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Livingston AJ, Dvergsten T, Morgan TN. Initial Postoperative Prostate Specific Antigen and PSA Velocity Are Important Indicators of Underlying Malignancy After Simple Prostatectomy. J Endourol 2023; 37:1057-1062. [PMID: 37376750 DOI: 10.1089/end.2023.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
Background: There is a paucity of guidelines for prostate-specific antigen (PSA) monitoring after simple prostatectomy (SP) despite these patients remaining at risk for prostate cancer (PCa). Our objective was to determine if PSA kinetics can be a potential indicator of PCa after SP. Methods: A retrospective review was performed of all simple prostatectomies at our institution from 2014 to 2022. All patients who met criteria were included in the study. Relevant clinical variables were collected preoperatively, including PSA value, prostate size, and voiding symptoms. Surgical and urinary function outcomes were analyzed. Results: A total of 92 patients were divided into two groups based on malignancy status. Sixty-eight patients did not have PCa, while 24 patients had known PCa before surgery (14) or were diagnosed as having incidental PCa from the pathological specimen (10). Patients with benign prostates had an initial postoperative PSA value of 0.76 ng/mL compared with 1.68 ng/mL for those with cancer (p < 0.01). PSA velocity for the first 24 months after surgery was 0.042 ± 1.61 ng/(mL·year) for the benign cohort compared with 1.29 ± 1.02 ng/(mL·year) for the malignant cohort (p = 0.01). Voiding improvements were noted by objective (postvoid residual and flow rate) and subjective (American Urological Association symptom score and quality of life score) measures in both groups. Conclusions: PSA interpretation and monitoring after SP have not been well established. Our study indicates that initial postoperative PSA value and PSA velocity are important indicators of underlying malignancy in patients after SP. Further efforts are needed to establish threshold values and formal guidelines.
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Affiliation(s)
- Austin J Livingston
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Thomas Dvergsten
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Tara N Morgan
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Krughoff K, Livingston AJ, Peterson AC. Synchronous Bladder Neck Contracture Dilation at the Time of Artificial Urinary Sphincter Placement Is Safe and Effective. Urology 2023; 178:155-161. [PMID: 37100178 DOI: 10.1016/j.urology.2023.02.050] [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] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To treat men with bladder neck contracture (BNC) and stress urinary incontinence, neither long-term nor comparative data exist to support the superiority of simultaneous BNC intervention at the time of artificial urinary sphincter placement (synchronous) or staged BNC intervention followed by artificial urinary sphincter placement (asynchronous). This study aimed to compare the outcomes of patients treated with synchronous and asynchronous protocols. METHODS Using a prospectively maintained quality improvement database, we identified all men between the years of 2001-2021 with a history of BNC and artificial urinary sphincter placement. Baseline patient characteristics and outcome measures were collected. Categorical data were assessed with Pearson's Chi-square, and continuous data were assessed using independent sample t tests or the Wilcoxon Rank-Sum test. RESULTS In total, 112 men met the inclusion criteria. Thirty-two patients were treated synchronously, and 80 were treated asynchronously. There were no significant differences between groups across 15 relevant variables. Overall follow-up duration was 7.1 (2.8, 13.1) years. Three (9.3%) in the synchronous group and 13 (16.2%) in the asynchronous group experienced an erosion. There were no significant differences in frequency of erosion, time to erosion, artificial sphincter revision, time to revision, or BNC recurrence. BNC recurrences after artificial sphincter placement were treated with serial dilation with no early device failure or erosion. CONCLUSION Similar outcomes are achieved following synchronous and asynchronous treatment of BNC and stress urinary incontinence. Synchronous approaches should be considered safe and effective for men with stress urinary incontinence and BNC.
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Affiliation(s)
- Kevin Krughoff
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC.
| | - Austin J Livingston
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Andrew C Peterson
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC
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Hughes FM, Odom MR, Cervantes A, Livingston AJ, Purves JT. Why Are Some People with Lower Urinary Tract Symptoms (LUTS) Depressed? New Evidence That Peripheral Inflammation in the Bladder Causes Central Inflammation and Mood Disorders. Int J Mol Sci 2023; 24:2821. [PMID: 36769140 PMCID: PMC9917564 DOI: 10.3390/ijms24032821] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Anecdotal evidence has long suggested that patients with lower urinary tract symptoms (LUTS) develop mood disorders, such as depression and anxiety, at a higher rate than the general population and recent prospective studies have confirmed this link. Breakthroughs in our understanding of the diseases underlying LUTS have shown that many have a substantial inflammatory component and great strides have been made recently in our understanding of how this inflammation is triggered. Meanwhile, studies on mood disorders have found that many are associated with central neuroinflammation, most notably in the hippocampus. Excitingly, work on other diseases characterized by peripheral inflammation has shown that they can trigger central neuroinflammation and mood disorders. In this review, we discuss the current evidence tying LUTS to mood disorders, its possible bidirectionally, and inflammation as a common mechanism. We also review modern theories of inflammation and depression. Finally, we discuss exciting new animal studies that directly tie two bladder conditions characterized by extensive bladder inflammation (cyclophosphamide-induced hemorrhagic cystitis and bladder outlet obstruction) to neuroinflammation and depression. We conclude with a discussion of possible mechanisms by which peripheral inflammation is translated into central neuroinflammation with the resulting psychiatric concerns.
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Affiliation(s)
- Francis M. Hughes
- Department Urology, Duke University Medical Center, P.O. Box 3831, Durham, NC 27710, USA
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Krughoff K, Livingston AJ, Inouye B, Peterson AC, Lentz AC. Indications and Outcomes for Intermittent Catheterization following Bulbar AUS Cuff Placement. Urology 2023; 171:216-220. [PMID: 36332702 DOI: 10.1016/j.urology.2022.10.013] [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] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the functional and surgical impact of CIC protocols in men with a bulbar AUS in place. Stress urinary incontinence (SUI) and poor bladder emptying are both sequelae of prostate cancer treatment, though there is sparse data to guide concomitant management. The safety of intermittent catheterization (CIC) in men with an artificial urinary sphincter (AUS) at the bulbar urethra remains unclear. METHODS We performed a retrospective review of all bulbar urethral AUS procedures at our institution. Inclusion criteria were patients with a history of prostate cancer treatment, AUS placement for SUI, and a history of CIC before and/or after AUS placement. All eligible cases were retrospectively reviewed. Surgical and continence outcomes were analyzed. RESULTS A total of 57 patients were identified with a history of CIC and AUS placement under the care of two surgeons. Eighteen continued to perform CIC or first initiated CIC after AUS placement and 39 discontinued CIC prior to AUS placement. The incidence of erosion was no different amongst patients who continued or discontinued CIC after AUS placement (17.9% vs 22.2%, P = .79). There was no difference in future AUS removal or replacement (56.4% vs 44.4%, P = .41). Both groups experienced improvement in urinary incontinence after placement of an AUS. CONCLUSION Bulbar AUS placement in the setting of continuous intermittent catheterization can be considered in patients who are not surgical candidates for definitive treatment of their outlet obstruction.
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Affiliation(s)
| | - Austin J Livingston
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Brian Inouye
- Division of Urology, Department of Surgery, Albany Medical College, Albany, NY
| | - Andrew C Peterson
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Aaron C Lentz
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC
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Livingston AJ, Bailey CE. Invited Editorial: Does Side Really Matter? Survival Analysis Among Patients with Right- Versus Left-Sided Colon Cancer: A Propensity Score-Adjusted Analysis. Ann Surg Oncol 2021; 29:9-10. [PMID: 34561778 DOI: 10.1245/s10434-020-09522-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Austin J Livingston
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Christina E Bailey
- Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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Livingston AJ, Hickman L, Imani RA, Alexopoulos SP, Matsuoka L. Noninvasive Management of Complications From Splenic Artery Aneurysm Embolization After Liver Transplant: A Case Report. EXP CLIN TRANSPLANT 2021; 20:218-221. [PMID: 34142938 DOI: 10.6002/ect.2020.0531] [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: 11/05/2022]
Abstract
Splenic artery aneurysms are more common in patients with cirrhosis than in the general population. We report the case of a patient with a history of an orthotopic liver transplant who developed an enlarging splenic artery aneurysm that was treated with splenic artery embolization. He developed extensive portal vein thrombosis and subsequently splenic abscess. Both complications were managed endovascularly, with catheter-directed thrombolysis and percutaneous drains. This case illustrates the possible complications after splenic artery embolization and demonstrates the nonsurgical options for treatment.
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Affiliation(s)
- Austin J Livingston
- From the Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Livingston AJ, Bailey CE, Washington MK, Eng C. Squamous Cell Carcinoma of the Anal Verge with Sigmoid Colon Metastasis. Clin Colorectal Cancer 2021; 20:e210-e213. [PMID: 34092493 DOI: 10.1016/j.clcc.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Austin J Livingston
- Section of Surgical Sciences, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - Christina E Bailey
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - M Kay Washington
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Cathy Eng
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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Livingston AJ, Espahbodi M, Harvey SA, Albano K, Quinet SA, Bovi JA, Friedland DR. Gamma Knife Treatment of Vestibular Schwannoma Planned With Computed Tomography Cisternography. Adv Radiat Oncol 2021; 6:100631. [PMID: 33748544 PMCID: PMC7966823 DOI: 10.1016/j.adro.2020.100631] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
| | - Mana Espahbodi
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Steven A Harvey
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Katherine Albano
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stephen A Quinet
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Joseph A Bovi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David R Friedland
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
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Livingston AJ, Laing B, Zwagerman NT, Harris MS. Lumbar drains: Practical understanding and application for the otolaryngologist. Am J Otolaryngol 2020; 41:102740. [PMID: 32979671 DOI: 10.1016/j.amjoto.2020.102740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/13/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Lumbar drains are frequently used in patients with otolaryngologic concerns. These can be used therapeutically or prophylactically with the primary purpose being to modulate CSF pressure. Within otolaryngology, lumbar drains are most frequently used for cerebrospinal fluid leaks - either due to cerebrospinal fluid fistulas or in skull base surgery as these allow for potential healing of the defect. While not typically placed by otolaryngologists, a basic understanding of lumbar drains is beneficial in the context of patient management. MANAGEMENT A lumbar drain is inserted into the intrathecal space in a patient's lumbar spine. Though considered to be a benign procedure, complications are relatively frequent, and adjustment or replacement of the drain may be required. Complications include infection, epidural bleeding, retained hardware, sequelae of relative immobility, or may relate to over-drainage, ranging from mild headache to cranial neuropathies, altered mental status, pneumocephalus, intracranial hemorrhage, and death. While in place, neurologic exams should be performed routinely and should include motor and sensory exams of the lower extremities. A patient should be monitored for fevers, nuchal rigidity, and other signs of infection or meningitis. The CSF fluid should be grossly examined to identify changes, but routine laboratory tests are not typically run on the fluid itself. Drainage rates will vary usually between 5 and 20 mL per hour and must be frequently reassessed and adjusted based upon signs of intracranial hypotension. Drains should be removed when appropriate and should not be left in more than 5 days due to the increased infectious risk. CONCLUSION Lumbar drains are important tools used in patients with otolaryngologic pathologies. Otolaryngologists and otolaryngology residents should be familiar with these catheters to determine if they are working correctly and to identify adverse effects as early as possible.
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Affiliation(s)
| | - Brandon Laing
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Nathan T Zwagerman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Michael S Harris
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America
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