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Bhatia S, Acharya V, Jalaeian H, Kumar J, Bryant E, Richardson A, Malkova K, Harward S, Sinha V, Kably I, Kava BR. Effect of Prostate Artery Embolization on Erectile Function - A Single Center Experience of 167 Patients. J Sex Med 2022; 19:594-602. [PMID: 35184995 DOI: 10.1016/j.jsxm.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prostate artery embolization (PAE) is an emerging therapy for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). AIM This retrospective study was conducted to assess the effect of prostate artery embolization (PAE) on erectile function in a cohort of patients with LUTS attributable to BPH at 3-months after the procedure. METHODS A retrospective review was performed on 167 patients who underwent PAE. Data collected included Sexual Health Inventory in Men (SHIM) scores at 3, 6, and 12 months post-PAE, in conjunction with the International Prostate Symptom Scores (IPSS), Quality of Life (QoL) scores, and prostate volumes. Primary outcome was erectile function as assessed by SHIM scores at 3 months after PAE. An analysis was performed to identify patients with a ±5-point SHIM change to group them according to this minimum clinically significant difference in erectile function. Adverse events were recorded using the Clavien-Dindo (CD) classification. OUTCOMES At 3 months following PAE, median IPSS decreased by 16.0 [IQR, 9.0-22.0] points, median QOL decreased by 4.0 [IQR, 2.0-5.0] points, and median prostate volume decreased by 33 g [IQR, 14-55]. RESULTS Median SHIM score was 17.0 [IQR, 12.0-22.0] at baseline, 18.0 [IQR, 14.0-23.0] at 3 months [P = .031], 19.0 [IQR, 14.5-21.5] at 6 months [P = .106] and 20 [IQR, 16.0-24.0] at 12 months [P = .010] following PAE. In patients with no erectile dysfunction (ED) at baseline, 21% (n = 9) reported some degree of decline in erectile function post-PAE. However, 38% (n = 40) of patients who presented with mild-to-moderate ED reported improvement in their erectile function 3 months following PAE. Overall, the changes in baseline SHIM score were relatively small; 82% (n = 137) of patients did not have more than 5 points of change in their SHIM scores at 3 months following PAE. CLINICAL IMPLICATIONS Our findings suggest PAE has no adverse impact on erectile function for most patients. STRENGTHS & LIMITATIONS The study was performed at a single center with 1 operator's experience, and is retrospective with no control group. CONCLUSION Findings suggest that prostate artery embolization has no adverse effect on erectile function in the majority of patients with LUTS attributable to BPH at 3 months after the procedure. Bhatia S, Acharya V, Jalaeian H, et al., Effect of Prostate Artery Embolization on Erectile Function - A Single Center Experience of 167 Patients. J Sex Med 2022;19:594-602.
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Affiliation(s)
- Shivank Bhatia
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Vedant Acharya
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Hamed Jalaeian
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Jessica Kumar
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA.
| | - Evan Bryant
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Andrew Richardson
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Kseniia Malkova
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Sardis Harward
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Vishal Sinha
- Weill Cornell Department of Radiology, New York, NY, USA
| | - Issam Kably
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Bruce R Kava
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
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Kava BR, Levine A, Hauser N, Masterson T, Ramasamy R. Direct Vision, Transfascial (DVT) Approach to Submuscular Reservoir Placement in Patients Undergoing Multicomponent Penile Implant Surgery Following Prior Pelvic Surgery or Radiation Therapy. J Sex Med 2021; 19:394-400. [PMID: 34969612 DOI: 10.1016/j.jsxm.2021.11.012] [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: 05/22/2021] [Revised: 09/27/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Submuscular reservoir placement has fulfilled a critical need for patients desiring multicomponent penile implants following pelvic surgery and radiation therapy. Passage of the reservoir through the inguinal canal into the submuscular space is often challenging and carries the risk of the reservoir being placed unknowingly outside of the targeted space. AIM To evaluate the safety and accuracy of a direct vision, transfascial (DVT) approach to submuscular reservoir placement. METHODS We retrospectively reviewed outcomes for consecutive patients undergoing DVT submuscular reservoir placement abstracted from a large IRB-approved database at our institution. Postimplant cross-sectional imaging performed on many of these patients was used to ascertain the final location of the reservoir. OUTCOMES Outcome measures included the perioperative and intermediate-term safety and complications of the procedure. Postimplant imaging ascertained the accuracy in providing patients with a submuscular reservoir. RESULTS There were 107 DVT submuscular reservoirs placed in 100 consecutive patients. No intraoperative complications occurred, there were no postoperative rectus hematomas, and there were 4 (3.7%) postoperative infections. With a mean follow up of 17.5 +/- 20.5 months there was one reservoir herniation, one patient had autoinflation, and one patient required repositioning of a high riding pump. There were 4 mechanical malfunctions requiring revision at a median of 74 months (range: 69-108 months.) following implant placement. Of the 43 patients who underwent imaging: 34 (79%) reservoirs were accurately positioned, 5 (12%) were in the lateral abdominal wall, 1(2%) was in the retroperitoneum, and 3 (7%) were intraperitoneal. Intraperitoneal reservoirs occurred exclusively in postcystectomy patients. CLINICAL IMPLICATIONS The DVT approach is technically safe, although a slightly higher than expected infection risk was noted. It provides accurate reservoir placement for the majority of imaged patients. Postcystectomy patients have a risk of insidious intraperitoneal reservoir placement. Preoperative counseling should mention this and postimplant imaging may be considered for some of these patients. Imaging may also helpful prior to future revision surgery in order to identify and remove insidious intraperitoneal reservoirs. STRENGTHS AND LIMITATIONS We investigated 100 patients, almost half underwent cross sectional imaging. Weaknesses include the retrospective nature of this single-institutional study, which may not have similar outcomes at other centers. CONCLUSION DVT submuscular reservoir placement is safe following pelvic surgery and radiation therapy. Despite careful and deliberate surgical technique imaging found that approximately 20% of reservoirs are not in their expected location. Intraperitoneal reservoirs are of concern, particularly in postcystectomy patients. Kava BR, Levine A, Hauser N, et al. Direct Vision, Transfascial (DVT) Approach to Submuscular Reservoir Placement in Patients Undergoing Multicomponent Penile Implant Surgery Following Prior Pelvic Surgery or Radiation Therapy. J Sex Med 2021;XX:XXX-XXX.
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Affiliation(s)
- Bruce R Kava
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA.
| | - Amanda Levine
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Nicholas Hauser
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Thomas Masterson
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
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Kryvenko ON, Iakymenko OA, De Lima Guido LP, Bhattu AS, Merhe A, Mouzannar A, Briski LM, Oymagil I, Lugo I, Nemov I, Ritch CR, Kava BR, Punnen S, Jorda M, Parekh DJ, Gonzalgo ML. Prostatic Ductal Adenocarcinoma Controlled for Tumor Grade, Stage, and Margin Status Does Not Independently Influence the Likelihood of Biochemical Recurrence in Localized Prostate Cancer After Radical Prostatectomy. Arch Pathol Lab Med 2021; 146:1012-1017. [PMID: 34739539 DOI: 10.5858/arpa.2021-0048-oa] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Prostatic ductal adenocarcinoma (PDA) has historically been considered to be an aggressive subtype of prostate cancer. OBJECTIVE.— To investigate if PDA is independently associated with worse biochemical recurrence (BCR)-free survival after radical prostatectomy. DESIGN.— A review of 1584 radical prostatectomies was performed to grade, stage, and assess margin status in each tumor nodule. Radical prostatectomies with localized PDA (ie, those lacking metastasis) in the tumor nodule with the highest grade and stage and worst margin status were matched with prostatic acinar adenocarcinoma according to grade, stage, and margin status. The effect of PDA on BCR was assessed by multivariable Cox regression and Kaplan-Meier analyses. RESULTS.— Prostatic ductal adenocarcinoma was present in 171 cases. We excluded 24 cases because of lymph node metastasis (n = 13), PDA not in the highest-grade tumor nodule (n = 9), and positive surgical margin in a lower-grade tumor nodule (n = 2). The remaining 147 cases included 26 Grade Group (GG) 2, 44 GG3, 6 GG4, and 71 GG5 cancers. Seventy-six cases had extraprostatic extension, 33 had seminal vesicle invasion, and 65 had positive margins. Follow-up was available for 113 PDA and 109 prostatic acinar adenocarcinoma cases. Prostate-specific antigen density (odds ratio, 3.7; P = .001), cancer grade (odds ratio, 3.3-4.3; P = .02), positive surgical margin (odds ratio, 1.7; P = .02), and tumor volume (odds ratio, 1.3; P = .02) were associated with BCR in multivariable analysis. Prostatic ductal adenocarcinoma, its percentage, intraductal carcinoma, and cribriform Gleason pattern 4 were not significant independent predictors of BCR. CONCLUSIONS.— Advanced locoregional stage, higher tumor grade, and positive surgical margin status rather than the mere presence of PDA are more predictive of worse BCR-free survival outcomes following radical prostatectomy in men with a component of PDA.
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Affiliation(s)
- Oleksandr N Kryvenko
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida.,Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Oleksii A Iakymenko
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Luiz P De Lima Guido
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Amit S Bhattu
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Ali Merhe
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Ali Mouzannar
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Laurence M Briski
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Irfan Oymagil
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Isabella Lugo
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Ivan Nemov
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida
| | - Chad R Ritch
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Bruce R Kava
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Sanoj Punnen
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Merce Jorda
- From the Department of Pathology and Laboratory Medicine (Kryvenko, Iakymenko, De Lima Guido, Briski, Lugo, Nemov, Jorda), University of Miami Miller School of Medicine, Miami, Florida.,Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Dipen J Parekh
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
| | - Mark L Gonzalgo
- Department of Urology (Kryvenko, Bhattu, Merhe, Mouzannar, Oymagil, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida.,The Sylvester Comprehensive Cancer Center (Kryvenko, Briski, Ritch, Kava, Punnen, Jorda, Parekh, Gonzalgo), University of Miami Miller School of Medicine, Miami, Florida
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Ory J, Lima TFN, Towe M, Frech FS, Best JC, Kava BR, Ramasamy R. Understanding the Complex Relationship Between Androgens and SARS-CoV2. Urology 2020; 144:1-3. [PMID: 32653566 PMCID: PMC7346809 DOI: 10.1016/j.urology.2020.06.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Jesse Ory
- Department of Urology, Dalhousie University, Halifax, Canada; Department of Urology, Miller School of Medicine, University of Miami, Miami, FL
| | | | - Maxwell Towe
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL
| | - Fabio Stefano Frech
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL
| | - Jordan C Best
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL
| | - Bruce R Kava
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL.
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Gross MS, Reinstatler L, Henry GD, Honig SC, Stahl PJ, Burnett AL, Maria PP, Bennett NE, Kava BR, Kohler TS, Beilan JA, Carrion RE, Munarriz RM. Multicenter Investigation of Fungal Infections of Inflatable Penile Prostheses. J Sex Med 2020; 16:1100-1105. [PMID: 31255212 DOI: 10.1016/j.jsxm.2019.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Fungal infections of inflatable penile prostheses (IPPs) are inadequately understood in the literature. AIM To review a multi-institution database of IPP infections to examine for common patient and surgical factors related to IPP fungal infections. METHODS This is a retrospective Institutional Review Board-approved analysis of 217 patients at 26 institutions who underwent salvage or device explant between 2001 and 2018. Patient data were compiled after an extensive record review. OUTCOMES 26 patients (12%) with fungal infections were identified. RESULTS 23 of 26 patients (83%) with a fungal IPP infection were either diabetic or overweight. 15 patients had undergone primary IPP implantation, and the other 11 had previously undergone an average of 1.7 IPP-related surgeries (range 1-3; median 2). The average age at implantation was 63 years (range 31-92; median 63). 18 of the 26 patients with fungal infection had diabetes (69%), with a mean hemoglobin A1c (HbA1c) value of 8.4 (range 5.8-13.3; median 7.5). Twenty-two patients (85%) were overweight or obese. The mean body mass index for all patients was 30.1 kg/m2 (range 23.7-45 kg/m2; median 28.4 kg/m2), and that for diabetic patients was 30.8 kg/m2 (range 24.1-45 kg/m2, median 29.7 kg/m2). Ninety-one percent of implants were placed with intravenous antibiotics, consistent with current American Urological Association guidelines: an aminoglycoside plus first- or second-generation cephalosporin or vancomycin or ampicillin/sulbactam or piperacillin/tazobactam. 65% (17 of 26) of infected IPPs had only fungal growth in culture. No patient had concomitant immunosuppressive disease or recent antibiotic exposure before IPP implantation. CLINICAL IMPLICATIONS More than two-thirds of the fungal infections occurred in diabetic patients and 85% occurred in overweight or obese patients, suggesting that antifungal prophylaxis may be appropriate in these patients. STRENGTHS & LIMITATIONS This is the largest series of fungal infections reported to date in the penile prosthesis literature. The overall number of such cases, however, remains small. CONCLUSION Fungal infections represent 12% of all penile prosthesis infections in our series and were seen mostly in diabetic or overweight patients, who may benefit from antifungal prophylaxis. Gross MS, Reinstatler L, Henry GD, et al. Multicenter Investigation of Fungal Infections of Inflatable Penile Prostheses. J Sex Med 2019;16:1100-1105.
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Affiliation(s)
- Martin S Gross
- Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
| | - Lael Reinstatler
- Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Stanton C Honig
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Peter J Stahl
- Department of Urology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Arthur L Burnett
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pedro P Maria
- Department of Urology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nelson E Bennett
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jonathan A Beilan
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Rafael E Carrion
- Department of Urology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Ricardo M Munarriz
- Department of Urology, Boston University Medical Center, Boston, MA, USA
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Kava BR, Lopategui DM, Levine A, Ramasamy R. Trans-Fascial Placement of a High, Sub Muscular Reservoir in Patients Following Radical Cystectomy: Safety, Efficacy, and Predictability of Final Reservoir Location Verified With Abdominal Imaging. J Sex Med 2020; 16:338-345. [PMID: 30770075 DOI: 10.1016/j.jsxm.2018.12.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 12/09/2018] [Accepted: 12/20/2018] [Indexed: 01/16/2023]
Abstract
INTRODUCTION With the increasing utilization of ectopic reservoir placement during multicomponent penile implant surgery, safety concerns have been raised about whether passing the reservoir through the floor of the inguinal canal consistently results in placement of the reservoir within the correct location. AIM To evaluate the safety, efficacy, and patient satisfaction associated with direct-vision, trans-fascial sub muscular reservoir placement in consecutive patients who had previously undergone radical cystectomy. METHODS Perioperative data, complications, and follow up for the 12 cystectomy patients were evaluated using a comprehensive database of consecutive patients undergoing penile prosthesis placement at our center. Efficacy and patient satisfaction were based upon responses to the Erectile Function and Satisfaction Domains of the International Index of Erectile Function (IIEF). Taking advantage of the need for post cystectomy imaging in monitoring for cancer recurrence, we reviewed post- implant imaging with the purpose of ascertaining the final reservoir location. MAIN OUTCOME MEASURE Using intraoperative photographs, we describe the technique of trans-fascial sub muscular reservoir placement. Perioperative complications, device efficacy and satisfaction, and the accuracy of reservoir placement are also evaluated. RESULTS Average patient age was 65 ± 7 years old and the mean time between cystectomy and implant placement was 41 ± 29 months. With a mean follow up of 26 ± 21 months, complications included: 1 reservoir herniation and 1 high riding pump requiring repositioning. Mean IIEF-EF domain was 29.8 ± 0.5 and mean IIEF-satisfaction domain was 17.7 ± 4.5. Other than the herniated reservoir, imaging confirmed accurate reservoir placement in 8 of 9 cases. In 3 patients a small cephalad portion of the reservoir extends posteriorly into the peritoneal or preperitoneal space, with no clinical consequences. CLINICAL IMPLICATIONS Ectopic reservoir placement using a trans-fascial submuscular approach seems to be a safe method for multicomponent penile implant surgery in patients who have undergone radical cystectomy. Post-implant imaging confirms that the device is consistently placed in the correct sub muscular location. STRENGTHS & LIMITATIONS This is a novel approach to performing the procedure and a practical manner to ascertain the reservoir position. The limited number of patients prevents generalization of our findings. CONCLUSION Trans-fascial, sub muscular reservoir placement is a safe means of ectopically placing the reservoir of a multicomponent penile implant following radical cystectomy. Post implant IIEF scores indicate high device efficacy and patient satisfaction. Post implant imaging confirms that the reservoir is almost always in the desired location. Kava BR, Lopatagui DM, Levine A, et al. Trans-Fascial Placement of a High, Sub Muscular Reservoir in Patients Following Radical Cystectomy: Safety, Efficacy, and Predictability of Final Reservoir Location Verified With Abdominal Imaging. J Sex Med 2019;16:338-345.
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Affiliation(s)
- Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Diana M Lopategui
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amanda Levine
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Lokeshwar SD, Patel P, Kava BR. Editorial comment: Multicenter investigation on the influence of climate in penile prosthesis infection. Int J Impot Res 2019; 32:469-470. [PMID: 31570824 DOI: 10.1038/s41443-019-0202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Soum D Lokeshwar
- Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Premal Patel
- Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA.
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Kava BR, Verbeek AE, Wruck JM, Gittelman M. Tamsulosin dispensation patterns in the United States: a real-world, longitudinal, population claims database analysis. Transl Androl Urol 2019; 8:329-338. [PMID: 31555556 DOI: 10.21037/tau.2019.07.02] [Citation(s) in RCA: 3] [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] [Indexed: 12/26/2022] Open
Abstract
Background Tamsulosin remains the single most popular uroselective alpha adrenoceptor antagonist approved for the treatment of lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH). Over the last 3 decades, the utilization of tamsulosin has extended to conditions beyond its original indication. To identify potential changes to prescribing patterns and the extent of tamsulosin use for conditions beyond its original indication, we evaluated tamsulosin dispensing patterns in the United States using a large, multi-payer claims database. Methods We conducted a retrospective analysis using IMS PharMetrics Plus™. Patients with a tamsulosin dispensation/BPH diagnosis code (index dates), identified during a 12-month selection period (October 2012-September 2013), were included if continuously enrolled in a health plan during the 18-month analysis period (12 months pre-index-6 months post-index). Patient and provider characteristics were evaluated using descriptive statistics and were contrasted with previously reported data from the literature. Results Of 133,977 patients dispensed tamsulosin during the analysis period, 72,583 (54.2%) were new users [59,197 (81.6%) men; 13,386 (18.4%) women]. Tamsulosin was newly initiated in men and women mostly by primary care physicians (PCPs; 31.6%) and emergency medicine physicians (21.6%). During the analysis period, 35,071 (59.2%) male new tamsulosin users did not receive a BPH diagnosis code during the analysis period. Of 199,468 men with a BPH diagnosis code, 143,444 (71.9%) were newly diagnosed, mostly [70,412 (49.1%)] by urologists. Few men received hypotension diagnosis: 252 (0.4%) new tamsulosin users within 1 month of starting tamsulosin and 640 (0.4%) within 1 month of a new BPH diagnosis. Conclusions Tamsulosin was prescribed in patients without a recorded diagnosis of BPH and in women. Physicians were comfortable prescribing tamsulosin in the presence of comorbidity and polypharmacy, and PCPs and emergency medicine physicians were the primary prescribers. These results have important implications for future retrospective research for tamsulosin.
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Affiliation(s)
- Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anna E Verbeek
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Jan M Wruck
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Marc Gittelman
- South Florida Medical Research, Uromedix/Division of 21st Century Oncology, Aventura, FL, USA
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McWilliams JP, Bilhim TA, Carnevale FC, Bhatia S, Isaacson AJ, Bagla S, Sapoval MR, Golzarian J, Salem R, McClure TD, Kava BR, Spies JB, Sabharwal T, McCafferty I, Tam AL. Society of Interventional Radiology Multisociety Consensus Position Statement on Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: From the Society of Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, Société Française de Radiologie, and the British Society of Interventional Radiology: Endorsed by the Asia Pacific Society of Cardiovascular and Interventional Radiology, Canadian Association for Interventional Radiology, Chinese College of Interventionalists, Interventional Radiology Society of Australasia, Japanese Society of Interventional Radiology, and Korean Society of Interventional Radiology. J Vasc Interv Radiol 2019; 30:627-637.e1. [PMID: 30926185 DOI: 10.1016/j.jvir.2019.02.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Justin P McWilliams
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Tiago A Bilhim
- Interventional Radiology Department, St. Louis Hospital, Lisbon, Portugal
| | - Francisco C Carnevale
- Department of Interventional Radiology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Shivank Bhatia
- Department of Radiology and Division of Vascular Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ari J Isaacson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Sandeep Bagla
- Vascular Institute of Virginia, Woodbridge, Virginia
| | - Marc R Sapoval
- Department of Vascular and Oncologic Interventional Radiology, Hôpital Européen Georges Pompidou, Paris, France
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology and Vascular Imaging, University of Minnesota, Minneapolis, Minnesota
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Timothy D McClure
- Department of Urology, Weill Cornell Medicine, Lefrak Center for Robotic Surgery, New York, New York
| | - Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - James B Spies
- Department of Radiology, Georgetown University Medical Center, Washington, DC
| | - Tarun Sabharwal
- Department of Radiology, Guys and St Thomas' Hospital, London, United Kingdom
| | - Ian McCafferty
- Department of Clinical Radiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Alda L Tam
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
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Bhatia S, Sinha VK, Harward S, Gomez C, Kava BR, Parekh DJ. Prostate Artery Embolization in Patients with Prostate Volumes of 80 mL or More: A Single-Institution Retrospective Experience of 93 Patients. J Vasc Interv Radiol 2018; 29:1392-1398. [PMID: 30217744 DOI: 10.1016/j.jvir.2018.05.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of prostate artery embolization (PAE) for the treatment of benign prostatic hyperplasia for prostates ≥ 80 mL. PATIENTS AND METHODS A retrospective review was conducted of 93 patients with prostate volumes (PVs) ≥ 80 mL treated with PAE from April 2014 through October 2017. Mean patient age was 68.5 years (range 52-88) and mean age-adjusted Charlson comorbidity index was 3.2 (range 1-8). Exclusion criteria included history of biopsy-proven prostate cancer or catheter dependency. Clinical and urodynamic outcomes were reviewed at 1, 3, 6, and 12 months. Adverse events were graded according to the Clavien-Dindo classification. RESULTS Mean PV decreased significantly from 141.7 mL to 98.1 mL at 3 months (P < .01) and 82.2 mL at 12 months (P < .01). Significant improvements were seen in 3- and 12-month mean International Prostate Symptom Scores (IPSS) (22.3 vs 7.1 and 7.3, respectively; P < .01 for both), quality of life (QOL) (4.4 vs 1.2 and 1.3; P < .01 for both), and postvoid residual volume (196.7mL vs 92.1 and 61.2 mL; P < .01 and P < .01, respectively). Significant improvement was also seen in 3-month mean maximum urinary flow: 7.7 mL/s vs 12.8 mL/s (P < .01). One grade II complication of stroke occurred; all other complications were self-limited and grade I. CONCLUSIONS PAE achieved a clinically and statistically significant improvement in symptom burden and secondary outcome measures in patients with PVs ≥ 80 mL. PAE may be an alternate treatment for patients for whom conventional surgical options are limited or associated with significant morbidity.
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Affiliation(s)
- Shivank Bhatia
- Department of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami VA Healthcare, 1150 NW 14th St, Suite 511, Miami, Florida 33136.
| | - Vishal K Sinha
- University of Miami Miller School of Medicine, Miami VA Healthcare, 1150 NW 14th St, Suite 511, Miami, Florida 33136
| | - Sardis Harward
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Christopher Gomez
- Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami VA Healthcare, 1150 NW 14th St, Suite 511, Miami, Florida 33136
| | - Bruce R Kava
- Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami VA Healthcare, 1150 NW 14th St, Suite 511, Miami, Florida 33136
| | - Dipen J Parekh
- Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami VA Healthcare, 1150 NW 14th St, Suite 511, Miami, Florida 33136
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11
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Lopategui DM, Balise RR, Bouzoubaa LA, Wilson SK, Kava BR. The Impact of Immediate Salvage Surgery on Corporeal Length Preservation in Patients Presenting with Penile Implant Infections. J Urol 2018; 200:171-177. [PMID: 29408215 DOI: 10.1016/j.juro.2018.01.082] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Removal of an infected penile implant often results in corporeal fibrosis, irreversible penile shortening and dissatisfaction with future implant surgery. Salvage surgery may avoid these problems but to our knowledge no study to date has evaluated these specific end points. We evaluated patients who presented to our center with an infected implant to determine the impact of salvage surgery on penile length. MATERIALS AND METHODS We evaluated consecutive patients undergoing removal of an infected penile prosthesis with immediate salvage or delayed reimplantation using a comprehensive, prospective database. Total corporeal length prior to and following immediate salvage or delayed reimplantation were compared. The impact of patient age, comorbidities, bacterial species, initial penile length and time to reimplantation on subsequent total corporeal length was evaluated. RESULTS The cohort consisted of 40 patients. Overall 81% of salvaged cases were successful, resulting in a mean 0.6 cm (95% CI 0.20 to 1.1) reduction in total corporeal length. Delayed reimplantation resulted in a mean 3.7 cm (95% CI 2.9-4.5) total corporeal length loss. In patients who underwent delayed reimplantation the total corporeal length reduction was directly proportionate to the initial penis size of the patient. No statistically significant impact on penile length was attributable to patient age, diabetes, bacterial species or time to reimplantation. CONCLUSIONS When possible, salvage surgery should be offered to patients with an infected penile implant. Our data confirmed that successful salvage surgery preserves penile length. When a device is explanted and replaced at a later date, patients can expect to lose 15% to 30% of penile length irrespective of age, diabetes, type of infecting organism and time to reimplantation.
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Affiliation(s)
- Diana M Lopategui
- Clinical and Translational Science Institute, University of Miami, Miami, Florida
| | - Raymond R Balise
- Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami, Florida
| | - Layla A Bouzoubaa
- Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami, Florida
| | | | - Bruce R Kava
- Department of Urology, University of Miami, Miami, Florida.
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12
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Lokeshwar SD, Talukder A, Yates TJ, Hennig MJP, Garcia-Roig M, Lahorewala SS, Mullani NN, Klaassen Z, Kava BR, Manoharan M, Soloway MS, Lokeshwar VB. Molecular Characterization of Renal Cell Carcinoma: A Potential Three-MicroRNA Prognostic Signature. Cancer Epidemiol Biomarkers Prev 2018; 27:464-472. [PMID: 29440068 DOI: 10.1158/1055-9965.epi-17-0700] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/28/2017] [Accepted: 01/09/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Aberrantly expressed miRNAs promote renal cell carcinoma (RCC) growth and metastasis and are potentially useful biomarkers for metastatic disease. However, a consensus clinically significant miRNA signature has not been identified. To identify an miRNA signature for predicting clinical outcome in RCC patients, we used a four-pronged interconnected approach.Methods: Differentially expressed miRNAs were identified and analyzed in 113 specimens (normal kidney: 59; tumor: 54). miRNA profiling was performed in matched normal and tumor specimens from 8 patients and extended to 32 specimens. Seven aberrantly expressed miRNAs were analyzed by qPCR, and their levels were correlated with RCC subtypes and clinical outcome. miRNA signature was confirmed in The Cancer Genome Atlas RCC dataset (n = 241).Results: Discovery phase identified miR-21, miR-142-3p, miR-142-5p, miR-150, and miR-155 as significantly upregulated (2-4-fold) and miR-192 and miR-194 as downregulated (3-60-fold) in RCC; miR-155 distinguished small tumors (<4 cm) from benign oncocytomas. In univariate and multivariate analyses, miRNA combinations (miR-21+194; miR-21+142-5p+194) significantly predicted metastasis and/or disease-specific mortality; miR-21+142-5p+194 (for metastasis): P = 0.0017; OR, 0.53; 95% confidence interval (CI), 0.75-0.33; 86.7% sensitivity; 82% specificity. In the TCGA dataset, combined biomarkers associated with metastasis and overall survival (miR-21+142-5p+194: P < 0.0001; OR, 0.37; 95% CI, 0.58-0.23).Conclusions: The interconnected discovery-validation approach identified a three-miRNA signature as a potential predictor of disease outcome in RCC patients.Impact: With 10% survival at 5 years, metastatic disease presents poor prognosis for RCC patients. The three-miRNA signature discovered and validated may potentially at an early stage detect and predict metastasis, to allow early intervention for improving patient prognosis. Cancer Epidemiol Biomarkers Prev; 27(4); 464-72. ©2018 AACR.
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Affiliation(s)
- Soum D Lokeshwar
- Honors Program in Medical Education, Miller School of Medicine, University of Miami, Miami, Florida.,Department of Biochemistry and Molecular Biology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Asif Talukder
- Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Travis J Yates
- Sheila and David Fuente Graduate Program in Cancer Biology, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, Florida
| | - Martin J P Hennig
- Department of Urology, University of Schleswig-Holstein, Lübeck, Germany
| | - Michael Garcia-Roig
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Sarrah S Lahorewala
- Honors Program in Medical Education, Miller School of Medicine, University of Miami, Miami, Florida
| | - Naureen N Mullani
- Honors Program in Medical Education, Miller School of Medicine, University of Miami, Miami, Florida
| | - Zachary Klaassen
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Bruce R Kava
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Murugesan Manoharan
- Division of Urologic Oncology Surgery, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | | | - Vinata B Lokeshwar
- Honors Program in Medical Education, Miller School of Medicine, University of Miami, Miami, Florida.
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13
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Bhatia S, Sinha VK, Kava BR, Gomez C, Harward S, Punnen S, Kably I, Miller J, Parekh DJ. Efficacy of Prostatic Artery Embolization for Catheter-Dependent Patients with Large Prostate Sizes and High Comorbidity Scores. J Vasc Interv Radiol 2017; 29:78-84.e1. [PMID: 29150394 DOI: 10.1016/j.jvir.2017.08.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 06/27/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate efficacy and safety of prostate artery embolization (PAE) in urinary catheter-dependent patients with large prostate volumes and high comorbidity scores. MATERIALS AND METHODS A retrospective single-center review was conducted of 30 patients with urinary retention at time of PAE from November 2014 through February 2017. Mean (range) age was 73.1 years (48-94 y), age-adjusted Charlson comorbidity index was 4.5 (0-10), duration of urinary retention was 63.4 days (2-224 d), International Prostate Symptom Score quality-of-life (IPSS-QOL) was 5.3 (3-6), and prostate volume was 167.3 cm3 (55-557 cm3). These parameters were collected at 3, 6, and 12 months after PAE. Trials of voiding were performed approximately 2 weeks after PAE and, if failed, every 2 weeks thereafter. Adverse events were graded using the Clavien-Dindo classification. RESULTS At a mean (range) of 18.2 days (1-72 d), 26 (86.7%) patients were no longer reliant on catheters. Follow-up was obtained in all patients eligible at 3 and 6 months and 17 of 20 (85.0%) patients eligible at 1 year. Mean (range) IPSS-QOL improved significantly to 1.2 (0-5), 0.7 (0-4), and 0.6 (0-4) at 3, 6, and 12 months (all P < .001). Mean (range) prostate volume decreased significantly to 115.9 cm3 (27-248 cm3) at 3 months (P < .001). Two patients experienced grade II urosepsis complications, which were successfully treated with intravenous antibiotics. All other complications were self-limited grade I complications. CONCLUSIONS PAE represents a safe and effective option for management of patients with urinary retention, especially patients with large prostates who are not ideal surgical candidates.
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Affiliation(s)
- Shivank Bhatia
- Department of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1150 NW 14th Street, Suite 511, Miami, FL 33136; Miami VA Healthcare System, Miami, Florida.
| | - Vishal K Sinha
- University of Miami Miller School of Medicine, 1150 NW 14th Street, Suite 511, Miami, FL 33136
| | - Bruce R Kava
- Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1150 NW 14th Street, Suite 511, Miami, FL 33136; Miami VA Healthcare System, Miami, Florida
| | - Christopher Gomez
- Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1150 NW 14th Street, Suite 511, Miami, FL 33136
| | - Sardis Harward
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Sanoj Punnen
- Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1150 NW 14th Street, Suite 511, Miami, FL 33136
| | - Issam Kably
- Department of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1150 NW 14th Street, Suite 511, Miami, FL 33136
| | - Jeffrey Miller
- Department of Urology, Boca Raton Regional Hospital, Boca Raton, Florida
| | - Dipen J Parekh
- Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1150 NW 14th Street, Suite 511, Miami, FL 33136
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Kava BR, Andrade AD, Marcovich R, Idress T, Ruiz JG. Communication Skills Assessment Using Human Avatars: Piloting a Virtual World Objective Structured Clinical Examination. Urol Pract 2017; 4:76-84. [PMID: 37592593 DOI: 10.1016/j.urpr.2016.01.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Proficiency in communication skills is a core competency of residency training. We evaluated the feasibility, acceptability and applicability of a virtual world objective structured clinical examination that enables practice based learning and assessment of resident communication skills. METHODS A virtual clinical encounter situated in 2 practice settings was developed that uses a human avatar physician and a standardized patient. Following an online tutorial house staff participated in 4 communication tasks, including shared decision making, delivering bad news, obtaining informed consent and disclosing a medical error. Validated instruments and semistructured interviews were used to assess house staff acceptability and applicability of the platform. Three faculty members used ACS (Affective Competency Scale) and communication specific assessment instruments to evaluate house staff performance. RESULTS A total of 12 urology house staff completed the simulation. Direct costs were approximately $1,000. The virtual world was easy to use and immersive. Applicability directly correlated with presence (Pearson r = 0.67, p = 0.01) and co-presence (Pearson r = 0.8, p = 0.002). House staff identified problems with 1) limited nonverbal cues, 2) too much information presented and 3) a lack of immediate feedback. The ICC (intraclass correlation) of faculty assessments was high for ACS at 0.53 (95% CI 0.36-0.69) for single measures, 0.77 (95% CI 0.63-0.86) for average measures and less for other assessment instruments. CONCLUSIONS A virtual world objective structured clinical examination is a feasible, acceptable and applicable method of communication skills assessment. Improving nonverbal cues, focusing on individual skill sets and providing immediate feedback are measures to be adopted in future iterations of this platform.
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Affiliation(s)
- Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Allen D Andrade
- Geriatric Research Education and Clinical Centers, James J. Peters Veterans Affairs Medical Center, Bronx, New York
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Marcovich
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Thaer Idress
- Laboratory of E-learning and Multimedia Research, Geriatric Research Education and Clinical Centers, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida
| | - Jorge G Ruiz
- Laboratory of E-learning and Multimedia Research, Geriatric Research Education and Clinical Centers, Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida
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Abstract
INTRODUCTION Sarcoidosis is a multisystem disease that commonly involves the lungs, but may also present with extrapulmonary manifestations. Genitourinary (GU) tract involvement has been traditionally thought to be rare, but that view may underestimate the true prevalence of the disease due to the often, silent presentation thereof. METHODS The literature pertaining to sarcoidosis from the general systemic point of view, etiology and therapy and with regard to specific organs was reviewed by identifying key words in a PubMed search. That material with special relevance to the Indian experience was emphasized. RESULTS There are a number of isolated case reports in the literature describing symptomatic and asymptomatic GU tract sarcoidosis. The world literature associated with the generalized syndrome was reviewed and summarized. Specific aspects of GU involvement are presented for each organ of the GU tract. CONCLUSIONS It is critical for the practicing clinician to have a working knowledge of the clinical manifestations of this disease as it involves the GU tract, as well as to be able to distinguish it from tuberculosis and the various malignancies that affect this organ system.
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Affiliation(s)
- Norman L. Block
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Bruce R. Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
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16
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Iremashvili V, Manoharan M, Kava BR, Parekh DJ, Punnen S. Predictive models and risk of biopsy progression in active surveillance patients. Urol Oncol 2016; 35:37.e1-37.e8. [PMID: 27692836 DOI: 10.1016/j.urolonc.2016.08.015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/07/2016] [Accepted: 08/23/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To analyze the performance of different radical prostatectomy-based prognostic tools in predicting the biopsy progression in our active surveillance cohort. MATERIALS AND METHODS We analyzed 326 patients with biopsy Gleason grade≤6,≤2 positive biopsy cores,≤20% tumor present in any core, prostate-specific antigen<15ng/dl, and clinical stages T1-T2a all of whom had at least single surveillance biopsy. Probabilities of pathologically relatively aggressive disease were estimated using Partin and Dinh risk tables and Kattan, Truong, and Kulkarni nomograms for each individual patient. Using these predictions, performance of these tools was quantified regarding discrimination, stratification at different cut-points, calibration, and the clinical net benefit. RESULTS Predictions of Partin and Dinh tables were not associated with the biopsy progression. The predictive value of Kattan and Truong nomograms was higher when compared with the other tools, although it was significant only on the first and second surveillance biopsies. Both nomograms were able to identify low- and high-risk subgroups within the cohort. Kattan nomogram demonstrated better correlation with the observed rate of progression over the first 3 biopsies and higher clinical net benefit. CONCLUSION Kattan and Truong nomograms demonstrated the best performance in predicting biopsy progression, although their value was largely limited to the first 2 surveillance biopsies. Both tools were able to stratify patients into subgroups with different risks of progression. These nomograms have important differences, which suggest that a more effective predictive model combining the strong sides of both tools and possibly some other variables could be developed.
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Affiliation(s)
| | - Murugesan Manoharan
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL
| | - Bruce R Kava
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL
| | - Dipen J Parekh
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL
| | - Sanoj Punnen
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL
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Iremashvili V, Kava BR, Manoharan M, Parekh DJ, Punnen S. Is It Time to Revisit the Role of Prostate-specific Antigen Kinetics in Active Surveillance for Prostate Cancer? Urology 2016; 95:139-44. [DOI: 10.1016/j.urology.2016.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/03/2016] [Accepted: 04/16/2016] [Indexed: 11/16/2022]
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18
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Anderson C, Weber R, Patel D, Lowrance W, Mellis A, Cookson M, Lang M, Barocas D, Chang S, Newberger E, Montgomery JS, Weizer AZ, Lee CT, Kava BR, Jackson M, Meraney A, Sjoberg D, Bochner B, Dalbagni G, Donat M, Herr H. A 10-Item Checklist Improves Reporting of Critical Procedural Elements during Transurethral Resection of Bladder Tumor. J Urol 2016; 196:1014-20. [PMID: 27044571 DOI: 10.1016/j.juro.2016.03.151] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE Previous studies have demonstrated significant variation in recurrence rates after transurethral resection of bladder tumor, likely due to differences in surgical quality. We sought to create a framework to define, measure and improve the quality of transurethral resection of bladder tumor using a surgical checklist. MATERIALS AND METHODS We formed a multi-institutional group of urologists with expertise with bladder cancer and identified 10 critical items that should be performed during every high quality transurethral bladder tumor resection. We prospectively implemented a 10-item checklist into practice and reviewed the operative reports of such resections performed before and after implementation. Results at all institutions were combined in a meta-analysis to estimate the overall change in the mean number of items documented. RESULTS The operative notes for 325 transurethral bladder tumor resections during checklist use were compared to those for 428 performed before checklist implementation. Checklist use increased the mean number of items reported from 4.8 to 8.0 per resection, resulting in a mean increase of 3.3 items (95% CI 1.9-4.7) on meta-analysis. With the checklist the percentage of reports that included all 10 items increased from 0.5% to 27% (p <0.0001). Surgeons who reported more checklist items tended to have a slightly higher proportion of biopsies containing muscle, although not at conventional significance (p = 0.062). CONCLUSIONS The use of a 10-item checklist during transurethral resection of bladder tumor improved the reporting of critical procedural elements. Although there was no clear impact on the inclusion of muscle in the specimen, checklist use may enhance surgeon attention to important aspects of the procedure and be a lever for quality improvement.
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Affiliation(s)
- Christopher Anderson
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Ryan Weber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Darshan Patel
- Department of Urology, University of Utah, Salt Lake City, Utah
| | | | - Adam Mellis
- Department of Urology, University of Oklahoma, Oklahoma City, Oklahoma
| | - Michael Cookson
- Department of Urology, University of Oklahoma, Oklahoma City, Oklahoma
| | - Maximilian Lang
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Daniel Barocas
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Sam Chang
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | | | | | - Alon Z Weizer
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Cheryl T Lee
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Max Jackson
- Department of Urology, Hartford Hospital, Hartford, Connecticut
| | - Anoop Meraney
- Department of Urology, Hartford Hospital, Hartford, Connecticut
| | - Daniel Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bernard Bochner
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Guido Dalbagni
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Machele Donat
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Harry Herr
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Iremashvili V, Barney SL, Manoharan M, Kava BR, Parekh DJ, Punnen S. Prediagnostic prostate-specific antigen kinetics and the risk of biopsy progression in active surveillance patients. Int J Urol 2016; 23:313-7. [PMID: 26763088 DOI: 10.1111/iju.13048] [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: 11/04/2015] [Accepted: 12/10/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyze the association between prediagnostic prostate-specific antigen kinetics and the risk of biopsy progression in prostate cancer patients on active surveillance, and to study the effect of prediagnostic prostate-specific antigen values on the predictive performance of prostate-specific antigen velocity and prostate-specific antigen doubling time. METHODS The study included 137 active surveillance patients with two or more prediagnostic prostate-specific antigen levels measured over a period of at least 3 months. Two sets of analyses were carried out. First, the association between prostate-specific antigen kinetics calculated using only the prediagnostic prostate-specific antigen values and the risk of biopsy progression was studied. Second, using the same cohort of patients, the predictive value of prostate-specific antigen kinetics calculated using only post-diagnostic prostate-specific antigens and compared with that of prostate-specific antigen kinetics based on both pre- and post-diagnostic prostate-specific antigen levels was analyzed. RESULTS Of 137 patients included in the analysis, 37 (27%) had biopsy progression over a median follow-up period of 3.2 years. Prediagnostic prostate-specific antigen velocity of more than 2 ng/mL/year and 3 ng/mL/year was statistically significantly associated with the risk of future biopsy progression. However, after adjustment for baseline prostate-specific antigen density, these associations were no longer significant. None of the tested prostate-specific antigen kinetics based on combined pre- and post-diagnostic prostate-specific antigen values were statistically significantly associated with the risk of biopsy progression. CONCLUSIONS Historical prediagnostic prostate-specific antigens seems to be not clinically useful in patients diagnosed with low-risk prostate cancer on active surveillance.
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Affiliation(s)
- Viacheslav Iremashvili
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Shane L Barney
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Murugesan Manoharan
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Bruce R Kava
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Dipen J Parekh
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Sanoj Punnen
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Bustillo NE, McGinty HL, Dahn JR, Yanez B, Antoni MH, Kava BR, Penedo FJ. Fatalism, medical mistrust, and pretreatment health-related quality of life in ethnically diverse prostate cancer patients. Psychooncology 2015; 26:323-329. [PMID: 26553139 DOI: 10.1002/pon.4030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 09/23/2015] [Accepted: 10/16/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Few studies have examined the impact of cultural processes prevalent in minority ethnic groups such as cancer fatalism and medical mistrust on health-related quality of life (HRQoL) following a cancer diagnosis. The present study examined relationships among ethnicity, HRQoL, and two possible cultural vulnerability factors-fatalistic attitudes and medical mistrust-among an ethnically diverse sample of men with prostate cancer (PC) prior to undergoing active treatment. METHODS A total of 268 men with localized PC (30% African American, 29% Hispanic, and 41% non-Hispanic White) were assessed cross-sectionally prior to active treatment. Path analyses examined relationships among ethnicity, vulnerability factors, and HRQoL. RESULTS Ethnicity was not related to HRQoL after controlling for relevant covariates. Hispanic men reported greater cancer fatalism compared with non-Hispanic White men (β = 0.15, p = 0.03), and both Hispanics (β = 0.19, p < 0.01) and African Americans (β = 0.20, p < 0.01) reported greater medical mistrust than non-Hispanic Whites. Fatalism demonstrated a trend toward negatively impacting physical well-being (β = -0.12, p = 0.06), but was not significantly related to emotional well-being (β = -0.10, p = 0.11). Greater medical mistrust was associated with poorer physical (β = -0.14, p = 0.03) and emotional well-being (β = -0.13, p = 0.04). CONCLUSIONS Results indicate that fatalistic attitudes and medical system mistrust were more prevalent among minority men. Less trust in the medical system was associated with poorer physical and emotional well-being. Attention to perceptions of the healthcare system and its relation to HRQoL may have implications for targeting culturally driven attitudes that may compromise adjustment to a PC diagnosis.Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Heather L McGinty
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | | | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Michael H Antoni
- Department of Psychology, University of Miami and Sylvester Cancer Center, Miami, FL, USA
| | - Bruce R Kava
- Miami VA Healthcare System, Miami, FL, USA.,Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Frank J Penedo
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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Baracco GJ, Kava BR, Caso J, Paez C, Schroeder H, Rodriguez M, Alonzo D, Lichtenberger P. Effective Control of an Outbreak of Sepsis After Prostate Biopsy Using Antibiogram-Guided Antimicrobial Prophylaxis. Journal of Men's Health 2014. [DOI: 10.1089/jomh.2013.0025] [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: 11/13/2022] Open
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22
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Penedo FJ, Benedict C, Zhou ES, Rasheed M, Traeger L, Kava BR, Soloway M, Czaja S, Antoni MH. Association of stress management skills and perceived stress with physical and emotional well-being among advanced prostrate cancer survivors following androgen deprivation treatment. J Clin Psychol Med Settings 2013; 20:25-32. [PMID: 22739661 DOI: 10.1007/s10880-012-9308-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Advanced prostate cancer (APC) is associated with disruptions that compromise health related quality of life (HRQOL). Treatment often includes androgendeprivation therapy (ADT), which results in a range of side effects (e.g., fatigue, urinary dysfunction) that further impact HRQOL. Despite these challenges, there are limited evaluations of the impact of stress and stress management skills on HRQOL among APC survivors on ADT. This study evaluated relationships among stress, stress management skills, and HRQOL, and it was hypothesized that better stress management skills would relate to greater physical and emotional well-being by mitigating perceived stress levels. Participants (N = 77) were 69.7 years old (SD = 9.8), 18.6 months post-treatment (SD = 17.5), and ethnically diverse (65 % Non-Hispanic White, 13 % Hispanic, 21 % African-American). Measures included the Measure of Current Status for stress management skills, the Perceived Stress Scale for perceived stress, and the Medical Outcomes Study-Short Form (MOS SF-36; physical functioning and emotional well-being subscales) for HRQOL. Direct effects and mediation models were evaluated to determine the relationships between perceived stress, stress management skills, and HRQOL domains, controlling for relevant covariates. Stress management skills and perceived stress were significantly associated with physical functioning (β = .24, p < .05 and β = -.43, p < .01, respectively) and emotional well-being (β = .35, p < .01 and β = -.64, p < .01, respectively). Regression analyses supported the hypothesis that reduced perceived stress mediated the relationship between stress management skills and both physical functioning and emotional well-being. These results demonstrate that one way stress management skills may impact HRQOL is by lessening ongoing perceptions of stress.
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Affiliation(s)
- Frank J Penedo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Kava BR, Burdick-Will J. Complications associated with retained foreign bodies from infected penile implants: proposal for the use of an implant-specific checklist at the time of device removal. J Sex Med 2013; 10:1659-66. [PMID: 23551861 DOI: 10.1111/jsm.12145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Infection of a penile prosthesis requires that all device hardware and associated foreign materials are removed, irrespective of whether a salvage procedure will be performed. Failure to remove all foreign bodies from the operative field may result in persistent infection, necessitating surgical intervention. AIM To review our experience with complications arising from retained foreign bodies following removal of an infected penile prosthesis. We highlight the clinical features that should raise suspicion of retained device-associated materials, and also the role of imaging in evaluating these patients. Finally, a rational approach to prevent these occurrences is proposed with the implementation of an implant-specific checklist. METHODS Medical records and imaging studies of patients presenting to our center with retained foreign bodies following removal of an infected penile prosthesis were reviewed. MAIN OUTCOME MEASURES Clinical and radiologic details of each of these cases were abstracted, including patient demographics, presenting symptoms, characteristics of retained materials, bacterial cultures, treatment, and follow-up. RESULTS Presenting symptoms included: (i) persistent and relapsing drainage from cutaneous fistulae; (ii) cellulitis overlying an infected reservoir; (iii) persistent penile pain; and (iv) an asymptomatic individual requesting elective placement of a second implant. Infected foreign materials retrieved included: two rear-tip extenders, a tubing connector, two infected reservoirs, and nonabsorbable mesh. Preoperative computerized tomography scan confirmed the presence and the location of all of these materials. Using this data, we propose using an implant-specific checklist to insure removal of all device-related foreign bodies when explanting an infected penile prosthesis. CONCLUSIONS A number of adverse sequelae may result from inadvertently leaving behind device-related materials when an infected implant is removed. Ultimately it is the responsibility of the surgeon removing an infected implant to insure that all device components and associated materials are removed. We believe that implementing a two-step implant-specific checklist is a rational prevention strategy.
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Affiliation(s)
- Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL 33101, USA.
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Kanagarajah P, Ayyathurai R, Manoharan M, Narayanan G, Kava BR. Current concepts in the management of adrenal incidentalomas. Urol Ann 2012; 4:137-44. [PMID: 23248518 PMCID: PMC3519103 DOI: 10.4103/0974-7796.102657] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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: 09/29/2011] [Accepted: 01/08/2012] [Indexed: 11/27/2022] Open
Abstract
Adrenal tumors are among the commonest incidental findings discovered. The increased incidence of diagnosing adrenal incidentalomas is due to the widespread availability and use of noninvasive imaging studies. Extensive research has been conducted to define a cost-effective diagnostic and therapeutic protocol to guide physicians in managing incidental adrenal lesions. However, there is little consensus on the optimal management strategy. Published literature to date, describes a wide spectrum of treatment options ranging from excision of all adrenal lesions regardless of the size and functional status to extensive hormonal and radiological evaluation to avoid surgery. In this review, we present a comprehensive overview of the presentation, evaluation and management of adrenal incidentalomas. Additionally, we propose a management algorithm to optimally manage these tumors.
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25
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Ramos JA, Kava BR. CT scan anatomic drawing and morphological correlation of a penile prosthesis cylinder aneurism. ARCH ESP UROL 2012; 65:586-587. [PMID: 22732788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- J A Ramos
- Carabobo University, Valencia, Venezuela.
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26
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Ayyathurai R, Garcia-Roig M, Gorin MA, González J, Manoharan M, Kava BR, Soloway MS, Ciancio G. Bland thrombus association with tumour thrombus in renal cell carcinoma: analysis of surgical significance and role of inferior vena caval interruption. BJU Int 2012; 110:E449-55. [DOI: 10.1111/j.1464-410x.2012.11128.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kava BR, Eldefrawy A, Ayyathurai R, Thompson SM, Ciancio G, Manoharan M. Renal cell carcinoma with solitary metastasis to the bladder: mode of spread and prognosis. Can J Urol 2012; 19:6121-6123. [PMID: 22316515] [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] [Indexed: 05/31/2023]
Abstract
Recurrent renal cell carcinoma (RCC) that presents as a solitary metastasis to the bladder is extremely rare. We report our experience with two patients who presented with hematuria within 1 year of their radical nephrectomy. Both patients underwent endoscopic resection of the tumor metastasis. One patient developed a metastasis in the head of pancreas 12 months following endoscopic resection. The other patient developed bilateral femoral and spinal bone metastasis. Our aim is to report our experience, and discuss the proposed modes of spread, management and prognosis.
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Affiliation(s)
- Bruce R Kava
- Department of Urology, Miller School of Medicine, University of Miami, Florida 33101, USA
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Sun Z, R. Sinha V, E. Young E, Bensadigh B, Ceron C, R. Kava B, N. Landon J, J. Salgado C. The Use of Bovine Collagen and Skin Graft for Reconstruction of the Glans Penis Following Cancer Resection. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/oju.2012.223038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Kava BR, Ayyathurai R, Soloway CT, Suarez M, Kanagarajah P, Murugesan M. Prospective randomized comparison of the safety, efficacy, and cosmetic outcome associated with mini-transverse and mini-longitudinal radical prostatectomy incisions. Indian J Urol 2011; 26:345-9. [PMID: 21116351 PMCID: PMC2978431 DOI: 10.4103/0970-1591.70563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/17/2022] Open
Abstract
Aims: Open radical retropubic prostatectomy (ORP) has traditionally been performed through a lower midline incision. Prior efforts to reduce pain and expedite recovery include a variety of alterations in length and the orientation of the incision. The aim of our study is to compare the safety, efficacy, and cosmetic outcomes associated with transverse and longitudinal mini-radical prostatectomy incisions. Materials and Methods: Consecutive patients undergoing ORP at a single institution were studied. Patients were randomized to receive either a modified transverse or longitudinal incision. In all patients, the length of the incision was 7cm. The following parameters were compared between the two groups: Perioperative blood loss, duration of surgery, technical factors, pain and analgesic requirements, length of hospital stay (LOS), and pathological stage. The Patient and Observer Scar Assessment Scale (POSAS) was used to compare the cosmetic aspects associated with the incisions. Results: Fifty-six patients underwent a transverse (n=27) and longitudinal (n=29) mini- incision ORP. No significant differences were noted in the perioperative parameters that were compared (P>0.116). None of the patients required blood transfusion, there were no wound complications. Perioperative pain and analgesic requirements were not significantly different among the two study arms (P>0.433). The POSAS indicated no significant difference in cosmesis scores with both incisions (P>0.09). Conclusions: Seven-centimeter transverse and longitudinal mini-incisions offer alternatives to the standard ORP incision, and to minimally invasive approaches. Both incisions are safe, associated with little postoperative pain, and a short postoperative LOS. Both incisions provide highly satisfactory cosmesis for the patient.
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Affiliation(s)
- Bruce R Kava
- Department of Urology, University of Miami, Miami, Florida
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30
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Kava BR, Kanagarajah P, Ayyathurai R. Contemporary revision penile prosthesis surgery is not associated with a high risk of implant colonization or infection: a single-surgeon series. J Sex Med 2011; 8:1540-6. [PMID: 21366878 DOI: 10.1111/j.1743-6109.2011.02222.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Revision penile prosthesis surgery has traditionally been associated with a greater risk of postoperative infection than primary implant placement. This has been attributed to the high prevalence of asymptomatic bacteria found surrounding the implant at the time of revision surgery. AIM To validate whether contemporary revision surgery remains associated with a high risk of asymptomatic colonization and postoperative infection. METHODS A comprehensive, prospective database consisting of consecutive patients undergoing primary and revision penile prosthesis surgery at our center was analyzed. MAIN OUTCOME MEASURES The infection risk in primary and revision implant surgery was compared. The prevalence of asymptomatic implant colonization during revision surgery, and whether this was associated with clinical infection was evaluated. The spectrum of bacterial species causing infection in this contemporary single-surgeon series was described. RESULTS One hundred seventeen primary and 72 revision implant recipients were studied. Infection developed in four (3.4%) patients undergoing primary implants, two (4.3%) patients undergoing removal and replacement for mechanical malfunction, and three (12%) patients undergoing rerouting for extrusion (P = 0.26). Intraoperative cultures were positive in 5 (9.8%) of 51 revision patients, none of whom developed infections. Organisms causing infection included Staphylococcus aureus and Enterobacter aerogenes. Unexpectedly, an adjuvant, alcohol-based skin prep in our last 83 patients reduced the infection risk to 1.2%. CONCLUSIONS In our series, the infection risk associated with revision of malfunctioning devices was no greater than primary implant placement. Rerouting was associated with a higher infection risk, likely due to technical factors, and not implant colonization. Less than 10% of our revision implants were colonized, and this had no bearing on the development of a postoperative infection. S. epidermidis was not the most common organism implicated in device infections. Finally, our experience with an adjuvant, alcohol-based skin prep warrants further randomized prospective evaluation.
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Affiliation(s)
- Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
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Zhou ES, Penedo FJ, Bustillo NE, Benedict C, Rasheed M, Lechner S, Soloway M, Kava BR, Schneiderman N, Antoni MH. Longitudinal effects of social support and adaptive coping on the emotional well-being of survivors of localized prostate cancer. ACTA ACUST UNITED AC 2010; 8:196-201. [PMID: 21086876 DOI: 10.1016/j.suponc.2010.09.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Survivors of prostate cancer experience treatment-related physical side effects that can compromise emotional well-being for years post-treatment. There is limited research investigating how social support and the use of coping may affect the emotional well-being of this population following treatment. The aim of this study was to investigate how social support and coping impact emotional well-being 2 years after treatment in survivors of localized prostate cancer who have received either radical prostatectomy or radiotherapy. Psychosocial and disease-specific measures were administered to an ethnically and demographically diverse sample of 180 men treated for localized prostate cancer at baseline and at 2-year follow-up. Regression analyses demonstrated that higher levels of social support at baseline predicted better emotional well-being 2 years later. Furthermore, higher levels of adaptive coping at baseline partially mediated the relationship between social support and emotional well-being. Supportive relationships may contribute to improved emotional well-being following treatment by facilitating the use of adaptive coping strategies. Attention should be given to strengthening social support networks and educating survivors of prostate cancer on adaptive coping techniques.
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Affiliation(s)
- Eric S Zhou
- Department of Psychology, University of Miami, Coral Gables, Miami, Florida 33124, USA
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Zhou ES, Penedo FJ, Lewis JE, Rasheed M, Traeger L, Lechner S, Soloway M, Kava BR, Antoni MH. Perceived stress mediates the effects of social support on health-related quality of life among men treated for localized prostate cancer. J Psychosom Res 2010; 69:587-90. [PMID: 21109047 PMCID: PMC2994072 DOI: 10.1016/j.jpsychores.2010.04.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 02/04/2010] [Accepted: 04/09/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the longitudinal effect of social support on general health-related quality of life (HRQOL) in men treated for localized prostate cancer, and to evaluate the role of perceived stress as a potential mediator of that relationship, in an ethnically and demographically diverse sample. METHODS Psychosocial assessments were administered to a sample of 175 men at baseline, and 2 years later. Hierarchical regression analyses were conducted to investigate the relationships between social support, perceived stress and HRQOL, while controlling for possible covariates that may affect HRQOL (e.g., age, time since diagnosis, medical comorbidities, etc.). RESULTS Higher levels of social support at baseline predicted higher levels of HRQOL at 2-year follow-up after controlling for relevant covariates and baseline levels of HRQOL. This relationship was partially mediated by level of perceived stress at baseline. Furthermore, men perceiving high levels of social support reported significantly higher HRQOL compared with men perceiving low levels of social support. CONCLUSIONS Results indicate positive social relationships contribute to improved HRQOL in patients who have undergone treatment for localized prostate cancer. One pathway through which social support can benefit HRQOL is through lower perceptions of stress. Enhancing or maintaining social support and reducing perceived stress may be potential targets for future psychosocial interventions aimed at improving HRQOL.
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Affiliation(s)
| | - Frank J. Penedo
- Department of Psychology, University of Miami, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami VA Healthcare System, Geriatric Research, Education and Clinical Center
| | - John E. Lewis
- Department of Psychiatry and Behavioral Sciences, University of Miami
| | | | | | - Suzanne Lechner
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
| | - Mark Soloway
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Miami
| | - Bruce R. Kava
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Miami
| | - Michael H. Antoni
- Department of Psychology, University of Miami, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
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Zhou ES, Kim Y, Rasheed M, Benedict C, Bustillo NE, Soloway M, Kava BR, Penedo FJ. Marital satisfaction of advanced prostate cancer survivors and their spousal caregivers: the dyadic effects of physical and mental health. Psychooncology 2010; 20:1353-7. [PMID: 20925137 DOI: 10.1002/pon.1855] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 08/26/2010] [Accepted: 08/28/2010] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Coping with the physical and mental side effects of diagnosis and treatment for advanced prostate cancer (APC) is a challenge for both survivors and their spousal caregivers. There is a gap in our current understanding of the dyadic adjustment process on marital satisfaction in this population. The current study sought to: (1) document levels of physical and mental health, and marital satisfaction, and (2) evaluate the relationship between physical and mental health with marital satisfaction in this understudied population. METHODS APC survivors who had undergone androgen deprivation therapy within the past year and their spousal caregiver participated in the study (N = 29 dyads). Physical and mental health was assessed using the MOS SF-36 Health Survey and marital satisfaction was evaluated using the Dyadic Adjustment Scale. RESULTS The Actor-Partner Interdependence Model revealed strong relations between physical and mental health with marital satisfaction for both survivor and caregiver (actor effects). Furthermore, caregiver physical and mental health was related with the survivor's marital satisfaction (partner effect). CONCLUSIONS Levels of mental health and marital satisfaction were comparable to community-based and prostate cancer samples, while physical health was higher. Marital satisfaction between APC survivors and their spousal caregivers may be influenced by both physical and mental health functioning. In particular, APC survivor functioning may affect his marital satisfaction as well as his spousal caregiver's. This has implications for psychosocial interventions for APC dyads. Further evaluation of the complex nature of survivor/caregiver dyadic adjustment in dealing with APC is necessary.
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Affiliation(s)
- Eric S Zhou
- Department of Psychology, University of Miami, Coral Gables, FL 33124-0751, USA
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34
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Eldefrawy A, Kava BR. An Unusual Complication During Inflatable Penile Prosthesis Implantation. Urology 2010; 76:847. [DOI: 10.1016/j.urology.2009.11.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 11/05/2009] [Accepted: 11/17/2009] [Indexed: 11/29/2022]
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Kava BR, De Los Santos R, Ayyathurai R, Shirodkar S, Manoharan M, Soloway MS. CONTEMPORARY OPEN NEPHRON SPARING SURGERY IS ASSOCIATED WITH DIMINISHED PERIOPERATIVE MORBIDITY, DESPITE MORE CHALLENGING SURGERY. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61337-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
In this article, we review available evidence on the treatment of patients with nonurothelial cancer of the bladder. More than 150 published works were reviewed in preparation for this summary. Squamous cell carcinoma and adenocarcinoma are ideally treated with radical cystectomy. High-risk groups for these diseases are defined. Small cell carcinoma should be treated with multimodality therapy, including chemotherapy. Other rarer tumors of the bladder are also discussed.
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Affiliation(s)
- Hassan Abol-Enein
- Department of Urology, University of Mansoura, Urology and Nephrology Center, Egypt.
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Manoharan M, Reyes MA, Nieder AM, Kava BR, Soloway M. 191: Does the Body Mass Index Affect the Outcome Following Reconstruction of Orthotopic Neobladder? J Urol 2007. [DOI: 10.1016/s0022-5347(18)30456-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
INTRODUCTION Complications that arise after placement of a penile prosthesis may result in the need for revision surgery. Few contemporary penile prosthesis series have focused solely on describing the efficacy and patient satisfaction associated with penile prosthesis revision surgery. AIM To determine the overall success of penile prosthesis revision surgery in providing the patient with a functional implant. Device efficacy and patient satisfaction with penile prosthesis revision surgery will be assessed using psychometrically validated instruments. MAIN OUTCOME MEASURES The erectile function (EF) and satisfaction domains of the International Index of Erectile Function (IIEF) were used to quantify the overall efficacy and patient satisfaction with revision surgery. METHODS Data were derived from a prospective database of consecutive patients undergoing penile prosthesis revision surgery performed by a single surgeon (B.R.K.). Eleven patients filled out the IIEF prior to surgery and 26 completed it following surgery. RESULTS Thirty-nine consecutive patients underwent 55 revision procedures related to a prior penile prosthesis. Thirty-four patients (87%) have a functional implant with a median follow-up of 6.5 months (range 1-42 months). Significant improvements in the overall IIEF, EF domain, and satisfaction domain were seen in those patients studied prior to and following revision surgery. The total IIEF, EF domain, and satisfaction domain of the IIEF for the group of 26 responders were 60.7 +/- 19.3, 26.6 +/- 8.7, and 15.7 +/- 5.6, respectively. Patients with fibrotic corporal bodies scored significantly lower on the EF and satisfaction domains than did any other group. CONCLUSIONS Penile prosthesis revision surgery is highly successful in providing men with a functional implant. The prostheses function well and patients are satisfied with their devices. Further study of those men with corporal fibrosis is warranted in order to determine the factors needed to improve their overall satisfaction with revision surgery.
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Affiliation(s)
- Bruce R Kava
- Urology, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
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Reyes MA, Nieder AM, Kava BR, Soloway MS, Manoharan M. Does Body Mass Index Affect Outcome After Reconstruction of Orthotopic Neobladder? Urology 2007; 69:475-8. [PMID: 17382148 DOI: 10.1016/j.urology.2006.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 04/18/2006] [Revised: 09/06/2006] [Accepted: 11/20/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the impact of body mass index (BMI) on outcome after orthotopic neobladder (NB) reconstruction. METHODS We performed a retrospective analysis of patients who underwent radical cystectomy and NB from 1992 to 2004. The patients were categorized according to BMI into group 1, BMI less than 25 kg/m2; group 2, BMI 25 to 29.9 kg/m2; and group 3, BMI greater than 30 kg/m2. The relationships among the BMI categories, the predominant complications (eg, urinary tract infection [UTI]; pyelonephritis; ureteral, bladder neck, and urethral stricture), other complications, and continence were analyzed. RESULTS Of the 343 patients who underwent radical cystectomy, 116 had an NB. The patient characteristics among the BMI groups were similar. Group 1 had fewer complications compared with the other groups (P <0.012). The principal complications observed were UTI, stricture, and pyelonephritis. The incidence of UTI, pyelonephritis, and wound infection were less in group 1 than in the other groups, with statistically significant differences (P = 0.001, P = 0.04, and P = 0.04, respectively). At the last follow-up visit, only 10% of the patients required clean intermittent catheterization to empty the NB, and no statistically significant differences were found in the continence status and voiding pattern among the groups. CONCLUSIONS An increased incidence of UTI, pyelonephritis, and wound infection was found in patients with increased BMI. However, they were transient and not life threatening. The continence and voiding patterns were relatively similar. Hence, an NB can be offered to patients with an increased BMI, and they should be formally counseled.
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Affiliation(s)
- Martha A Reyes
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida 33101, USA
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Manoharan M, Reyes MA, Singal R, Kava BR, Nieder AM, Soloway MS. Orthotopic ileal neobladder reconstruction for bladder cancer: is adjuvant chemotherapy safe? Int Braz J Urol 2006; 32:529-35. [PMID: 17081321 DOI: 10.1590/s1677-55382006000500005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2006] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We examined our database of patients undergoing radical cystectomy (RC) with orthotopic neobladder (NB) to determine whether adjuvant chemotherapy in this group is safe. MATERIALS AND METHODS We performed a retrospective analysis of patients who underwent radical cystectomy and urinary diversion between 1992 and 2004. Relevant clinical and therapeutic data were entered into a database. High-risk bladder cancer patients who underwent NB were identified. They were stratified into 2 groups, those who received adjuvant chemotherapy and those who did not. The incidence of complications between the 2 groups was analyzed and compared. RESULTS Over the 12-year period, 136 patients underwent RC and NB construction for bladder cancer. Of these, 83 patients were at high risk for recurrence. Nineteen patients received adjuvant chemotherapy and 64 did not. The complication rate in the adjuvant chemotherapy group was 53% and it was 23% in those who did not receive chemotherapy. There were no perioperative or treatment related death. There were 2 patients with grade 4 toxicity in the adjuvant chemotherapy group. There was a statistical difference between these two groups with regard to the incidence of complications. However, none of these complications was life-threatening, required only conservative treatment and caused no long-term disability. CONCLUSIONS Adjuvant chemotherapy is a safe treatment for patients undergoing RC and NB substitution. Hence, the option of orthotopic NB should not be denied in selected bladder cancer patients with high risk for recurrent disease.
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Affiliation(s)
- Murugesan Manoharan
- Department of Urology, University of Miami School of Medicine, Miami, FL 33101, USA.
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Manoharan M, Reyes MA, Kava BR, Singal R, Kim SS, Soloway MS. Is adjuvant chemotherapy for bladder cancer safer in patients with an ileal conduit than a neobladder? BJU Int 2005; 96:1286-9. [PMID: 16287446 DOI: 10.1111/j.1464-410x.2005.05822.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the safety of adjuvant chemotherapy in patients with neobladder reconstruction in comparison to ileal conduit, as radical cystectomy and urinary diversion is an effective curative surgical treatment for muscle-invasive and high-risk superficial bladder cancer, and adjuvant chemotherapy is usually considered for patients with clinical stage > T2 and nodal metastasis. PATIENTS AND METHODS We analysed retrospectively patients who had had a radical cystectomy and urinary diversion between 1992 and 2004. Patients with high-risk disease who had adjuvant chemotherapy were identified and stratified based on the type of urinary diversion (ileal conduit or neobladder). The chemotherapy regimen, complications from the adjuvant chemotherapy and other relevant data were analysed. RESULTS Overall, 343 patients had radical cystectomy, 40 had adjuvant chemotherapy; 25 had an ileal conduit and 15 had a neobladder. Patient characteristics including age, stage and follow-up were similar. In all, 55% of patients had grade 1 toxicity, 23% grade 2, 18% grade 3, and 13% grade 4. No patients had serious organ toxicity and none died. There were no significant differences in the toxicity among the two groups. CONCLUSIONS Adjuvant chemotherapy appears to be safe in patients with a neobladder and equally safe in patients with an ileal conduit. Hence neobladder reconstruction should not be denied to patients with bladder cancer who are at high risk of recurrence and who might require adjuvant chemotherapy.
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Affiliation(s)
- Murugesan Manoharan
- Department of Urology, University of Miami School of Medicine, Miami, FL 33101, USA
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Abstract
OBJECTIVES To examine the levels of sexual, psychological and dyadic functioning of the prostate cancer 'couple' (as studies have shown that spouses/partners play an integral role in the patient's adjustment to prostate cancer treatment), to encourage the creation of innovative psychosexual interventions to be used in the outpatient setting, and to offer insights into a novel area of prostate cancer research. PATIENTS AND METHODS In all, 103 men newly diagnosed with prostate cancer, and their partners, were assessed in an academic outpatient setting using instruments measuring sexual function, depressed mood, psychological distress and dyadic adjustment. RESULTS The partners' mean scores on sexual function questions were 55.75, significantly higher than those of the patients (51.7, P = 0.018), showing that partners perceived their sexual performance at a better level. Partners' mean scores on the depression and distress measures were also significantly higher. On those items that monitored the accuracy of the patients' perceptions of their sexual function, partners rated the patients significantly lower in ability to gain erections (patient/partner means 2.67/4.52; P < 0.001) and to perform sexually (patient/partner means 1.38/4.68; P < 0.001) than they rated themselves. CONCLUSIONS Information from this study could be useful in constructing interventions that allow the physician and the prostate cancer 'couple' to reflect on issues of sexual function and psychological distress that might once have been considered taboo. The results characterize the disparities between patients with prostate cancer and their partners on self-reported questionnaires, and underscore how important it is to hear the voice of the 'couple'.
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Affiliation(s)
- Cynthia T Soloway
- Department of Urology, University of Miami School of Medicine, Miami, Florida, USA.
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Kava BR. Advances in the Management of Post-Radical Prostatectomy Erectile Dysfunction: Treatment Strategies When PDE-5 Inhibitors Don't Work. Rev Urol 2005; 7 Suppl 2:S39-50. [PMID: 16985897 PMCID: PMC1477601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Phosphodiesterase type-5 (PDE-5) inhibitors have revolutionized the treatment of post-radical prostatectomy erectile dysfunction. For those patients who undergo a non-nerve-sparing radical prostatectomy or whose condition fails to respond to PDE-5 inhibitors, alternative treatment with intracavernous injection therapy, transurethral alprostadil, vacuum erection devices, and recently described combination therapy is available. The goals of therapy are to provide the patient with a means of obtaining an erection so that the patient and his partner may resume sexual relations as soon as possible following radical prostatectomy. There is evidence that early institution of treatment may promote improvement in the return of spontaneous erections in patients who have undergone nerve preservation. In patients who undergo non-nerve-sparing procedures, therapy may improve penile rigidity. Intracavernous injection therapy, transurethral alprostadil, and vacuum devices are highly effective in the management of post-prostatectomy erectile dysfunction. High dropout rates, which are not related to adverse effects, have been described with all 3 modalities. Pre- and postoperative counseling may improve patient and partner satisfaction.
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Gousse AE, Pareek K, Lavernia CJ, Kava BR. Omental interposition for repair of a vesico-acetabular fistula. J Urol 2001; 166:2313. [PMID: 11696767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- A E Gousse
- Department of Urology, University of Miami, Miami, Florida, USA
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Rabbani F, Stroumbakis N, Kava BR, Cookson MS, Fair WR. [Incidence and clinical significance of false-negative sextant biopsies of the prostate]. Urologe A 1998; 37:660. [PMID: 9887497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Rabbani F, Stroumbakis N, Kava BR, Cookson MS, Fair WR. Incidence and clinical significance of false-negative sextant prostate biopsies. J Urol 1998; 159:1247-50. [PMID: 9507846] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Since most patients do not undergo repeat sextant prostate biopsies after a biopsy is positive for prostate cancer, the true incidence of false-negative biopsies is not well defined. We assess the incidence and clinical significance of false-negative sextant prostate biopsies in patients undergoing radical prostatectomy. MATERIALS AND METHODS A total of 118 patients with biopsy proved prostate cancer underwent repeat sextant prostate biopsy before enrollment in a prospective randomized trial of radical prostatectomy with or without neoadjuvant hormonal therapy. Clinical parameters were assessed to determine potential sources of bias. Pathological parameters and prostate specific antigen relapse-free survival rates were compared to determine the clinical significance of false-negative biopsies. RESULTS Of the 118 patients 27 (23%) had a negative repeat sextant biopsy. Except for initial clinical stage, no differences were noted in the clinical or pathological parameters, or prostate specific antigen relapse rates in patients with negative versus positive repeat biopsies. CONCLUSIONS Our findings suggest that this 23% incidence of false-negative biopsies represents significant cancer. This relatively high incidence is important to consider in treatment modalities in which prostate biopsy may be performed to determine response to therapy.
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Affiliation(s)
- F Rabbani
- Urology Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Kava BR, Dalbagni G, Conlon KC, Russo P. Results of laparoscopic pelvic lymphadenectomy in patients at high risk for nodal metastases from prostate cancer. Ann Surg Oncol 1998; 5:173-80. [PMID: 9527271 DOI: 10.1007/bf02303851] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic pelvic lymphadenectomy (LPLND) can be performed safely and with minimal morbidity in the staging of prostate cancer. Its utility in evaluating patients at high risk for metastatic disease before primarily nonsurgical treatment modalities was evaluated. METHODS Twenty-four consecutive patients who underwent LPLND between June 1993 and July 1996 were studied. These patients were considered poor surgical candidates based on several risk factors, as follows: elevation of serum PSA >20 in 19 patients (79%); elevation of serum acid phosphatase in 4 patients (17%); digital rectal examination findings indicative of extraprostatic extension or seminal vesical involvement in 14 patients (58%); and poorly differentiated tumors on prostate biopsy in 19 patients (79%). Nineteen patients (79%) had two or more of these risk factors. Median PSA for the entire series of patients was 35.2 ng/mL (range 7.9 to 133 ng/mL), and median Gleason score was 7 (range 5 to 9). Preoperative CT or MRI was negative for pelvic lymph node metastases in 17 of 23 patients (79%), and bone scan was negative in all 24 patients. RESULTS Unilateral (n = 2) or bilateral (n = 22) LPLND was performed in all patients. Six patients (25%) had lymph node metastases detected laparoscopically. Five of the six patients had palpable extraprostatic extension (T3a/b) or invasion of a seminal vesical (T3c), and in four of these patients the site of the metastatic lymph nodes was ipsilateral to the palpable prostate abnormality. None of the risk factors was independently predictive of lymph node metastases within this series of patients. An average of 10.8 +/- 6.5 lymph nodes was removed at a mean operative time of 174 +/- 10 minutes for patients undergoing bilateral LPLND. Estimated blood loss was minimal for 20 of 22 patients (92%) undergoing LPLND alone, and there were no complications requiring open exploration. Mean postoperative hospital stay was 1.2 +/- 0.5 days for patients undergoing LPLND alone. CONCLUSIONS LPLND can be used efficiently to identify patients with nodal metastases from select high-risk patients. This, in turn, can exclude such patients from noncurative local and regional therapy.
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Affiliation(s)
- B R Kava
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Abstract
Retroperitoneal fibrosis may be caused by a number of disease processes, both benign and malignant. Traditionally, open exploration and biopsy has been performed to exclude a malignant etiology prior to ureterolysis. We report a patient in whom a diagnosis of malignant retroperitoneal fibrosis was confirmed using laparoscopy. In patients in whom a metastatic etiology for retroperitoneal fibrosis is suspected, laparoscopy should be performed and representative biopsies taken. Laparoscopic techniques offer the urologist the ability to obtain an adequate tissue biopsy with a reduction in postoperative morbidity and convalescence associated with traditional laparotomy.
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Affiliation(s)
- B R Kava
- Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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