indolent PCa could be avoided, while missing 5% of csPCa. CONCLUSION Using our prediction model can help reduce unnecessary prostate biopsies with minimal impact on csPCa detection rates.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Anna Lantz
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Ugo Giovanni Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Li Li
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Kenneth Haines Iii
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Sanoj Punnen
- Department of Urology, University of Miami, Miller School of Medicine, Miami, USA.
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
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Wagaskar VG, Levy M, Ratnani P, Sullimada S, Gerenia M, Schlussel K, Choudhury S, Gabriele M, Haas I, Haines K, Tewari A. A SelectMDx/magnetic resonance imaging-based nomogram to diagnose prostate cancer. Cancer Rep (Hoboken) 2022; 6:e1668. [PMID: 36168681 PMCID: PMC9875685 DOI: 10.1002/cnr2.1668] [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: 09/22/2021] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND 70%-80% of prostate cancer (PCa) biopsies performed in the US annually may be unnecessary. Specific antigen testing (PSA) and tans rectal ultrasound (TRUS) are imprecise predictive methods for risk of PCa. Novel strategies are critical to guide biopsy decision-making. AIM We assessed the utility and accuracy of combining Select MDx and multiparametric magnetic resonance imaging (mpMRI) scores for predicting risk of PCa. METHODS AND RESULTS Our study was conducted at Mount Sinai hospital at Urology department in New York City from January 2020 to April 2021. Total 129 men performed select MDx test. Indications for prostate biopsy were high-risk Select MDx score, suspicious DRE, PI-RADS scores 3/4/5 on mpMRI, or any combination of these. Fifty-one percentage of 129 patients underwent systemic or combined systemic and MRI/US (ultrasound) fusion biopsy; All men underwent 3 T MRI of Prostate w/wo contrast using standard protocols prior to biopsy. A single surgeon performed prostate biopsies. Gleason score ≥3 + 3 on biopsy is defined as outcome. Descriptive statistics were calculated as cross tables. Binary logistic regression model is used to determine the outcome. The nomogram was based on the coefficients of the logit function. ROCs were plotted and decision curve analysis was performed. Using both high-risk Select MDx and PI-RADS scores of 4/5, 87% of biopsies could have been avoided, while detecting 64% of PCa and missing 36%. If biopsies were performed on men with positive Select MDx or PI-RADS 4/5 results, 16% of biopsies could have been avoided while detecting all PCa. Combining these scores improved specificity and accuracy for the detection of PCa over either used alone. Study limitations include limited sample size, sole institution study, and risk or overfitting for the proposed model which may limit generalizability. CONCLUSION Combining SelectMDx and mpMRI PI-PADS scores of 4/5 may be useful for PCa biopsy decision-making.
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Affiliation(s)
- Vinayak G. Wagaskar
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Micah Levy
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Parita Ratnani
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Sharmila Sullimada
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Mae Gerenia
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Kacie Schlussel
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Samia Choudhury
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Marla Gabriele
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Ian Haas
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Kenneth Haines
- Department of PathologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Ash Tewari
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
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Nasri J, Barthe F, Parekh S, Ratnani P, Pedraza AM, Wagaskar VG, Olivier J, Villers A, Tewari A. Nomogram predicting adverse pathology outcome on radical prostatectomy in low-risk prostate cancer men. Urology 2022; 166:189-195. [DOI: 10.1016/j.urology.2022.02.019] [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: 12/15/2021] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 10/18/2022]
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Wagaskar VG, Sobotka S, Ratnani P, Young J, Lantz A, Parekh S, Falagario UG, Li L, Lewis S, Haines K, Punnen S, Wiklund P, Tewari A. Cover Image. Cancer Rep (Hoboken) 2021. [DOI: 10.1002/cnr2.1529] [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: 11/07/2022] Open
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Wagaskar VG, Ratnani P, Levy M, Moody K, Garcia M, Pedraza AM, Parekh S, Pandav K, Shukla B, Sobotka S, Haines K, Wiklund P, Tewari A. Clinical characteristics and oncological outcomes in negative multiparametric MRI patients undergoing robot-assisted radical prostatectomy. Prostate 2021; 81:772-777. [PMID: 34057211 DOI: 10.1002/pros.24174] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/21/2021] [Accepted: 05/23/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Efforts are ongoing to try and find ways to reduce the number of unnecessary prostate biopsies without missing clinically significant prostate cancers (csPCa). The utility of multiparametric magnetic resonance imaging (mpMRI) in detecting prostate cancer (PCa) shows promise to be used as triage test for systematic prostate biopsy. Our aim is to Study clinical parameters and oncological outcomes in men with negative mpMRI (nMRI; PI-RADS v2 scores of ≤ 2) who underwent robot-assisted radical prostatectomy (RARP) to evaluate nMRI's practicality as a biopsy triage test. METHODS Retrospective analysis of 331 men with nMRI who underwent RARP between 2014 and 2020 compared with men with positive mpMRI (pMRI; PI-RADS v2 scores ≥ 3, N = 1770). csPCa was defined as Gleason score ≥ 3 + 4 and biochemical recurrence (BCR) was defined as PSA > 0.2 ng/ml on two occasions. Biopsies were graded with the International Society of Urologic Pathology [ISUP] grade. Descriptive statistics for nMRI and pMRI were performed. Mann-Whitney U test was used for continuous variables and χ 2 for categorical variables. Univariable and multivariable regression analyses were performed. RESULTS Univariable analysis shows statistically significant difference (p < .05) between median age (nMRI-61 years vs. pMRI 63 years), race (higher incidence of nMRI in African American men), use of 5-alpha reductase inhibitors (higher rate in nMRI). While incidence rates of family history of PCa, suspicious digital rectal examination (DRE) findings, median PSA levels and 4Kscore, were lower in nMRI versus pMRI. Rates of positive surgical margins and BCR were comparable in nMRI versus pMRI. Biopsy ISUP Grades I and II upgraded by 51% and 12%, respectively in final pathology. African American race and no history of the prior negative biopsy were significant predictors for upgrading. CONCLUSION Men with nMRI pose diagnostic challenges as they tend to be younger patients with lower rates of suspicious DRE findings and lower 4K scores, yet comparable oncological outcomes in csPCa rates, positive surgical margins, and BCR rates.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Micah Levy
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Kate Moody
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Mariely Garcia
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Adriana M Pedraza
- Department of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Krunal Pandav
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Bhavya Shukla
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
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Wagaskar VG, Levy M, Ratnani P, Moody K, Garcia M, Pedraza AM, Parekh S, Pandav K, Shukla B, Prasad S, Sobotka S, Haines K, Punnen S, Wiklund P, Tewari A. Clinical Utility of Negative Multiparametric Magnetic Resonance Imaging in the Diagnosis of Prostate Cancer and Clinically Significant Prostate Cancer. EUR UROL SUPPL 2021; 28:9-16. [PMID: 34337520 PMCID: PMC8317880 DOI: 10.1016/j.euros.2021.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
Background Multiparametric magnetic resonance imaging (MRI) is increasingly used to diagnose prostate cancer (PCa). It is not yet established whether all men with negative MRI (Prostate Imaging-Reporting and Data System version 2 score <3) should undergo prostate biopsy or not. Objective To develop and validate a prediction model that uses clinical parameters to reduce unnecessary prostate biopsies by predicting PCa and clinically significant PCa (csPCa) for men with negative MRI findings who are at risk of harboring PCa. Design setting and participants This was a retrospective analysis of 200 men with negative MRI at risk of PCa who underwent prostate biopsy (2014-2020) with prostate-specific antigen (PSA) >4 ng/ml, 4Kscore of >7%, PSA density ≥0.15 ng/ml/cm3, and/or suspicious digital rectal examination. The validation cohort included 182 men from another centre (University of Miami) with negative MRI who underwent systematic prostate biopsy with the same criteria. Outcome measurements and statistical analysis csPCa was defined as Gleason grade group ≥2 on biopsy. Multivariable logistic regression analysis was performed using coefficients of logit function for predicting PCa and csPCa. Nomogram validation was performed by calculating the area under receiver operating characteristic curves (AUC) and comparing nomogram-predicted probabilities with actual rates of PCa and csPCa. Results and limitations Of 200 men in the development cohort, 18% showed PCa and 8% showed csPCa on biopsy. Of 182 men in the validation cohort, 21% showed PCa and 6% showed csPCa on biopsy. PSA density, 4Kscore, and family history of PCa were significant predictors for PCa and csPCa. The AUC was 0.80 and 0.87 for prediction of PCa and csPCa, respectively. There was agreement between predicted and actual rates of PCa in the validation cohort. Using the prediction model at threshold of 40, 47% of benign biopsies and 15% of indolent PCa cases diagnosed could be avoided, while missing 10% of csPCa cases. The small sample size and number of events are limitations of the study. Conclusions Our prediction model can reduce the number of prostate biopsies among men with negative MRI without compromising the detection of csPCa. Patient summary We developed a tool for selection of men with negative MRI (magnetic resonance imaging) findings for prostate cancer who should undergo prostate biopsy. This risk prediction tool safely reduces the number of men who need to undergo the procedure.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Micah Levy
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Kate Moody
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Mariely Garcia
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Adriana M Pedraza
- Department of Urology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogota, Colombia
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Krunal Pandav
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Bhavya Shukla
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sonya Prasad
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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Wagaskar VG, Sobotka S, Ratnani P, Young J, Lantz A, Parekh S, Falagario UG, Li L, Lewis S, Haines K, Punnen S, Wiklund P, Tewari A. A 4K score/MRI-based nomogram for predicting prostate cancer, clinically significant prostate cancer, and unfavorable prostate cancer. Cancer Rep (Hoboken) 2021; 4:e1357. [PMID: 33661541 PMCID: PMC8388161 DOI: 10.1002/cnr2.1357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/18/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background The detection of prostate cancer requires histological confirmation in biopsy core. Currently, number of unnecessary prostate biopsies are being performed in the United States. This is due to the absence of appropriate biopsy decision‐making protocol. Aim To develop and validate a 4K score/multiparametric magnetic resonance imaging (mpMRI)‐based nomogram to predict prostate cancer (PCa), clinically significant prostate cancer (csPCa), and unfavorable prostate cancer (uPCa). Methods and Results Retrospective, single‐center study evaluating a cohort of 574 men with 4K score test >7% or suspicious digital rectal examination (DRE) or Prostate Imaging Reporting and Data System (PI‐RADS) scores 3, 4, or 5 on mpMRI that underwent systematic and/or mpMRI/ultrasound fusion–targeted prostate biopsy between 2016 and 2020. External cohort included 622 men. csPCa and uPCa were defined as Gleason score ≥3 + 4 and ≥4 + 3 on biopsy, respectively. Multivariable logistic regression analysis was performed to build nomogram for predicting PCa, csPCa, and uPCa. Validation was performed by plotting the area under the curve (AUC) and comparing nomogram‐predicted probabilities with actual rates of PCa, csPCa, and uPCa probabilities in the external cohort. 4K score, a PI‐RADS ≥4, prostate volume and prior negative biopsy were significant predictors of PCa, csPCa, and uPCa. AUCs were 0.84, 0.88, and 0.86 for the prediction of PCa, csPCa, and uPCa, respectively. The predicted and actual rates of PCa, csPCa, and uPCa showed agreement across all percentage probability ranges in the validation cohort. Using the prediction model at threshold of 30, 30% of overall biopsies, 41% of benign biopsies, and 19% of diagnosed indolent PCa could be avoided, while missing 9% of csPCa. Conclusion This novel nomogram would reduce unnecessary prostate biopsies and decrease detection of clinically insignificant PCa.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - James Young
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Anna Lantz
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Ugo Giovanni Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Li Li
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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Wagaskar VG, Mittal A, Sobotka S, Ratnani P, Lantz A, Falagario UG, Martini A, Dovey Z, Treacy PJ, Pathak P, Nair S, Roy B, Chakravarty D, Lewis S, Haines K, Wiklund P, Tewari A. Hood Technique for Robotic Radical Prostatectomy-Preserving Periurethral Anatomical Structures in the Space of Retzius and Sparing the Pouch of Douglas, Enabling Early Return of Continence Without Compromising Surgical Margin Rates. Eur Urol 2020; 80:213-221. [PMID: 33067016 DOI: 10.1016/j.eururo.2020.09.044] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [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: 06/24/2020] [Accepted: 09/21/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND A common side effect following radical prostatectomy is urinary incontinence. Here, we describe a novel surgical technique to reduce postoperative urinary incontinence and facilitate early return of continence. OBJECTIVE To describe the novel "hood technique" for robotic-assisted radical prostatectomy (RARP). DESIGN, SETTING, AND PARTICIPANTS This is an institutional review board-approved prospective study of 300 patients (median age 64 yr) with localized prostate cancer treated with the RARP hood technique at a major urban hospital between April 2018 and March 2019. The exclusion criteria were as follows: patients with anterior tumor location based on biopsy or multiparametric magnetic resonance imaging. All but one patient participated in follow-up over 12 mo after the procedure. SURGICAL PROCEDURE The RARP "hood technique" was performed to preserve the detrusor apron, puboprostatic ligament complex, arcus tendineus, endopelvic fascia, and pouch of Douglas. MEASUREMENTS Clinical data collected included pre- and intraoperative variables, and postoperative functional and oncological outcomes and complications. Descriptive statistical analysis was performed. RESULTS AND LIMITATIONS Continence rates at 1, 2, 4, 6 12, 24, and 48 wk after catheter removal were 21%, 36%, 83%, 88%, 91%, 94%, and 95%, respectively. Positive surgical margin rate was 6%. Thirty patients (9.7%) experienced complications after RARP: 17 (5.7%), 11 (3.6%), and one (0.4%) had Clavien-Dindo grade I, II, and III complications, respectively. This study was conducted within a single health system and may not be generalizable. The study lacked randomization and a comparative arm. CONCLUSIONS Results indicate that the hood technique spares musculofascial structures anterior to the urethral sphincter complex with early return of continence after surgery, without compromising positive surgical margin rates. Exclusion of anterior tumor location contributed to a reduction in positive surgical margins. PATIENT SUMMARY By better preservation of anatomical structures around the urethra, we were able to achieve early return of urinary continence without a negative impact on complications and cancer outcomes.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Ankur Mittal
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, India
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Anna Lantz
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Ugo Giovanni Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Zach Dovey
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Patrick-Julien Treacy
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Prachee Pathak
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Suit Nair
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Berryhill Roy
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Dimple Chakravarty
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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Gupta SS, Martini A, Wagaskar VG, Tewari AK. Prostate Cancer in a Patient with Giant Prostatic Hyperplasia: The Robotic Approach to a Difficult Problem. J Endourol Case Rep 2019; 5:99-101. [PMID: 32775637 DOI: 10.1089/cren.2019.0024] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The robotic approach toward radical prostatectomy for prostate cancer has only recently become widespread. Two of the advantages of the robotic approach have been described to be the optical magnification afforded by camera and the ability to reach deep into the pelvis. These advantages are particularly salient in cases where the pelvis is particularly narrow or the prostate is particularly large. In this report, we describe the management of a patient with two simultaneous prostatic diseases: prostate cancer and a massive prostate weighing 560 g causing urinary retention and hematuria, who underwent robot-assisted radical prostatectomy for prostate removal. To the best of our knowledge, this is the largest prostate to be removed through the means of robot-assisted surgery.
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Affiliation(s)
- Sarina S Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
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Maheshwari PN, Wagaskar VG, Maheshwari RP. Comparison of the efficiency and complications of Lumenis and Wolf morcellators after holmium laser enucleation of the prostate. Indian J Urol 2018; 34:140-143. [PMID: 29692508 PMCID: PMC5894287 DOI: 10.4103/iju.iju_133_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Indexed: 11/29/2022] Open
Abstract
Introduction: Holmium laser enucleation of the prostate (HoLEP) is a recognized option for the surgical management of benign prostatic hyperplasia. While the laser parameters and enucleation techniques have been widely studied, the morcellation techniques still remain under-evaluated. The current study evaluates the two commonly used morcellation devices for their in vivo efficiency and patient safety. Materials and Methods: A total of 222 patients who underwent HoLEP at two medical centres between January 2011 to December 2013 by a single surgeon were included. Of these 222 patients, the Richard Wolf Piranha Morcellation System, Germany (WM), was used on 140 patients, while on the remaining 82, the Lumenis® VersaCut™ Morcellator, Yokneam, Israel (LM), was used. These devices were compared for safety parameters such as the incidence of bladder mucosal injury, deep muscle injury, bladder perforation, and bleeding requiring electrocoagulation. The morcellation efficiency (ME) defined as the ratio of the weight of morcellated tissue in grams to the time required for morcellation in minutes was also compared. Results: The incidence of bladder mucosal injury, deep muscle injury, and bleeding requiring electrocoagulation was statistically significantly lower for the WM than the LM. None of the patients had a full-thickness bladder perforation with either of the morcellators. The ME was higher for the LM. In eight patients, hard, smooth rounded adenomatous nodules could not be morcellated by the WM and had to be crushed by a stone grasping forceps before morcellation. Conclusions: While the LM is a faster morcellator, WM has a better safety profile.
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Affiliation(s)
| | - Vinayak G Wagaskar
- Department of Urology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Reeta P Maheshwari
- Department of Urology, Fortis Hospital Mulund, Mumbai, Maharashtra, India
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Sarode S, Mhaske S, Wagaskar VG, Patil B, Patwardhan SK, Gopalakrishnan G. Surgical repair in case of covered exstrophy of bladder with complete duplication of lower genitourinary tract and visceral sequestration. Int Braz J Urol 2017; 44:647-648. [PMID: 29135412 PMCID: PMC5996788 DOI: 10.1590/s1677-5538.ibju.2016.0634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/30/2017] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sachin Sarode
- Department of Urology, Seth GSMC and King's Edward Memorial Hospital, Mumbai, India
| | - Sunil Mhaske
- Department of Urology, Dr. D. Y. Patil Medical College Pimpri, Pune, India
| | - Vinayak G Wagaskar
- Department of Urology, Seth GSMC and King's Edward Memorial Hospital, Mumbai, India
| | - Bhushan Patil
- Department of Urology, Seth GSMC and King's Edward Memorial Hospital, Mumbai, India
| | - Sujata K Patwardhan
- Department of Urology, Seth GSMC and King's Edward Memorial Hospital, Mumbai, India
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Abstract
Zoon's balanitis is an asymptomatic lesion that requires histopathological examination of involved tissue for confirmation of diagnosis. Till today, circumcision is considered as the treatment of choice as topical medical therapy is insufficient to cure the disease and also there was a risk of recurrence after discontinuation of therapy. Herein, we have treated the Zoon's balanitis with 0.1% topical tacrolimus with complete resolution of the lesion in 6 weeks. Hence, we think topical tacrolimus therapy should be considered as an alternative to circumcision in the treatment of Zoon's balanitis.
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Affiliation(s)
- Sudarshan O Daga
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Vinayak G Wagaskar
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Snehal F Jumnake
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sujata K Patwardhan
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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16
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Maheshwari PN, Abiola OO, Wagaskar VG, Oswal AT. Hydrocele with a surprise: Malignant mesothelioma of the tunica vaginalis - Case report and review of literature. Urol Ann 2017; 9:110-112. [PMID: 28216946 PMCID: PMC5308028 DOI: 10.4103/0974-7796.198877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hydrocele is a very common condition that is simple to evaluate and treat. Management of hydrocele is usually delegated to the junior members of the surgical team. Sometimes this simple condition can spring huge surprises. A 20-year-old man presented with acute onset large, painless fluctuant left hemi-scrotal swelling. Scrotal ultrasonography showed thickened tunica vaginalis. A diagnosis of left hydrocele was made and repair by excision of sac was planned. During the procedure, the sac was found studded with red nodular growths; histopathology reported malignant mesothelioma of tunica vaginalis. Metastatic evaluation showed extensive retroperitoneal lymph nodal involvement. Despite receiving adjuvant chemotherapy with radiotherapy patient died due to extensive metastasis within 16 months. This case is presented for rarity of diagnosis, young age of presentation, absence of etiological factor and rapidly progressive clinical course.
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Affiliation(s)
| | - Olajide O Abiola
- Department of Surgery, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Vinayak G Wagaskar
- Department of Urology, Seth G.S. Medical College and Hospital, Mumbai, Maharashtra, India
| | - Ajay T Oswal
- Department of Urology, Kamalnayan Bajaj Hospital, Aurangabad, Maharashtra, India
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17
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Daga S, Wagaskar VG, Tanwar H, Shelke U, Patil B, Patwardhan S. Efficacy of Medical Expulsive Therapy in Renal Calculi Less than or Equal to 5 Millimetres in Size. Urol J 2016; 13:2893-2898. [PMID: 27928809] [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] [Received: 05/29/2016] [Revised: 09/27/2016] [Accepted: 10/25/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Natural history and modality of treatment for asymptomatic renal calculi less than or equal to 5 millimetres in size is still unknown. Many options are available ranging from medical expulsive therapy to minimally invasive surgery. Till date no study has focussed on this very common but asymptomatic issue. Hence, this study is undertaken to evaluate efficacy of medical expulsive therapy in renal calculi less than or equal to 5mm in size. MATERIALS AND METHODS A prospective, parallel group, randomized study was carried out from 1st June 2014 to 31st May 2015, with total of 100 patients, 50 patients in each group. Patients with renal stones less than or equal to 5mm were included in the study. Group A Patients were administered medical expulsive therapy which included tamsulosin 0.4 mg daily at night time, furosemide 20mg, spironolactone 50mg in a single morning dose, and syrup potassium magnesium citrate 20Meq per dose three times a day for 12 weeks while group B patients were given placebo. The primary outcome variable was number of patients achieving clearance of stone during 12-week treatment period in both groups. RESULTS No statistically significant differences in age, gender, stone size, and calyceal stone location was found between the two treatment arms. A spontaneous stone expulsion rate of 50% (at 6 weeks) and 86 %( at 12 weeks) was noted in group A versus 28% (at 6 weeks) and 38 % (at 12 weeks) in group B. Less number of pain episodes and less analgesic medication was required in group A as compared to group B. CONCLUSION Medical Expulsive therapy for 12 weeks significantly improves stone free rates in renal calyceal calculi less than or equal to 5mm.
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Affiliation(s)
- Sudarshan Daga
- Department of Urology, King's Edward Memorial Hospital, Mumbai, India
| | | | | | - Umesh Shelke
- Department of Urology, King's Edward Memorial Hospital, Mumbai, India
| | - Bhushan Patil
- Department of Urology, King's Edward Memorial Hospital, Mumbai, India
| | - Sujata Patwardhan
- Department of Urology, King's Edward Memorial Hospital, Mumbai, India
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Maheshwari PN, Sharma GR, Wagaskar VG. RE: A Novel method of ensuring safe and accurate dilatation during percutaneous nephrolithotomy. Int Braz J Urol 2016; 42:628-9. [PMID: 27286133 PMCID: PMC4920587 DOI: 10.1590/s1677-5538.ibju.2016.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/08/2016] [Indexed: 11/22/2022] Open
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19
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Tanwar HV, Wagaskar VG, Fernandes G, Patil B, Patwardhan SK. Surgical Management of Ectopic Kidney with Bilateral Iliac Vein Invasion. J Clin Diagn Res 2016; 10:PH01-2. [PMID: 27134940 DOI: 10.7860/jcdr/2016/17317.7354] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/24/2015] [Indexed: 11/24/2022]
Abstract
Renal cell carcinoma (RCC) is a very rare phenomenon in an ectopic kidney. We come across a 61-year-old gentleman with a history of 2 months of gross, painless haematuria and palpable pelvic mass on examination. CT scan showed 6.5cm X 5.1cm X 5.8cm mass in pelvic kidney with bilateral iliac vein invasion. With the help of intra-operative ultra-sound, tumour thrombus was extracted from both iliac veins with en mass removal of tumour. Patient was well intraoperatively as well as in postoperatively. We also presented an elegant imaging for the case.
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Affiliation(s)
| | | | - Gwendolyn Fernandes
- Incharge-Renal, Department of Pathology, SGSMC and KEM Hospital , Mumbai, India
| | - Bhushan Patil
- Assistant Professor, Department of Urology, SGSMC and KEM Hospital , Mumbai, India
| | - Sujata K Patwardhan
- Professor and Head, Department of Urology, SGSMC and KEM Hospital , Mumbai, India
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Abstract
A 30-year-old lady underwent a Boari flap repair for post-hysterectomy mid-ureteric stricture. The upper end of the double J stent inserted during the procedure was misplaced in the supra-renal inferior venal cava. Cystoscopic stent removal could be performed uneventfully, while the stricture was managed by endoureterotomy.
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Affiliation(s)
- Pankaj N Maheshwari
- Department of Urology Fortis Hospital Mulund, Mulund-Goregoan Link Road, Mumbai, India
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21
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Baheti VH, Wagaskar VG, Patwardhan SK. Missed Iatrogenic Bladder Rupture Following Normal Vaginal Delivery. J Clin Diagn Res 2015; 9:PD01-2. [PMID: 26557563 DOI: 10.7860/jcdr/2015/14098.6555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/10/2015] [Indexed: 11/24/2022]
Abstract
Bladder rupture following caesarian section is well documented complications. Intraperitoneal bladder rupture following normal vaginal delivery is very rare. Hereby, we present a case report of intraperitoneal bladder rupture presented late following normal vaginal delivery. We report a case of spontaneous intraperitoneal urinary bladder rupture following uneventful outlet forceps delivery in a 22-year-old primi gravid woman with gestational diabetes mellitus and fetal macrosomia who presented with large urinary ascites, anuria and renal failure. Emergent exploratory laparotomy with repair of the intraperitoneal bladder rupture helped to prevent its potential complications. Postpartum patients who undergo episiotomy or perineal repair may land up in unnoticed urinary retention which may rarely terminate in spontaneous urinary bladder rupture. Awareness of its manifestations amongst emergency physician would help to initiate appropriate timely management.
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Affiliation(s)
- Vidyasagar H Baheti
- Resident, Department of Urology, Seth G S Medical College and KEM Hospital Mumbai, India
| | - Vinayak G Wagaskar
- Resident, Department of Urology, Seth G S Medical College and KEM Hospital Mumbai, India
| | - Sujata K Patwardhan
- Professor and Head of Department, Department of Urology, Seth G S Medical College and KEM Hospital Mumbai, India
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Nandanwar AS, Patil Y, Wagaskar VG, Baheti VH, Tanwar HV, Patwardhan SK. A Comparison of Efficacy of Segmental Epidural Block versus Spinal Anaesthesia for Percutaneous Nephrolithotomy. J Clin Diagn Res 2015; 9:UC01-4. [PMID: 26436021 DOI: 10.7860/jcdr/2015/14091.6301] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/20/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is done under general anaesthesia in most of the centres. Associated complications and cost are higher for general anaesthesia than for regional anaesthesia. Present study is designed to compare the efficacy of epidural block versus spinal anaesthesia with regards to intraoperative mean arterial pressure, heart rate, postoperative pain intensity, analgesic requirement, Postoperative complications and patient satisfaction in patients undergoing PCNL. MATERIALS AND METHODS After taking Ethical Committee clearance, patients were randomly allocated into 2 groups using table of randomization (n= 40 each) Group E- Epidural block, Group S- Spinal block. Various parameters like intraoperative mean arterial pressure, heart rate, postoperative pain intensity, analgesic requirement, postoperative complications and patient satisfaction were studied in these groups. STATISTICAL ANALYSIS Quantitative data was analysed using unpaired t-test and qualitative data was analysed using chi-square test. RESULTS Twenty four times in Epidural as compared to fifteen times in spinal anaesthesia two or more attempts required. Mean time (min) required to achieve the block of anaesthesia in group E and group S was 15.45±2.8 and 8.52±2.62 min respectively. Mean arterial pressure (MAP) at 5 min, 10 min and 15 min were significantly lower in spinal group as compared to epidural group. After 30 minutes, differences were not significant but still MAP was lower in spinal group. After 30 minutes difference in heart rate between two groups was statistically significant and higher rate recorded in spinal group till the end of 3 hours. Postoperative VAS score was significantly higher in spinal group and 4 hours onwards difference was highly significant. Postoperative Nausea Vomiting (PONV) Score was significantly higher in spinal group as compared to epidural group. CONCLUSION For PCNL, segmental epidural block is better than spinal anaesthesia in terms of haemodynamic stability, postoperative analgesia, patient satisfaction and reduced incidence of PONV. Epidural anaesthesia is difficult to execute and takes longer time to act as compared to spinal block which limits its use.
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Affiliation(s)
- Avinash S Nandanwar
- Resident, Department of Anaesthesia, King's Edward Memorial Hospital and S.G.S. Medical College , Mumbai, India
| | - Yogita Patil
- Associate Professor, Department of Anaesthesia, King's Edward Memorial Hospital and S.G.S. Medical College , Mumbai, India
| | - Vinayak G Wagaskar
- Resident, Department of Urology, King's Edward Memorial Hospital and S.G.S. Medical College , Mumbai, India
| | - Vidyasagar H Baheti
- Resident, Department of Urology, King's Edward Memorial Hospital and S.G.S. Medical College , Mumbai, India
| | - Harshwardhan V Tanwar
- Resident, Department of Urology, King's Edward Memorial Hospital and S.G.S. Medical College , Mumbai, India
| | - Sujata K Patwardhan
- Professor and Head of Department, Department of Urology, King's Edward Memorial Hospital and S.G.S. Medical College , Mumbai, India
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