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Hiramoto B, Redd WD, Muftah M, Jonnadula S, Okwara NC, Jenkins A, Cricco-Lizza E, Lee DJH, Cai JX, Chan WW. Higher obesity class is associated with more severe esophageal symptoms and reflux burden but not altered motor function or contractile reserve. Neurogastroenterol Motil 2024; 36:e14691. [PMID: 37849439 PMCID: PMC10842391 DOI: 10.1111/nmo.14691] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/07/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Patients with obesity often report esophageal symptoms, with abnormal reflux and esophageal motility suggested as potential mechanisms. However, prior studies showed varying results, often limited by study design/size and esophageal function/symptom measures utilized. We aimed to examine the relationship between obesity and objective esophageal function testing and patient-reported outcomes, utilizing prospective symptom, manometric and reflux monitoring data with impedance. METHODS Adults referred for high-resolution impedance-manometry (HRiM) and multichannel intraluminal impedance-pH monitoring (MII-pH) to evaluate esophageal symptoms were enrolled. Validated symptom and health-related quality of life (HR-QOL) instruments were prospectively collected: GERDQ, reflux symptoms index (RSI), dominant symptom intensity (DSI, multiplied 5-point Likert scales for symptom frequency/severity), global symptom severity (GSS, 100-point visual analog scale), and Short Form-12 (SF-12) for HR-QOL. Esophageal function testing measures were compared across body mass index (BMI) categories and correlated with patient-reported outcomes. KEY RESULTS Seven hundred and fifty four patients were included (Normal:281/Overweight:253/Class I obesity:137/Class II/III obesity:83). Reflux burden measures on MII-pH (acid exposure time, total reflux episodes, bolus exposure time), conclusive pathologic reflux (Lyon), and hiatal hernia were increased in higher obesity classes compared to normal BMI. Class II/III obesity was associated with more normal/hypercontractile swallows, less ineffective swallows, and better bolus transit on HRiM. BMI correlated positively with GERDQ/RSI/DSI/GSS, and negatively with physical component score (SF-12). Esophageal symptom severity and HR-QOL correlated strongly with MII-pH findings, but not HRiM measures. CONCLUSIONS/INFERENCES Obesity is associated with increased esophageal symptom burden and worse physical HR-QOL, which correlate with higher acid/bolus reflux burden but not altered esophageal motility/transit/contractile reserve.
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Affiliation(s)
- Brent Hiramoto
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Walker D Redd
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mayssan Muftah
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Saikiran Jonnadula
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Noreen C Okwara
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Eliza Cricco-Lizza
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Darren J H Lee
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jennifer X Cai
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Walter W Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Cricco-Lizza E, Wilcox Vanden Berg RN, Laviana A, Pantuck M, Basourakos SP, Salami SS, Hung AJ, Margolis DJ, Hu JC, McClure TD. Comparative Effectiveness and Tolerability of Transperineal MRI-Targeted Prostate Biopsy under Local versus Sedation. Urology 2021; 155:33-38. [PMID: 34217762 DOI: 10.1016/j.urology.2021.06.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess the prostate cancer diagnostic yield, complications, and costs of transperineal prostate biopsies when performed with local anesthesia versus sedation. METHODS Data were prospectively collected for men undergoing transperineal MRI-targeted biopsy at the outpatient clinic and tertiary hospital of a single center between October 2017 to February 2020. These data included demographic, procedural, and pathologic variables and complications. Time-driven activity-based costing was performed to compare procedural costs. RESULTS 126 men were included. Age, BMI and PSA were similar for local (n = 45) vs sedation (n = 81), all P>0.05. Detection of clinically significant prostate cancer (CSPC) on combined systematic and targeted biopsy was similar for local vs sedation (24% vs 36%; P = 0.2). Local had lower detection on targeted biopsies alone (8.9% vs 25%; P = 0.03). However, fewer targeted cores were obtained per region of interest with local vs sedation (median 3 vs 4 cores; P<0.01). For local vs sedation, the complication rate was 2.6% and 6.1% (P = 0.6). The median visual analog pain score for local vs sedation was 3/10 vs 0/10 (P<0.01). The mean procedure time for local vs sedation was 22.5 vs 17.5 minutes (48.3 minutes when including anesthesia time). Time-driven activity-based costs for local vs sedation were $961.64 vs $2208.16 (P<0.01). CONCLUSION Transperineal biopsy with local anesthesia is safe with comparable outcomes to sedation. While the number of cores taken differed, there was no statistical difference in the detection of clinically significant cancer.
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Affiliation(s)
- Eliza Cricco-Lizza
- Department of Urology, Weill Cornell Medicine, New York Presbyterian, New York, NY
| | | | - Aaron Laviana
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas, Austin, TX
| | - Morgan Pantuck
- Department of Urology, Weill Cornell Medicine, New York Presbyterian, New York, NY
| | | | - Simpa S Salami
- Department of Urology, University of Michigan, Ann Arbor, MI; Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Andrew J Hung
- Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Daniel J Margolis
- Department of Radiology, Weill Cornell Medicine, New York Presbyterian, New York, NY
| | - Jim C Hu
- Department of Urology, Weill Cornell Medicine, New York Presbyterian, New York, NY.
| | - Timothy D McClure
- Department of Urology, Weill Cornell Medicine, New York Presbyterian, New York, NY; Department of Interventional Radiology, Weill Cornell Medicine, New York Presbyterian, New York, NY
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Hur S, Tzeng M, Cricco-Lizza E, Basourakos S, Yu M, Ancker J, Abramson E, Saigal C, Ross A, Hu J. Perceptions of partial gland ablation for prostate cancer among men on active surveillance: A qualitative study. BMJ Surg Interv Health Technol 2021; 3:e000068. [PMID: 34458727 PMCID: PMC8388575 DOI: 10.1136/bmjsit-2020-000068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/18/2021] [Accepted: 04/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES – Partial gland ablation (PGA) therapy is an emerging treatment modality that targets specific areas of biopsy proven prostate cancer (PCa) to minimize treatment-related morbidity by sparing benign prostate. This qualitative study aims to explore and characterize perceptions and attitudes toward PGA in men with very-low-risk, low-risk, and favorable intermediate-risk PCa on active surveillance (AS). DESIGN – 92 men diagnosed with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS were invited to participate in semi-structured telephone interviews on PGA. SETTING – Single tertiary care center located in New York City. PARTICIPANTS – 20 men with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS participated in the interviews. MAIN OUTCOME MEASURES – Emerging themes on perceptions and attitudes toward PGA were developed from transcripts inductively coded and analyzed under standardized methodology. RESULTS – Four themes were derived from twenty interviews that represent the primary considerations in treatment decision-making: (1) the feeling of psychological safety associated with low-risk disease; (2) preference for minimally invasive treatments; (3) the central role of the physician; (4) and the pursuit of treatment options that align with disease severity. Eleven men (55%) expressed interest in pursuing PGA only if their cancer were to progress, while 9 men (45%) expressed interest at the current moment. CONCLUSIONS – Though an emerging treatment modality, patients were broadly accepting of PGA for PCa with men primarily debating the risks versus benefits of proactively treating low-risk disease. Additional research on men's preferences and attitudes toward PGA will further guide counseling and shared decision-making for PGA.
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Affiliation(s)
- Sonia Hur
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Michael Tzeng
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Eliza Cricco-Lizza
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Spyridon Basourakos
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Miko Yu
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Jessica Ancker
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - Erika Abramson
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
- Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
| | - Christopher Saigal
- Department of Urology, David Geffen School of Medicine, Los Angeles, California, USA
| | - Ashley Ross
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jim Hu
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
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Tzeng M, Cricco-Lizza E, Al Hussein Al Awamlh B, Pantuck M, Margolis DJ, Yu M, Hu J. IDEAL Stage 2a experience with in-office, transperineal MRI/ultrasound software fusion targeted prostate biopsy. BMJ Surg Interv Health Technologies 2019; 1:e000025. [PMID: 35047782 PMCID: PMC8749267 DOI: 10.1136/bmjsit-2019-000025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/11/2019] [Accepted: 10/25/2019] [Indexed: 11/18/2022] Open
Abstract
Objective Although the feasibility of transperineal biopsy under local anesthesia has been demonstrated, little is known regarding the application of MRI/ultrasound software fusion targeted biopsy for transperineal biopsy under local anesthesia. The objective of our study is to describe our initial experience with in-office transperineal MRI/ultrasound software fusion targeted biopsy (Idea, Development, Exploration, Assessment, Long-term Follow-up [IDEAL] Stage 2a). Methods Between October 2017 and July 2019, 33 men underwent in-office transperineal MRI-targeted biopsy using the Artemis (Eigen, Grass Valley, CA, USA) fixed-robotic arm system. The indication for biopsy was elevated prostate specific antigen (PSA) (n=14), prior negative biopsy (n=10), active surveillance (n=6), and surveillance after partial gland cryoablation (n=3). We prospectively captured patient demographic and clinical characteristics, biopsy outcomes, and complications. Complications were classified according to Common Terminology Criteria for Adverse Events (CTCAE) V.5.0. Results The median patient age was 67 years (IQR 61–71) and the median serum PSA level was 7.0 ng/mL (IQR 5.1–11.4). The median duration of in-office MRI-targeted transperineal biopsy was 26 min (IQR 23–28). Overall, transperineal MRI-targeted biopsy detected prostate cancer in 18 (54.6%) men, with 8 (24.2%) being clinically significant (Gleason Score ≥3+4, Grade Group ≥2). Clinically significant prostate cancer was detected in four (28.6%) biopsy naïve men, two (20.0%) men with a prior negative, one (16.7%) man on active surveillance and one (33.3%) man following partial gland ablation. Three (9.1%) men experienced complications: two hematuria and one urinary retention. Conclusion Our findings demonstrate the feasibility of the fixed-robotic arm fusion platform for in-office transperineal MRI-targeted biopsy and a low rate of adverse events. However, larger prostate size precludes MRI/ultrasound software fusion and pubic arch interference hindered the transperineal MRI-targeted approach in 9.1% of men. Pubic arch interference was overcome by a free-hand approach with software fusion guidance.
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Affiliation(s)
- Michael Tzeng
- Department of Urology, Weill Cornell Medical College, New York City, New York, USA
| | - Eliza Cricco-Lizza
- Department of Urology, Weill Cornell Medical College, New York City, New York, USA
| | | | - Morgan Pantuck
- Department of Urology, Weill Cornell Medical College, New York City, New York, USA
| | - Daniel J Margolis
- Department of Radiology, Weill Cornell Medical College, New York City, New York, USA
| | - Miko Yu
- Department of Urology, Weill Cornell Medical College, New York City, New York, USA
| | - Jim Hu
- Department of Urology, Weill Cornell Medical College, New York City, New York, USA
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Lazow SP, Venn RA, Lubor B, Kocharian G, Kreines FM, Gilbert E, Marnell CS, Cricco-Lizza E, Cooley V, Christos P, Dakin GF. The PreOp Program: Intensive Preclinical Surgical Exposure is Associated With Increased Medical Student Surgical Interest and Competency. J Surg Educ 2019; 76:1278-1285. [PMID: 31005481 DOI: 10.1016/j.jsurg.2019.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE As medical students' interest in surgical fields wanes, we investigated the impact of a preclinical surgical exposure program on students' attitudes toward pursuing surgical careers. DESIGN This is a prospective longitudinal study of PreOp, a preclinical rotation-based surgical exposure program for first-year medical students, from 2013 to 2017. Surveys assessed PreOp rotation quality, students' surgical interest, and students' self-reported preparedness for the surgical clerkship. Surgery clerkship grades were obtained as a measure of surgical competency and compared to class-wide peers. Match data was collected and compared to class-wide peers as well as historical norms. SETTING NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY; tertiary care center. PARTICIPANTS Fifty-four PreOp students from 2013 to 2017. RESULTS Fifty-four PreOp participants were recruited. After completing the PreOp program, 66.7% of PreOp students reported being very likely to apply into a surgical field compared to 29.4% when they started medical school. Ultimately, 71.4% of PreOp students versus 21.7% of non-PreOp class-wide peers matched into surgical fields (p < 0.001). From the preceding 5 match years before PreOp implementation, 21.4% of all students matched into surgical fields compared to 25.6% of all students after PreOp was started (p = 0.26). In terms of preparedness, 75% of PreOp students reported feeling more prepared for the third-year surgery clerkship than their non-PreOp peers after the second year of medical school. PreOp students were significantly more likely than non-PreOp class-wide peers to receive honors in the surgery clerkship when controlling for cumulative clerkship GPA (p = 0.012, adjusted odds ratio = 5.5 [95% confidence interval 1.5-22.1]). CONCLUSIONS Hands-on preclinical surgical exposure was associated with student-reported increased surgical interest that was maintained longitudinally and reflected in significantly increased surgical matches relative to non-PreOp class-wide peers. This study uniquely demonstrates that participation in PreOp was also associated with increased self-reported surgical preparedness and significantly higher surgery clerkship grades relative to overall academic performance.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Victoria Cooley
- Department of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York
| | - Paul Christos
- Department of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York
| | - Gregory F Dakin
- Weill Cornell Medicine, New York, New York; Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York.
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Patel N, Cricco-Lizza E, Kasabwala K, Xu C, Robinson BD, Khani F, Wang Y, Margolis D, Hu JC. Corrigendum to 'The Role of Systematic and Targeted Biopsies in Light of Overlap on Magnetic Resonance Imaging Ultrasound Fusion Biopsy' [European Urology Oncology 1 (2018) 263-267]. Eur Urol Oncol 2019; 3:394. [PMID: 31378664 DOI: 10.1016/j.euo.2019.06.015] [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] [Indexed: 10/26/2022]
Affiliation(s)
- Neal Patel
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Chris Xu
- School of Applied and Engineering Physics, Cornell University, Ithaca, NY, USA
| | - Brian D Robinson
- Department of Urology, Weill Cornell Medicine, New York, NY, USA; Department of Pathology, Weill Cornell Medicine, New York, NY, USA
| | - Francesca Khani
- Department of Pathology, Weill Cornell Medicine, New York, NY, USA
| | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Daniel Margolis
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Jim C Hu
- Department of Urology, Weill Cornell Medicine, New York, NY, USA.
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Cricco-Lizza E, Tavakkoli M, Kingery JR. Abdominal Distension in an Elderly Man after Presumed Vertical Transmission of Chagas Disease. Am J Trop Med Hyg 2019; 100:773-774. [PMID: 31971127 PMCID: PMC6447105 DOI: 10.4269/ajtmh.18-0764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Eliza Cricco-Lizza
- Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York
| | - Montreh Tavakkoli
- Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York
| | - Justin R. Kingery
- Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York
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Patel N, Cricco-Lizza E, Kasabwala K, Xu C, Robinson BD, Khani F, Wang Y, Margolis D, Hu JC. The Role of Systematic and Targeted Biopsies in Light of Overlap on Magnetic Resonance Imaging Ultrasound Fusion Biopsy. Eur Urol Oncol 2018; 1:263-267. [DOI: 10.1016/j.euo.2018.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/26/2018] [Accepted: 03/20/2018] [Indexed: 11/26/2022]
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Patel N, Halpern JA, Kasabwala K, Cricco-Lizza E, Herman M, Margolis D, Xu C, Robinson BD, Wang Y, McClure T, Hu JC. Multiple Regions of Interest on Multiparametric Magnetic Resonance Imaging are Not Associated with Increased Detection of Clinically Significant Prostate Cancer on Fusion Biopsy. J Urol 2018. [DOI: 10.1016/j.juro.2018.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Neal Patel
- Department of Urology, Weill Cornell Medicine, New York, New York
| | | | | | | | - Michael Herman
- Division of Urology, South Nassau Communities Hospital, Oceanside, New York
| | - Daniel Margolis
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Chris Xu
- School of Applied and Engineering Physics, Cornell University, Ithaca, New York
| | - Brian D. Robinson
- Department of Urology, Weill Cornell Medicine, New York, New York
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Yi Wang
- Department of Radiology, Weill Cornell Medicine, Cornell University, New York, New York
| | - Timothy McClure
- Department of Urology, Weill Cornell Medicine, New York, New York
| | - Jim C. Hu
- Department of Urology, Weill Cornell Medicine, New York, New York
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Kasabwala K, Patel N, Cricco-Lizza E, Weng S, Khani F, Margolis DJ, Motanagh S, Robinson BD, Hu JC. MP46-12 THE LEARNING CURVE OF THE MR/US FUSION PROSTATE BIOPSY: A PATHOLOGY-GUIDED ANALYSIS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1471] [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] [Indexed: 10/17/2022]
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