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Elbakry AA, Abdelhalim A, Al-Omar O. Tips and tricks for the extravesical robotic-assisted laparoscopic ureteral reimplantation for pediatric vesicoureteral reflux. J Pediatr Urol 2023; 19:816-817. [PMID: 37524572 DOI: 10.1016/j.jpurol.2023.07.014] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 08/02/2023]
Abstract
Over the past few years, robotic-assisted laparoscopic ureteral reimplantation (RALUR) has gained popularity as an acceptable alternative for the traditional open approach if surgery is elected for children with vesicoureteral reflux (VUR). We present our technique including the tips and tricks for both male and female patients, including a stepwise approach for ureteral identification in female patients depending on the level of technical difficulty. Our series include 30 patients who represent a spectrum in which we presented the different tips and tricks included in this video.
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Affiliation(s)
- Amr A Elbakry
- Division of Pediatric Urology, Department of Urology, West Virginia University Hospital, Morgantown, WV, USA.
| | - Ahmed Abdelhalim
- Division of Pediatric Urology, Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
| | - Osama Al-Omar
- Division of Pediatric Urology, Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
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Victory JH, Minc SD, Zaslau S, Elbakry AA, Almenoff MI. Open retrieval management of inferior vena cava filter erosion resulting in symptomatic hydroureteronephrosis. J Vasc Surg Cases Innov Tech 2023; 9:101188. [PMID: 37799839 PMCID: PMC10547826 DOI: 10.1016/j.jvscit.2023.101188] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/28/2023] [Indexed: 10/07/2023] Open
Abstract
Inferior vena cava filters are effective for the management of thromboembolic disease but can erode into adjacent organ systems in rare instances. Endovascular retrieval of eroded filters has been the preferred management for this complication. We present a case for which endovascular retrieval was not appropriate because of filter orientation and erosion into the ureter and describe successful management using open retrieval of a permanent filter with erosion into the renal collecting system requiring reconstruction. Although minimally invasive retrieval is preferred over open repair, this approach should be considered when filter erosion is not amenable to endovascular retrieval.
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Affiliation(s)
| | - Samantha D. Minc
- Division of Vascular Surgery, Department of Cardiovascular and Thoracic Surgery, WVU Heart and Vascular Institute, West Virginia University, Morgantown, WV
| | - Stanley Zaslau
- Department of Urology, School of Medicine, West Virginia University, Morgantown, WV
| | - Amr A. Elbakry
- Department of Urology, School of Medicine, West Virginia University, Morgantown, WV
| | - Maxwell Ian Almenoff
- Division of Vascular Surgery, Department of Cardiovascular and Thoracic Surgery, WVU Heart and Vascular Institute, West Virginia University, Morgantown, WV
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Harraz AM, Nabeeh A, Elbaz R, Abdelhamid A, Tharwat M, Elbakry AA, El-Hefnawy AS, El-Assmy A, Mosbah A, Zahran MH. Could the bulbar urethral end location on the cystourethrogram predict the outcome after posterior urethroplasty for pelvic fracture urethral injury? Arab J Urol 2022; 21:94-101. [PMID: 37234680 PMCID: PMC10208150 DOI: 10.1080/2090598x.2022.2138119] [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: 04/14/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives To identify cystourethrogram (CUG) findings that independently predict the outcome of posterior urethroplasty (PU) following pelvic fracture urethral injury (PFUI). Methods Findings of CUG included the location of the proximal end of the bulbar urethra in zones A (superficial) or B (deep) according to its relationship with the pubic arch. Others included the presence of pelvic arch fracture, bladder neck, and posterior urethral appearance. The primary outcome was the need for reintervention either endoscopically or by redo urethroplasty. Independent predictors were modeled using a logistic regression model and a nomogram was constructed and internally validated using 100-bootstrap resampling. Time-to-event analysis was performed to validate the results. Results A total of 196 procedures in 158 patients were analyzed. The success rate was 83.7% with 32 (16.3%) procedures requiring direct vision internal urethrotomy, urethroplasty, or both in 13 (6.6%), 12 (6.1%), and 7 (3.6%) patients, respectively. On multivariate analysis, bulbar urethral end located at zone B (odds ratio [OR]: 3.1; 95% confidence interval [CI]: 1.1-8.5; p = 0.02), pubic arch fracture (OR: 3.9; 95%CI: 1.5-9.7; p = 0.003), and previous urethroplasty (OR: 4.2; 95% CI: 1.8-10.1; p = 0.001) were independent predictors. The same predictors were significant in the time-to-event analysis. The nomogram discrimination was 77.3% and 75% in the current data and after validation. Conclusions The location of the proximal end of the bulbar urethra and redo urethroplasty could predict the need for reintervention after PU for PFUI. The nomogram could be used preoperatively for patient counseling and procedure planning.
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Affiliation(s)
- Ahmed M. Harraz
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Adel Nabeeh
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ramy Elbaz
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Mohamed Tharwat
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Amr A. Elbakry
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Ahmed El-Assmy
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Mosbah
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Zagade T, Trump T, Elbakry AA, Zekan D, Williams HJ, Morley C. Selective angioembolization as a management strategy for angiomyolipoma causing urinary tract obstruction. Urol Case Rep 2022; 45:102240. [PMID: 36199836 PMCID: PMC9529498 DOI: 10.1016/j.eucr.2022.102240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 12/01/2022] Open
Abstract
Angiomyolipoma (AML) is a benign renal tumor usually found incidentally. Rarely, AML can present with renal colic due to urinary tract obstruction. Prior cases of obstructing AML have been presented and managed successfully with surgical removal. Selective angioembolization has emerged as an alternative management strategy for AML, but no documented cases have been presented for this strategy in the setting of obstruction. Here, we present a case of obstructing AML treated with selective angioembolization with subsequent resolution of obstruction.
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Affiliation(s)
- Tarek Zagade
- Eastern Virginia Medical School, Norfolk, VA, United States
| | - Tyler Trump
- West Virginia University Department of Urology, Morgantown, WV, United States
- Corresponding author. West Virginia University Department of Urology, Morgantown, WV, 26506, United States.
| | - Amr A Elbakry
- West Virginia University Department of Urology, Morgantown, WV, United States
| | - David Zekan
- West Virginia University Department of Urology, Morgantown, WV, United States
| | - H James Williams
- West Virginia University Department of Pathology, Morgantown, WV, United States
| | - Chad Morley
- West Virginia University Department of Urology, Morgantown, WV, United States
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Haffar A, Elbakry AA, Trump T, Werner Z, McCluskey K, Salkini MW. Trans-hepatic trans-portal selective angioembolization; a management option for severe acute variceal bleeding of ileal conduit stoma. Urol Case Rep 2022; 45:102222. [PMID: 36147194 PMCID: PMC9485032 DOI: 10.1016/j.eucr.2022.102222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022] Open
Abstract
We present a case of severe acute variceal bleeding in an ileal conduit stoma successfully managed with trans-hepatic trans-portal selective angioembolization as a lifesaving measure. Despite repeated transfusions, the patient's hemoglobin continued to be unstable. The patient underwent transhepatic embolization of ileal stoma varicose veins. Angioembolization was followed up with excision of ileal conduit stoma and creation of cutaneous ureterostomy for definitive treatment management of hemorrhage. In conclusion, trans-hepatic trans-portal embolization is an effective option for management of severe acute variceal bleeding in an ileal conduit stoma as a lifesaving measure and can be followed by excision of the conduit.
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Affiliation(s)
- Ahmad Haffar
- Johns Hopkins University, Department of Urology, Division of Pediatric Urology, Baltimore, MD, USA
- Corresponding author. Suite 6300, Health Sciences Center, Morgantown, WV, 26505, USA.
| | - Amr A. Elbakry
- Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
| | - Tyler Trump
- Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
| | - Zachary Werner
- Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
| | - Kevin McCluskey
- Division of Interventional Radiology, Department of Radiology, West Virginia University Hospital, Morgantown, WV, USA
| | - Mohamed W. Salkini
- Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
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Elbakry AA, Trump T, Ferari C, Mattes MD, Luchey A. Survival outcomes in node-positive non-metastatic bladder cancer: An analysis of the national cancer database. Arab J Urol 2022; 20:175-181. [PMID: 36353472 PMCID: PMC9639493 DOI: 10.1080/2090598x.2022.2077001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Clinically node-positive non-metastatic bladder cancer (cN+) has been the target of several studies aiming to establish a standard of care for this population. Limited studies have shown a survival benefit for various multimodal therapy approaches. The role of radiation therapy has not been well established. Our study aims to study the trends of the reported treatment options offered to patients with cN+ bladder cancer in a national database and to evaluate the effect of various treatments, including radiation, on survival. Methods The National Cancer Database (NCDB) was used to identify cN+ bladder cancer patients who received chemotherapy alone or in combination with radical cystectomy (RC) or radiotherapy. 3,481 patients were included and divided into 4 groups: chemotherapy only, chemotherapy and RC, chemotherapy and radiation therapy, and chemotherapy, RC, and radiation therapy. Demographic data was compared using ANOVA for continuous variables, and Chi-square for categorical variables. Multivariable analysis was done to compare groups using a multinomial logistic regression model. Kaplan-Meier test was used for survival analysis and Cox-Regression was used for multivariable survival analysis. Results Patients undergoing RC were significantly younger (P <0.001). There was a significant difference between the groups regarding racial distribution, facility-type and insurance status. There was no difference in gender, Charlson\Deyo score, financial or educational status. Patients who underwent combination therapy with chemotherapy and RC were found to have the longest median survival time at 27 months. Multivariable analysis showed that final treatment, age, sex, Charlson\Deyo comorbidity score, TNM edition and facility-type were significant survival predictors. Race, insurance and financial status failed to maintain significance. There was no survival difference between the chemotherapy group and chemo-radiotherapy group. Conclusions The combination of surgery and chemotherapy achieves statistically significant superior survival in cN+ bladder cancer. Adding radiotherapy to chemotherapy did not improve survival in this group of patients. Abbreviations (cN+): Clinically node-positive non-metastatic, (MIBC): Muscle invasive bladder cancer, (NCDB): National Cancer Database, (NAC): Neoadjuvant chemotherapy, (RC): Radical Cystectomy
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Affiliation(s)
- Amr A Elbakry
- Department of Urology, West Virginia University, Morgantown, WV, USA
| | - Tyler Trump
- Department of Urology, West Virginia University, Morgantown, WV, USA
| | | | - Malcom D Mattes
- Department of Radiation Oncology, Rutgers Robert Wood Johnson, New Brunswick, NJ, USA
| | - Adam Luchey
- Department of Urology, West Virginia University, Morgantown, WV, USA
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Mitchell K, Elbakry AA, Naili RE, AL-Omar O. Dysfunctional Voiding- Presentation of a Rare Case of Pediatric Non Muscle Invasive Urothelial Bladder Carcinoma. Urology 2022; 166:233-235. [DOI: 10.1016/j.urology.2022.01.030] [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: 01/03/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
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Trump T, Elbakry AA, Al-Omar O. Commentary on: Referral patterns for undescended testis: A 7 Year comparative analysis of primary care providers. J Pediatr Urol 2021; 17:884. [PMID: 34702650 DOI: 10.1016/j.jpurol.2021.09.026] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Tyler Trump
- West Virginia University, Department of Urology, USA.
| | - Amr A Elbakry
- West Virginia University, Department of Urology, USA
| | - Osama Al-Omar
- West Virginia University, Department of Urology, USA
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Elbakry AA, Aldabek K, Crigger C, Trump T, Salkini MW. Robot-assisted laparoscopic repair of a huge sliding inguinal hernia of the urinary bladder, left ureter and sigmoid colon. Urology Video Journal 2021. [DOI: 10.1016/j.urolvj.2021.100104] [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: 11/26/2022] Open
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Trump T, Elbakry AA, Haffar A, McClelland D, Morley C, Al-Omar O. The Impact of Targeted Education of American Urological Association Cryptorchidism Guidelines in a Rural State: Improvement Still Needed. Res Rep Urol 2021; 13:437-443. [PMID: 34235100 PMCID: PMC8254607 DOI: 10.2147/rru.s316563] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background The American Urological Association published guidelines in 2014 regarding management of undescended testicles (UDT). Despite these guidelines, prior studies have indicated discordance between guidelines and actual practice, especially in rural states. This study aims to identify if educating referring providers improves management of UDT. Methods Patients with UDT referred to our institution were divided into two groups: those referred prior to (Group 1) and after (Group 2) targeted education. A retrospective review was performed to compare the groups in terms of age at time of referral and surgery, laterality, specialty, and practice setting of referring provider, and whether or not ultrasound (US) was performed prior to referral. Results A total of 100 patients were identified in Group 1 and 168 in Group 2. No significant differences were noted between groups regarding age, variability of referring provider, or those receiving US prior to referral. Median age at referral was 20.7 months (range=0-194) and 33 months (range=0-205.1) in Groups 1 and 2, respectively (p=0.26). Sixty-two (37%) patients underwent surgical evaluation within 18 months of age or younger in Group 1 compared to 39 (39%) in Group 2 (p=0.73). Private practice pediatricians comprised the majority of referring providers in both cohorts. US was performed prior to referral in 41% of patients in Group 1 compared to 35.8% in Group 2 (p=0.51). The number of US ordered prior to referral significantly decreased from 10 (50%) to six (19%) following education among academic providers (p=0.02). No significant difference was found following education for private practice physicians (p=0.27). Conclusion Targeted education did not improve age at referral in the short-term, which may reflect suboptimal healthcare access. Additionally, more research is needed to evaluate whether more diverse targeted education provided on a regular basis to both physician and mid-level providers would have a meaningful impact.
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Affiliation(s)
- Tyler Trump
- West Virginia University Department of Urology, Morgantown, WV, USA
| | - Amr A Elbakry
- West Virginia University Department of Urology, Morgantown, WV, USA
| | - Ahmad Haffar
- West Virginia University School of Medicine, Morgantown, WV, USA
| | | | - Chad Morley
- West Virginia University Department of Urology, Morgantown, WV, USA
| | - Osama Al-Omar
- West Virginia University Department of Urology, Morgantown, WV, USA
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Morley C, Hajiran A, Elbakry AA, Al-Qudah HS, Al-Omar O. Evaluation of Preoperative Tamsulosin Role in Facilitating Ureteral Orifice Navigation for School-Age Pediatric Ureteroscopy. Res Rep Urol 2020; 12:563-568. [PMID: 33235880 PMCID: PMC7678704 DOI: 10.2147/rru.s283126] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/19/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To address whether preoperative tamsulosin increases the rate of successful ureteral orifice navigation for ureteroscopy (URS) without prestenting in school-age pediatric patients. Methods We retrospectively reviewed all pediatric patients who had undergone ureteroscopy (URS) at our institution from 2013 to 2020. Patients were divided into two groups: those who had received tamsulosin 0.4 mg daily ≥48 hours preoperatively and those who had not. Statistical analysis was done using independent-sample t-tests and Mann–Whitney U tests for continuous variables, and χ2 and Fisher’s exact tests were used for categorical variables. Multivariate analysis was done using binary logistic regression test. Results Overall, successful ureteral orifice navigation occurred in 44 of 50 patients (88%) who had received tamsulosin and 17 of 26 (65.4%) who had not (p=0.019). On further subanalysis based on stone location and instrumentation used, successful ureteral orifice navigation had occurred in 21 of 24 patients (87.5%) in the tamsulosin group and one of five (20%) in the no-tamsulosin group for semirigid ureteroscopy for mid–distal ureterolithiasis (p=0.007). For proximal ureteral and renal stones, successful ureteral orifice navigation with a flexible ureteroscope or ureteral access sheath had occurred in 23 of 26 patients (88.5%) in the tamsulosin group and 16 of 21 (76.2%) in the no-tamsulosin group (p=0.437). Multivariate analysis showed no significant difference between success rates in the two groups after controlling for patient weight, height, BMI, and stone location. We did not observe any adverse effects from tamsulosin. Conclusion This is the first study to evaluate preoperative tamsulosin on successful ureteral orifice navigation in school-age pediatric patients. Although not reaching statistical significance, further evaluation should be done on larger cohorts. Patient height was found to be an independent predictor of successful ureteral orifice navigation.
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Affiliation(s)
- Chad Morley
- Department of Urology, West Virginia University, Morgantown, WV, USA
| | - Ali Hajiran
- Department of Urology, West Virginia University, Morgantown, WV, USA
| | - Amr A Elbakry
- Department of Urology, West Virginia University, Morgantown, WV, USA
| | - Hosam S Al-Qudah
- Division of Urology, AL Zahra Hospital, Dubai, United Arab Emirates
| | - Osama Al-Omar
- Department of Urology, West Virginia University, Morgantown, WV, USA
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Ghali F, Elbakry AA, Hamilton Z, Nasseri R, Eldefrawy A, Ryan ST, Yim K, Patel S, Bradshaw A, Meagher M, Reddy M, Lee HJ, Derweesh I. Association of robotic partial nephrectomy for clinical T2a renal mass with improved trifecta outcome compared to open partial nephrectomy: A single surgeon comparative analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.653] [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
653 Background: We compared surgical quality and functional outcomes of robotic partial nephrectomy (RPN) and open PN (OPN) for cT2a renal masses (cT2aRM). Methods: Retrospective analysis of 150 consecutive patients [RPN 59/OPN 91] from 6/2008 to 6/2016. Main outcome was achievement of Trifecta [negative surgical margin, no major urologic complications, and ≥90% preservation of estimated glomerular filtration rate (eGFR)]. Multivariable analysis was performed to identify factors of Trifecta attainment. Results: Mean tumor size (RPN 7.9 vs. OPN 8.4 cm, p=0.139) and median RENAL score (p=0.361) were similar. No difference was noted for positive margins (RPN 3.4% vs. OPN 1.1%, p=0.561), DeGFR (RPN -6.2 vs. OPN -7.8, p=0.543), and ≥90% eGFR recovery (RPN 54.1% vs. OPN 47.2%, p=0.504). RPN had lower blood loss (p=0.015), hospital stay (p=0.013), and Clavien ≥3 complications (RPN 5.1% vs. OPN 16.5%, p=0.041). Trifecta rate was significantly higher in RPN (47.5% vs. 34.0%, p=0.041). Multivariable analysis demonstrated decreasing RENAL score (OR 1.11, p<0.001), RPN (OR 1.2, p=0.013), and decreasing EBL (OR 1.02, p=0.016) to be associated with Trifecta attainment. Conclusions: RPN provided similar functional and oncologic precision to OPN, while being associated with improvements in major complications, the latter of which was reflected in a higher rate of Trifecta achievement for RPN. RPN may be considered to be a first-line option for select patients with cT2aRM when feasible and safe.
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Affiliation(s)
- Fady Ghali
- UC San Diego, Department of Urology, San Diego, CA
| | | | - Zachary Hamilton
- Saint Louis University Department of Surgery-Urology Division, St Louis, MO
| | | | | | | | - Kendrick Yim
- University of California San Diego, San Diego, CA
| | - Sunil Patel
- University of California San Diego, San Diego, CA
| | | | | | | | - Hak J. Lee
- Department of Urology, University of California San Diego, San Diego, CA
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Ghali F, Elbakry AA, Hamilton ZA, Yim K, Nasseri R, Patel S, Eldefrawy A, Ryan S, Bradshaw AW, Meagher M, Bree K, Reddy M, Lee HJ, Derweesh IH. Robotic partial nephrectomy for clinical T2a renal mass is associated with improved trifecta outcome compared to open partial nephrectomy: a single surgeon comparative analysis. World J Urol 2019; 38:1113-1122. [PMID: 31701211 DOI: 10.1007/s00345-019-02994-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/20/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Utilization of partial nephrectomy (PN) for T2 renal mass is controversial due to concerns regarding burden of morbidity, though most cited data are from open PN (OPN). We compared surgical quality and functional outcomes of RPN and OPN for clinical T2a renal masses (cT2aRM). METHODS Retrospective analysis of 150 consecutive patients [RPN 59/OPN 91] who underwent PN from July 2008 to June 2016. Main outcome was achievement of Trifecta [negative surgical margin, no major urologic complications, and ≥90% preservation of estimated glomerular filtration rate (eGFR)]. Multivariable analysis was performed to identify factors of Trifecta attainment. RESULTS Mean tumor size (RPN 7.9 vs. OPN 8.4 cm, p = 0.139) and median RENAL score (p = 0.361) were similar. No difference was noted for positive margins (RPN 3.4% vs. OPN 1.1%, p = 0.561), ΔeGFR (RPN - 6.2 vs. OPN - 7.8, p = 0.543), and ≥ 90% eGFR recovery (RPN 54.1% vs. OPN 47.2%, p = 0.504). RPN had lower blood loss (p = 0.015), hospital stay (p = 0.013), and Clavien ≥ 3 complications (RPN 5.1% vs. OPN 16.5%, p = 0.041). Trifecta rate was significantly higher in RPN (47.5% vs. 34.0%, p = 0.041). Multivariable analysis demonstrated decreasing RENAL score (OR 1.11, p < 0.001), RPN (OR 1.2, p = 0.013), and decreasing EBL (OR 1.02, p = 0.016) to be associated with Trifecta attainment. CONCLUSIONS RPN provided similar functional and oncologic precision to OPN, while being associated with improvements in major complications, the latter of which was reflected in a higher rate of Trifecta achievement for RPN. RPN may be considered to be a first-line option for select patients with cT2aRM when feasible and safe.
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Affiliation(s)
- Fady Ghali
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA
| | - Amr A Elbakry
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA
| | - Zachary A Hamilton
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA
| | - Kendrick Yim
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA
| | - Ryan Nasseri
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA
| | - Sunil Patel
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA
| | - Ahmed Eldefrawy
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA
| | - Stephen Ryan
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA
| | - Aaron W Bradshaw
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA
| | - Margaret Meagher
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA
| | - Kelly Bree
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA
| | - Madhumitha Reddy
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA
| | - Hak J Lee
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA.
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Harraz AM, El-Assmy A, Mahmoud O, Elbakry AA, Tharwat M, Omar H, Farg H, Laymon M, Mosbah A. Is there a way to predict failure after direct vision internal urethrotomy for single and short bulbar urethral strictures? Arab J Urol 2015; 13:277-81. [PMID: 26609447 PMCID: PMC4656799 DOI: 10.1016/j.aju.2015.07.007] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 07/06/2015] [Accepted: 07/13/2015] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To identify patient and stricture characteristics predicting failure after direct vision internal urethrotomy (DVIU) for single and short (<2 cm) bulbar urethral strictures. PATIENTS AND METHODS We retrospectively analysed the records of adult patients who underwent DVIU between January 2002 and 2013. The patients' demographics and stricture characteristics were analysed. The primary outcome was procedure failure, defined as the need for regular self-dilatation (RSD), redo DVIU or substitution urethroplasty. Predictors of failure were analysed. RESULTS In all, 430 adult patients with a mean (SD) age of 50 (15) years were included. The main causes of stricture were idiopathic followed by iatrogenic in 51.6% and 26.3% of patients, respectively. Most patients presented with obstructive lower urinary tract symptoms (68.9%) and strictures were proximal bulbar, i.e. just close to the external urethral sphincter, in 35.3%. The median (range) follow-up duration was 29 (3-132) months. In all, 250 (58.1%) patients did not require any further instrumentation, while RSD was maintained in 116 (27%) patients, including 28 (6.5%) who required a redo DVIU or urethroplasty. In 64 (6.5%) patients, a redo DVIU or urethroplasty was performed. On multivariate analysis, older age at presentation [odds ratio (OR) 1.017; P = 0.03], obesity (OR 1.664; P = 0.015), and idiopathic strictures (OR 3.107; P = 0.035) were independent predictors of failure after DVIU. CONCLUSION The failure rate after DVIU accounted for 41.8% of our present cohort with older age at presentation, obesity, and idiopathic strictures independent predictors of failure after DVIU. This information is important in counselling patients before surgery.
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Affiliation(s)
- Ahmed M Harraz
- Urology and Nephrology Center, Mansoura University, Egypt
| | - Ahmed El-Assmy
- Urology and Nephrology Center, Mansoura University, Egypt
| | - Osama Mahmoud
- Urology and Nephrology Center, Mansoura University, Egypt
| | - Amr A Elbakry
- Urology and Nephrology Center, Mansoura University, Egypt
| | | | - Helmy Omar
- Urology and Nephrology Center, Mansoura University, Egypt
| | - Hashim Farg
- Urology and Nephrology Center, Mansoura University, Egypt
| | - Mahmoud Laymon
- Urology and Nephrology Center, Mansoura University, Egypt
| | - Ahmed Mosbah
- Urology and Nephrology Center, Mansoura University, Egypt
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