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Able C, Stewart C, Gabrielson AT, Overholt T, Banner S, Gilliam K, Srinivasan A, Haney N, Kohn TP, Crigger CB, Gerber J. National Postoperative Opioid Prescribing Rates Following Pediatric Urology Procedures Before and After the 2018 American Academy of Pediatrics Challenge to Reduce Opioid Prescribing: A Claims Database Analysis. Urology 2024; 184:217-223. [PMID: 38043907 DOI: 10.1016/j.urology.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To evaluate trends in opioid prescribing rates following pediatric urologic surgery. METHODS We queried the TriNetX Research database for patients under age 18 who underwent one of seven common pediatric urology procedures. We identified the proportion of patients that received an oral opioid prescription within 5days of surgery. The primary analysis evaluated the trend in postoperative opioid prescriptions using 3-month intervals from January 2010 to December 2022. We performed an interrupted time series analysis assessing trends in opioid prescribing patterns both before and after the American Academy of Pediatrics challenge. RESULTS Of the 81,644 pediatric urology procedures, 29,595 (36.2%) received a postoperative opioid prescription, including 29.8% of circumcisions, 25.8% of hydrocelectomies, 39.6% of hypospadias repairs, 42.7% of pyeloplasties, 42.8% of ureteral reimplants. For all procedures we observed rising rates of opioid prescribing, increasing by 0.9% per 3-month interval prior to the challenge statement release from 2010 to 2018. We observed an overall significant decrease in opioid prescribing by 2.2% per 3-month interval following the challenge statement release. Additionally, since 2018, there was a significant decrease in opioid prescribing in all of the race, ethnicity, and age cohorts. CONCLUSION Opioid prescribing following pediatric urology procedures has sharply decreased following the 2018 American Academy of Pediatrics challenge statement which underscores the value of cross-specialty quality improvement initiatives. Nonetheless, opioid prescribing remains high with potential racial or age disparities that warrant further investigation.
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Affiliation(s)
- Corey Able
- University of Texas Medical Branch School of Medicine, Department of Surgery, Division of Urology, Galveston, TX
| | - Courtney Stewart
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX
| | - Andrew T Gabrielson
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tyler Overholt
- Atrium Health Wake Forest Baptist, Department of Urology, Winston-Salem, NC
| | - Steven Banner
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX
| | - Kelli Gilliam
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX
| | - Aditya Srinivasan
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX
| | - Nora Haney
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Chad B Crigger
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan Gerber
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX
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Gabrielson AT, Galansky L, Sholklapper T, Crigger C, Patel HD, Harris K, Haney N, Jing Y, Wang MH, Wu C, Gearhart JP, Di Carlo HN. Effectiveness of Liposomal Bupivacaine With Bupivacaine Hydrochloride vs Bupivacaine Hydrochloride Alone as a Local Anesthetic for Children Undergoing Ambulatory Urologic Surgery: The Baby ORIOLES Randomized Clinical Trial. J Urol 2024; 211:37-47. [PMID: 37871332 DOI: 10.1097/ju.0000000000003764] [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: 06/14/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE We sought to determine if the addition of liposomal bupivacaine to bupivacaine hydrochloride improves opioid-free rate and postoperative pain scores among children undergoing ambulatory urologic surgery. MATERIALS AND METHODS A prospective, phase 3, single-blinded, single-center randomized trial with superiority design was conducted in children 6 to 18 years undergoing ambulatory urologic procedures between October 2021 and April 2023. Patients were randomized 1:1 to receive dorsal penile nerve block (penile procedures) or incisional infiltration with spermatic cord block (inguinal/scrotal procedures) with weight-based liposomal bupivacaine plus bupivacaine hydrochloride or bupivacaine hydrochloride alone. The primary outcome was opioid-free rate at 48 hours. Secondary outcomes included parents' postoperative pain measure scores, numerical pain scale scores, and weight-based opioid utilization at 48 hours and 10 to 14 days. RESULTS We randomized 104 participants, with > 98% (102/104) with complete follow-up data at 48 hours and 10 to 14 days. At interim analysis, there was no significant difference in opioid-free rate at 48 hours between arms (60% in the intervention vs 62% in the control group; estimated difference in proportion -1.9% [95% CI, -20%-16%]; P = .8). We observed no increased odds of patients being opioid-free at 48 hours with the intervention compared to the control group (OR 0.96 [95% CI 0.41-2.3]; P = .9). The trial met the predetermined futility threshold for early stopping. There was no difference in parents' postoperative pain measure scores, numerical pain scale scores, or opioid utilization at 48 hours or 10 to 14 days. No difference in adverse events was observed. CONCLUSIONS The addition of liposomal bupivacaine to bupivacaine hydrochloride did not significantly improve opioid-sparing effect or postoperative pain compared with bupivacaine hydrochloride alone among children ≥ 6 years undergoing ambulatory urologic surgery.
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Affiliation(s)
- Andrew T Gabrielson
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Logan Galansky
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tamir Sholklapper
- Department of Urology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Chad Crigger
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hiten D Patel
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kelly Harris
- Department of Urology, University of Colorado School of Medicine, Aurora, Colorado
| | - Nora Haney
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yuezhou Jing
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ming-Hsien Wang
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charlotte Wu
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John P Gearhart
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Heather N Di Carlo
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Gabrielson AT, Galansky L, Sholklapper T, Crigger C, Patel HD, Harris K, Haney N, Jing Y, Wang MH, Wu C, Gearhart JP, Di Carlo HN. Reply by Authors. J Urol 2024; 211:47. [PMID: 38063169 DOI: 10.1097/ju.0000000000003764.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/12/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Andrew T Gabrielson
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Logan Galansky
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tamir Sholklapper
- Department of Urology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Chad Crigger
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hiten D Patel
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kelly Harris
- Department of Urology, University of Colorado School of Medicine, Aurora, Colorado
| | - Nora Haney
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yuezhou Jing
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ming-Hsien Wang
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charlotte Wu
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John P Gearhart
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Heather N Di Carlo
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Grutman AJ, Stewart C, Able C, Agrawal P, Galansky L, Gabrielson A, Haney N, Kohn TP, Crigger CB. Postoperative Opioid Prescribing in Adolescents and Young Adults After Urologic Procedures Is Associated With New Persistent Opioid Use Disorder: A Large Claims Database Analysis. Urology 2023; 182:211-217. [PMID: 37696308 DOI: 10.1016/j.urology.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To assess the risk of persistent opioid use following various urologic procedures in adolescents and young adults. MATERIALS AND METHODS The TriNetX LLC Diamond Network was queried for patients aged 13-21years who underwent pyeloplasty, hypospadias repair, inguinal hernia repair, inguinal orchiopexy, hydrocelectomy, or circumcision. Cohorts of patients prescribed and not prescribed postoperative opioids were created and propensity-matched for age, race/ethnicity, psychiatric diagnoses, and preoperative pain diagnoses. The primary outcome was new persistent opioid use, defined as new opioid use 3-9months after index procedure without another surgery requiring anesthesia during the postoperative timeframe. RESULTS Of 32,789 patients identified, 66.0% received a postoperative opioid prescription. After propensity score matching for each procedure, 18,416 patients were included: 197 for pyeloplasty, 469 for hypospadias repair, 1818 for inguinal hernia repair, 2664 for inguinal orchiopexy, 534 for hydrocelectomy, and 3526 for circumcision. Overall, 0.41% of patients who did not receive postoperative opioids developed new persistent opioid use, whereas 1.69% of patients who received postoperative opioids developed new persistent opioid use (P < .05). Patients prescribed postoperative opioids had statistically higher odds of developing new persistent opioid use for hypospadias repair (RR: 17.0; 95% CI: 2.27-127.2), inguinal orchiopexy (RR: 3.46; 95% CI: 1.87-6.4), inguinal hernia repair (RR: 2.18; 95% CI: 1.07-4.44), and circumcision (RR: 4.83; 95% CI: 2.60-8.98). CONCLUSION The use of postoperative opioids after urological procedures in adolescents and young adults is associated with a significant risk of developing new persistent opioid use.
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Affiliation(s)
| | - Courtney Stewart
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX
| | - Corey Able
- University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX
| | | | - Logan Galansky
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew Gabrielson
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nora Haney
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chad B Crigger
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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Gabrielson AT, Galansky L, Sholklapper T, Florissi I, Crigger C, Harris K, Haney N, Patel HD, Wang MH, Wu C, Gearhart JP, Di Carlo HN. Safety and Efficacy of Long-Acting Liposomal Bupivacaine Plus Bupivacaine Hydrochloride for Dorsal Penile Block During Ambulatory Pediatric Urologic Surgery. Urology 2023; 176:190-193. [PMID: 36997075 DOI: 10.1016/j.urology.2023.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 03/30/2023]
Abstract
This study evaluates the tolerability and efficacy of preoperative dorsal penile nerve block with Exparel plus bupivacaine hydrochloride in children>6 years old undergoing ambulatory urologic surgery. We demonstrate that the drug combination is well-tolerated, with appropriate analgesic efficacy in the recovery room as well as at 48-hour and 10-14 day follow-up periods. These preliminary data justify the need to perform a prospective, randomized trial comparing Exparel plus bupivacaine hydrochloride to other common local anesthetic regimens used in pediatric urologic surgery.
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Affiliation(s)
- Andrew T Gabrielson
- Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
| | - Logan Galansky
- Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Isabella Florissi
- Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Chad Crigger
- Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Kelly Harris
- University of Colorado School of Medicine, Aurora, CO
| | - Nora Haney
- Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Hiten D Patel
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Ming-Hsien Wang
- Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Charlotte Wu
- Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - John P Gearhart
- Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Heather N Di Carlo
- Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
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Guan H, Sholklapper T, Crigger C, Haney N, Harris TGW, Gearhart JP. The use of a modified tanagho flap in the repair of posterior urethral stricture after primary exstrophy closure. J Pediatr Urol 2023; 19:37.e1-37.e7. [PMID: 36369236 DOI: 10.1016/j.jpurol.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/03/2022] [Accepted: 10/08/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION In patients with classic bladder exstrophy (CBE), posterior urethral strictures after primary bladder closure can be difficult to manage and therefore necessitate alternative techniques in reconstruction of the proximal urethra. There is a paucity of literature describing treatment and management of posterior urethral stricture arising after repair of classic bladder exstrophy. OBJECTIVE To describe the technique of a bladder neck reconstruction (BNR) with a modified Tanagho anterior detrusor flap in the treatment of posterior urethral stricture arising after repair of classic bladder exstrophy. PATIENTS AND METHODS A prospectively maintained, IRB-approved database of 1401 exstrophy-epispadias patients was reviewed for patients who underwent bladder neck or proximal urethral reconstruction with modified Tanagho flap for proximal urethral stricture disease from the time period of 1975-2021. A total of 5 patients (1 female and 4 males) with classic bladder exstrophy who underwent proximal urethral reconstruction with modified Tanagho flap were identified. Of these 5 patients, the 1 female patient was treated for ongoing incontinence, not posterior urethral stricture, and was thus excluded from this report. Outcomes measured included post operative bladder capacity, post-operative continence status, upper urinary tract status, and stricture recurrence. RESULTS Four male patients with CBE were treated for posterior urethral strictures and are reviewed here. Three patients underwent successful primary closure (1 via modern staged repair of exstrophy (MSRE) and 2 via complete primary repair of exstrophy (CPRE)), and 1 patient (MSRE) required repeat closure at the time of stricture repair. Mean age at BNR Tanagho flap was 3.8 (range 2.3-5.0) years. All patients remained stricture free with post-operative urinary incontinence; 2 patients underwent subsequent elective bladder neck transection to achieve continence. Mean follow up 9.9 (range 2.1-15.6) years. DISCUSSION All 4 patients had excellent long term success rates, comparable to results reported in several adult studies utilizing a modified Tanagho flap in women with post-traumatic bladder neck contractures. In addition, our technique described here shares similarities with both the originally described Tanagho flap as well as with a dorsal onlay graft urethroplasty. CONCLUSION In this limited series, modified Tanagho flap reconstruction is effective in treating posterior urethral stricture disease in CBE. This technique adds a valuable adjunct to the armamentarium of surgical options for this difficult to manage condition.
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Affiliation(s)
- Hannah Guan
- Brady Urological Institute, Johns Hopkins Medicine; Baltimore, MD, USA; Department of Urology, University of Maryland, MD, USA
| | - Tamir Sholklapper
- Brady Urological Institute, Johns Hopkins Medicine; Baltimore, MD, USA
| | - Chad Crigger
- Brady Urological Institute, Johns Hopkins Medicine; Baltimore, MD, USA
| | - Nora Haney
- Brady Urological Institute, Johns Hopkins Medicine; Baltimore, MD, USA
| | - Thomas G W Harris
- Plastic and Reconstructive Surgery, Johns Hopkins Medicine; Baltimore, MD, USA
| | - John P Gearhart
- Brady Urological Institute, Johns Hopkins Medicine; Baltimore, MD, USA.
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Sholklapper T, Crigger C, Morrill C, Harris TGW, Haney N, Lue K, Young E, Gearhart JP. Application of Tunica Vaginalis Flap for Epispadias Repair in the Epispadias-Exstrophy Complex. Urology 2023; 171:190-195. [PMID: 36336142 DOI: 10.1016/j.urology.2022.10.015] [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] [Received: 05/10/2022] [Revised: 10/13/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe long-term outcomes and experience with the tunica vaginalis flap (TVF) as a tissue augment for complex epispadias repair. METHODS A prospectively maintained institutional database was reviewed for patients who underwent epispadias repair with TVF from 2010 to 2021. Evaluation of patient characteristics between those who developed dehiscence or UCF and those who did not was performed via Mann-Whitney U, Kruskal-Wallis, or Fisher's exact test, as appropriate. RESULTS A total of 47 male patients were identified, of whom, 1 (2.1%) had cloacal exstrophy, 38 (80.9%) had classic bladder exstrophy or a variant, and 8 (17.0%) had epispadias as their primary exstrophy-epispadias complex diagnosis. The median age at epispadias repair was 13 months (IQR 11 - 19). The overall rate of fistula or dehiscence development was 19.1% (9 patients), of whom, 7 developed urethrocutaneous fistulae, 1 dehiscence, and 1 both. Notably, 0 of the 5 patients who had undergone prior epispadias repair and 0 of the 8 patients with a diagnosis of isolated epispadias developed a UCF or dehiscence after repair with TVF. Differences in age at repair, primary EEC diagnosis, prior epispadias repair, pre-repair testosterone, fibrin sealant utilization, closure layers, stent removal time, and bladder capacity at repair were not statistically significant (P>.05) CONCLUSION: Our expanded evaluation indicates that utilization of the tunica vaginalis as an adjunct to epispadias repair may provide durable protection against fistula development in EEC patients who have undergone prior epispadias repair and in primary repair of patients with isolated epispadias.
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Affiliation(s)
- Tamir Sholklapper
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chad Crigger
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christian Morrill
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thomas G W Harris
- Division of Plastic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nora Haney
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kathy Lue
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ezekiel Young
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - John P Gearhart
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD.
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Sholklapper TN, Crigger C, Haney N, Khandge P, Wu W, Sponseller PD, Gearhart JP. Orthopedic complications after osteotomy in patients with classic bladder exstrophy and cloacal exstrophy: a comparative study. J Pediatr Urol 2022; 18:586.e1-586.e8. [PMID: 36216696 DOI: 10.1016/j.jpurol.2022.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/28/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The addition of pelvic osteotomy to the armamentarium of tools for correction of classic bladder exstrophy (CBE) and cloacal exstrophy (CE) has undeniably served as one of the most effective advancements in improving the likelihood of successful primary bladder closure. Osteotomy-related complications have been studied and documented extensively in patients with CBE, yet evaluation remains limited in CE concordant with its relative rarity. OBJECTIVE To compare orthopedic complications in patients with CBE and CE who underwent primary bladder closure with osteotomy. METHODS A prospectively maintained, IRB-approved database of 1401 exstrophy-epispadias patients was reviewed for patients with CBE or CE after primary closure and pelvic osteotomy performed at a single institution from 1975 to 2021. Failed closure was defined as dehiscence, bladder prolapse, or vesicocutaneous fistula at any point. Surgery or anesthesia-related complications were captured within 6 weeks of osteotomy or closure. RESULTS A total of 146 patients were included in the analysis with 109 and 37 patients with CBE and CE, respectively. Between the CBE and CE cohorts, there were significant differences in median age at primary closure (68 days [IQR 10-260] vs 597 [448-734]; p < 0.001), diastasis width (4 cm IQR [3.8-4.6] vs 6.1 [5.0-7.2]; p < 0.001), osteotomy at time of closure (99.1% vs 75.7%; p < 0.001), and utilization of external hip fixation (67.9% vs 89.2%; p = 0.011). There was no significant difference by gender, osteotomy technique, or hip immobilization technique. Regarding exstrophy closure outcomes, there were 5 failures in the CBE group and 1 in the CE group (p = 1.000). Complications were experienced in 38.5% and 56.8% of CBE and CE patients (p = 0.054) with a significant difference in orthopedic complications (primarily consisting of superficial pin-site infections) between the cohorts (4.6% vs 16.2%, p = 0.031). There was no significant difference in grade 3 or higher complications between cohorts (5.5% vs 13.5%, p = 0.147). DISCUSSION This was the first study comparing orthopedic complications after osteotomy between CBE and CE, providing valuable insight into which factors vary among cohorts and which are associated with increased complication rates. Despite availability of high case numbers for these rare disorders, the analysis continued to be limited sample size and missing data for retrospective analysis. CONCLUSIONS While exstrophy closure success and overall complications rates are similar in patients with CBE and CE, patients with CE experience more superficial pin-site infections after pelvic osteotomy. External hip fixation may be associated with the increase in orthopedic complications, though further research is required to elucidate the underlying cause of these complications.
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Affiliation(s)
- Tamir N Sholklapper
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Chad Crigger
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Nora Haney
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Preeya Khandge
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Wayland Wu
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Paul D Sponseller
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John P Gearhart
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA.
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Kohn T, Haney N, Herati AS, Kates M, Pienta K. MEASURING SEMINIFEROUS TUBULES DIAMETER USING HIGH FREQUENCY ULTRASOUND IN MURINE MODELS AND MEN WITH NON-OBSTRUCTIVE AZOOSPERMIA AND OBSTRUCTIVE AZOOSPERMIA. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.179] [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: 11/04/2022]
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Griggs-Demmin A, Mudalegundi S, Haney N, Cohen A. Robotic Excision of Large, Multi-Focal Ureteral Fibroepipthelial Polyps. Urology 2022; 167:e3. [PMID: 35728672 DOI: 10.1016/j.urology.2022.06.002] [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: 01/17/2022] [Revised: 05/24/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Abstract
Ureteral fibroepithelial polyps (UFP) are benign neoplasms of mesodermal origin. In this report, we describe the rare presentation and robotic surgical management of UFP in an adult female. A 25-year-old female with recurrent bilateral UFP s/p multiple ureteroscopic ablations and right partial ureterectomy with ureto-ureteral anastomosis presented with left flank pain. Four-phase CT with delayed images demonstrated a filling defect in the left ureter. Ureteroscopy confirmed left UFP. The number, size, and multifocality precluded endoscopic management. Creatinine was normal and split function 53%/47%. The patient was recommended for robotic repair. After mobilization of the colon, the ureter was identified and traced up to the hilum. There was an inflammatory rind surrounding the ureter through majority of its length. Care was taken to avoid circumferential dissection of the ureter. Upon longitudinal incision of the ureter, polyps erupted with a release of hydronephrotic urine, despite pre-stenting. Polyps were transected at their base, revealing abnormal underlying urothelium. A ureteroscope was advanced through a robotic port to examine the proximal ureter and renal pelvis. Remaining polyps were removed after which a wire and stent was placed antegrade into the open distal ureter and proximally into the renal pelvis. The anastomosis was performed with 5-0 PDS. ICG and firefly confirmed suitable blood flow to the ureter. Pathology revealed benign fibroepithelial polyps with reactive changes to the urothelium. Retrograde pyelogram two months later revealed a patent ureter. This video demonstrates successful robotic surgical management of large, multifocal UFPs.
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Affiliation(s)
| | - Shwetha Mudalegundi
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205 USA.
| | - Nora Haney
- Brady Urological Institute, Johns Hopkins Medicine, 4940 Eastern Avenue, Baltimore, MD 21224 USA.
| | - Andrew Cohen
- Brady Urological Institute, Johns Hopkins Medicine, 4940 Eastern Avenue, Baltimore, MD 21224 USA.
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Gupta N, Rasmussen S, Haney N, Smith A, Pierorazio P, Johnson M, Hoffman-Censits J, Bivalacqua T. 130 Understanding Psychosocial and Sexual Health Concerns among Women with Bladder Cancer Undergoing Radical Cystectomy. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.149] [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: 11/30/2022]
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Gupta N, Rasmussen SEVP, Haney N, Smith A, Pierorazio PM, Johnson MH, Hoffman-Censits J, Bivalacqua TJ. Understanding Psychosocial and Sexual Health Concerns Among Women With Bladder Cancer Undergoing Radical Cystectomy. Urology 2020; 151:145-153. [PMID: 32853645 DOI: 10.1016/j.urology.2020.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/22/2020] [Accepted: 08/10/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To better understand the physical and psychosocial components of female sexual dysfunction (FSD) among women undergoing radical cystectomy (RC) for bladder cancer (BCa). METHODS We conducted semistructured individual interviews and a focus group with pre- and post-RC female patients and their partners regarding the impact of RC on sexual health and psychosocial wellbeing. Themes were inductively identified by 2 independent coders and subsequently organized into themes and subthemes using qualitative description and constant comparison. RESULTS In the preoperative cohort, 6 women and 1 partner participated (50% contact rate, 75% participation rate). In the postoperative cohort, 16 women and 2 partners participated (61% contact rate, 64% participation rate). Major themes that emerged in interviews with both cohorts included concerns about changes to body image, the psychological impact of BCa diagnosis and treatment, concerns about the impact of RC on sexual function, and inadequacies in provider-led sexual health counseling. Participants varied in the importance they placed on sexual function, with factors such as age, relationship status, and oncologic concerns impacting prioritization, although both younger and older patients expressed a desire to retain the option of sexual function. CONCLUSION Female patients with BCa undergoing RC experience changes in body image, psychological distress, physical disruptions in sexual function, and inadequacies in sexual health counseling and education. Future efforts should be directed towards improving sexual health counseling and psychosocial support resources for women with BCa.
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Affiliation(s)
- Natasha Gupta
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | | | - Nora Haney
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Armine Smith
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael H Johnson
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jean Hoffman-Censits
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
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Haney N, Kohn T, Nichols P, Hellstrom W. 117 The Effect of Adjunct Mechanical Traction on Penile Length in Men Undergoing Primary Treatment for Peyronie's Disease: A Systematic Review and Meta-analysis. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.126] [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: 10/27/2022]
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14
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Nichols PE, Harris KT, Brant A, Manka MG, Haney N, Johnson MH, Herati A, Allaf ME, Pierorazio PM. Patient Decision-making and Predictors of Genital Satisfaction Associated With Testicular Prostheses After Radical Orchiectomy: A Questionnaire-based Study of Men With Germ Cell Tumors of the Testicle. Urology 2018; 124:276-281. [PMID: 30381246 DOI: 10.1016/j.urology.2018.09.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To better understand patient decision-making and genital satisfaction associated with postorchiectomy testicular prosthesis (TP) implantation in patients with germ cell tumors of the testicle. MATERIALS AND METHODS An electronic survey to assess TP decision-making and genital satisfaction was distributed to patients via an institutional database (n = 70) and social media outlets (n = 167). Statistical analyses were performed using chi-square tests for categorical variables, Wilcoxon-Mann-Whitney tests for continuous variables, and multivariate regression analyses to identify independent predictors of receiving a prosthesis, genital satisfaction, and prosthesis satisfaction. RESULTS 24.9% of respondents elected to receive a TP, but 42% of men without a prosthesis reported never being offered one. Identifying as a heterosexual man (2.86) and receiving a TP (odds ratio = 3.29) were both positive predictors of overall genital satisfaction. Having the orchiectomy performed at an academic institution (odds ratio = 2.87) was a positive predictor of testicular prosthesis TP placement. 89.8% of TP recipients were satisfied with the look of their prosthetic, but only 59.3% of respondents were satisfied with prosthetic feel. CONCLUSION There are high levels of genital satisfaction in those who elect to receive a TP postorchiectomy. Associations between TP placement, genital satisfaction, and sexuality merit further investigation. Our results also indicate that patients who pursue an orchiectomy at an academic institution are more likely to receive a TP. The use of social media to recruit study participants in urology should be explored further.
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Affiliation(s)
- Paige E Nichols
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Urology, Mayo Clinic, Rochester, MN.
| | - Kelly T Harris
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron Brant
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Madeleine G Manka
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Urology, Mayo Clinic, Rochester, MN
| | - Nora Haney
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael H Johnson
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amin Herati
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohamed E Allaf
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Phillip M Pierorazio
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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Shakir NA, Fuchs JS, Haney N, Viers BR, Cordon BH, McKibben M, Scott J, Armenakas NA, Morey AF. Excision and Primary Anastomosis Reconstruction for Traumatic Strictures of the Pendulous Urethra. Urology 2018; 125:234-238. [PMID: 30125648 DOI: 10.1016/j.urology.2018.05.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/14/2018] [Accepted: 05/17/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To present a multi-institutional experience with functional and patient-reported outcomes among men undergoing excision and primary anastomosis (EPA) urethroplasty for pendulous urethral strictures. METHODS We describe the technique and present our experience with EPA for focal penile strictures. Patients undergoing urethroplasty (2004-2017) at 2 tertiary referral centers were reviewed, of whom 14 (0.7%) underwent EPA of radiographically confirmed pendulous urethral strictures. Validated questionnaires were utilized to evaluate overall improvement (Patient Global Impression of Improvement), urinary bother (International Prostate Symptom Score), and sexual function (International Index of Erectile Function-5). Treatment success was defined as urethral patency without need for subsequent reconstruction. RESULTS Among 14 men undergoing penile EPA, 13/14 (93%) had durable treatment success over a median follow-up of 43 months. No patient reported penile curvature postoperatively. Stricture etiology in most cases was posttraumatic (12/14), of which 4 had a history of urethral disruption secondary to penile fracture and 8 iatrogenic trauma. Median age was 51 years (IQR 30-60) and stricture length 1.0 cm (IQR 1.0-1.4). Erectile function was normal in 8/14 patients preoperatively, and postoperative median International Index of Erectile Function was 21. Most men reported significant global improvement in condition (median Patient Global Impression of Improvement 2, IQR 1-3) and most had only mild urinary bother (median International Prostate Symptom Score 4, quality of life 1). The single treatment failure had a history of hypospadias with multiple prior urethral procedures. CONCLUSION For men with short strictures of the pendulous urethra, EPA has a high success rate, without adverse sequelae such as erectile function or penile curvature.
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Anaissie J, Haney N, Song B, Barabadi Z, Sholl A, Chen T, Swan K, Reddy A, Daneshi-Mehr F, DeLay K, Alzweri L, Kadowitz P, Izadpanah R, Hellstrom W. PD31-12 THE EFFECTS OF MULTIPLE ADIPOSE-DERIVED STEM CELL INTRACORPOREAL INJECTIONS ON ERECTILE DYSFUNCTION IN A RAT MODEL OF CAVERNOSAL NERVE INJURY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1543] [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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DeLay K, Haney N, Anaissie J, Yafi F, Hellstrom W. MP56-01 RACIAL VARIATIONS IN RESPONSE TO INTRALESIONAL COLLAGENASE CLOSTRIDIUM HISTOLYTICUM IN MEN WITH PEYRONIE'S DISEASE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1754] [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: 10/19/2022]
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DeLay K, Haney N, Gabrielson A, Chiang J, Stewart C, Yafi F, Angermeier K, Lacy J, Wood H, Boone T, Kavanagh A, Gretzer M, Boyd S, Loh-Doyle J, Hellstrom W. MP46-06 COMPARISON OF ADJUVANT RADIATION THERAPY BEFORE OR AFTER ARTIFICIAL URINARY SPHINCTER PLACEMENT: A MULTI-INSTITUTIONAL ANALYSIS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1445] [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: 10/19/2022]
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Anaissie J, DeLay K, Haney N, Yafi F, Hellstrom W. MP56-02 SAFETY AND EFFICACY OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM IN THE TREATMENT OF ACTIVE PHASE PEYRONIE'S DISEASE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1755] [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: 11/17/2022]
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20
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DeLay KJ, Haney N, Hellstrom WJ. Modifying Risk Factors in the Management of Erectile Dysfunction: A Review. World J Mens Health 2016; 34:89-100. [PMID: 27574592 PMCID: PMC4999494 DOI: 10.5534/wjmh.2016.34.2.89] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/20/2016] [Indexed: 12/16/2022] Open
Abstract
Erectile dysfunction (ED) is prevalent among men and its presence is often an indicator of systemic disease. Risk factors for ED include cardiovascular disease, hypertension, diabetes mellitus (DM), tobacco use, hyperlipidemia, hypogonadism, lower urinary tract symptoms, metabolic syndrome, and depression. Addressing the modifiable risk factors frequently improves a patient's overall health and increases lifespan. The literature suggests that smoking cessation, treatment of hyperlipidemia, and increasing physical activity will improve erectile function in many patients. How the treatment of DM, depression, and hypogonadism impacts erectile function is less clear. Clinicians need to be aware that certain antihypertensive agents can adversely impact erectile function. The treatment of men with ED needs to address the underlying risk factors to ameliorate the disease process.
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Affiliation(s)
- Kenneth J DeLay
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Nora Haney
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne Jg Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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21
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Katz EG, Moustafa AA, Heidenberg D, Haney N, Peak T, Lasker GF, Knoedler M, Rittenberg D, Rezk BM, Abd Elmageed ZY, Yafi FA, Sikka S, Abdel-Mageed AB, Hellstrom WJG. Pioglitazone Enhances Survival and Regeneration of Pelvic Ganglion Neurons After Cavernosal Nerve Injury. Urology 2016; 89:76-82. [PMID: 26772642 DOI: 10.1016/j.urology.2015.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 11/16/2015] [Accepted: 12/07/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the effects of pioglitazone on pelvic ganglion neurons in a rat model of bilateral cavernosal nerve crush injury (BCNI), thereby elucidating the actions of pioglitazone in preventing post-prostatectomy neurogenic erectile dysfunction. METHODS Sprague-Dawley rats aged 12 weeks were divided into four groups: (a) sham procedure, (b) BCNI, (c) BCNI + postsurgical pioglitazone, and (d) BCNI + pre and postsurgical pioglitazone (preventive therapy). Preoperative injection of Fluoro-Gold (FG) fluorescent tracer into the cavernosal tissue was performed for retrograde labeling of pelvic ganglion cells. Pelvic ganglia were resected at 2 weeks in all rats and processed for real-time polymerase chain reaction, immunohistochemistry, and Western blot to examine the expression of FG, neuronal nitric oxide synthase, β-III tubulin, neurturin, and glial cell line-derived neurotrophic factor family receptor alpha-2 (GFRα2). RESULTS Animals treated with pre- and postsurgical pioglitazone demonstrated increased staining for FG similar to sham levels. Gene expression of neuronal nitric oxide synthase, neurturin, GFRα2, and β-III tubulin was also upregulated in the group receiving preventive therapy. CONCLUSION Pioglitazone provides a protective effect on pelvic ganglion neurons after BCNI.
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Affiliation(s)
- Eric G Katz
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Ahmed A Moustafa
- Department of Urology, Tulane University School of Medicine, New Orleans, LA; Department of Zoology and Entomology, Faculty of Science, Helwan University, Cairo, Egypt
| | - Daniel Heidenberg
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Nora Haney
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Taylor Peak
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - George F Lasker
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Margaret Knoedler
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Daniel Rittenberg
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Bashir M Rezk
- Department of Biology, Southern University of New Orleans, New Orleans, LA
| | | | - Faysal A Yafi
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Suresh Sikka
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Asim B Abdel-Mageed
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA.
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Haney N, Mitchell K. Acute Blockade of PDGF Receptors Decreases Arterial Blood Pressure and Renal Vascular Resistance in Cyp1a1‐Ren2 Transgenic Rats with Angiotensin II‐Dependent Malignant Hypertension. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.960.1] [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: 11/11/2022]
Affiliation(s)
- Nora Haney
- Physiology, Hypertension and RenalCenter of ExcellenceTulane UniversitySchool of MedicineNew OrleansLousianaUnited States
| | - Kenneth Mitchell
- Physiology, Hypertension and RenalCenter of ExcellenceTulane UniversitySchool of MedicineNew OrleansLousianaUnited States
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Shetty S, Gladden JB, Henson ES, Hu X, Villanueva J, Haney N, Gibson SB. Tumor necrosis factor-related apoptosis inducing ligand (TRAIL) up-regulates death receptor 5 (DR5) mediated by NFkappaB activation in epithelial derived cell lines. Apoptosis 2002; 7:413-20. [PMID: 12207174 DOI: 10.1023/a:1020031023947] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Tumor necrosis factor-related apoptosis inducing ligand (TRAIL/APO-2L) activates nuclear factor kappaB (NFkappaB). This activation is regulated by the recruitment of an adaptor protein Fas associating death domain (FADD) to TRAIL death receptors, death receptor 4 (DR4, TRAIL-R1) and death receptor 5 (DR5 TRAIL-R2). This leads to recruitment of caspase 8 and receptor interacting protein (RIP) to the receptor complex. Upon recruitment of caspase 8 and RIP, NFkappaB inducing kinase (NIK) becomes activated causing NFkappaB activation. The role of TRAIL induced NFkappaB activation in epithelial cells is unknown. Herein we demonstrate that TRAIL increases expression of DR5 in human embryonic kidney (HEK) 293, MCF-7 and MDA MB 231 epithelial cell lines while DR4 expression remains unchanged. Blockage of NFkappaB activation either by expression of dominant negative IkappaB or treatment with proteasome inhibitor lactacystin eliminates TRAIL induced DR5 expression. Expression of FADD dominant negative in HEK 293 cells that prevents the recruitment of caspase 8 and RIP to TRAIL death receptors also eliminates this increase. By over expression of the p65 subunit of NFkappaB that increases NFkappaB transcriptional activity, DR5 expression was increased compared to vector alone expressing cells. By blocking TRAIL induced NFkappaB activation, the sensitivity of cells to undergo TRAIL induced apoptosis was significantly decreased. Conversely, the amount of TRAIL induced apoptosis was increased in HEK 293 cells over expressing p65 subunit of NFkappaB. Finally blockage of NFkappaB activation eliminates the synergistic apoptotic response of TRAIL and etoposide. Thus, TRAIL mediated NFkappaB activation increases DR5 expression thereby amplifying the apoptotic response of TRAIL in epithelial derived cells.
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Affiliation(s)
- S Shetty
- Manitoba Institute of Cell Biology, University of Manitoba, 675 McDermot Ave, Winnipeg, MB R3E 0V9
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Robinow M, Haney N, Chen H, Sorauf T, Van Dyke DL, Babu VR, Powell S, Maliszewski W, Guerin S, Landers JW. Secondary trisomy or mosaic "tetrasomy" 8p. Am J Med Genet 1989; 32:320-4. [PMID: 2729351 DOI: 10.1002/ajmg.1320320309] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We report on two patients with mosaic tetrasomy of 8p[46,XY/47,XY,+i(8p)], a previously unreported cytogenetic anomaly. The first patient had a low percentage of tetrasomic (secondary trisomic) cells in lymphocytes and fibroblasts, an only mildly abnormal phenotype, and a rather benign clinical course. The second patient had a considerably larger percentage of tetrasomic cells in lymphocytes and fibroblasts, and had more severe congenital anomalies that led to his death at 8 months. A characteristic phenotype +i(8p) is suggested but not yet established. The manifestations of these two patients resemble those of mosaic trisomy 8 and mosaic trisomy 8p, with rib and vertebral abnormalities, absent corpus callosum, and enlarged cerebral ventricles.
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Affiliation(s)
- M Robinow
- Department of Pediatrics, Wright State University School of Medicine, Dayton, Ohio
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