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Zoabi A, Bentov-Arava E, Sultan A, Elia A, Shalev O, Orevi M, Gofrit ON, Margulis K. Adipose tissue composition determines its computed tomography radiodensity. Eur Radiol 2024; 34:1635-1644. [PMID: 37656176 DOI: 10.1007/s00330-023-09911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES Adipose tissue radiodensity in computed tomography (CT) performed before surgeries can predict surgical difficulty. Despite its clinical importance, little is known about what influences radiodensity. This study combines desorption electrospray ionization mass spectrometry imaging (DESI-MSI) and electrospray ionization (ESI) with machine learning to unveil how chemical composition of adipose tissue determines its radiodensity. METHODS Patients in the study underwent abdominal surgeries. Before surgery, CT radiodensity of fat near operated sites was measured. Fifty-three fat samples were collected and analyzed by DESI-MSI, ESI, and histology, and then sorted by radiodensity, demographic parameters, and adipocyte size. A non-negative matrix factorization (NMF) algorithm was developed to differentiate between high and low radiodensities. RESULTS No associations between radiodensity and patient age, gender, weight, height, or fat origin were found. Body mass index showed negative correlation with radiodensity. A substantial difference in chemical composition between adipose tissues of high and low radiodensities was observed. More radiodense tissues exhibited greater abundance of high molecular weight species, such as phospholipids of various types, ceramides, cholesterol esters and diglycerides, and about 70% smaller adipocyte size. Less radiodense tissue showed high abundance of short acyl-tail fatty acids. CONCLUSIONS This study unveils the connection between abdominal adipose tissue radiodensity and its chemical composition. Because the radiodensity of the fat around the surgical site is associated with surgical difficulty, it is important to understand how adipose tissue composition affects this parameter. We conclude that fat tissue with a higher content of various phospholipids and waxy lipids is more CT radiodense. CLINICAL RELEVANCE STATEMENT This study establishes the connection between the CT radiodensity of adipose tissue and its chemical composition. Clinicians may use this information for preoperative planning of surgical procedures, potentially modifying their surgical approach (for example, performing partial nephrectomy openly rather than laparoscopically). KEY POINTS • Adipose tissue radiodensity values in computed tomography images taken prior to the surgery can potentially predict surgery difficulty. • Fifty-three human specimens were analyzed by advanced mass spectrometry, molecular imaging, and machine learning to establish the key features that determine Hounsfield units' values of adipose tissue. • The findings of this research will enable clinicians to better prepare for surgical procedures and select operative strategies.
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Affiliation(s)
- Amani Zoabi
- The Institute for Drug Research, the School of Pharmacy, the Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Einav Bentov-Arava
- The Institute for Drug Research, the School of Pharmacy, the Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adan Sultan
- The Institute for Drug Research, the School of Pharmacy, the Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anna Elia
- Department of Pathology, Hadassah Medical Center, the Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ori Shalev
- Metabolomics Center, Core Research Facility, the Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Marina Orevi
- Nuclear Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Medical Center the Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Katherine Margulis
- The Institute for Drug Research, the School of Pharmacy, the Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
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Gofrit ON, Greenblatt CL, Klein BY, Ben-Hur T, Bercovier H. Can immunization with BCG delay the onset of Alzheimer's disease? Geriatr Gerontol Int 2023; 23:889-890. [PMID: 37735105 DOI: 10.1111/ggi.14680] [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] [Received: 07/12/2023] [Revised: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Ofer N Gofrit
- Department of Urology, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Charles L Greenblatt
- Department of Microbiology and Molecular Genetics, Hebrew University-Hadassah Faculty of Medicine, Jerusalem, Israel
| | - Benjamin Y Klein
- Department of Microbiology and Molecular Genetics, Hebrew University-Hadassah Faculty of Medicine, Jerusalem, Israel
| | - Tamir Ben-Hur
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Herve Bercovier
- Department of Microbiology and Molecular Genetics, Hebrew University-Hadassah Faculty of Medicine, Jerusalem, Israel
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Gofrit ON, Gofrit B, Roditi Y, Popovtzer A, Frank S, Sosna J, Orevi M, Goldberg SN. The different clonal origins of metachronous and synchronous metastases. J Cancer Res Clin Oncol 2023; 149:11085-11092. [PMID: 37340186 PMCID: PMC10465669 DOI: 10.1007/s00432-023-05007-3] [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: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Metastases are the leading cause of mortality in cancer patients. Linear and parallel are the two prominent models of metastatic progression. Metastases can be detected synchronously along with the primary tumor or metachronously, following treatment of localized disease. The aim of the study was to determine whether synchronous metastases (SM) and metachronous metastases (MM) differ only in lead-time or stem from different biological processes. MATERIALS AND METHODS We retrospectively studied the chest CTs of 791 patients inflicted by eleven malignancy types that were treated in our institution in the years 2010-2020. Patient's population included 396 with SM and 395 with MM. The diameter of 15,427 lung metastases was measured. Clonal origin was deduced from the linear/parallel ratio (LPR)-a computerized analysis of metastases diameters. LPR of 1 suggests pure linear dissemination and - 1 pure parallel. RESULTS Patients with MM were significantly older (average of 62.9 vs 60.7 years, p = 0.02), and higher percentage of them were males (58.7% vs 51.1%, p = 0.03). Median overall survival of patients with MM and SM was remarkably similar (23 months and 26 months respectively, p = 0.774) when calculated from the time of metastases diagnosis. Parallel dissemination (LPR ≤ 0) was found in 35.4% of patients with MM compared to only 19.8% of the patients with SM (p < 0.00001). CONCLUSION Patients with SM and MM differ in demography and in clonal origin. Different therapeutic approaches may be considered in these two conditions.
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Affiliation(s)
- Ofer N Gofrit
- Department of Urology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, P.O.B 12000, 91120, Jerusalem, Israel.
| | - Ben Gofrit
- School of Engineering and Computer Science, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yuval Roditi
- School of Engineering and Computer Science, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aron Popovtzer
- Department of Oncology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Steve Frank
- Department of Oncology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Marina Orevi
- Department of Nuclear Medicine, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Nahum Goldberg
- Department of Radiology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Hinden L, Ludyansky R, Leidershnaider S, Harris Y, Nemirovski A, Gofrit ON, Tam J, Hidas G. Peripheral Cannabinoid-1 Receptor Blockade Ameliorates Cystitis Severity. Cannabis Cannabinoid Res 2023; 8:623-633. [PMID: 35647939 PMCID: PMC10442677 DOI: 10.1089/can.2022.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The endocannabinoid system (ECS) plays a key physiological role in bladder function and it has been suggested as a potential target for relieving lower urinary tract symptoms (LUTSs). Whereas most studies indicate that activating the ECS has some beneficial effects on the bladder, some studies imply the opposite. In this study, we investigated the therapeutic potential of peripheral cannabinoid-1 receptor (CB1R) blockade in a mouse model for LUTSs. Materials and Methods: To this end, we used the cyclophosphamide (CYP; 300 mg/kg, intraperitoneal)-induced cystitis model of bladder dysfunction, in which 12-week-old, female C57BL/6 mice were treated with the peripherally restricted CB1R antagonist, JD5037 (3 mg/kg), or vehicle for three consecutive days. Bladder dysfunction was assessed using the noninvasive voiding spot assay (VSA) as well as the bladder-to-body weight (BW) ratio and gene and protein expression levels; ECS tone was assessed at the end of the study. Results: Peripheral CB1R blockade significantly ameliorated the severity of CYP-induced cystitis, manifested by reduced urination events measured in the VSA and an increased bladder-to-BW ratio. Moreover, JD5037 normalized CYP-mediated bladder ECS tone imbalance by affecting both the expression of CB1R and the endocannabinoid levels. These effects were associated with the ability of JD5037 to reduce CYP-induced inflammatory response, manifested by a reduction in levels of the proinflammatory cytokine, tumor necrosis factor alpha (TNFα), in the bladder and serum. Conclusions: Collectively, our results highlight the therapeutic relevance of peripheral CB1R blockade in ameliorating CYP-induced cystitis; they may further support the preclinical development and clinical use of peripherally restricted CB1R antagonism for treatment of LUTSs.
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Affiliation(s)
- Liad Hinden
- Obesity and Metabolism Laboratory, Department of Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rami Ludyansky
- Department of Urology Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sary Leidershnaider
- In partial fulfillment of MD requirements, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yoav Harris
- In partial fulfillment of MD requirements, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Alina Nemirovski
- Obesity and Metabolism Laboratory, Department of Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer N. Gofrit
- Department of Urology Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joseph Tam
- Obesity and Metabolism Laboratory, Department of Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Gofrit ON, Abudi R, Lorber A, Duvdevani M. Predicting urine culture results in candidates for lithotripsy. Curr Urol 2023; 17:113-117. [PMID: 37691989 PMCID: PMC10489201 DOI: 10.1097/cu9.0000000000000117] [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: 03/14/2021] [Accepted: 04/06/2021] [Indexed: 11/26/2022] Open
Abstract
Background Urological guidelines assert that "urine culture should be obtained" before surgical management of ureteral or kidney stones. Thus, many surgeries are delayed by 1-3 days until the results of urine culture are available. During this time, the patient frequently experience pain and possible kidney damage. We investigated the hypothesis that it is possible to predict the results of urine culture in candidates for surgical intervention using parameters that are accessible immediately upon admission. Materials and methods A database of 1000 patients who underwent either percutaneous nephrolithotomy (PCNL) or ureteroscopy/retrograde intrarenal surgery was analyzed. Eleven parameters potentially related to urinary infections and accessible to the clinician at the emergency department were correlated with the preoperative urine culture results. Results Of the patients, 234 (23.4 %) had positive cultures. On multivariate analysis, only sex, hydronephrosis grade, and history of previous nephrolithotomy were significantly associated with a positive preoperative urine culture. The risk of a positive culture can be easily determined from a simple table or an Excel-based calculator. This risk could be as low as 0.45% for a man without a history of PCNL and no hydronephrosis (4% in a woman with similar parameters) or as high as 79.5% in a man with a history of PCNL and hydronephrosis (85% in a woman with similar parameters). Conclusions The risk of preoperative positive urine culture can be predicted using 3 parameters that are accessible upon admission. In low-risk cases, prompt surgical treatment can be provided, eliminating the anticipation time for urine culture results.
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Affiliation(s)
- Ofer N. Gofrit
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Department of Urology, Hadassah University Hospital, Jerusalem, Israel
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Gofrit ON, Gofrit B, Roditi Y, Popovtzer A, Frank S, Sosna J, Goldberg SN. Is it time for redefining oligometastatic disease? Analysis of lung metastases CT in ten tumor types. Discov Oncol 2023; 14:19. [PMID: 36745242 PMCID: PMC9902583 DOI: 10.1007/s12672-023-00625-2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/31/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Oligometastatic disease (OD) is usually defined arbitrarily as a condition in which there are ≤ 5 metastases. Given limited disease, it is expected that patients with OD should have better prognosis compared to other metastatic patients and that they can potentially benefit from metastasis-directed therapy (MDT). In this study, we attempted to redefine OD based upon objective evidence that fulfill these assumptions. METHODS Chest CTSs of 773 patients with 15,947 lung metastases originating from ten malignancy types were evaluated. The number and largest diameter of each metastasis was recorded. Metastatic cluster was defined as a cluster of two or more metastases with diameter difference ≤ 1 mm. The prognostic power of seven statistical models on overall survival (OS) was analyzed. FINDINGS Both the number of metastases and metastatic clusters had a highly significant impact on OS (p < 0.0001, p = 0.003 respectively). Patients with a single metastasis or a single cluster of metastases (regardless of metastases number), equaling 16.2% of all patients, had significantly better prognosis compared to other patients (p = 0.0002). If metastases diameter variability is ignored, as in the standard definition of OD, then patients with 2-5 and 6-10 metastases would have a similar prognosis. INTERPRETATION Patients with a single cluster of metastases, theoretically originating from a single clone, have significantly better prognosis compared to patients with more than one cluster. Using this definition can potentially improve the results of MDT. The upper limit of metastases number should be determined by the technical capabilities of the MDT used.
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Affiliation(s)
- Ofer N Gofrit
- Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, 12000, 91120, Jerusalem, Israel.
| | - Ben Gofrit
- School of Engineering and Computer Science, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yuval Roditi
- School of Engineering and Computer Science, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aron Popovtzer
- Department of Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Steve Frank
- Department of Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Nahum Goldberg
- Department of Radiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Gofrit ON, Gofrit B, Roditi Y, Popovtzer A, Frank S, Sosna J, Goldberg SN. Patterns of metastases progression- The linear parallel ratio. PLoS One 2022; 17:e0274942. [PMID: 36129954 PMCID: PMC9491615 DOI: 10.1371/journal.pone.0274942] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Linear and parallel are the two leading models of metastatic progression. In this study we propose a simple way to differentiate between them. While the linear model predicts accumulation of genetic and epigenetic alterations within the primary tumor by founder cells before spreading as waves of metastases, the parallel model suggests preclinical distribution of less advanced disseminated tumor cells with independent selection and expansion at the ectopic sites. Due to identical clonal origin and time of dispatching, linear metastases are expected to have comparable diameters in any specific organ while parallel metastases are expected to appear in variable sizes. Methods and findings Retrospective revision of chest CT of oncological patients with lung metastases was performed. Metastasis number and largest diameters were recorded. The sum number of metastases with a similar diameter (c) and those without (i) was counted and the linear/parallel ratio (LPR) was calculated for each patient using the formula (∑c-∑i)/(∑c+∑i). A LPR ratio of 1 implies pure linear progression pattern and -1 pure parallel. 12,887 metastases were measured in 503 patients with nine malignancy types. The median LPR of the entire group was 0.71 (IQR 0.14–0.93). In carcinomas of the pancreas, prostate, and thyroid the median LPR was 1. Median LPRs were 0.91, 0.65, 0.60, 0.58, 0.50 and 0.43 in renal cell carcinomas, melanomas, colorectal, breast, bladder, and sarcomas, respectively. Conclusions Metastatic spread of thyroid, pancreas, and prostate tumors is almost exclusively by a linear route. The spread of kidney, melanoma, colorectal, breast, bladder and sarcoma is both linear and parallel with increasing dominance of the parallel route in this order. These findings can explain and predict the clinical and genomic features of these tumors and can potentially be used for evaluation of metastatic origin in the individual patient.
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Affiliation(s)
- Ofer N. Gofrit
- Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- * E-mail:
| | - Ben Gofrit
- School of Engineering and Computer Science, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yuval Roditi
- School of Engineering and Computer Science, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aron Popovtzer
- Department of Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Steve Frank
- Department of Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S. Nahum Goldberg
- Department of Radiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Klein BY, Greenblatt CL, Gofrit ON, Bercovier H. Bacillus Calmette–Guérin in Immuno-Regulation of Alzheimer’s Disease. Front Aging Neurosci 2022; 14:861956. [PMID: 35832066 PMCID: PMC9271739 DOI: 10.3389/fnagi.2022.861956] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022] Open
Abstract
Bacillus Calmette–Guérin is frequently the treatment of choice of superficial bladder cancer. Exposing the urinary bladder of elderly patients with bladder cancer to the BCG vaccine reduced the risk of Alzheimer’s disease (AD) substantially. Vaccines against other infectious microorganisms by other vaccination methods showed a similar but a lesser effect. This suggests that immune effects on AD are antigenically non-specific, likely being a metabolic result of immune system activation, similar to that shown for Juvenile diabetes. In this mini review we point to the benefit of BCG vaccine. We then briefly highlight the pathological involvement of the immune system in the AD both, in the peripheral and the central (brain) compartments. Given the uncertain prophylactic mechanism of the BCG effect against AD we propose to take advantage of the therapeutically planned bladder exposure to BCG. Based on pathological aggregation of wrongly cleaved amyloid precursor protein (APP) resistant to the unfolded protein response (UPR) which results in amyloid beta plaques we predict that BCG may impact the UPR signaling cascade. In addition pathways of innate immunity training concerned with energy metabolism, predict capability of activated immune cells to substitute deranged astrocytes that fail to support neuronal energy metabolism. This mini review points to ways through which immune cells can mediate between BCG vaccination and AD to support the wellness of the central nervous system.
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Affiliation(s)
- Benjamin Y. Klein
- Department of Microbiology and Molecular Genetics, The Hebrew University of Jerusalem, Jerusalem, Israel
- *Correspondence: Benjamin Y. Klein,
| | - Charles L. Greenblatt
- Department of Microbiology and Molecular Genetics, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer N. Gofrit
- Department of Urology, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hervé Bercovier
- Department of Microbiology and Molecular Genetics, The Hebrew University of Jerusalem, Jerusalem, Israel
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Orevi M, Ben-Haim S, Abourbeh G, Chicheportiche A, Mishani E, Yutkin V, Gofrit ON. False Positive Findings of [18F]PSMA-1007 PET/CT in Patients After Radical Prostatectomy with Undetectable Serum PSA Levels. Front Surg 2022; 9:943760. [PMID: 35813044 PMCID: PMC9263625 DOI: 10.3389/fsurg.2022.943760] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background PET-CT using prostate-specific membrane antigen (PSMA)-targeting radiopharmaceuticals labeled with 68Ga or 18F has emerged as the most sensitive staging tool in prostate cancer (PC). Nonetheless, the occurrence of false positive (FP) findings presents a major concern of this approach. In this prospective study, we investigated the frequency and pattern of false-positive findings of [18F]PSMA-1007 PET/CT in patients after radical prostatectomy with undetectable serum PSA levels. Any discrete non-physiological accumulation of [18F]PSMA-1007 in this population is by definition FP. Methods Seventeen men after radical prostatectomy, whose serum PSA levels were <0.05 ng/mL at 2–24 months after surgery were prospectively recruited. PET/CT was acquired at both 1 and 2 h after injection of [18F]PSMA-1007. Findings Three studies (18%) were interpreted as completely normal. Thirty-five foci of “non-physiological” uptake were observed in the remaining 14 (82%) patients, including a single skeletal focus in four patients, multiple skeletal foci in five patients and soft tissue uptake in eight, including in a desmoid tumor and in pelvic lymphocele. The SUVmax of all lesions was in the range of 1–7, except for the desmoid tumor which measured 12.7. All foci were visible in both the 1- and the 2 h studies, presenting a minor (<10%), statistically insignificant increase of SUVmax during this time-interval. Interpretation FP [18F]PSMA-1007-avid foci are found in about 80% of patients with undetectable serum PSA levels. Thus, focal uptake of [18F]PSMA-1007 outside its physiological distribution is not a categorical sign of metastasis and can arise from non-specific uptake of the ligand. The interpretation of [18F]PSMA-1007 PET/CT studies should always consider the clinical context, and lesions with SUVmax < 7 are suspicious for FP.
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Affiliation(s)
- Marina Orevi
- Department of Nuclear Medicine and Medical Biophysics, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Simona Ben-Haim
- Department of Nuclear Medicine and Medical Biophysics, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
- University College London and UCL Hospitals, NHS Trust, London, United Kingdom
| | - Galith Abourbeh
- Cyclotron/Radiochemistry Unit, Hadassah Medical Center, Jerusalem, Israel
| | | | - Eyal Mishani
- Cyclotron/Radiochemistry Unit, Hadassah Medical Center, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Ofer N. Gofrit
- Department of Urology, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
- Correspondence: Ofer N. Gofrit
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Fishberg SE, Gofrit ON, Orevi M. 18F-FDG PET/CT Imaging of Boari Flap Mimicking Urothelial Cancer Recurrence. World J Nucl Med 2022; 21:161-162. [PMID: 35865154 PMCID: PMC9296240 DOI: 10.1055/s-0042-1750340] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 63-year-old man underwent distal ureterectomy as a treatment for urothelial carcinoma of the ureter. Reconstruction of the urinary system was accomplished by tubularizing part of the bladder roof (Boari flap). A year later, metastatic evaluation with
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F-fluorodeoxyglucose positron emission tomography/computed tomography (
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F-FDG PET/CT) showed high metabolic activity in the reconstructed area. Thorough evaluation confirmed the presence of a bladder diverticulum (the Boari flap) with no evidence of malignancy. We present the first
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F-FDG PET/CT images of a Boari flap in the literature.
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Affiliation(s)
| | - Ofer N. Gofrit
- Department of Urology, Hadassah Medical Center, Jerusalem, Israel
| | - Marina Orevi
- Department of Nuclear Medicine, Hadassah Medical Center, Jerusalem, Israel
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Mekayten M, Meir E, Yutkin V, Gofrit ON, Duvdevani M, Landau EH, Hidas G. Is there a correlation between meatal stenosis severity, lower urinary tract symptoms and uroflowmetry? J Pediatr Urol 2022; 18:342.e1-342.e6. [PMID: 35491305 DOI: 10.1016/j.jpurol.2022.03.021] [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: 11/11/2021] [Revised: 03/03/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION We have recently validated a meatal Stenosis (MS) severity grading system that is based on physical examination. OBJECTIVES The study objective was to examine the correlation between this grading system, patients' urinary symptoms, uroflowmetry and postvoid residual parameters. STUDY DESIGN Patients referred for our clinic for urinary and non-urinary complaints, were prospectively enrolled. Urinary symptoms questionnaire, uroflowmetry parameters and post-voiding residuals (PVR) were assessed, and photographs of the urethral meatus were taken for each patient. The photographs were graded blindly according to the previously validated grading system and correlated with urinary symptoms, uroflowmetry parameters and PVR. RESULTS Overall, 75 patients were assessed (20 grade 0, 23 grade 1 and 32 grade 2). When using grade 0 as a reference, the odds ratio (OR) for reporting narrow stream was 6.4 (95%CI 1.65-24.77) and 4 (95%CI 1.18-14.16) for grade 1 and 2 respectively. OR for prolonged urination was 6 (95% CI 1.47-24.89) for Grade 1 and 2; OR for upward stream deviation was10.08 (95%CI -2.43-41.82) for grade 1 and 15.12 (95%CI - 3.74-61.17) for grade 2. Uroflowmetry results showed lower Qmax from 16.8(SD ± 8.0) ml/sec in grade 0-9.6 ml/s on grade 1 and 2 (p < 0.001) (Figure 1). PVR was not statistically different in the three groups. DISCUSSION Our main findings were that meatal stenosis severity grade is associated with narrow stream as reported by parent, prolonged urination, and upward deviation of urinary stream, with increasing severity with worsening stenosis. MS grade was also associated with significant worsening of uroflow measures: a lower Qmax, Qmean and a longer time-to-Qmax. Post-void residual volume was not significantly different between the different severity grades. This study showed the clinical significance of the grading system. With subjective and objective measures. The implementation of this grading system in clinics, may aid in decision making regarding surgical intervention in the appropriate patients, and avoid unnecessary procedures. CONCLUSION The Severity of MS seen on physical examination correlates well with obstructive symptoms and decrease of urine stream seen on uroflowmetry. These findings confirm the importance of the grading system in the evaluation of patients with MS and may be additional measure that assist in consulting parents on the indications to meatotomy.
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Affiliation(s)
- Matan Mekayten
- Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, PO Box 12000, Ein Kerem, Jerusalem 91120, Israel.
| | - Eyal Meir
- Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, PO Box 12000, Ein Kerem, Jerusalem 91120, Israel.
| | - Vladimir Yutkin
- Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, PO Box 12000, Ein Kerem, Jerusalem 91120, Israel.
| | - Ofer N Gofrit
- Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, PO Box 12000, Ein Kerem, Jerusalem 91120, Israel.
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, PO Box 12000, Ein Kerem, Jerusalem 91120, Israel.
| | - Ezekiel H Landau
- Pediatric Urology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Guy Hidas
- Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, PO Box 12000, Ein Kerem, Jerusalem 91120, Israel.
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12
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Halevy D, Simanovsky N, Lev-Cohain N, Sosna J, Hiller N, Duvdevani M, Gofrit ON, Hidas G. Correction to: Parenchymal echotexture changes as a predictor of viability in testicular torsion. Emerg Radiol 2022; 29:621. [PMID: 35381873 DOI: 10.1007/s10140-022-02043-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dan Halevy
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel.
| | - Natalia Simanovsky
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel
| | - Namma Lev-Cohain
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel
| | - Nurith Hiller
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel
| | | | - Ofer N Gofrit
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
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13
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Greenblatt CL, Bercovier H, Klein BY, Gofrit ON. Adult Vaccination, Getting to Know Their Nonspecific Effects. J Gerontol A Biol Sci Med Sci 2021; 76:e235-e236. [PMID: 34245285 DOI: 10.1093/gerona/glab202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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)
- Charles L Greenblatt
- Department of Microbiology and Molecular Genetics, Hebrew University Jerusalem, Israel
| | - Hervé Bercovier
- Department of Microbiology and Molecular Genetics, Hebrew University Jerusalem, Israel
| | - Benjamin Y Klein
- Department of Microbiology and Molecular Genetics, Hebrew University Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hebrew University Medical Center, Jerusalem, Israel
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14
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Luwisch H, Rabinovich I, Yutkin V, Frank S, Neuman T, Duvdevani M, Youssef F, Hidas G, Gofrit ON. [NEOADJUVANT CHEMOTHERAPY BEFORE RADICAL CYSTECTOMY - MIGHT IT BE OFFERED SELECTIVELY?]. Harefuah 2021; 160:559-564. [PMID: 34482666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Neoadjuvant cisplatin-based chemotherapy prior radical cystectomy is the standard of care in patients with a muscle invasive bladder cancer. It is intended to treat micro-metastases. However, most patients do not develop metastases even without chemotherapy and are receiving this treatment in vain. In this study, we looked for pre-operative risk factors for developing metastases that can triage the patients that really need neoadjuvant therapy. METHODS From 1998 to 2018, 285 patients underwent radical cystectomy without neoadjuvant chemotherapy. During a median follow-up of 42.5 months, 99 patients (34%) developed recurrent disease after a median duration of 12 months. The study compared 10 different preoperative parameters of patients who developed or did not develop recurrence. RESULTS An increased risk of metastases was found in older patients (39.8% in older than 69 years vs. 33.3% in younger patients, p=0.045), in patients with a high Charlson Comorbidity index (46.2% in 5 and above vs. 28.2% when lower than 4, p=0.003), and in patients with large tumor diameter (p=0.01). No difference was found in the other variables examined including: gender, primary versus secondary tumor, tumor stage, presence of histological variant, hydronephrosis, carcinoma in situ (CIS) or sarcomatoid differentiation. CONCLUSIONS Older age, comorbidity, and large tumor diameter predict the risk of recurrence after radical cystectomy. However, overlap between the groups precludes the use of these parameters for clinical decisions. Therefore, neoadjuvant chemotherapy treatment should currently be offered to all candidates for radical cystectomy. Hopefully, future molecular markers will be able to predict the risk of metastases.
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Affiliation(s)
- Hemda Luwisch
- Department of Urology, Hadassah University Hospital, Jerusalem
| | - Igal Rabinovich
- Department of Urology, Hadassah University Hospital, Jerusalem
| | - Vladimir Yutkin
- Department of Urology, Hadassah University Hospital, Jerusalem
| | - Stephen Frank
- Department of Oncology, Hadassah University Hospital, Jerusalem
| | - Tzahi Neuman
- Department of Pathology, Hadassah University Hospital, Jerusalem
| | | | - Fadi Youssef
- Department of Urology, Hadassah University Hospital, Jerusalem
| | - Guy Hidas
- Department of Urology, Hadassah University Hospital, Jerusalem
| | - Ofer N Gofrit
- Department of Urology, Hadassah University Hospital, Jerusalem
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15
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Camargo S, Gofrit ON, Assis A, Mitrani E. Paracrine Signaling from a Three-Dimensional Model of Bladder Carcinoma and from Normal Bladder Switch the Phenotype of Stromal Fibroblasts. Cancers (Basel) 2021; 13:2972. [PMID: 34198488 PMCID: PMC8231763 DOI: 10.3390/cancers13122972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 12/21/2022] Open
Abstract
We present a three-dimensional model based on acellular scaffolds to recreate bladder carcinoma in vitro that closely describes the in vivo behavior of carcinoma cells. The integrity of the basement membrane and protein composition of the bladder scaffolds were examined by Laminin immunostaining and LC-MS/MS. Human primary bladder carcinoma cells were then grown on standard monolayer cultures and also seeded on the bladder scaffolds. Apparently, carcinoma cells adhered to the scaffold basement membrane and created a contiguous one-layer epithelium (engineered micro-carcinomas (EMCs)). Surprisingly, the gene expression pattern displayed by EMCs was similar to the profile expressed by the carcinoma cells cultured on plastic. However, the pattern of secreted growth factors was significantly different, as VEGF, FGF, and PIGF were secreted at higher levels by EMCs. We found that only the combination of factors secreted by EMCs, but not the carcinoma cells grown on plastic dishes, was able to induce either the pro-inflammatory phenotype or the myofibroblast phenotype depending on the concentration of the secreted factors. We found that the pro-inflammatory phenotype could be reversed. We propose a unique platform that allows one to decipher the paracrine signaling of bladder carcinoma and how this molecular signaling can switch the phenotypes of fibroblasts.
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Affiliation(s)
- Sandra Camargo
- Department of Cell and Developmental Biology, The Hebrew University of Jerusalem, Givat Ram, Jerusalem 91904, Israel; (S.C.); (A.A.)
| | - Ofer N. Gofrit
- Department of Urology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel;
| | - Assaf Assis
- Department of Cell and Developmental Biology, The Hebrew University of Jerusalem, Givat Ram, Jerusalem 91904, Israel; (S.C.); (A.A.)
| | - Eduardo Mitrani
- Department of Cell and Developmental Biology, The Hebrew University of Jerusalem, Givat Ram, Jerusalem 91904, Israel; (S.C.); (A.A.)
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16
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Zuaiter M, Axelrod JH, Pizov G, Gofrit ON. Hyper-Interleukin-6 Protects Against Renal Ischemic-Reperfusion Injury-A Mouse Model. Front Surg 2021; 8:605675. [PMID: 34055865 PMCID: PMC8155529 DOI: 10.3389/fsurg.2021.605675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 04/15/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Most of the ischemia-reperfusion injury (IR-I) occurs during reperfusion and is mediated by the immune system. In this study we determined whether immunomodulation with hyper-Interleukin-6 (a recombinant designer cytokine composed of interleukin-6 linked to its soluble receptor) is protective against IR-I in mice kidneys. Methods: Hyper-Interleukin-6 (HIL-6) was administered by in vivo plasmid DNA transfection to 10 male mice. Twenty-four hours later, unilateral nephrectomy was done. IR-I immediately followed by closure of the remaining kidney vascular pedicle for 40 min. Seven mice transfected with non-coding control plasmid served as the control group. The functional and morphological effects of IR-I and its effect on mice longevity were explored. This was done by serial blood tests and by histopathology done upon sacrifice of the animals at post-operative day 7. Findings: Mice pretreated with HIL-6 had a mean creatinine level at post-operative day 1 of 35.45 ± 4.03 μmol/l and mean Urea level was 14.18 ± 2.69 mmol/l, whereas mean creatinine was 89.33 ± 69.27 μmol/l (P = 0.025), and mean urea was 38.17 ± 20.77 mmol/l (P = 0.0024) in the control group. Histological changes in the control group included inflammatory infiltration, tubular damage, and architectural distortion. These were not seen in the treatment group. Seven days post-operatively the survival rate of treated mice was 100% compared to 50% in the control group (P = 0.015). Interpretation: In this single kidney mouse model, pretreatment with HIL-6 administration effectively protected against IR-I both morphologically and functionally. Further studies are needed to better understand the mechanism and feasibility of using this immunomodulator.
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Affiliation(s)
- Mohammad Zuaiter
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Jonathan H Axelrod
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Galina Pizov
- Department of Pathology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
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17
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Klinger D, Hill BL, Barda N, Halperin E, Gofrit ON, Greenblatt CL, Rappoport N, Linial M, Bercovier H. Bladder Cancer Immunotherapy by BCG Is Associated with a Significantly Reduced Risk of Alzheimer's Disease and Parkinson's Disease. Vaccines (Basel) 2021; 9:vaccines9050491. [PMID: 34064775 PMCID: PMC8151667 DOI: 10.3390/vaccines9050491] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 04/17/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/16/2022] Open
Abstract
Bacillus Calmette–Guerin (BCG) is a live attenuated form of Mycobacterium bovis that was developed 100 years ago as a vaccine against tuberculosis (TB) and has been used ever since to vaccinate children globally. It has also been used as the first-line treatment in patients with nonmuscle invasive bladder cancer (NMIBC), through repeated intravesical applications. Numerous studies have shown that BCG induces off-target immune effects in various pathologies. Accumulating data argue for the critical role of the immune system in the course of neurodegenerative diseases such as Alzheimer’s disease (AD) and Parkinson’s disease (PD). In this study, we tested whether repeated exposure to BCG during the treatment of NMIBC is associated with the risk of developing AD and PD. We presented a multi-center retrospective cohort study with patient data collected between 2000 and 2019 that included 12,185 bladder cancer (BC) patients, of which 2301 BCG-treated patients met all inclusion criteria, with a follow-up of 3.5 to 7 years. We considered the diagnosis date of AD and nonvascular dementia cases for BC patients. The BC patients were partitioned into those who underwent a transurethral resection of the bladder tumor followed by BCG therapy, and a disjoint group that had not received such treatment. By applying Cox proportional hazards (PH) regression and competing for risk analyses, we found that BCG treatment was associated with a significantly reduced risk of developing AD, especially in the population aged 75 years or older. The older population (≥75 years, 1578 BCG treated, and 5147 controls) showed a hazard ratio (HR) of 0.726 (95% CI: 0.529–0.996; p-value = 0.0473). While in a hospital-based cohort, BCG treatment resulted in an HR of 0.416 (95% CI: 0.203–0.853; p-value = 0.017), indicating a 58% lower risk of developing AD. The risk of developing PD showed the same trend with a 28% reduction in BCG-treated patients, while no BCG beneficial effect was observed for other age-related events such as Type 2 diabetes (T2D) and stroke. We attributed BCG’s beneficial effect on neurodegenerative diseases to a possible activation of long-term nonspecific immune effects. We proposed a prospective study in elderly people for testing intradermic BCG inoculation as a potential protective agent against AD and PD.
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Affiliation(s)
- Danielle Klinger
- Department of Biological Chemistry, Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem 91904, Israel;
| | - Brian L. Hill
- Department of Computer Science, University of California Los Angeles, Los Angeles, CA 90095-1596, USA; (B.L.H.); (E.H.)
| | - Noam Barda
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat-Gan 6578898, Israel;
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, USA
| | - Eran Halperin
- Department of Computer Science, University of California Los Angeles, Los Angeles, CA 90095-1596, USA; (B.L.H.); (E.H.)
| | - Ofer N. Gofrit
- Department of Urology, Hadassah University Hospital, Jerusalem 91904, Israel;
| | - Charles L. Greenblatt
- Department of Microbiology and Molecular Genetics, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91904, Israel; (C.L.G.); (H.B.)
| | - Nadav Rappoport
- Department of Software and Information Systems Engineering, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel;
| | - Michal Linial
- Department of Biological Chemistry, Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem 91904, Israel;
- Correspondence: ; Tel.: +972-54-882-0035
| | - Hervé Bercovier
- Department of Microbiology and Molecular Genetics, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91904, Israel; (C.L.G.); (H.B.)
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18
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Zarbiv Y, Peerless Y, Wygoda M, Orevi M, Meir K, Gofrit ON, Yutkin V, Frank S. Real-world Israeli single institution experience with PET-PSMA for staging of patients with clinically staged localized prostate carcinoma. Cancer Rep (Hoboken) 2021; 4:e1386. [PMID: 33934567 PMCID: PMC8551983 DOI: 10.1002/cnr2.1386] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/07/2021] [Accepted: 03/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background A recent prospective trial, the proPSMA study, showed superior specificity and sensitivity of Positron emission tomography (PET) ‐ Prostate‐specific membrane antigen (PSMA) imaging compared standard Computerized tomography (CT) and bone scan for staging of recently diagnosed high‐risk local prostate carcinoma for curative intent treatment. Aim To share our experience with false‐positive PET PSMA scans in newly diagnosed intermediate‐risk prostate cancer. Methods and results Here, we report a series of eight patients who underwent systemic staging using PET‐PSMA with false‐positive results who were ultimately treated with definitive radiation or surgery. Of the eight patients, two patients were diagnosed with favorable intermediate disease, four with unfavorable intermediate risk, and two with high‐risk disease. Seven of eight were shown to have false‐positive bone uptake, one patient had uptake in lung nodules. Three patients underwent bone biopsy and proven benign. The rest of the patients were proven as non‐metastatic radiologically by repeat PSMA, CT, or Magnetic resonance imaging (MRI). All subsequently preceded to definitive localized treatment and remain disease free as of this study. Conclusion This study emphasizes the importance of prudent clinical judgment when utilizing this highly sensitive imaging technique.
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Affiliation(s)
- Yonaton Zarbiv
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yehudit Peerless
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Marc Wygoda
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Marina Orevi
- Department of Nuclear Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Karen Meir
- Department of Pathology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Stephen Frank
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Molineros G, Meirovitz A, Wygoda M, Zuaiter M, Yutkin V, Duvdevani M, Hidas G, Gofrit ON. Transurethral Prostatectomy Before or After External Beam Radiotherapy: Complications and Reoperation Rates. Res Rep Urol 2021; 13:175-179. [PMID: 33907693 PMCID: PMC8064713 DOI: 10.2147/rru.s307999] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose Patients treated by external beam radiotherapy (EBRT) for localized carcinoma of the prostate (CAP) often suffer from urinary obstruction. While most patients can be treated medically, some require transurethral prostatectomy (TURP) for alleviation of obstruction. The consequences of combing EBRT and TURP are controversial. The objective of this study was to evaluate the success and complication rates of TURP combined with EBRT. Patients and Methods Between 2001 and 2017, 3501 patients underwent TURP. Sixty-six of them were treated with EBRT for CAP. Surgical complications according to the Clavien–Dindo (CD) scale and the need for secondary interventions were compared to 66 randomly selected patients operated on for benign prostatic hyperplasia (BPH). Results Patients who underwent TURP for BPH were significantly older compared to the patients with CAP with an average of 76.4 (SD 4.3) vs 71 (SD 8.2) years, p<0.0001. Substantial post-operative complications were rare in both groups with only a single case of CD grade 3 in each group. However, patients with CAP required significantly more secondary surgeries (21% vs 6%, p=0.02) and significantly more additional interventions (37.9% vs 13.6%, p=0.0025). There was no difference in complication rate, in the need for additional interventions or in the oncological outcome when comparing patients operated before or after EBRT. Conclusion The complication rate of TURP done before or after EBRT is low and comparable to surgery for BPH. However, the rates of secondary surgeries and additional interventions in these patients are high (40%). TURP before or after EBRT provides similar results.
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Affiliation(s)
- Gabriel Molineros
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Amichay Meirovitz
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Marc Wygoda
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Mohammad Zuaiter
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
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20
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Gofrit ON, Meirovitz A, Frank S, Rabinovich I, Luwisch H, Yutkin V, Neuman T, Hidas G, Duvdevani M, Wygoda M. Trimodal therapy in T2-4aN0M0 bladder cancer--How to select the best candidate? Cancer Med 2020; 9:8491-8497. [PMID: 32960495 PMCID: PMC7666756 DOI: 10.1002/cam4.3478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 12/24/2022] Open
Abstract
The reported results of trimodal treatment (TMT) in muscle-invasive bladder cancer vary widely. We attempted to characterize the profile of ideal candidates for this approach. Between 2000 and 2019, 105 patients (median age 78 years) with T2-4aN0M0 bladder cancer were treated with TMT and analyzed retrospectively. Mean radiotherapy dose was 62 Gy (SD 8.4). Ten pretreatment prognostic parameters were evaluated including tumor diameter on pre-TURBT CT. Multivariate analyses was performed and combination of parameters was studied. After a median follow-up of 29 months, 53 patients (50.5%) developed recurrence and 70 patients (67.7%) died. Death was disease-specific in 46 patients (65.7%). Tumor diameter was the most significant prognostic parameter with p < 0.0001 for overall, disease-specific and recurrence-free survivals. For every 1 cm increase in tumor diameter, the risk of disease-specific mortality increased by 1.57. Age, cisplatin eligibility and the Charlson Comorbidity Index were significant predictors of overall survival but not of disease-specific or recurrence-free survival. Patients who were cisplatin-eligible with a tumor diameter ≤3 cm had a 5-year disease-specific survival rate of 79.2% as opposed to 33.9% in patients without one of these features (p < 0.001). When tumor diameter exceeded 5 cm (irrelevant of all other parameters), 5-year disease-specific survival rate was only 28.2%. Patient profiles can accurately predict response to TMT. In cisplatin-eligible patients with a tumor diameter ≤3 cm, TMT provides an excellent disease-specific survival rate. In patients with a tumor diameter >5 cm TMT renders unacceptably poor treatment outcomes.
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Affiliation(s)
- Ofer N. Gofrit
- Department of UrologyHadassah Hebrew University Medical CenterJerusalemIsrael
| | - Amichay Meirovitz
- Department of OncologyHadassah Hebrew University Medical CenterJerusalemIsrael
| | - Stephen Frank
- Department of OncologyHadassah Hebrew University Medical CenterJerusalemIsrael
| | - Igal Rabinovich
- Department of UrologyHadassah Hebrew University Medical CenterJerusalemIsrael
| | - Hemda Luwisch
- Department of UrologyHadassah Hebrew University Medical CenterJerusalemIsrael
| | - Vladimir Yutkin
- Department of UrologyHadassah Hebrew University Medical CenterJerusalemIsrael
| | - Tzahi Neuman
- Department of PathologyHadassah Hebrew University Medical CenterJerusalemIsrael
| | - Guy Hidas
- Department of UrologyHadassah Hebrew University Medical CenterJerusalemIsrael
| | - Mordechai Duvdevani
- Department of UrologyHadassah Hebrew University Medical CenterJerusalemIsrael
| | - Marc Wygoda
- Department of OncologyHadassah Hebrew University Medical CenterJerusalemIsrael
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21
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Safrai M, Stern S, Gofrit ON, Hidas G, Kabiri D. Urinary tract injuries during cesarean delivery: long-term outcome and management. J Matern Fetal Neonatal Med 2020; 35:3547-3554. [PMID: 33016166 DOI: 10.1080/14767058.2020.1828336] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Urinary tract injury during cesarean delivery is a rare but severe complication. Due to the high prevalence of cesarean delivery, this injury may pose a high burden of morbidity. We reviewed the cases of lower urinary tract injuries identified during cesarean delivery in a tertiary medical center and identified diagnosis and treatment methods, as well as short and long-term outcomes, to establish a protocol of care for such cases. METHODS We included women with urinary tract injury during cesarean delivery between 2004 and 2018. The cases were identified according to ICD-9 codes, as well as free text in the medical report and discharge letter. Data were collected retrospectively. Telephone interviews were conducted to obtain additional data regarding long-term outcomes. RESULTS In14 years, a total of 17,794 cesarean deliveries were performed at our institution (17.5% of all deliveries), 14 cases of bladder injury, and 11 cases of ureteral injury were identified featuring an incidence of 0.08 and 0.06%, respectively. All bladder injuries were diagnosed and repaired intra-operatively. Six (55%) cases of ureteral injury were diagnosed in the post-operative period, and 3 of these patients required further surgery for definitive treatment. None of the patients suffered long-term adverse effects. Most bladder injuries occurred in women with previous cesarean delivery in the presence of abdominal adhesions. In contrast, most ureteral injuries occurred in women with emergency cesarean delivery during the second stage of labor, and were accompanied by an extension of the uterine incision. All women had normal kidney function in follow up and did not suffer from long term sequelae. CONCLUSION Urinary tract injury is an uncommon complication of cesarean delivery. A high index of suspicion is recommended to avoid late diagnosis and complications. We propose a comprehensive protocol for the management of these injuries.
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Affiliation(s)
- Myriam Safrai
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shira Stern
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Doron Kabiri
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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22
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Mekayten M, Meir E, Ben-Chaim J, Landau EH, Khoury AE, Gofrit ON, Duvdevani M, Hidas G. Formulation and validation of meatal stenosis grading system. J Pediatr Urol 2020; 16:205.e1-205.e5. [PMID: 31964617 DOI: 10.1016/j.jpurol.2019.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/27/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Meatal stenosis (MS) is a common finding in circumcised children. Indication for surgical correction is based on urinary symptoms such as strength and direction of urine stream as well as physical examination, including direction and caliber of the urinary stream. There is no objective grading of MS severity, and therefore indications for surgery and management protocols are vague. OBJECTIVE We aimed to formulate a standardized, validated, and reliable grading system for MS severity based on the physical examination finding. STUDY DESIGN Photographs of the urethral meatus were taken in patients scheduled for meatotomy due to MS, whereas patients without this condition served as control. The photographs were rated by three experienced fellowship trained pediatric urologists. The study was conducted in two phases: 1) development of a grading system by the expert panel and 2) testing of the proposed grading system for inter- and intra-rater reliability. To estimate the correlation between different rates, the intra-class correlation coefficient (ICC) was calculated. RESULTS Three grades were generated: Grade 0 (wide open meatus, visible mucosa), Grade 1 (minimal mucosa/fibrotic tissue visible), and Grade 2 (pinpoint meatus/no mucosa visible/large fibrotic layer). A panel of 51 raters (pediatric urologist, community urologist, pediatricians) participated in the survey evaluating the representative photos from 86 patients. Inter-rater reliability was high ICC = 0.99 (95% confidence interval [CI] of 0.983-0.996, P < 0.0001) Cronbach's alpha = 0.992. In total, 18 raters participated in the same survey two weeks later for intra-rater reliability. An identical grading was obtained in 83.3% of photographs (kappa = 0.455 [P < 0.05]). CONCLUSION We propose a grading system that is a valid, reliable, and reproducible method to classify the severity of MS on physical exam. This grading system could improve the healthcare provider's and parent's communication and can be a building block for further research in this field. A further research should assess the correlation with clinical signs and symptoms.
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Affiliation(s)
- Matan Mekayten
- Pediatric Urology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Eyal Meir
- Pediatric Urology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Ben-Chaim
- Tel Aviv Sourasky Medical Center, Paediatric UroIogy Unit, Department of Urology, Tel Aviv, Israel
| | - Ezekiel H Landau
- Pediatric Urology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Antoine E Khoury
- CHOC Children's Hospital of Orange County, Orange, CA, USA; Department of Urology, University of California, Irvine, CA, USA
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Guy Hidas
- Pediatric Urology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Leotsakos I, Katafigiotis I, Gofrit ON, Duvdevani M, Mitropoulos D. Postoperative Delirium after Urological Surgery: A Literature Review. Curr Urol 2020; 13:133-140. [PMID: 31933591 DOI: 10.1159/000499280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/13/2018] [Accepted: 12/17/2018] [Indexed: 12/19/2022] Open
Abstract
Purpose We aimed to thoroughly search and identify studies referring to risk factors associated with postoperative delirium (POD) in patients undergoing open as well as en-doscopic urological surgery. Methods The review after a systematic literature search included 5 studies. Results The incidence of POD was reported to be between 7.8 and 30% depending on the type of the urologic surgery, while in the majority of the studies the onset happened on the first postoperative day and the symptoms lasted 3 ± 0.8 days. Seventeen different risk factors for POD were identified and presented in detail. Conclusion The Mini-Mental State Examination score and older age were significantly associated with the development of POD. However, the Confusion Assessment Method is very well validated against the diagnosis of delirium from the specialists.
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Affiliation(s)
- Ioannis Leotsakos
- 1st Department of Urology, University of Athens Medical School, Athens, Greece.,Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ioannis Katafigiotis
- 1st Department of Urology, University of Athens Medical School, Athens, Greece.,Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Gofrit ON, Klein BY, Cohen IR, Ben-Hur T, Greenblatt CL, Bercovier H. Bacillus Calmette-Guérin (BCG) therapy lowers the incidence of Alzheimer's disease in bladder cancer patients. PLoS One 2019; 14:e0224433. [PMID: 31697701 PMCID: PMC6837488 DOI: 10.1371/journal.pone.0224433] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) affects one in ten people older than 65 years. Thus far, there is no cure or even disease-modifying treatment for this disease. The immune system is a major player in the pathogenesis of AD. Bacillus Calmette-Guérin (BCG), developed as a vaccine against tuberculosis, modulates the immune system and reduces recurrence of non-muscle invasive bladder cancer. Theoretical considerations suggested that treatment with BCG may decrease the risk of AD. We tested this hypothesis on a natural population of bladder cancer patients. METHODS AND FINDINGS After removing all bladder cancer patients presenting with AD or developing AD within one-year following diagnosis of bladder cancer, we collected data on a total of 1371 patients (1134 males and 237 females) who were followed for at least one year after the diagnosis of bladder cancer. The mean age at diagnosis of bladder cancer was 68.1 years (SD 13.0). Adjuvant post-operative intra-vesical treatment with BCG was given to 878 (64%) of these patients. The median period post-operative follow-up was 8 years. During follow-up, 65 patients developed AD at a mean age of 84 years (SD 5.9), including 21 patients (2.4%) who had been treated with BCG and 44 patients (8.9%) who had not received BCG. Patients who had been treated with BCG manifested more than 4-fold less risk for AD than those not treated with BCG. The Cox proportional hazards regression model and the Kaplan-Meier analysis of AD free survival both indicated high significance: patients not treated with BCG had a significantly higher risk of developing AD compared to BCG treated patients (HR 4.778, 95%CI: 2.837-8.046, p = 4.08x10-9 and Log Rank Chi-square 42.438, df = 1, p = 7.30x10-11, respectively). Exposure to BCG did not modify the prevalence of Parkinson's disease, 1.9% in BCG treated patients and 1.6% in untreated (Fisher's Exact Test, p = 1). CONCLUSIONS Bladder cancer patients treated with BCG were significantly less likely to develop AD at any age than patients who were not so treated. This finding of a retrospective study suggests that BCG treatment might also reduce the incidence of AD in the general population. Confirmation of such effects of BCG in other retrospective studies would support prospective studies of BCG in AD.
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Affiliation(s)
- Ofer N. Gofrit
- Department of Urology, Hadassah- Hebrew University Medical Center, Jerusalem, Israel
- * E-mail: (HB); (ONG)
| | - Benjamin Y. Klein
- Department of Microbiology and Molecular Genetics, Hebrew University Jerusalem, Israel
| | - Irun R. Cohen
- Department of Immunology, Weizmann Institute, Rehovot, Israel
| | - Tamir Ben-Hur
- Department of Neurology Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Charles L. Greenblatt
- Department of Microbiology and Molecular Genetics, Hebrew University Jerusalem, Israel
| | - Hervé Bercovier
- Department of Microbiology and Molecular Genetics, Hebrew University Jerusalem, Israel
- * E-mail: (HB); (ONG)
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Gold DD, Lorber A, Levine H, Rosenberg S, Duvdevani M, Landau EH, Yutkin V, Gofrit ON, Hidas G. Door To Detorsion Time Determines Testicular Survival. Urology 2019; 133:211-215. [DOI: 10.1016/j.urology.2019.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
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Katafigiotis I, Sabler IM, Heifetz EM, Isid A, Sfoungaristos S, Lorber A, Yutkin V, Hidas G, Latke A, Landau EH, Pode D, Gofrit ON, Duvdevani M. Factors Predicting Operating Room Time in Ureteroscopy and Ureterorenoscopy. Curr Urol 2019; 12:195-200. [PMID: 31602185 DOI: 10.1159/000499306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022] Open
Abstract
Backgrounds/Aims Operation room (OR) time is of great value affecting surgical outcome, complications and the daily surgical program with financial implications. Methods We retrospectively evaluated 570 consecutive patients submitted to ureteroscopy or ureterorenoscopy for the treatment of ureteral or renal stones. Demographic parameters, patient's stones characteristics, type of ureteroscope, surgeon experience and surgical theater characteristics were analyzed. OR time was calculated from the initiation of anesthesia to patient extubation. Multivariate analysis was conducted using a linear regression test with multiple parameters to identify predictors of OR time. Results Eight factors were identified as significant. These include total stones volume, ureteroscope used, stone number, nurses experience, radio-opacity of the stone on kidney-ureter-bladder X-ray, main surgeon experience, operating room type, and having a nephrostomy tube prior to surgery. Conclusions The surgical team experience and familiarity with endourological procedure, and the surgical room characteristics has a crucial impact on OR time and effectiveness.
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Affiliation(s)
- Ioannis Katafigiotis
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,1st University Urology Clinic, Laiko Hospital, Athens, Greece
| | - Itay M Sabler
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Eliyahu M Heifetz
- Department of Health Informatics, Jerusalem College of Technology, Jerusalem, Israel
| | - Ayman Isid
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Stavros Sfoungaristos
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,1st Department of Urology, Aristotle University, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Amitay Lorber
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Arie Latke
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ezekiel H Landau
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Dov Pode
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Gofrit ON, Bercovier H, Klein BY, Cohen IR, Ben-Hur T, Greenblatt CL. Can immunization with Bacillus Calmette-Guérin (BCG) protect against Alzheimer’s disease? Med Hypotheses 2019; 123:95-97. [DOI: 10.1016/j.mehy.2019.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/24/2018] [Accepted: 01/10/2019] [Indexed: 12/16/2022]
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Sabler IM, Katafigiotis I, Sfoungaristos S, Lorber A, Leotsakos I, Yutkin V, Hidas G, Gofrit ON, Duvdevani M. Is emergency percutaneous antegrade drainage of the upper urinary tract useful for future percutaneous nephrolithotomy access? Investig Clin Urol 2018; 60:29-34. [PMID: 30637358 PMCID: PMC6318205 DOI: 10.4111/icu.2019.60.1.29] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/13/2018] [Indexed: 12/05/2022] Open
Abstract
Purpose To compare percutaneous nephrolithotomy (PCNL) operations between patients with a preoperative nephrostomy tube and patients that the renal access was obtained at the time of the surgery. Materials and Methods We retrospectively evaluated PCNL cases. Patients were divided into two groups. Group 1 – a non-nephrostomy tube (percutaneous nephrostomy, PCN) group and Group 2 – patients with a PCN placed before the procedure. All preoperatively placed PCN's were performed in emergency situations by interventional radiologists (IR). Complications were classified according to the Clavien-Dindo classification. We compared stone characteristics, operation time, complications, efficacy and PCN usability at surgery. Results Five hundred twenty-seven patients who were submitted to PCNL for renal stones were included in the study. In 73 patients (13.9%) the PCNs were placed before the surgery. Patients and stone characteristics, mean operative time (p=0.830), complications (p=0.859) and stone-free rates (93.0%) were similar between the groups. There was a trend toward higher complication rates in Group 1, but the difference was not statistically significant. Only 21 (29.0%) of preoperatively placed PCNs were used during PCNL for establishing a tract. The reasons for not using PCN tract were: pelvic or infundibular insertion (30.0%) and suboptimal anatomic location (70.0%). Conclusions Preoperative emergency inserted PCNs by IR usage rates were low during PCNL. Its placement neither affects the incidence of complications nor affects the operation time and outcomes. As such, when emergency renal drainage is indicated, the need for a future definitive PCNL should not influence the decision about the modality of renal drainage.
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Affiliation(s)
- Itay M Sabler
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ioannis Katafigiotis
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Athens Stone Clinic, Athens, Greece
| | - Stavros Sfoungaristos
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Athens Stone Clinic, Athens, Greece
| | - Amitay Lorber
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ioannis Leotsakos
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Gofrit ON, Yutkin V, Pode D, Duvdevani M, Landau EH, Gielchinsky I, Hidas G. A study of prostate volumes in patients with spinal cord injury. Neurourol Urodyn 2018; 38:684-688. [DOI: 10.1002/nau.23891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/06/2018] [Accepted: 10/17/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Ofer N. Gofrit
- From the Department of UrologyHadassah Hebrew University HospitalJerusalemIsrael
| | - Vladimir Yutkin
- From the Department of UrologyHadassah Hebrew University HospitalJerusalemIsrael
| | - Dov Pode
- From the Department of UrologyHadassah Hebrew University HospitalJerusalemIsrael
| | - Mordechai Duvdevani
- From the Department of UrologyHadassah Hebrew University HospitalJerusalemIsrael
| | - Ezekiel H. Landau
- From the Department of UrologyHadassah Hebrew University HospitalJerusalemIsrael
| | - Ilan Gielchinsky
- From the Department of UrologyHadassah Hebrew University HospitalJerusalemIsrael
| | - Guy Hidas
- From the Department of UrologyHadassah Hebrew University HospitalJerusalemIsrael
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Sabler IM, Katafigiotis I, Gofrit ON, Duvdevani M. Present indications and techniques of percutaneous nephrolithotomy: What the future holds? Asian J Urol 2018; 5:287-294. [PMID: 30364501 PMCID: PMC6197369 DOI: 10.1016/j.ajur.2018.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/10/2018] [Accepted: 05/25/2018] [Indexed: 12/12/2022] Open
Abstract
The purpose of the review was to present the latest updates on percutaneous nephrolithotomy (PCNL) procedure in terms of indications and evolving techniques, and to identify the advantages and disadvantages of each modality. The data for this review were collected after a thorough PubMed search in core clinical journals in English language. The key words included “PCNL” and “PNL” in combination with “indications”, “techniques”, “review” and “miniaturized PCNL”. Publications relevant to the subject were retrieved and critically reviewed. Current European and American Urology Association Nephrolithiasis Guidelines were included as well. The indications for standard PCNL have been changed through the past decade. Despite evolution of the procedure, innovations and the development of new technical approaches, the indications for miniaturized PCNL have not been standardized yet. There is a need for well-constructed randomized trials to explore the indications, complications and results for each evolving approach. A continuous reduction of tract size is not the only revolution of the last years. There is constant ongoing interest in developing new efficient miniature instruments, intracorporeal lithotripters and sophisticated tract creation methods. We can summarize that, PCNL represents a valuable well-known tool in the field of endourology. We should be open minded to future changes in surgical approaches and technological improvements.
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Affiliation(s)
- Itay M Sabler
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Ioannis Katafigiotis
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
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Gofrit ON, Rabinovich I, Yutkin V, Pode D, Duvdevani M, Landau EH, Hidas G, Goldberg SN. Abbreviated CT protocol for postoperative surveillance of renal cancer. Urol Oncol 2018; 36:498.e9-498.e13. [PMID: 30228095 DOI: 10.1016/j.urolonc.2018.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/24/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Postoperative surveillance protocols after nephrectomy for kidney cancer include periodic computed tomography (CT) scans of the chest and abdomen. A single study exposes the patient to 21 mSv (equivalent to 7-year exposure to natural background radiation). The objective of this study was to evaluate the hypothesis that an abbreviated CT protocol restricted to the chest and upper abdomen (i.e., to the level of the intervertebral disk L3-L4) is sufficient for routine postnephrectomy follow-up as it detects most tumor recurrence with lower radiation exposure. METHODS We identified 493 patients treated with radical or partial nephrectomy for localized kidney cancer and followed with periodic CT scans of the chest and abdomen for prolonged periods. The frequency and location of cancer recurrence were documented. The ratio of infield recurrence for the complete chest, and abdomen and for the abbreviated protocol was recorded. The decrease in radiation exposure was calculated. RESULTS At a median follow up of 96 months, 82 patients (16.6%) developed recurrence. The frequent sites of recurrence were the lungs (53), the bones (9), and local recurrence (22). Complete chest and abdominal CT identified 78 of the recurrences (95%) and the abbreviated protocol identifying all but one of these (94%). The abbreviated protocol exposed the patient to 48% (standard deviation 4.3%) less radiation compared to the full protocol. CONCLUSIONS Using an abbreviated CT protocol that includes the chest and upper abdomen for surveillance after surgery of localized kidney cancer decreases radiation exposure by half with only a minor decrease in the sensitivity of the examination.
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Affiliation(s)
- Ofer N Gofrit
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel.
| | - Igal Rabinovich
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | - Dov Pode
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | | | - Ezekiel H Landau
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | - S Nahum Goldberg
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel
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Katafigiotis I, Sabler IM, Heifetz EM, Rosenfeld A, Stavros S, Lorber A, Latke A, Yutkin V, Hidas G, Landau EH, Pode D, Gofrit ON, Duvdevani M. "Stoneless" or Negative Ureteroscopy: A Reality in the Endourologic Routine or Avoidable Source of Frustration? Estimating the Risk Factors for a Negative Ureteroscopy. J Endourol 2018; 32:825-830. [PMID: 29978710 DOI: 10.1089/end.2018.0291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION A "Negative" ureteroscopy (URS) is defined as a URS in which no stone is found during the procedure. It may occur when the stone has already been passed spontaneously or when it is located outside the collecting system. The aim of the study was to outline risk factors for Negative-URS. MATERIALS AND METHODS We retrospectively analyzed the possible risk factors for Negative-URS from a database of 341 URS cases. In every case where presumptive ureteral stone was not found, a formal nephroscopy as well as a whole collecting system revision was completed. The Negative-URS group was compared with the non-Negative-URS group, in terms of patient and stone characteristics. RESULTS The database of 341 URS cases included 448 different stone instances, of which 17 (3.8%) were negative and 431 (96.2%) were therapeutic. There was no statistical significant difference between the two groups concerning age, body mass index, stone location in the ureter, stone laterality, and whether the patient was prestented. The stepwise multiple logistic regression revealed three important risk factors, namely CT stone surface area (p < 0.0001), radiopacity of the stone at kidney, ureter, and bladder radiograph (KUB; p = 0.0004), and gender (p = 0.0011) with an area under the curve of 0.91. Women were found to have more possibilities to have a negative procedure by four- to sevenfold than men depending on the model. A nonradio-opaque stone at KUB is more likely to be correlated with a Negative-URS by 9.5- to 11-fold more than a radiopaque stone at KUB. For each increase of 1 U in CT stone surface area, there is an increase of 10%-12% to be non-negative. CONCLUSIONS Female gender, a nonradio-opaque stone at KUB, and a smaller stone surface were statistically significantly different in the Negative-URS population.
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Affiliation(s)
- Ioannis Katafigiotis
- 1 Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem, Israel
| | - Itay M Sabler
- 1 Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem, Israel
| | - Eliyahu M Heifetz
- 2 Department of Health Informatics, Jerusalem College of Technology , Jerusalem, Israel
| | - Avi Rosenfeld
- 2 Department of Health Informatics, Jerusalem College of Technology , Jerusalem, Israel
| | - Sfoungaristos Stavros
- 1 Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem, Israel
| | - Amitay Lorber
- 1 Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem, Israel
| | - Arie Latke
- 1 Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem, Israel
| | - Vladimir Yutkin
- 1 Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem, Israel
| | - Guy Hidas
- 1 Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem, Israel
| | - Ezekiel H Landau
- 1 Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem, Israel
| | - Dov Pode
- 1 Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem, Israel
| | - Ofer N Gofrit
- 1 Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem, Israel
| | - Mordechai Duvdevani
- 1 Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem, Israel
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Parnasa E, Shapiro A, Pode D, Yutkin V, Hidas G, Landau EH, Duvdevani M, Gofrit ON. [ACTIVE SURVEILLANCE IN RECURRENT LOW-RISK BLADDER TUMORS]. Harefuah 2018; 157:507-510. [PMID: 30175566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To report our experience with the active surveillance policy in patients with recurrent low-risk bladder tumors. METHODS The files of 52 patients who underwent active surveillance instead of immediate surgical resection were reviewed. Different variables concerning tumor growth rate were evaluated. RESULTS A total of 75 surveillance periods were documented in 52 patients (mean age 75.6 years S.D. 10.45 years, 37 males and 14 females), Mean surveillance period length was 16.5 months (S.D. 16.1). All tumors resected after surveillance were found in stage Ta and in low-grade except one tumor which was high-grade; 70 active surveillance periods ended with tumor resection, and 5 patients were still under surveillance when the research ended; 27 surveillance periods (37.7%) ended because of the growth of additional tumors. Active surveillance therefore spared 27 surgeries. The rate of tumor growth during surveillance depended on the tumor's largest diameter at the beginning of surveillance. If initial tumor diameter was smaller than 5 mm (68 cases), the median tumor growth rate was 1.12 mm3/month (IRQ: 0-6.55). If the initial tumor diameter was ≥5 mm (7 cases), the median tumor growth rate was 137.14 mm3/month (IRQ: 2.21-1787.5, p < 0.05). CONCLUSIONS Small, recurrent papillary bladder tumors pose minimal risk to the patient. An active surveillance policy, without immediate resection of the tumor is safe, can spare surgeries and can be considered in patients presenting with small papillary recurrence.
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Affiliation(s)
- Elhanan Parnasa
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem
| | - Amos Shapiro
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem
| | - Dov Pode
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem
| | - Vladimir Yutkin
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem
| | - Guy Hidas
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem
| | - Ezekiel H Landau
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem
| | | | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem
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Mekayten M, Yutkin V, Duvdevani M, Pode D, Hidas G, Landau EH, Youssef F, Gofrit ON. High frequency of bladder cancer after nephroureterectomy: justification for adjuvant intravesical treatment? Res Rep Urol 2018; 10:33-38. [PMID: 29872646 PMCID: PMC5973432 DOI: 10.2147/rru.s164166] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Bladder recurrence after nephroureterectomy (NU) is common. However, there is no acceptable policy of adjuvant intravesical treatment after NU. Objective To assess the rate of bladder recurrence following NU and to identify the high-risk subgroups that may become candidates for adjuvant intravesical therapy after NU. Patients and methods Ninety-one patients (mean age 66.4 years) underwent NU. High-grade (HG) tumors were found in 63 patients and low-grade (LG) tumors in 28. Median follow-up was 72 months. The risk of bladder recurrence was assessed by uni- and multivariate analyses of patient and tumor characteristics. Results Bladder recurrence developed in 38 patients (41.8%) after a median period of 11 months. Among these, 25 patients with HG upper tract urothelial carcinoma (39.7%) and 13 patients with LG upper tract urothelial carcinoma (46.4%) developed recurrence. HG bladder recurrence developed in 24 patients (63.2%) and LG recurrence developed in 14 patients (36.8%). Stages pTa, pT1, pT2, or higher bladder recurrence developed in 26 (68.4%), 7 (18.4%), and 4 patients (10.5%), respectively, and pure pTis developed in 1 patient. On uni- and multivariate analyses, the risk of bladder recurrence was independent of any clinicopathologic characteristics. Conclusion High rate and short time interval of bladder recurrence after NU were found, with no specific subgroup of patients with increased risk. These findings support prescribing adjuvant intravesical therapy to all patients after NU.
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Affiliation(s)
- Matan Mekayten
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Dov Pode
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ezekiel H Landau
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Fadi Youssef
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Sabler IM, Isid A, Katafigiotis I, Lorber A, Latke A, Shorka D, Harhel T, Sfoungaristos S, Yutkin V, Hidas G, Landau EH, Pode D, Gofrit ON, Duvdevani M. Does Retrograde Treatment of Upper Urinary Tract Stones Necessitate Postoperative Upper Urinary Tract Drainage? Conclusions from More Than 500 Single Center Consecutive Cases. J Endourol 2018; 32:477-481. [DOI: 10.1089/end.2018.0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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)
- Itay M. Sabler
- Urology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Aiman Isid
- Urology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ioannis Katafigiotis
- Urology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Amitay Lorber
- Urology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Arie Latke
- Urology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Dorit Shorka
- Urology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Tehila Harhel
- Urology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Stavros Sfoungaristos
- 1st Department of Urology, Aristotle University, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Vladimir Yutkin
- Urology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Guy Hidas
- Urology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ezekiel H. Landau
- Urology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Dov Pode
- Urology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N. Gofrit
- Urology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mordechai Duvdevani
- Urology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Abstract
INTRODUCTION Blunt scrotal trauma (BST) is common among soldiers but its incidence and outcome are unknown. The purpose of this study was to estimate the incidence, clinical findings, and outcome of BST in soldiers referred to a primary care field physician. MATERIALS AND METHODS The medical records of soldiers in their military services who sustained BST and were evaluated by primary care field doctors over a 10-year period were reviewed. Anamnestic data, physical findings, primary care physician decisions, hospitalization, and surgery rates as well as final outcomes were analyzed. RESULTS The medical records of 382,036 soldiers were reviewed and 668 cases (0.175%) of BST were identified. All patients complained of scrotal pain and 10% of dysuria. The most common physical findings included: scrotal tenderness (71.7%), scrotal edema (16.2%), and scrotal hematoma (4.8%). In 11.8% of the visits microhematuria was found in urine dip stick. A total of 243 patients (36.4%) were referred to emergency department, but only 9 (3.7%) were hospitalized. Of these, 3 patients underwent surgical exploration due to suspected testicular rupture in ultrasonography. Finally, testicular rupture was found only in 1 patient. This testis was sutured. In another patient testicular torsion was found and orchiectomy done. 168 patients (25.1%) developed prolonged scrotal pain lasting for more than 2 weeks after the trauma. CONCLUSIONS Blunt testicular trauma is not an uncommon phenomenon among soldiers. Surgical intervention is rarely needed and in 99.6% of cases seen by general practitioners supportive management is suffice. The phenomenon of prolonged post-traumatic testicular pain, developing in a quarter of the patients after BST pain deserves more research.
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Affiliation(s)
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Lorber A, Goldberg NS, Gofrit ON, Pode D, Yutkin V, Gielchinsky I, Duvdevani M, Landau EH, Hidas G, Apelbaum L. [PERCUTANEOUS TREATMENT OF SMALL RENAL TUMORS BY THERMAL ABLATION]. Harefuah 2018; 157:154-157. [PMID: 29582944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Kidney cancer accounts for approximately 2-3 % of all types of cancers. Renal tumors prevalence and especially the prevalence of small renal tumors, is on the rise. About half of the tumors currently diagnosed are smaller than 4 cm. Minimally invasive methods of radiofrequency ablation technology were recently developed for the treatment of small renal tumors and are characterized by reducing the surgical and anesthetic risk. The ablation is performed with a percutaneous approach guided by ultrasound, CT or MRI. We reviewed the results of this treatment. METHODS A total of 75 patients with a mean age of 69.5 years (27 - 90) were treated using RF during the period 2007-2014. The average tumor diameter was 28.4 mm (11-58 mm); 40 tumors were exophytic and 30 were central. Monitoring protocol after treatment included imaging after 1, 3, 6, 12 months subsequent to treatment and later annually; median follow-up time was 21 months (1 - 97). RESULTS Evidence of tumor recurrence was observed in 9 patients (11.4%); 8 were treated successfully by another RF session. Cases in which recurrence was observed were characterized by a tumor larger than 30 mm (5/9) and adjacent to renal cysts (3/9); 5 of the lesions were central (endophytic) (P=0.5). One patient died due to metastatic RCC and a metastatic disease developed in two additional patients who died of other causes. CONCLUSIONS It is possible to destroy most of the small renal tumors by RF ablation. When the tumor size is up to 30 mm, a 94% long-term cure may be reached. In the event of renewed growth of the tumor, the treatment can be repeated with good results. In light of short-term experience, it is recommended to limit this treatment to older patients, with a short life expectancy or when anesthetic risks prohibit surgery.
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Affiliation(s)
| | | | | | - Dov Pode
- The Urology Department, Hadassah Medical Center
| | | | | | | | | | - Guy Hidas
- The Urology Department, Hadassah Medical Center
| | - Liat Apelbaum
- The Department of Medical Imaging, Hadassah Medical Center
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Abstract
OBJECTIVE To evaluate the homogeneity of the 'low-risk' bladder cancer group in an attempt to optimise follow-up protocols. PATIENTS AND METHODS Between June 1998 and December 2008, 211 patients (mean [sd] age of 66.7 [12.8] years) underwent transurethral resection of low-risk bladder cancer. Postoperative follow-up included cystoscopy at 3 and 12 months after surgery, then annually for a total of 5 years, and then annual ultrasonography indefinitely. RESULTS After a median follow-up of 10 years, 65 patients (30.7%) developed tumour recurrence and three (1.4%) stage progressions. In all, 84 patients (40%) had tumours of ≤1 cm; these patients were significantly younger than patients with 1.1-3 cm tumours (64.6 vs 68.3 years, P = 0.03). Their 5-year recurrence-free survival rate was significantly higher (92% vs 70% in patients with larger tumours, P < 0.001). The median time to recurrence was 5.7 years in patients with smaller tumours and 3.6 years in patients with larger tumours (P = 0.03). Only 43.7% of the recurrences in patients with small tumours occurred within 5 years, compared to 75.5% in patients with larger tumours. CONCLUSIONS Patients with low-risk bladder cancer make an inhomogeneous group. They can be stratified according to tumour size. Patients with tumours of ≤1 cm are younger, have lower risk of tumour recurrence, and most of their recurrences arise beyond the recommended 5-year surveillance period. It seems that these patients can be classified separately to a 'very-low-risk' group. Follow-up in these cases can be based on prolonged non-invasive evaluations.
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Affiliation(s)
- Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Dov Pode
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Galina Pizov
- Department of Pathology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Ezekiel H Landau
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
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Lorber A, Bauman D, Chapchay K, Duvdevani M, Pode D, Gofrit ON, Landau EH, Hidas G. Double mucosal flap for the reconstruction of transverse vaginal septum - A novel surgical approach using the vaginal septal tissue. Urol Case Rep 2017; 16:92-94. [PMID: 29204361 PMCID: PMC5709346 DOI: 10.1016/j.eucr.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/28/2017] [Accepted: 11/12/2017] [Indexed: 12/16/2022] Open
Affiliation(s)
- Amitay Lorber
- Urology Department, Hadassah Medical Center, Israel
- Corresponding author. Urology Department, Hadassah Medical Center, POB:12000, Jerusalem, Israel.Urology DepartmentHadassah Medical CenterPOB:12000JerusalemIsrael
| | - Dvora Bauman
- Obstetrics and Gynecology Department, Hadassah Medical Center, Israel
| | - Katya Chapchay
- Plastic Surgery Department, Hadassah Medical Center, Israel
| | | | - Dov Pode
- Urology Department, Hadassah Medical Center, Israel
| | | | | | - Guy Hidas
- Urology Department, Hadassah Medical Center, Israel
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Sfoungaristos S, Mykoniatis I, Katafigiotis I, Isid A, Gofrit ON, Constantinides CA, Duvdevani M. Single lower calyceal percutaneous tract combined with flexible nephroscopy: A valuable treatment paradigm for staghorn stones. Can Urol Assoc J 2017; 12:E21-E24. [PMID: 29173274 DOI: 10.5489/cuaj.4393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION We evaluated the efficacy and safety of single lower calyceal tract combined with flexible nephroscopy for the management of staghorn renal stones by percutaneous nephrolithotomy. METHODS The medical records of patients who underwent percutaneous nephrolithotomy for the management of staghorn stones were analyzed. We included patients aged >18 years, while patients with incomplete data and renal anatomical anomalies were excluded from the study. Stone-free rate, postoperative complications, procedure duration, fluoroscopy time, and length of hospitalization were recorded. Postoperative outcomes were evaluated by non-contrast computed tomography scan 4-6 weeks after the operation. Stone-free status was defined as the absence of residual stones >4 mm. RESULTS The study cohort consisted of 103 consecutive patients. Stone-free rate was 65.0%. No complications were observed in 69.9% of the cases; most postoperative complications were Grade 1 (13.6%) and 2 (10.7%). Five patients (4.9%) suffered a Grade 3a complication and another patient (1.0%) suffered a Grade 3b complication. CONCLUSIONS Percutaneous nephrolithotomy through a single lower calyceal tract combined with flexible nephroscopy can be a valuable treatment option for the treatment of staghorn calculi, providing efficacy and safety. Nevertheless, the present study is limited by both its retrospective nature and being conducted at a single centre and, thus, proper prospective studies with head-on comparisons are needed to prove or disprove the advantages and disadvantages of either approach.
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Affiliation(s)
- Stavros Sfoungaristos
- Hadassah and Hebrew University Medical Centre, Department of Urology, Jerusalem, Israel.,G. Gennimatas Hospital, 1st Department of Urology, Aristotle University, Thessaloniki, Greece
| | - Ioannis Mykoniatis
- G. Gennimatas Hospital, 1st Department of Urology, Aristotle University, Thessaloniki, Greece
| | | | - Ayman Isid
- Hadassah and Hebrew University Medical Centre, Department of Urology, Jerusalem, Israel
| | - Ofer N Gofrit
- Hadassah and Hebrew University Medical Centre, Department of Urology, Jerusalem, Israel
| | | | - Mordechai Duvdevani
- Hadassah and Hebrew University Medical Centre, Department of Urology, Jerusalem, Israel
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Geva GA, Gielchinsky I, Aviv N, Max KEA, Gofrit ON, Gur-Wahnon D, Ben-Dov IZ. Urine cell-free microRNA as biomarkers for transitional cell carcinoma. BMC Res Notes 2017; 10:641. [PMID: 29187235 PMCID: PMC5708087 DOI: 10.1186/s13104-017-2950-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/21/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE MicroRNA (miRNA) are short nucleotide strands with a regulatory function in the cell. Several miRNAs have been shown to be useful as biomarkers for different neoplasms. The aim of this project was to assess whether levels of miRNA in cell free urine could be used as a biomarker in transitional cell carcinoma (TCC). RESULTS cDNA libraries were produced based on small RNAs in urine samples of fourteen TCC patients and twenty healthy volunteers. Resulting reads were deep sequenced on Illumina HiSeq sequencer with the intent of characterizing cell free urine miRNA profiles. A statistically significant difference was found for a single miRNA; miR-210 was > sixfold higher in the TCC group compared to the control group. Furthermore, we were able to produce a diagnostic score by summing of standardized levels of overexpressed miRNA. This score was considerably higher in TCC patients with a sensitivity of 0.93, specificity of 0.76 and negative predictive value > 0.97.
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Affiliation(s)
- Gil A. Geva
- Nephrology and Hypertension, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel
| | - Ilan Gielchinsky
- Department of Urology, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel
| | - Nina Aviv
- Nephrology and Hypertension, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel
| | - Klaas E. A. Max
- Laboratory of RNA Molecular Biology, The Rockefeller University, New York, NY 10065 USA
| | - Ofer N. Gofrit
- Department of Urology, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel
| | - Devorah Gur-Wahnon
- Nephrology and Hypertension, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel
| | - Iddo Z. Ben-Dov
- Nephrology and Hypertension, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel
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Gielchinsky I, Pode D, Duvdevani M, Yutkin V, Landau EH, Hidas G, Gofrit ON. The Transparency of Irrigation Fluids Used in Endoscopic Surgery. J Endourol 2017; 31:701-704. [PMID: 28385032 DOI: 10.1089/end.2016.0894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Transurethral surgery has been traditionally done using the nonelectrolyte, isotonic 1.5% glycine solution as irrigation fluid. The emergence of modern technologies, which can be applied with electrolyte solutions, such as bipolar resection and LASER evaporation, as well as the worry of transurethral resection (TUR) syndrome have driven urologists away from glycine toward the use of physiologic solution. Differences in the transparencies of these fluids have not been studied. MATERIALS AND METHODS The ability to resolve two bars at 1 mm apart using a 30° cystoscope lens immersed in different solutions was studied. Physiologic solution, distilled water (DW), and 1.5% glycine solutions containing increasing concentrations of blood, from 0.5% to 2%, were tested. Solutions containing 2% blood were inspected with magnification and microscopy. RESULTS One-millimeter resolution was reached in as much as 2% blood in 1.5% glycine solution and as much as 1% blood in DW, but in none of the blood-saline solutions. Magnified and microscopic views of 2% blood solutions showed an even distribution of red blood cells (RBCs) in physiologic solution, clumps of RBCs in 1.5% glycine, and an almost complete hemolysis in DW. CONCLUSIONS Glycine solution increases the transparency compared to physiologic solution or DW owing to the clumping of RBCs. When the risk of TUR syndrome is low, as in resection of bladder tumors or small prostates, we propose that 1.5% glycine solution should be preferred over saline, owing to its improved visibility.
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Affiliation(s)
- Ilan Gielchinsky
- Department of Urology, Hadassah Hebrew University Hospital , Jerusalem, Israel
| | - Dov Pode
- Department of Urology, Hadassah Hebrew University Hospital , Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Hospital , Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah Hebrew University Hospital , Jerusalem, Israel
| | - Ezekiel H Landau
- Department of Urology, Hadassah Hebrew University Hospital , Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah Hebrew University Hospital , Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Hospital , Jerusalem, Israel
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Gielchinsky I, Gilon M, Abu-Lail R, Matouk I, Hochberg A, Gofrit ON, Ben-Dov IZ. H19 non-coding RNA in urine cells detects urothelial carcinoma: a pilot study. Biomarkers 2017; 22:661-666. [PMID: 28067543 DOI: 10.1080/1354750x.2016.1276625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONTEXT Urothelial carcinoma (UC) is common and highly recurrent. Diagnosis and follow-up involve invasive cystoscopies. OBJECTIVE To evaluate H19 RNA in urine cells as diagnostic tool for UC. MATERIALS AND METHODS RT-PCR analysis of urine samples from healthy volunteers and UC patients. RESULTS H19 RNA was unequivocally detected in the urine of 90.5% of patients and 25.9% of controls. H19 copies were three orders of magnitude higher in patients. Receiver operating characteristic analysis showed an area under the curve of 0.933. CONCLUSIONS This pilot study shows that urinary cell H19 is a highly sensitive test for UC and pending verification could transform patient management.
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Affiliation(s)
- Ilan Gielchinsky
- a Department of Urology , Hadassah - Hebrew University Medical Centre , Jerusalem , Israel
| | - Michal Gilon
- b Department of Biological Chemistry , Institute of Life Sciences, the Hebrew University , Jerusalem , Israel
| | - Rasha Abu-Lail
- b Department of Biological Chemistry , Institute of Life Sciences, the Hebrew University , Jerusalem , Israel
| | - Imad Matouk
- b Department of Biological Chemistry , Institute of Life Sciences, the Hebrew University , Jerusalem , Israel
| | - Avraham Hochberg
- b Department of Biological Chemistry , Institute of Life Sciences, the Hebrew University , Jerusalem , Israel
| | - Ofer N Gofrit
- a Department of Urology , Hadassah - Hebrew University Medical Centre , Jerusalem , Israel
| | - Iddo Z Ben-Dov
- c Nephrology and Hypertension Services , Hadassah - Hebrew University Medical Centre , Jerusalem , Israel
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Hidas G, Ben Chaim J, Udassin R, Graeb M, Gofrit ON, Zisk-Rony RY, Pode D, Duvdevani M, Yutkin V, Neheman A, Fruman A, Arbel D, Kopuler V, Armon Y, Landau EH. Timing of Orchidopexy for Undescended Testis in Israel: A Quality of Care Study. Isr Med Assoc J 2016; 18:697-700. [PMID: 28466623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Strong evidence suggests that in order to prevent irreversible testicular damage surgical correction (orchidopexy) for undescended testis (UDT) should be performed before the age of 1 year. OBJECTIVES To evaluate whether orchidopexy is delayed in our medical system, and if so, to explore the pattern of referral for orchidopexy as a possible contributing factor in such delays. METHODS We conducted a retrospective chart review of all children who underwent orchidopexy for UDT between 2003 and 2013 in our institution. We collected data on the age at surgery and the child's health insurance plan. We also surveyed pediatricians from around the country regarding their pattern of UDT patient referral to a pediatric urologist or surgeon for surgical correction. RESULTS A total of 813 children underwent orchidopexy in our institute during the study period. The median age at surgery was 1.49 years (range 0.5-13). Only 11% of the children underwent surgery under the age of 1 year, and 53% between the ages of 1 and 2 years. These findings were consistent throughout the years, with no difference between the four health insurance plans. Sixty-three pediatricians who participated in the survey reported that they referred children to surgery at a median age of 1 year (range 0.5-3 years). CONCLUSIONS Our results demonstrate delayed orchidopexy in our medical system. There is a need to improve awareness for early specialist consultation in order to facilitate earlier surgery and better care.
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Affiliation(s)
- Guy Hidas
- Pediatric Urology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Ben Chaim
- Pediatric Urology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Refael Udassin
- Department of Pediatric Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mary Graeb
- Pediatric Urology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Dov Pode
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mordechai Duvdevani
- Departments of Urology and Pediatric Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amos Neheman
- Pediatric Urology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amos Fruman
- Department of Pediatric Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dan Arbel
- Department of Pediatric Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Vadim Kopuler
- Department of Pediatric Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yaron Armon
- Department of Pediatric Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ezekiel H Landau
- Pediatric Urology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Fried E, Yutkin V, Pode D, Shapiro A, Hidas G, Gielchinsky I, Landau EH, Rosenberg S, Duvdevani M, Gofrit ON. [FACTORS PREDICTING OVERALL AND DISEASE-FREE SURVIVAL AFTER SURGERY FOR INVASIVE BLADDER CANCER]. Harefuah 2016; 155:660-664. [PMID: 28530072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the prognosis of patients who underwent surgery for invasive bladder cancer and to search for prognostic factors. METHODS The files of all the patients who underwent radical or partial cystectomy for invasive bladder cancer between 1992 and 2014 were reviewed. The effect of various prognostic factors was evaluated by uni- and multivariate analyses. RESULTS A total of 160 patients were included in the study and were followed for a median period of 25.5 months after surgery. The overall 2 years and 5 years survival rates were 70% and 61.2% respectively. The disease-free 2 years and 5 years survival rates were 64.4% and 61.9% respectively. The overall 2 years and 5 years survival rates of patients with disease limited to the bladder (≥T2N0) were 88.2% and 82.4% and of patients with disease extending beyond the bladder (≤T3N0) 56.5% and 45.7% respectively. Factors that were found to be significantly associated with overall survival were: TNM stage, co-morbidity (Charlson 6-11) and the tumor's diameter. No association was found between: disease presentation, smoking habits, positive cytology, the tumor being primary or secondary, variant histology, the presence of endophytic growth pattern, the presence of CIS, hydronephrosis, positive lymph nodes on pre-operative imaging, surgery type (radical or partial cystectomy) and adjuvant chemotherapy. CONCLUSIONS The survival rates of the locally treated patients match the reported rates in the literature. Tumors' T stage were found to be the strongest prognostic factor. Tumors' diameter was found to be an independent prognostic factor. This is reported here for the first time in the literature.
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Affiliation(s)
- Eli Fried
- Department of Urology, Hadassah University Hospital, Jerusalem
| | - Vladimir Yutkin
- Department of Urology, Hadassah University Hospital, Jerusalem
| | - Dov Pode
- Department of Urology, Hadassah University Hospital, Jerusalem
| | - Amos Shapiro
- Department of Urology, Hadassah University Hospital, Jerusalem
| | - Guy Hidas
- Department of Urology, Hadassah University Hospital, Jerusalem
| | | | | | - Shilo Rosenberg
- Department of Urology, Hadassah University Hospital, Jerusalem
| | | | - Ofer N Gofrit
- Department of Urology, Hadassah University Hospital, Jerusalem
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Sfoungaristos S, Mykoniatis I, Isid A, Lorber A, Gofrit ON, Hidas G, Landau EH, Pode D, Duvdevani M. Interobserver Reliability and Reproducibility of the Clinical Research Office of the Endourological Society Nomogram in Predicting Percutaneous Nephrolithotomy Results. Urology 2016; 97:56-60. [PMID: 27443463 DOI: 10.1016/j.urology.2016.07.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess interobserver reliability and reproducibility of the Clinical Research Office of the Endourological Society (CROES) nephrolithometric nomogram. PATIENTS AND METHODS Preoperative data and postoperative outcomes of 100 consecutive patients who underwent percutaneous nephrolithotomy were obtained. Patients' data were reviewed separately by 4 independent urologists of different academic level: an experienced attending endourologist, a graduated fellow, a young fellow, and a resident. Each rater adjusted a CROES score in all 100 patients. Interobserver reliability was analyzed by assessing intraclass correlation (ICC) and kappa coefficient among and between all different raters. RESULTS Assessment of interobserver reliability showed good or excellent agreement among all raters. Moderate agreement was only found between the raters for the "presence of staghorn" score. ICCs among all raters expressed excellent levels for each independent CROES parameter and reached great statistical significance. The highest correlation was noticed for "stone burden" in contrast to "presence of staghorn" parameter that showed the lowest. ICC for the final CROES score revealed good to excellent agreement among all raters and all pairs of raters. CONCLUSION CROES nephrolithometry is a reproducible nomogram. Reproducible results were obtained within a single institution by multiple reviewers of varying experience within a short period of time after undergoing standardized training.
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Affiliation(s)
- Stavros Sfoungaristos
- Department of Urology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel.
| | - Ioannis Mykoniatis
- 1st Department of Urology, G. Gennimatas Hospital, Aristotle University, Thessaloniki, Greece
| | - Ayman Isid
- Department of Urology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
| | - Amitay Lorber
- Department of Urology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
| | - Ezekiel H Landau
- Department of Urology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
| | - Dov Pode
- Department of Urology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
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Gofrit ON, Orevi M. Diagnostic Challenges of Kidney Cancer: A Systematic Review of the Role of Positron Emission Tomography-Computerized Tomography. J Urol 2016; 196:648-57. [PMID: 27140072 DOI: 10.1016/j.juro.2016.02.2992] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Positron emission tomography-computerized tomography is a leading imaging modality for many types of solid tumors. The ability to characterize molecular processes noninvasively during a relatively fast whole-body scan is the major advantage of this technology. We reviewed the literature in an attempt to clarify the usefulness of positron emission tomography-computerized tomography in patients with a renal mass. MATERIALS AND METHODS We searched PubMed® for articles published from 2004 through September 2015 using the keywords "renal," "kidney," "mass," "tumor," "cancer," and "PET/CT." RESULTS A total of 158 relevant articles were included in the review. Most diagnostic studies used (18)F-fluorodeoxyglucose, a marker of glucose metabolism, as the radiotracer. The results were substandard, with sensitivity rates in the range of 31.5% to 77% for diagnosis of renal cell carcinomas. There were higher success rates for diagnosis of clear cell carcinomas. Carbonic anhydrase IX is an enzyme expressed in 95% of clear cell carcinomas but not in normal renal tissue or in benign or nonclear cell malignancies. A chimeric mouse-human antibody to carbonic anhydrase IX labeled with (124)I-girentuximab was demonstrated to diagnose clear cell tumors with sensitivity of 86.2% and specificity of 85.9%. For diagnosis of metastases positron emission tomography-computerized tomography with (18)F-fluorodeoxyglucose was observed to be more accurate than computerized tomography alone (94% vs 89%). Studies with other tracers also reveal encouraging results. Positron emission tomography-computerized tomography holds great promise in predicting prognosis and response to tyrosine kinase inhibitors. Current tyrosine kinase inhibitor treatments usually induce only mild lesion shrinkage. Thus, assessment of response based on changes in size of metastases is insufficient. Low (18)F-fluorodeoxyglucose uptake before treatment and decreased uptake after 2 cycles of treatment are associated with better survival. Using labeled medications as radiotracers before actual treatment may assist in selection of the most effective medication for a specific patient. CONCLUSIONS Positron emission tomography-computerized tomography with (18)F-fluorodeoxyglucose currently has lower sensitivity compared to enhanced computerized tomography for diagnosis of primary renal masses but better sensitivity for diagnosis of metastases. Predicting and monitoring response to targeted therapy could direct the clinician toward drug selection or modification during therapy. The possibility of treating patients with advanced renal cell carcinoma with (124)I-girentuximab attached to (177)Lu, a strong β-emitter, is investigated.
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Affiliation(s)
- Ofer N Gofrit
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Marina Orevi
- Department of Nuclear Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Gielchinsky I, Suraqui E, Hidas G, Zuaiter M, Landau EH, Simon A, Duvdevani M, Gofrit ON, Pode D, Rosenberg S. Pregnancy Rates after Testicular Torsion. J Urol 2016; 196:852-5. [PMID: 27117442 DOI: 10.1016/j.juro.2016.04.066] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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] [Accepted: 04/01/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To our knowledge the effect of testicular torsion on the pregnancy rate is unknown. In this study we focused on the pregnancy rate, which is the ultimate index of fertility status. MATERIALS AND METHODS We reviewed the records of 273 patients who presented to our emergency room with testicular torsion between 1994 and 2014. Study inclusion criteria included being in a relationship with the intent to conceive for at least 1 year, age greater than 25 years and a normal contralateral testis. Patients with primary infertility, those who were unwilling to participate or unreachable and those with a history of undescended testis and/or varicocele were excluded from analysis. Patients were contacted by telephone and interviewed according to a standardized questionnaire. Pregnancy rates in the orchiopexy and orchiectomy groups were compared to each other and to the accepted pregnancy rate in the literature. RESULTS A total of 63 patients met study inclusion criteria, including 41 and 22 in the orchiopexy and orchiectomy groups, respectively. The pregnancy rate in the orchiopexy and orchiectomy groups was 90.2% and 90.9%, respectively (p = 1.0). The accepted pregnancy rate in the general population is 82% to 92%. Mean ± SD time to pregnancy in the orchiopexy and orchiectomy groups was 6.6 ± 5.50 and 7.2 ± 5.4 months, respectively (p = 0.27). CONCLUSIONS Several studies suggest decreased fertility potential in patients with a history of testicular torsion. However, in the current study in couples in which the male had a history of testicular torsion the pregnancy rate and the interval to pregnancy were within the accepted range of the general population.
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Affiliation(s)
- Ilan Gielchinsky
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Efrat Suraqui
- Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mohammad Zuaiter
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ezekial H Landau
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Alexander Simon
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dov Pode
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shilo Rosenberg
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Rosenberg S, Gielchinsky I, Suraqui E, Hidas G, Landau EH, Simon A, Yutkin V, Duvdevani M, Gofrit ON, Pode D. MP91-14 PREGNANCY RATES IN COUPLES WITH A MALE HISTORY OF UNILATERAL TESTICULAR TORSION. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2601] [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: 11/29/2022]
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Gofrit ON, Yutkin V, Shapiro A, Pizov G, Zorn KC, Hidas G, Gielchinsky I, Duvdevani M, Landau EH, Pode D. The Response of Variant Histology Bladder Cancer to Intravesical Immunotherapy Compared to Conventional Cancer. Front Oncol 2016; 6:43. [PMID: 27014622 PMCID: PMC4791377 DOI: 10.3389/fonc.2016.00043] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 07/02/2015] [Accepted: 02/12/2016] [Indexed: 11/18/2022] Open
Abstract
Background High-grade urothelial carcinomas (UCs) often show foci of variant differentiation. There is limited information in the literature about the response of these variant urothelial tumors to immunotherapy with bacillus Calmette–Guerin (BCG). We compared the response, to treatment with BCG, of UC containing glandular, squamous, nested, and micropapillary types of differentiation to response of conventional non-muscle invasive high-grade UC. Methods A total of 100 patients were diagnosed with variant histology urothelial cancer between June 1995 and December 2013. Forty-one patients with Ta or T1, confirmed by second look biopsies, received immunotherapy with BCG. Fourteen patients in this group were diagnosed with micropapillary differentiation, 13 patients with squamous differentiation, 9 patients with glandular differentiation, and 7 patients with nested variants. The control group included 140 patients with conventional high-grade UC. Both groups have been treated and followed similarly. Findings Patients with variant tumors had similar clinical features to patients with conventional disease, including age, male to female ratio, stage, the presence of Tis, and median follow-up. Patients with variant tumors had a significantly worse prognosis compared to patients with conventional high-grade UC, including 5-year recurrence-free survival (63.5 Vs. 71.5%, p = 0.05), 5-year progression (≥T2)-free survival (60 Vs. 82.5%, p = 0.002), 5-year disease-specific survival (73 Vs. 92.5%, p = 0.0004), and overall survival (66 Vs. 89.5%, 0.05). Interpretation A patient with variant bladder cancer treated with intravesical immunotherapy has a 27% chance of dying from this disease within 5 years compared to 7.5% chance for a patient with conventional high-grade UC.
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Affiliation(s)
- Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Amos Shapiro
- Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Galina Pizov
- Department of Pathology, Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Kevin C Zorn
- Section of Urology, Department of Surgery , Montreal, QC , Canada
| | - Guy Hidas
- Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Ilan Gielchinsky
- Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ezekiel H Landau
- Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Dov Pode
- Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem , Israel
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