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Miyamoto H, Teramoto Y, Numbere N, Wang Y, Joseph JV. Prostate Cancer Risk Stratification by Simple Scoring of the Current pT3 Lesions: A Proposal for a New Pathologic T-Staging System. Mod Pathol 2024; 37:100429. [PMID: 38266919 DOI: 10.1016/j.modpat.2024.100429] [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: 08/17/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
Cancer spread beyond the prostate, including extraprostatic extension (other than seminal vesicle or bladder invasion; EPE)/microscopic bladder neck invasion and seminal vesicle invasion (SVI) currently classified as pT3a and pT3b lesions, respectively, does not uniformly indicate poor oncologic outcomes. Accurate risk stratification of current pT3 disease is therefore required. We herein further determined the prognostic impact of these histopathologic lesions routinely assessed and reported by pathologists, particularly their combinations. We assessed consecutive 2892 patients undergoing radical prostatectomy for current pT2 (n = 1692), pT3a (n = 956), or pT3b (n = 244) disease at our institution between 2009 and 2018. Based on our preliminary findings, point(s) were given (1 point to focal EPE, microscopic bladder neck invasion, or unilateral SVI; 2 points to nonfocal/established EPE or bilateral SVI) and summed up in each case. Our cohort had 0 point (n = 1692, 58.5%; P0), 1 point (n = 243, 8.4%; P1), 2 points (n = 657, 22.7%; P2), 3 points (n = 192, 6.6%; P3), 4 points (n = 76, 2.6%; P4), and 5 points (n = 32, 1.1%; P5). Univariate analysis revealed associations of higher points with significantly worse biochemical progression-free survival, particularly when P4 and P5 were combined. In multivariable analysis (P0 as a reference), P1 (hazard ratio [HR], 1.57; P = .033), P2 (HR, 3.25; P < .001), P3 (HR, 4.01; P < .001), and P4 + P5 (HR, 5.99; P < .001) showed significance for the risk of postoperative progression. Meanwhile, Harrell C-indexes for the current pT staging, newly developed point system, and the Cancer of the Prostate Risk Assessment post-Surgical (CAPRA-S) score were 0.727 (95% CI, 0.706-0.748), 0.751 (95% CI, 0.729-0.773), and 0.774 (95% CI, 0.755-0.794), respectively, for predicting progression. We believe our data provide a logical rationale for a novel pathologic T-staging system based on the summed points, pT1a (0 point), pT1b (1 point), pT2 (2 points), pT3a (3 points), and pT3b (4 or 5 points), which more accurately stratifies the prognosis of prostate cancer.
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Affiliation(s)
- Hiroshi Miyamoto
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, New York; Department of Urology, University of Rochester Medical Center, Rochester, New York; James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York.
| | - Yuki Teramoto
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
| | - Numbereye Numbere
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
| | - Ying Wang
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
| | - Jean V Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York
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Melnyk R, Saba P, Holler T, Cameron K, Mithal P, Rappold P, Wu G, Cubillos J, Rashid H, Joseph JV, Ghazi AE. Design and Implementation of an Emergency Undocking Curriculum for Robotic Surgery. Simul Healthc 2022; 17:78-87. [PMID: 34387245 DOI: 10.1097/sih.0000000000000596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Current training for robotic surgery crisis management, specifically emergency robotic undocking protocol (ERUP), remains limited to anecdotal experience. A curriculum to impart the skills and knowledge necessary to recognize and complete a successful ERUP was developed using an education approach then evaluated. METHODS Baseline knowledge and confidence regarding ERUP were established for 5 robotic teams before completing 2 full-immersion simulations separated by an online self-paced learning module. In each simulation, teams operated on a perfused hydrogel model and were tasked to dissect a retroperitoneal tumor abutting a major vessel. During vascular pedicle ligation, a major vascular bleed and nonrecoverable robotic fault were remotely induced, necessitating ERUP with open conversion. After the simulation, participants completed surgery task load index (cognitive load assessment) and realism surveys. Weighted checklists scored participants' actions during each simulation. Surgical metrics including estimated blood loss, time to control bleeding, and undocking time were recorded. Curriculum retention was assessed by repeating the exercise at 6 months. RESULTS Participants experienced high levels of cognitive demand and agreed that the simulation's realism and stress mimicked live surgery. Longitudinal analysis showed significant knowledge (+37.5 points, p = 0.004) and confidence (+15.3 points, p < 0.001) improvements from baseline to completion. Between simulations, checklist errors, undocking time, and estimated blood loss decreased (38⇾17, -40 seconds, and -500 mL, respectively), whereas action scores increased significantly (+27 points, p = 0.008). At 6 months, insignificant changes from curriculum completion were seen in knowledge (-4.8 points, p = 0.36) and confidence (+3.7 points, p = 0.1). CONCLUSIONS This simulation-based curriculum successfully improves operative team's confidence, knowledge, and skills required to manage robotic crisis events.
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Affiliation(s)
- Rachel Melnyk
- From the Simulation Innovation Lab (R.M., P.S., T.H., K.C., A.E.G.) and Department of Urology (P.M., P.R., G.W., J.C., H.R., J.V.J., A.E.G.), University of Rochester Medical Center (URMC), Rochester, NY
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Abstract
Robot-assisted radical prostatectomy (RARP) is currently the standard minimally invasive procedure for the surgical management of localized prostate cancer. It has been shown that the minimally invasive robotic approach offers comparable oncologic and functional outcomes with potential advantages, including decreased blood loss, shorter hospital stay, and recovery period when compared with open surgery. Generally, the transperitoneal RARP approach is the most commonly performed among robotic surgeons, owing to its wider space and early adoption. However, similar oncologic outcomes have been reported with the extraperitoneal approach. Owing to its perceived technical difficulty, extraperitoneal RARP is less adopted nowadays. This approach, however, has its merits particularly in cases where intraperitoneal access can be problematic with extensive adhesions from previous surgeries. Also, extraperitoneal approach allows for minimal bowel manipulation, less steep Trendelenburg positioning, and less pneumoperitoneum, which reflect on early recovery of bowel function after RARP. Both transperitoneal and extraperitoneal approaches can be performed using either the conventional multiport robotic system or the more recent single-port (SP) robotic system. With respect to extraperitoneal RARP, there has been an increased adoption of the SP system, with purported advantages such as better cosmesis, less postoperative analgesic and opioid requirements, and shorter duration of hospital stay. Herein, we describe the technical steps relevant to extraperitoneal single-port robot-assisted radical prostatectomy, and elaborate on the clinical outcomes reported in the literature.
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Affiliation(s)
- Mahmoud I Khalil
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jean V Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
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Zhu W, Ren W, Chang C, Messing EM, Joseph JV, Jain R, Levy D, Bushinsky D, Zeng G, Yeh S. MP07-03 THE PROTECTIVE ROLE OF ESTROGEN RECEPTOR Β IN RENAL CALCIUM OXALATE FORMATION VIA REDUCING THE LIVER OXALATE BIOSYNTHESIS AND RENAL CELL INJURY. J Urol 2021. [DOI: 10.1097/ju.0000000000001980.03] [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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Gurung PMS, Melnyk R, Holler T, Oppenhimer D, Witthaus M, Rashid HH, Frye TP, Wu G, Joseph JV, Ghazi AE. Application of IRIS Three-Dimensional Anatomical Models As Preoperative Surgical Planning Tools in the Management of Localized Renal Masses. J Endourol 2021; 35:383-389. [PMID: 33451273 DOI: 10.1089/end.2020.0405] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: The use of volume-rendered images is gaining popularity in the surgical planning for complex procedures. IRIS™ is an interactive software that delivers three-dimensional (3D) virtual anatomical models. We aimed to evaluate the preoperative clinical utility of IRIS for patients with ≤T2 localized renal tumors who underwent either partial nephrectomy (PN) or radical nephrectomy (RN). Patients and Methods: Six urologists (four faculty and two trainees) reviewed CT scans of 40 cases over 2 study phases, using conventional two-dimensional (2D) CT alone (Phase-I), followed by the CT + IRIS 3D model (Phase-II). After each review, surgeons reported their decision on performing a PN or an RN and rated (Likert scale) their confidence in completing the procedure as well as how the imaging modality influenced specific procedural decisions. Modifications to the choice of procedure and confidence in decisions between both phases were compared for the same surgeon. Concordance between surgeons was also evaluated. Results: A total of 462 reviews were included in the analysis (231 in each phase). In 64% (95% CI: 58-70%) of reviews, surgeons reported that IRIS achieved a better spatial orientation, understanding of the anatomy, and offered additional information compared with 2D CT alone. IRIS impacted the planned procedure in 20% of the reviews (3.5% changed decision from PN to RN and 16.5% changed from RN to PN). In the remaining 80% of reviews, surgeons' confidence increased from 78% (95% CI: 72-84%) with 2D CT, to 87% (95% CI: 82-92%) with IRIS (p = 0.02); this confidence change was more pronounced in cases with a high RENAL score (p = 0.009). In 99% of the reviews, surgeons rated that the IRIS accurately represented the anatomical details of all kidney components. Conclusion: Application of IRIS 3D models could influence the surgical decision-making process and improve surgeons' confidence, especially for robot-assisted management of complex renal tumors.
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Affiliation(s)
- Pratik M S Gurung
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Rachel Melnyk
- Simulation Innovation Laboratory, University of Rochester Medical Center, Rochester, New York, USA
| | - Tyler Holler
- Simulation Innovation Laboratory, University of Rochester Medical Center, Rochester, New York, USA
| | - Daniel Oppenhimer
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Michael Witthaus
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Hani H Rashid
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Thomas P Frye
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Guan Wu
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jean V Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Ahmed E Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.,Simulation Innovation Laboratory, University of Rochester Medical Center, Rochester, New York, USA
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Gurung PMS, Wang B, Hassig S, Wood J, Ellis E, Feng C, Ghazi AE, Joseph JV. Oncological and functional outcomes in patients over 70 years of age treated with robotic radical prostatectomy: a propensity-matched analysis. World J Urol 2020; 39:1131-1140. [PMID: 32537666 DOI: 10.1007/s00345-020-03304-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/08/2020] [Accepted: 06/08/2020] [Indexed: 02/16/2023] Open
Abstract
PURPOSE The aim of this study was to report on the safety (complications) and efficacy (oncological and functional outcomes) of robot-assisted radical prostatectomy (RARP), performed at our institution, in patients aged over 70. PATIENTS AND METHODS Review of our prospectively collected database [Cancer Information Systems (CAISIS)] identified two hundred and fifteen (215) patients, aged > 70, who underwent RARP for localized prostate cancer between July 2003 and August 2017. A propensity score-matched analysis, with multiple covariates, was performed to stratify the patients into Age ≤ 70 and Age > 70 comparison groups. RESULTS Apart from Age (mean ± SD years: 73.5 ± 2.1 vs 59.5 ± 5.9, p < 0.0001) and nerve-sparing status, the two groups were evenly matched for all covariates (p values > 0.05). Median follow-up was 10.6 years. There were no 90-day mortalities in either group. Minor complications (Clavien ≤ 2) were more common in the Age > 70 group (p = 0.0002). Operating room time (p = 0.83), length of hospital stay (p = 0.06) and catheterization duration (p = 0.13) were similar. On final pathology, a higher pT stage (p < 0.0001) and pN1 (p = 0.003) were observed in the Age > 70 group. However, this did not translate adversely into higher rates of positive surgical margin (p = 0.41) or biochemical relapse (p = 0.72). Allowing for the follow-up duration (median 10.6 years), cancer-specific survival was marginally significant (p = 0.05) with an observed lower rate in the Age > 70 group. In terms of functional outcomes, post-operative erectile dysfunction and pad-free continence were significantly better in the younger cohort (p < 0.0001). CONCLUSIONS Robot-assisted radical prostatectomy should not be denied to those over 70 years solely on the basis of age. Older men need to be counseled about the likelihood of encountering higher-risk features on final pathology and that their functional outcomes may be worse compared to a younger person.
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Affiliation(s)
- Pratik M S Gurung
- Department of Urology, University of Rochester Medical Center, New York, USA.
| | - Bokai Wang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, New York, USA
| | - Stephen Hassig
- Department of Urology, University of Rochester Medical Center, New York, USA
| | - Jasmine Wood
- Department of Urology, University of Rochester Medical Center, New York, USA
| | - Elizabeth Ellis
- Department of Urology, University of Rochester Medical Center, New York, USA
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, New York, USA
| | - Ahmed E Ghazi
- Department of Urology, University of Rochester Medical Center, New York, USA
| | - Jean V Joseph
- Department of Urology, University of Rochester Medical Center, New York, USA
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Gurung PMS, Messing EM, Joseph JV, Wu G. EDITORIAL COMMENT. Urology 2020; 136:110-111. [PMID: 32033663 DOI: 10.1016/j.urology.2019.09.048] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Pratik M S Gurung
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Edward M Messing
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Jean V Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Guan Wu
- Department of Urology, University of Rochester Medical Center, Rochester, NY
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Witthaus MW, Farooq S, Melnyk R, Campbell T, Saba P, Mathews E, Ezzat B, Ertefaie A, Frye TP, Wu G, Rashid H, Joseph JV, Ghazi A. Incorporation and validation of clinically relevant performance metrics of simulation (CRPMS) into a novel full-immersion simulation platform for nerve-sparing robot-assisted radical prostatectomy (NS-RARP) utilizing three-dimensional printing and hydrogel casting technology. BJU Int 2019; 125:322-332. [PMID: 31677325 DOI: 10.1111/bju.14940] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To incorporate and validate clinically relevant performance metrics of simulation (CRPMS) into a hydrogel model for nerve-sparing robot-assisted radical prostatectomy (NS-RARP). MATERIALS AND METHODS Anatomically accurate models of the human pelvis, bladder, prostate, urethra, neurovascular bundle (NVB) and relevant adjacent structures were created from patient MRI by injecting polyvinyl alcohol (PVA) hydrogels into three-dimensionally printed injection molds. The following steps of NS-RARP were simulated: bladder neck dissection; seminal vesicle mobilization; NVB dissection; and urethrovesical anastomosis (UVA). Five experts (caseload >500) and nine novices (caseload <50) completed the simulation. Force applied to the NVB during the dissection was quantified by a novel tension wire sensor system fabricated into the NVB. Post-simulation margin status (assessed by induction of chemiluminescent reaction with fluorescent dye mixed into the prostate PVA) and UVA weathertightness (via a standard 180-mL leak test) were also assessed. Objective scoring, using Global Evaluative Assessment of Robotic Skills (GEARS) and Robotic Anastomosis Competency Evaluation (RACE), was performed by two blinded surgeons. GEARS scores were correlated with forces applied to the NVB, and RACE scores were correlated with UVA leak rates. RESULTS The expert group achieved faster task-specific times for nerve-sparing (P = 0.007) and superior surgical margin results (P = 0.011). Nerve forces applied were significantly lower for the expert group with regard to maximum force (P = 0.011), average force (P = 0.011), peak frequency (P = 0.027) and total energy (P = 0.003). Higher force sensitivity (subcategory of GEARS score) and total GEARS score correlated with lower nerve forces (total energy in Joules) applied to NVB during the simulation with a correlation coefficient (r value) of -0.66 (P = 0.019) and -0.87 (P = 0.000), respectively. Both total and force sensitivity GEARS scores were significantly higher in the expert group compared to the novice group (P = 0.003). UVA leak rate highly correlated with total RACE score r value = -0.86 (P = 0.000). Mean RACE scores were also significantly different between novices and experts (P = 0.003). CONCLUSION We present a realistic, feedback-driven, full-immersion simulation platform for the development and evaluation of surgical skills pertinent to NS-RARP. The correlation of validated objective metrics (GEARS and RACE) with our CRPMS suggests their application as a novel method for real-time assessment and feedback during robotic surgery training. Further work is required to assess the ability to predict live surgical outcomes.
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Affiliation(s)
- Michael W Witthaus
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Shamroz Farooq
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Rachel Melnyk
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Timothy Campbell
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Patrick Saba
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Eric Mathews
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Bahie Ezzat
- Hajim School of Engineering, University of Rochester, Rochester, NY, USA
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Thomas P Frye
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Guan Wu
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Hani Rashid
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jean V Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Ahmed Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
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Gurung PMS, Campbell T, Wang B, Joseph JV, Ghazi AE. Accelerated Skills Acquisition Protocol (ASAP) in optimizing robotic surgical simulation training: a prospective randomized study. World J Urol 2019; 38:1623-1630. [DOI: 10.1007/s00345-019-02858-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/22/2019] [Indexed: 12/24/2022] Open
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Gurung PM, Mithal P, Lu DD, Ghazi AE, Joseph JV. Robot-Assisted Simple Prostatectomy: Illustration of a Simplified Extraperitoneal Transcapsular Technique. Videourology (New Rochelle) 2019; 33:10.1089/vid.2019.0032. [PMID: 32280559 PMCID: PMC7147249 DOI: 10.1089/vid.2019.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/12/2019] [Accepted: 08/17/2019] [Indexed: 06/11/2023]
Abstract
Introduction and Objectives: Robot-assisted simple prostatectomy (RASP) performed with the extraperitoneal (EP) technique (RASP-EP) minimizes the risk of bowel injury, particularly when bowel adhesions may be expected to be prominent, by negating the need to be in the transperitoneal space. However, there is a perception of its technical difficulty owing to the limited space that can be expanded within the space of Retzius. We aimed to describe, in the accompanying video, the step-by-step approach for a technically proficient procedure. Methods: From January 2010 to July 2018, 33 consecutive patients who had undergone RASP-EP were identified from our institutional database. Procedures were performed as described stepwise in the accompanying video. In RASP-EP, a 3 cm paraumbilical incision is made, anterior rectus sheath incised, muscle pushed laterally, and the EP space is entered. The EP space is expanded in the retropubic area using a balloon dilator and a blunt ended trocar, enabling the placement of further three ports for robot docking. A transverse capsulotomy, 2 cm from the bladder neck, is performed a la Millin's. Prostate adenoma is resected circumferentially. Electrocautery hemostasis is performed. Posterior bladder neck and urethra are sutured onto the prostatic fossa with 2-0 Vicryl. A 22F three-way catheter is placed. Anterior capsulotomy is closed in two layers with 2-0 and 0-0 Vicryl sutures. A drain is left in the retropubic space. Patient is discharged within 1-2 days with the catheter in situ, which is then removed 10 days later. Results: Of the 33 patients, median values were age (68), American Society of Anesthesiology (3), Charlson Comorbidity Index (3), and body mass index (28.5 kg/m2). Eight (24.2%) patients had prior abdominal surgeries. Twenty-five (75.8%) patients were catheter dependent. Adjunctive procedures were cystolithotomy (5), umbilical hernia repair (2), and ureteroscopy (1). Median values were operative time (178 minutes), estimated blood loss (200 mL), hemoglobin change (2.8 g/dL), and hematocrit change (9%); only one patient (3.0%) required 1 U transfusion. Median length of stay was 2 days. Clavien-Dindo complications were 0 (21), I (7), II (3), IIIa (1), IIIb (1), IV, and V (0). Median resected prostate weight was 122 g. Incidental prostate cancer was found in three patients (9%); one patient required adjuvant radiotherapy. No patients were catheter-dependent postoperatively; mean postvoid residual was 29 mL (range 0-250 mL). Median follow-up was 4 months. Conclusions: RASP-EP is a safe and efficacious technique that should form the repertoire of a urologist's armamentarium when dealing with large adenomas, particularly when entry into the peritoneal cavity is to be avoided. No competing financial interests exist. Runtime of video: 7 mins 5 secs.
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Affiliation(s)
- Pratik M. Gurung
- Department of Urology, University of Rochester Medical Center (URMC), Rochester, New York
| | - Prabhakar Mithal
- Department of Urology, University of Rochester Medical Center (URMC), Rochester, New York
| | - Diane D. Lu
- Department of Urology, University of Rochester Medical Center (URMC), Rochester, New York
| | - Ahmed E. Ghazi
- Department of Urology, University of Rochester Medical Center (URMC), Rochester, New York
| | - Jean V. Joseph
- Department of Urology, University of Rochester Medical Center (URMC), Rochester, New York
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Berrondo C, Feng C, Kukreja JB, Messing EM, Joseph JV. Antibiotic prophylaxis at the time of catheter removal after radical prostatectomy: A prospective randomized clinical trial. Urol Oncol 2019; 37:181.e7-181.e14. [DOI: 10.1016/j.urolonc.2018.10.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/02/2018] [Accepted: 10/31/2018] [Indexed: 12/01/2022]
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Truong M, Baack Kukreja JE, Rais-Bahrami S, Barashi NS, Wang B, Nuffer Z, Park JH, Lam K, Frye TP, Nix JW, Thomas JV, Feng C, Chapin BF, Davis JW, Hollenberg G, Oto A, Eggener SE, Joseph JV, Weinberg E, Messing EM. Multi-institutional Clinical Tool for Predicting High-risk Lesions on 3Tesla Multiparametric Prostate Magnetic Resonance Imaging. Eur Urol Oncol 2019; 2:257-264. [PMID: 31200839 DOI: 10.1016/j.euo.2018.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/26/2018] [Accepted: 08/13/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) for prostate cancer detection without careful patient selection may lead to excessive resource utilization and costs. OBJECTIVE To develop and validate a clinical tool for predicting the presence of high-risk lesions on mpMRI. DESIGN, SETTING, AND PARTICIPANTS Four tertiary care centers were included in this retrospective and prospective study (BiRCH Study Collaborative). Statistical models were generated using 1269 biopsy-naive, prior negative biopsy, and active surveillance patients who underwent mpMRI. Using age, prostate-specific antigen, and prostate volume, a support vector machine model was developed for predicting the probability of harboring Prostate Imaging Reporting and Data System 4 or 5 lesions. The accuracy of future predictions was then prospectively assessed in 214 consecutive patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Receiver operating characteristic, calibration, and decision curves were generated to assess model performance. RESULTS AND LIMITATIONS For biopsy-naïve and prior negative biopsy patients (n=811), the area under the curve (AUC) was 0.730 on internal validation. Excellent calibration and high net clinical benefit were observed. On prospective external validation at two separate institutions (n=88 and n=126), the machine learning model discriminated with AUCs of 0.740 and 0.744, respectively. The final model was developed on the Microsoft Azure Machine Learning platform (birch.azurewebsites.net). This model requires a prostate volume measurement as input. CONCLUSIONS In patients who are naïve to biopsy or those with a prior negative biopsy, BiRCH models can be used to select patients for mpMRI. PATIENT SUMMARY In this multicenter study, we developed and prospectively validated a calculator that can be used to predict prostate magnetic resonance imaging (MRI) results using patient age, prostate-specific antigen, and prostate volume as input. This tool can aid health care professionals and patients to make an informed decision regarding whether to get an MRI.
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Affiliation(s)
- Matthew Truong
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Janet E Baack Kukreja
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nimrod S Barashi
- Department of Urology, University of Chicago Medical Center, Chicago, IL, USA
| | - Bokai Wang
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Zachary Nuffer
- Department of Radiology and Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Ji Hae Park
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Khoa Lam
- Department of Radiology, Rochester General Hospital, Rochester, NY, USA
| | - Thomas P Frye
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John V Thomas
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Brian F Chapin
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John W Davis
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gary Hollenberg
- Department of Radiology and Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Aytekin Oto
- Department of Radiology, University of Chicago Medical Center, Chicago, IL, USA
| | - Scott E Eggener
- Department of Urology, University of Chicago Medical Center, Chicago, IL, USA
| | - Jean V Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Eric Weinberg
- Department of Radiology and Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Edward M Messing
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA.
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Joseph JV, Brasacchio R, Fung C, Reeder J, Bylund K, Sahasrabudhe D, Yeh SY, Ghazi A, Fultz P, Rubens D, Wu G, Singer E, Schwarz E, Mohile S, Mohler J, Theodorescu D, Lee YF, Okunieff P, McConkey D, Rashid H, Chang C, Fradet Y, Guru K, Kukreja J, Sufrin G, Lotan Y, Bailey H, Noyes K, Schwartz S, Rideout K, Bratslavsky G, Campbell SC, Derweesh I, Abrahamsson PA, Soloway M, Gomella L, Golijanin D, Svatek R, Frye T, Lerner S, Palapattu G, Wilding G, Droller M, Trump D. A Festschrift in Honor of Edward M. Messing, MD, FACS. Bladder Cancer 2018; 4:S1-S43. [PMID: 30443561 PMCID: PMC6226303 DOI: 10.3233/blc-189037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/28/2018] [Indexed: 12/02/2022]
Affiliation(s)
- Jean V. Joseph
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Chunkit Fung
- University of Rochester Medical Center, Rochester, NY, USA
| | - Jay Reeder
- University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin Bylund
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Shu Yuan Yeh
- University of Rochester Medical Center, Rochester, NY, USA
| | - Ahmed Ghazi
- University of Rochester Medical Center, Rochester, NY, USA
| | - Patrick Fultz
- University of Rochester Medical Center, Rochester, NY, USA
| | - Deborah Rubens
- University of Rochester Medical Center, Rochester, NY, USA
| | - Guan Wu
- University of Rochester Medical Center, Rochester, NY, USA
| | - Eric Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Edward Schwarz
- University of Rochester Medical Center, Rochester, NY, USA
| | - Supriya Mohile
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Yi Fen Lee
- University of Rochester Medical Center, Rochester, NY, USA
| | - Paul Okunieff
- UF Health Proton Therapy Institute, Gainesville, FL, USA
| | - David McConkey
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA
| | - Hani Rashid
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Yves Fradet
- CHU de Quebec-Hotel-Dieu de Quebec, Quebec, QC, Canada
| | | | | | - Gerald Sufrin
- State University of New York at Buffalo, Buffalo, NY, USA
| | - Yair Lotan
- UT Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Howard Bailey
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | - Kathy Rideout
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Steven C. Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | - Leonard Gomella
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Robert Svatek
- UT Health Science Center San Antonio, San Antonio, TX, USA
| | - Thomas Frye
- University of Rochester Medical Center, Rochester, NY, USA
| | - Seth Lerner
- Baylor College of Medicine Medical Center, Houston, TX, USA
| | | | | | | | - Donald Trump
- Virginia Commonwealth University, Fairfax, VA, USA
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Meng Y, Cubillos J, Borch M, Messing EM, Gentile D, Joseph JV, Rashid H, Kukreja JB. Antibiogram Directed Prophylaxis for Transrectal Prostate Biopsy: An Application of Recommendations in the Setting of High Fluoroquinolone Escherichia coli Resistance. Urology Practice 2017. [DOI: 10.1016/j.urpr.2016.10.005] [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: 11/16/2022]
Affiliation(s)
- Yifan Meng
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Jimena Cubillos
- Department of Urology, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Marianne Borch
- Department of Urology, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Edward M. Messing
- Department of Urology, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - David Gentile
- Department of Urology, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Jean V. Joseph
- Department of Urology, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Hani Rashid
- Department of Urology, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Janet Baack Kukreja
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
- Department of Urology, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
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Horovitz D, Lu X, Feng C, Messing EM, Joseph JV. Rate of Symptomatic Lymphocele Formation After Extraperitoneal vs Transperitoneal Robot-Assisted Radical Prostatectomy and Bilateral Pelvic Lymphadenectomy. J Endourol 2017; 31:1037-1043. [PMID: 28741376 DOI: 10.1089/end.2017.0153] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE With the peritoneum acting as a natural surface for lymphatic reabsorption, transperitoneal robot-assisted radical prostatectomy (tRARP) is thought to be associated with a lower incidence of symptomatic lymphoceles (SLs) compared with its extraperitoneal counterpart (eRARP) when bilateral pelvic lymph node dissection (BPLND) is performed. In this study, we aim to determine if there is a difference in SL formation and characteristics between the two approaches. MATERIALS AND METHODS We retrospectively reviewed the records of patients who underwent eRARP or tRARP and BPLND by a single surgeon at a tertiary care academic center from July 1, 2003, to May 31, 2016. Patients with a history of prior pelvic radiotherapy, concomitant inguinal hernia repair, RARP without BPLND, or nonadenocarcinoma of the prostate were excluded. The resulting eRARP and tRARP groups were propensity matched for age, body mass index (BMI), American Association of Anesthesiologists (ASA) score, D'Amico risk classification, and pathological lymph node (LN) count. RESULTS A total of 3183 RARPs were performed during this time period. After applying exclusion criteria and propensity score matching, 671 patients remained in each group. No statistically significant differences were noted between the groups with regard to age, BMI, ASA, pre-RARP prostate-specific antigen, D'Amico risk classification, biopsy and pathological Gleason sum score, pathological T stage, or margin status. The tRARP group had a higher clinical T stage (p = 0.0015), length of stay (LOS; p = 0.005), pathological N stage (4.92% vs 1.36%, p = 0.0002), and high total LN count (7.22 ± 5.54 vs 5.78 ± 4.18 LNs, p < 0.0001). The eRARP group had higher operating room times (197.4 ± 48.96 minutes vs 192.2 ± 44.12 minutes, p = 0.04) and estimated blood loss (218.4 ± 152.0 mL vs 179.9 ± 119.4 mL, p < 0.0001). No differences were noted in the frequency of SL formation [eRARP: 19/671 (2.83%) vs tRARP: 10/671 (1.49%), p = 0.09] or any clinical characteristics of the SL. Logistic regression analysis showed no effect of LN count (p = 0.071), pathological N stage (p = 0.111), or both combined (p = 0.085) on SL formation. CONCLUSIONS In this cohort, the rate and clinical characteristics of SL were similar among patients treated with eRARP or tRARP and BPLND. The low event rate of SL in each group and trends favoring higher SL with LN yield and pN1 disease in the tRAPR group may deem the study underpowered to make definitive conclusions.
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Affiliation(s)
- David Horovitz
- 1 Department of Urology, University of Rochester Medical Center , Rochester, New York
| | - Xiang Lu
- 2 Department of Biostatistics and Computational Biology, University of Rochester Medical Center , Rochester, New York
| | - Changyong Feng
- 2 Department of Biostatistics and Computational Biology, University of Rochester Medical Center , Rochester, New York
| | - Edward M Messing
- 1 Department of Urology, University of Rochester Medical Center , Rochester, New York
| | - Jean V Joseph
- 1 Department of Urology, University of Rochester Medical Center , Rochester, New York
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Horovitz D, Meng Y, Joseph JV, Feng C, Wu G, Rashid H, Messing EM. The role of urinary cytology when diagnostic workup is suspicious for upper tract urothelial carcinoma but tumour biopsy is nonconfirmatory. Can Urol Assoc J 2017; 11:E285-E290. [PMID: 28761589 DOI: 10.5489/cuaj.4150] [Citation(s) in RCA: 2] [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] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to determine the value of obtaining preoperative urinary cytology when diagnostic workup of an upper tract mass is suspicious for upper tract urothelial carcinoma (UTUC), but biopsy fails to confirm the diagnosis. METHODS Using billing code data, 239 patients were identified as having undergone radical nephroureterectomy (RNU) by 16 urologists from September 29, 1998 to July 31, 2015. Of this group, 19 adult patients had a presumed preoperative diagnosis of UTUC in a native kidney, at least three months of followup, no history of concurrent radical cystectomy with RNU, and negative/non-diagnostic tissue biopsy. These patients were divided into three groups: Group A had no urinary cytology taken (n=6); Group B had upper and/or lower tract cytology performed with neither positive nor atypical (n=7); Group C had upper and/or lower tract cytology performed with at least one positive or atypical (n=6). RESULTS Demographic information and diagnostic workup was similar between the groups, although Group A had more patients with a history of prior radical cystectomy for bladder cancer (p=0.02). One patient in Group B had benign tissue on final pathology. All patients in Groups A and C had malignancy on final pathology and overall, the three groups had similar rates of malignancy. CONCLUSIONS When a composite of clinical findings suggest UTUC, performing urinary cytology may not be necessary. A negative result in this setting should not be used to rule out UTUC, as this is often discordant with final pathology. A positive cytology result may help solidify the diagnosis when other findings are less clear.
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Affiliation(s)
- David Horovitz
- Department of Urology, University of Rochester Medical Centre; Rochester, NY, United States
| | - Yifan Meng
- School of Medicine and Dentistry, University of Rochester; Rochester, NY, United States
| | - Jean V Joseph
- Department of Urology, University of Rochester Medical Centre; Rochester, NY, United States
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester Medical Centre; Rochester, NY, United States
| | - Guan Wu
- Department of Urology, University of Rochester Medical Centre; Rochester, NY, United States
| | - Hani Rashid
- Department of Urology, University of Rochester Medical Centre; Rochester, NY, United States
| | - Edward M Messing
- Department of Urology, University of Rochester Medical Centre; Rochester, NY, United States
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Horovitz D, Feng C, Messing EM, Joseph JV. Extraperitoneal vs Transperitoneal Robot-Assisted Radical Prostatectomy in the Setting of Prior Abdominal or Pelvic Surgery. J Endourol 2017; 31:366-373. [DOI: 10.1089/end.2016.0706] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David Horovitz
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
| | - Edward M. Messing
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Jean V. Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York
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Abstract
Stocks of red blood cells (RBC) are held to ideally match supply and demand; hold too great a stock and unnecessary wastage occurs; too low a stock results in delay or lack of blood for the patient. Blood is a precious resource and its supply needs to be managed effectively. The aim was to identify how RBC units are wasted and propose laboratory-based reduction measures that would not compromise the clinical requirements of the patient. Wastage of RBC was investigated using a 'dashboard' query of a laboratory information management system. By employing service improvement tools, proposals were made to reduce unnecessary RBC waste while ensuring an adequate supply to the patient. The efficacy of those proposals was examined using the same dashboard to compare similar periods before and after their introduction. The reduction in RBC wastage for all groups during an eight month period (December to July) was from 6.4% (5.3% non-AB or B RhD-positive) pre-implementation to 4.4% (2.5% non-AB/B RhD-positive) post-implementation. Group O RhD-negative wastage reduced from 10.4% to 4.4% after introduction of waste-saving proposals. However, there was an increase in staff time required to introduce the changes and in associated Group and Screen testing (3.4 to 3.8 per unit issued). RBC wastage was significantly reduced (P<0.0001) by 32.8% (52%, non-AB/B RhD-positive), saving approximately 225 RBC units per annum. Financially, increased associated costs did not negate the savings made by the measures introduced.
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Horovitz D, Feng C, Messing EM, Joseph JV. MP69-13 EXTRAPERITONEAL VS. TRANSPERITONEAL ROBOT-ASSISTED RADICAL PROSTATECTOMY IN THE SETTING OF PRIOR ABDOMINAL OR PELVIC SURGERY. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1391] [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: 11/16/2022]
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21
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Kukreja JEB, Levey HR, Scosyrev E, Kiernan M, Berrondo C, McNamee C, Wu G, Joseph JV, Ghazi A, Rashid H, Dozier A, Messing EM. Effectiveness and safety of extended-duration prophylaxis for venous thromboembolism in major urologic oncology surgery. Urol Oncol 2015; 33:387.e7-16. [DOI: 10.1016/j.urolonc.2014.12.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/14/2014] [Accepted: 12/15/2014] [Indexed: 01/22/2023]
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Boer JC, van Marion DMS, Joseph JV, Kliphuis NM, Timmer-Bosscha H, van Strijp JAG, de Vries EGE, den Dunnen WFA, Kruyt FAE, Walenkamp AME. Microenvironment involved in FPR1 expression by human glioblastomas. J Neurooncol 2015; 123:53-63. [PMID: 25894595 PMCID: PMC4439437 DOI: 10.1007/s11060-015-1777-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/02/2015] [Indexed: 12/19/2022]
Abstract
Formyl peptide receptor 1 (FPR1) activity in U87 glioblastoma (GBM) cells contributes to tumor cell motility. The present study aimed to evaluate the FPR1 expression in human GBM, the possibility to elicit agonist induced FPR1 activation of GBM cells and inhibit this activation with chemotaxis inhibitory protein of Staphylococcus aureus (CHIPS). Immunohistochemistry was used to assess FPR1 expression in GBM patient samples, which was present in all 178 samples. Also FPR1 mRNA levels measured with quantitative PCR, could be detected in all 25 GBM patient samples tested. Activation of FPR1 in U87 cells, as measured by human mitochondrial-derived agonists, increased calcium mobilization, AKT and ERK1/2 phosphorylation, and ligand-induced migration. Inhibition of all responses could be achieved with CHIPS. Eight early passage human Groningen Glioma (GG) cell lines, isolated from primary GBM tissue were screened for the presence of FPR1. FPR1 mRNA and protein expression as well as receptor activation could not be detected in any of these early passage GG cell lines. However FPR1 was present in ex vivo tumors formed by the same GG cell lines after being implanted in mouse brains. FPR1 is highly expressed in human GBM specimens, it can be activated by human mitochondrial-derived agonists in U87 and inhibited with CHIPS. FPR1 cannot be detected in early passage GG cell lines in vitro, however when engrafted in the mouse brain these cells show FPR1 expression. These results suggest a role of the brain microenvironment in FPR1 expression in GBM.
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Affiliation(s)
- J C Boer
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30001, 9700, RB, Groningen, The Netherlands
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Gellhaus PT, Bhandari A, Monn MF, Gardner TA, Kanagarajah P, Reilly CE, Llukani E, Lee Z, Eun DD, Rashid H, Joseph JV, Ghazi AE, Wu G, Boris RS. Robotic management of genitourinary injuries from obstetric and gynaecological operations: a multi-institutional report of outcomes. BJU Int 2014; 115:430-6. [DOI: 10.1111/bju.12785] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Akshay Bhandari
- Division of Urology; Columbia University at Mount Sinai; Miami Beach FL USA
| | | | | | | | | | - Elton Llukani
- Department of Urology; Temple University; Philadelphia PA USA
| | - Ziho Lee
- Department of Urology; Temple University; Philadelphia PA USA
| | - Daniel D. Eun
- Department of Urology; Temple University; Philadelphia PA USA
| | - Hani Rashid
- Department of Urology; University of Rochester; Rochester NY USA
| | - Jean V. Joseph
- Department of Urology; University of Rochester; Rochester NY USA
| | - Ahmed E. Ghazi
- Department of Urology; University of Rochester; Rochester NY USA
| | - Guan Wu
- Department of Urology; University of Rochester; Rochester NY USA
| | - Ronald S. Boris
- Department of Urology; Indiana University; Indianapolis IN USA
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Patel HRH, Amodeo A, Joseph JV. Salvage laparoscopic surgery in advanced prostate cancer: is it possible or beneficial? Expert Rev Anticancer Ther 2014; 8:1509-13. [DOI: 10.1586/14737140.8.9.1509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dogra VS, Chinni BK, Valluru KS, Joseph JV, Ghazi A, Yao JL, Evans K, Messing EM, Rao NA. Multispectral Photoacoustic Imaging of Prostate Cancer: Preliminary Ex-vivo Results. J Clin Imaging Sci 2013; 3:41. [PMID: 24228210 PMCID: PMC3814905 DOI: 10.4103/2156-7514.119139] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [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] [Received: 08/09/2013] [Accepted: 09/12/2013] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The objective of this study is to validate if ex-vivo multispectral photoacoustic (PA) imaging can differentiate between malignant prostate tissue, benign prostatic hyperplasia (BPH), and normal human prostate tissue. MATERIALS AND METHODS Institutional Review Board's approval was obtained for this study. A total of 30 patients undergoing prostatectomy for biopsy-confirmed prostate cancer were included in this study with informed consent. Multispectral PA imaging was performed on surgically excised prostate tissue and chromophore images that represent optical absorption of deoxyhemoglobin (dHb), oxyhemoglobin (HbO2), lipid, and water were reconstructed. After the imaging procedure is completed, malignant prostate, BPH and normal prostate regions were marked by the genitourinary pathologist on histopathology slides and digital images of marked histopathology slides were obtained. The histopathology images were co-registered with chromophore images. Region of interest (ROI) corresponding to malignant prostate, BPH and normal prostate were defined on the chromophore images. Pixel values within each ROI were then averaged to determine mean intensities of dHb, HbO2, lipid, and water. RESULTS Our preliminary results show that there is statistically significant difference in mean intensity of dHb (P < 0.0001) and lipid (P = 0.0251) between malignant prostate and normal prostate tissue. There was difference in mean intensity of dHb (P < 0.0001) between malignant prostate and BPH. Sensitivity, specificity, positive predictive value, and negative predictive value of our imaging system were found to be 81.3%, 96.2%, 92.9% and 89.3% respectively. CONCLUSION Our preliminary results of ex-vivo human prostate study suggest that multispectral PA imaging can differentiate between malignant prostate, BPH and normal prostate tissue.
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Affiliation(s)
- Vikram S Dogra
- Department of Radiology, Urology, and BME, University of Rochester, Rochester, NY 14642, USA
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Abstract
Extraperitoneal robotic-assisted radical prostatectomy in carefully selected renal allograft recipients may be feasible in avoiding injury to the renal allograft, transplanted ureter, and ureteroneocystostomy. Introduction: Renal transplantation is the treatment of choice for patients with end-stage renal failure. With advances in immunosuppression, the short-term and long-term outcome has improved significantly. Subsequently, urologists are encountering more transplant recipients with genitourinary malignancies, and therefore urologists are becoming increasingly compelled to offer curative treatment options. Materials and Methods: We present modifications to facilitate E-RARP in these patients that include modified trocar arrangement, delayed bladder neck transection, utilizing the robotic Hem-o-lok applier, and posterior reconstruction of the anastomosis using a barbed V-loc suture. A 68-year-old male with a history of polycystic kidney disease, end-stage renal failure, and an allograft renal transplantation in the right iliac fossa, presented with T1c, Gleason 3+4 prostate cancer. He had a preoperative PSA of 6.93ng/mL, ASA score of 3, and a BMI of 26kg/m2. Follow-up for metastasis (MRI and bone scan) was negative. E-RARP was performed via the extraperitoneal approach using a 5-port 2-arm approach at an insufflation pressure of 10mm Hg. Results: The radical prostatectomy was successfully performed. Ureterovesical anastomosis was completed, and total console time was 130 minutes, with an estimated blood loss of 125mL. Final pathology was T2bNx, Gleason 3+4 with negative surgical margins. The patient was discharged with no change in serum creatinine or GFR. The catheter was removed on POD 10 with no intraoperative or immediate postoperative complications. Conclusion: E-RARP in the carefully selected renal allograft recipient is feasible and accomplished safely with technical modifications to avoid injuring the renal allograft, transplanted ureter, and ureteroneocystostomy.
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Affiliation(s)
- Ahmed Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, New York 14642, USA.
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Boer JC, Domanska UM, Timmer-Bosscha H, Boer IGJ, de Haas CJC, Joseph JV, Kruyt FAE, de Vries EGE, den Dunnen WFA, van Strijp JAG, Walenkamp AME. Inhibition of formyl peptide receptor in high-grade astrocytoma by CHemotaxis Inhibitory Protein of S. aureus. Br J Cancer 2013; 108:587-96. [PMID: 23322202 PMCID: PMC3593554 DOI: 10.1038/bjc.2012.603] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: High-grade astrocytomas are malignant brain tumours that infiltrate the surrounding brain tissue and have a poor prognosis. Activation of formyl peptide receptor (FPR1) on the human astrocytoma cell line U87 promotes cell motility, growth and angiogenesis. We therefore investigated the FPR1 inhibitor, Chemotaxis Inhibitory Protein of S. aureus (CHIPS), as a potential anti-astrocytoma drug. Methods and results: FPR1 expression was studied immunohistochemically in astrocytomas WHO grades I–IV. With intracellular calcium mobilisation and migration assays, human ligands were tested for their ability to activate FPR1 on U87 cells and on a cell line derived from primary astrocytoma grade IV patient material. Thereafter, we selectively inhibited these ligand-induced responses of FPR1 with an anti-inflammatory compound called Chemotaxis Inhibitory Protein of S. aureus (CHIPS). U87 xenografts in NOD-SCID mice served to investigate the effects of CHIPS in vivo. FPR1 was expressed in 29 out of 32 (90%) of all grades of astrocytomas. Two human mitochondrial-derived formylated peptides, formyl-methionil-leucine-lysine-isoleucine-valine (fMLKLIV) and formyl-methionil-methionil-tyrosine-alanine-leucine-phenylalanine (fMMYALF), were potent activators of FPR1 on tumour cells. Ligand-induced responses of FPR1-expressing tumour cells could be inhibited with FPR1 inhibitor CHIPS. Treatment of tumour-bearing mice with CHIPS slightly reduced tumour growth and improved survival as compared to non-treated animals (P=0.0019). Conclusion: Targeting FPR1 with CHIPS reduces cell motility and tumour cell activation, and prolongs the survival of tumour-bearing mice. This strategy could be explored in future research to improve treatment results for astrocytoma patients.
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Affiliation(s)
- J C Boer
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
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Tobis S, Venigalla S, Balakumaran K, Scosyrev E, Lloyd GL, Golijanin DJ, Joseph JV, Rashid H, Wu G. Analysis of a large single-center experience with robot-assisted pyeloplasty. Int J Urol 2012; 20:230-4. [DOI: 10.1111/j.1442-2042.2012.03119.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kilminster S, Müller S, Menon M, Joseph JV, Ralph DJ, Patel HR. Predicting erectile function outcome in men after radical prostatectomy for prostate cancer. BJU Int 2011; 110:422-6. [DOI: 10.1111/j.1464-410x.2011.10757.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [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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Ghazi A, Joseph JV. Re: Lasser et al.: An unbiased prospective report of perioperative complications of robot-assisted laparoscopic radical prostatectomy (Urology 2010;75:1083-1091). Urology 2011; 77:260-1; author reply 261-2. [PMID: 21195856 DOI: 10.1016/j.urology.2010.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 08/20/2010] [Accepted: 08/21/2010] [Indexed: 11/18/2022]
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Affiliation(s)
- Matthew M. Lux
- Department of Urology, University of Rochester, Rochester, New York
| | - Matthew Marshall
- Ergonomic and Body Mechanics, Rochester Institute of Technology, Rochester, New York
| | - Erdal Erturk
- Department of Urology, University of Rochester, Rochester, New York
| | - Jean V. Joseph
- Department of Urology, University of Rochester, Rochester, New York
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Patel H, Joseph JV, Amodeo A, Kothari K. Laparoscopic salvage total pelvic exenteration: Is it possible post-chemo-radiotherapy? J Minim Access Surg 2009; 5:111-4. [PMID: 20407571 PMCID: PMC2843126 DOI: 10.4103/0972-9941.59310] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 07/13/2009] [Indexed: 12/16/2022] Open
Abstract
Indications for total pelvic exenteration in a male (removal of the bladder, prostate and rectum) and in a woman (removal bladder, uterus, vagina, ovaries and rectum) are rare. The advanced stage generally dictates that the patient has some form of chemotherapy or radiotherapy, or a combination of two to shrink/debulk the tumour. We report the first two cases of a salvage laparoscopic total pelvic exenteration in a male for rectal adenocarcinoma invading into the bladder and prostate, post-chemo-radiotherapy and in a woman for squamous cell carcinoma of cervix invading the bladder and rectum post-chemo-radiotherapy. Salvage surgery is often difficult and has been noted to have high morbidity. Applying a laparoscopic approach to this group may have advantages for the patient and the surgeon, i.e. less pain, early recovery and magnified views. As we have technically shown it to be possible, perhaps laparoscopic approaches should be discussed if the teams in these centres are of advanced laparoscopic surgeons working in multi-skilled groups.
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Affiliation(s)
- H Patel
- Section of Laparoscopic Urology, Institute of Urology, University College Hospital, London, UK
| | - J V Joseph
- Section of Laparoscopy and Robotic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - A Amodeo
- Section of Laparoscopic Urology, Institute of Urology, University College Hospital, London, UK
| | - K Kothari
- Section of Minimally Invasive Surgery, Gujarat Cancer and Research Institute, Ahmadabad, India
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Affiliation(s)
- Hiten R H Patel
- Section of Laparoscopic Urology, University College London Hospital, London, UK.
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Zorn KC, Gautam G, Shalhav AL, Clayman RV, Ahlering TE, Albala DM, Lee DI, Sundaram CP, Matin SF, Castle EP, Winfield HN, Gettman MT, Lee BR, Thomas R, Patel VR, Leveillee RJ, Wong C, Badlani GH, Rha KH, Eggener SE, Wiklund P, Mottrie A, Atug F, Kural AR, Joseph JV. Training, Credentialing, Proctoring and Medicolegal Risks of Robotic Urological Surgery: Recommendations of the Society of Urologic Robotic Surgeons. J Urol 2009; 182:1126-32. [DOI: 10.1016/j.juro.2009.05.042] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Indexed: 11/30/2022]
Affiliation(s)
- Kevin C. Zorn
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Gagan Gautam
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Arieh L. Shalhav
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Ralph V. Clayman
- Department of Urology, University of California, Irvine, Orange, California
| | - Thomas E. Ahlering
- Department of Urology, University of California, Irvine, Orange, California
| | - David M. Albala
- Duke Prostate Center, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - David I. Lee
- Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Surena F. Matin
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | | | - Howard N. Winfield
- Department of Urology, University of Iowa, Hospitals and Clinics, Iowa City, Iowa
| | | | - Benjamin R. Lee
- Center for Minimally Invasive Urologic Surgery, Department of Urology, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Raju Thomas
- Center for Minimally Invasive Urologic Surgery, Department of Urology, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Vipul R. Patel
- Global Robotics Institute, Celebration Health-University of Central Florida, Orlando, Florida
| | - Raymond J. Leveillee
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Carson Wong
- Department of Urology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Gopal H. Badlani
- Department of Urology, Wake Forest University, Winston-Salem, North Carolina
| | - Koon H. Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Scott E. Eggener
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Peter Wiklund
- Department of Urology, Division of Surgery, Karolinska Hospital, Stockholm, Sweden
| | - Alex Mottrie
- Urological Department, O.L.V. Clinic, Aalst, Belgium
| | - Fatih Atug
- Department of Urology, Istanbul Bilim University, Istanbul, Turkey
| | - Ali R. Kural
- Department of Urology, Istanbul Bilim University, Istanbul, Turkey
| | - Jean V. Joseph
- University of Rochester Medical Center, Rochester, New York
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Amodeo A, Linares Quevedo A, Joseph JV, Belgrano E, Patel HRH. Robotic laparoscopic surgery: cost and training. MINERVA UROL NEFROL 2009; 61:121-128. [PMID: 19451894] [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: 05/27/2023]
Abstract
The advantages of minimally invasive surgery are well accepted. Shorter hospital stays, decreased postoperative pain, rapid return to preoperative activity, decreased postoperative ileus, and preserved immune function are among the benefits of the laparoscopic approach. However, the instruments of laparoscopy afford surgeons limited precision and poor ergonomics, and their use is associated with a significant learning curve and the amount of time and energy necessary to develop and maintain such advanced laparoscopic skills is not insignificant. The robotic surgery allows all laparoscopists to perform advanced laparoscopic procedures with greater ease. The potential advantages of surgical robotic systems include making advanced laparoscopic surgical procedures accessible to surgeons who do not have advanced video endoscopic training and broadening the scope of surgical procedures that can be performed using the laparoscopic method. The wristed instruments, x10 magnifications, tremor filtering, scaling of movements and three-dimensional view allow the urologist to perform the intricate dissection and anastomosis with high precision. The robot is not, however, without significant disadvantages as compared with traditional laparoscopy. These include greater expense and consumption of operating room resources such as space and the availability of skilled technical staff, complete elimination of tactile feedback, and more limited options for trocar placement. The current cost of the da Vinci system is $ 1.2 million and annual maintenance is $ 138000. Many studies suggest that depreciation and maintenance costs can be minimised if the number of robotic cases is increased. The high cost of purchasing and maintaining the instruments of the robotic system is one of its many disadvantages. The availability of the robotic systems to only a limited number of centres reduces surgical training opportunities. Hospital administrators and surgeons must define the reasons for developing a robotic surgical program: it is very important to show that robotics will add a dimension that will benefit the hospital, the patient care and institutional recognition. Another essential task to overcome is the important education of the operating room nursing staff, a significant difference between this modality and traditional surgery. Without operating room environment support, most surgeons will revert to traditional methods even after a few successful robotics cases. As the field of robotic surgery continues to grow, graduate medical education and continuing medical education programs that address the surgical robotic learning needs of residents and practicing surgeons need to be developed.
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Affiliation(s)
- A Amodeo
- Section of Laparoscopic Urology, Institute of Urology, University College Hospital, London, UK.
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Knopf JK, Golijanin DJ, Lux MM, Feng C, Joseph JV, Erturk E. STONE FRAGMENTATION AND CLEARANCE DURING SHOCKWAVE LITHOTRIPSY USING THE APPLIED® MEDICAL URETERAL ACCESS SHEATH. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61643-8] [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: 10/21/2022]
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Lux MM, Joseph JV. PREVENTION, IDENTIFICATION, AND REPAIR OF RECTAL INJURY DURING ROBOT ASSISTED RADICAL PROSTATECTOMY. J Urol 2009. [DOI: 10.1016/s0022-5347(09)60948-4] [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: 10/21/2022]
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Lux MM, Greene TD, Feng C, Erturk E, Patel HR, Joseph JV. DOES NERVE SPARING CONTRIBUTE TO CONTINENCE IN PATIENTS WITH POOR PREOPERATIVE ERECTILE FUNCTION? J Urol 2009. [DOI: 10.1016/s0022-5347(09)61902-9] [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: 11/13/2022]
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Greene TD, Joseph JV, Feng C, Erturk E. Evaluation and Management of Post–Shock Wave Lithotripsy Pain with Third-Generation Lithotriptors Using Rofecoxib. J Endourol 2009; 23:395-8. [DOI: 10.1089/end.2008.0243] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tricia D. Greene
- Department of Urology and Kidney Stone Treatment Center, University of Rochester School of Medicine, Rochester, New York
| | - Jean V. Joseph
- Department of Urology and Kidney Stone Treatment Center, University of Rochester School of Medicine, Rochester, New York
| | - Changyong Feng
- Department of Urology and Kidney Stone Treatment Center, University of Rochester School of Medicine, Rochester, New York
| | - Erdal Erturk
- Department of Urology and Kidney Stone Treatment Center, University of Rochester School of Medicine, Rochester, New York
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Abstract
A robot functioning in an environment may exhibit various forms of behavior emerge from the interaction with its environment through sense, control and plan activities. Hence, this paper introduces a behaviour selection based navigation and obstacle avoidance algorithm with effective method for adapting robotic behavior according to the environment conditions and the navigated terrain. The developed algorithm enable the robot to select the suitable behavior in real-time to avoid obstacles based on sensory information through visual and ultrasonic sensors utilizing the robot's ability to step over obstacles, and move between surfaces of different heights. In addition, it allows the robot to react in appropriate manner to the changing conditions either by fine-tuning of behaviors or by selecting different set of behaviors to increase the efficiency of the robot over time. The presented approach has been demonstrated on quadruped robot in several different experimental environments and the paper provides an analysis of its performance.
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Affiliation(s)
- HRH Patel
- Section of Laparoscopy, Institute of Urology, University College Hospital, London, UK
| | - A Amodeo
- Section of Laparoscopy, Institute of Urology, University College Hospital, London, UK
| | - JV Joseph
- Section of Laparoscopy and Robotic Surgery, University of Rochester Medical Center, Rochester, New York, USA
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Hoyt K, Castaneda B, Zhang M, Nigwekar P, di Sant'Agnese PA, Joseph JV, Strang J, Rubens DJ, Parker KJ. Tissue elasticity properties as biomarkers for prostate cancer. Cancer Biomark 2008; 4:213-25. [DOI: 10.3233/cbm-2008-44-505] [Citation(s) in RCA: 210] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kenneth Hoyt
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | - Benjamin Castaneda
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | - Man Zhang
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | - Priya Nigwekar
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Jean V. Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - John Strang
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Deborah J. Rubens
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin J. Parker
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
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Zhang M, Nigwekar P, Castaneda B, Hoyt K, Joseph JV, di Sant'Agnese A, Messing EM, Strang JG, Rubens DJ, Parker KJ. Quantitative characterization of viscoelastic properties of human prostate correlated with histology. Ultrasound Med Biol 2008; 34:1033-42. [PMID: 18258350 DOI: 10.1016/j.ultrasmedbio.2007.11.024] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 11/21/2007] [Accepted: 11/30/2007] [Indexed: 05/03/2023]
Abstract
Quantification of mechanical properties of human prostate tissue is important for developing sonoelastography for prostate cancer detection. In this study, we characterized the frequency-dependent complex Young's modulus of normal and cancerous prostate tissues in vitro by using stress relaxation testing and viscoelastic tissue modeling methods. After radical prostatectomy, small cylindrical tissue samples were acquired in the posterior region of each prostate. A total of 17 samples from eight human prostates were obtained and tested. Stress relaxation tests on prostate samples produced repeatable results that fit a viscoelastic Kelvin-Voigt fractional derivative (KVFD) model (r(2)>0.97). For normal (n = 8) and cancerous (n = 9) prostate samples, the average magnitudes of the complex Young's moduli (|E*|) were 15.9 +/- 5.9 kPa and 40.4 +/- 15.7 kPa at 150 Hz, respectively, giving an elastic contrast of 2.6:1. Nine two-sample t-tests indicated that there are significant differences between stiffness of normal and cancerous prostate tissues in the same gland (p < 0.01). This study contributes to the current limited knowledge on the viscoelastic properties of the human prostate, and the inherent elastic contrast produced by cancer.
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Affiliation(s)
- Man Zhang
- Department of Biomedical Engineering, University of Rochester, Rochester, NY 14627, USA.
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Capello SA, Gordetsky J, Erturk E, Yao J, Joseph JV. Factors associated with ureteral burn injury from an electrified guidewire. J Endourol 2008; 22:1189-92. [PMID: 18578651 DOI: 10.1089/end.2008.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE During ureteroscopic procedures, electrocautery is often utilized in the presence of an intra-ureteral guidewire. Inadvertent electrification of the guidewire may occur if the active electrode comes into contact with the guidewire, potentially resulting in a ureteral burn injury. This study investigates under what conditions electrification of a ureteral guidewire would result in ureteral burn injury. MATERIALS AND METHODS Porcine kidney/ureter units were tested in a saline bath using a guidewire within the ureter. The collecting system was filled with either saline or water and the guidewire was electrified with varying power and mode settings. The contact area between the wire and ureter was adjusted to 1/2 or 1/4 of the total ureteral length. The ureters were then inspected for evidence of burn injury microscopically by a pathologist in a blinded fashion. RESULTS Ten kidney/ureter units were tested. Four units were filled with saline and none of these demonstrated any burn injury. Six kidney/ureter units were filled with water prior to electrification of the wire. Small amounts of burned tissue were noted in those with the full length of the ureter exposed. Moderate to severe burning was present in those with 1/2 of the ureter exposed. Ureters exposed to 120-W cutting current had more injury than those exposed to 80-W coagulation current. CONCLUSIONS Inadvertent electrification of a ureteral guidewire does not necessarily result in ureteral burn injury. The presence and extent of ureteral injury depends primarily on the irrigating fluid used, as well as the amount of ureter exposed to the electrified guidewire.
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Affiliation(s)
- Seth A Capello
- Section of Laparoscopy and Robotics, University of Rochester, Rochester, New York 14642, USA
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Capello SA, Patel HRH, Joseph JV. Surgical case order does not affect outcomes during robot-assisted radical prostatectomy. J Robot Surg 2008; 2:25-9. [PMID: 27637214 DOI: 10.1007/s11701-007-0066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Accepted: 12/05/2007] [Indexed: 11/26/2022]
Abstract
Fatigue has been implicated in medical errors. There has not been any report in the surgical literature addressing the impact of case order on patient outcomes. The purpose of this study was to determine whether the order of robot-assisted radical prostatectomy (RARP) has an influence on surgical outcomes. All patients undergoing RARP by a single surgeon (J.V.J.) on days during which there were three consecutive RARP cases were divided into three groups based on case order. They were compared with respect to pre-operative, intra-operative, and post-operative parameters. Complications were classified as surgical (bladder neck contracture, urinary tract infection, post-operative bleeding) or medical (deep venous thrombosis, myocardial infarction, C. difficile colitis) and compared between the groups. A total of 381 patients were evaluated, 127 in each group. The median start time for group 1 was 0732 hours (range 0722-0900 hours), group 2 was 1108 hours (range 1008-1344 hours), and group 3 was 1458 hours (range 1258-1742 hours). Patient age, body mass index, pre-operative PSA, pre-operative Gleason score, and clinical stage were all similar amongst the groups. The total operative time was equivalent, as was the estimated blood loss. Prostate volume and pathologic Gleason score showed no significant changes between groups. Pathologic stage showed a slight trend toward increasing percentages of T3 disease with increasing group number (group 1 = 17%, group 2 = 19%, and group 3 = 24%). Positive margin rates were lowest in group 3 (11.8% for group 1, 12.6% for group 2, and 3.9% for group 3). Complication rates were equivalent at 5-7% overall (2-6% surgical complications, 2-4% medical). Three patients from each group had PSA recurrence. With an experienced surgical team, three RARP procedures may be performed in 1 day without significant variation in surgical outcomes among the cases.
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Affiliation(s)
- Seth A Capello
- Section of Laparoscopy and Robotics, University of Rochester, Rochester, NY, USA
| | | | - Jean V Joseph
- Section of Laparoscopy and Robotics, University of Rochester, Rochester, NY, USA.
- Department of Urology, University of Rochester, 601 Elmwood Avenue, Box 656, Rochester, NY, 14642, USA.
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Joseph JV, Greene TD, Capello SA, Mathe ME, Patel HR. EXTRAPERITONEAL ROBOT ASSISTED RADICAL PROSTATECTOMY: OUTCOMES IN > 1000 PATIENTS. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61780-2] [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: 11/28/2022]
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Greene TD, Capello SA, Joseph JV. AVOIDING BLEEDING COMPLICATIONS DURING EXTRAPERITONEAL ROBOT ASSISTED RADICAL PROSTATECTOMY. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61439-1] [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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Joseph JV, Greene T. Re: Standard versus limited pelvic lymph node dissection for prostate cancer in patients with a predicted probability of nodal metastasis greater than 1% K. Touijer, F. Rabbani, J. R. Otero, F. P. Secin, J. A. Eastham, P. T. Scardino And B. Guillonneau J Urol 2007; 178: 120-124. J Urol 2007; 179:789-90. [PMID: 18082824 DOI: 10.1016/j.juro.2007.09.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Indexed: 12/01/2022]
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Zacharakis E, Monem M, Joseph JV, Patel HRH. Molecular therapeutic targets for bladder cancer. Expert Rev Anticancer Ther 2007; 7:1691-3. [PMID: 18062742 DOI: 10.1586/14737140.7.12.1691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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