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McArthur R, Kommu SS. Re: Subcentimeter Pulmonary Nodules are Not Associated with Disease Progression in Patients with Renal Cell Carcinoma: R. Mano, E. Vertosick, A. I. Sankin, M. S. Chevinsky, Y. Larish, C. D. Jakubowski, A. M. Hötker, A. A. Hakimi, D. D. Sjoberg, O. Akin and P. Russo J Urol 2015;193:776-782. J Urol 2015; 194:851; discussion 852. [PMID: 26044109 DOI: 10.1016/j.juro.2015.03.129] [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] [Accepted: 03/28/2015] [Indexed: 11/30/2022]
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Kommu SS, McArthur R, Emara AM, Reddy UD, Anderson CJ, Barber NJ, Persad RA, Eden CG. Current Status of Hemostatic Agents and Sealants in Urologic Surgical Practice. Rev Urol 2015; 17:150-159. [PMID: 26543429 PMCID: PMC4633658] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
There has been a recent and near exponential increase in the use of hemostatic agents and sealants to supplement the rapidly evolving methods in the surgical management of urologic patients. This article reviews the use of hemostatic agents and sealants in current urologic practice.
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Affiliation(s)
| | | | | | - Utsav D Reddy
- Frimley Park Hospitals NHS Foundation Trust, Frimley, United Kingdom
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Emara AM, Kommu SS, Hindley RG, Barber NJ. Robot-assisted partial nephrectomy vs laparoscopic cryoablation for the small renal mass: redefining the minimally invasive ‘gold standard’. BJU Int 2013; 113:92-9. [DOI: 10.1111/bju.12252] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Amr M. Emara
- Department of Urology; Frimley Park Hospital NHS Foundation Trust; Camberley UK
| | - Sashi S. Kommu
- Department of Urology; Frimley Park Hospital NHS Foundation Trust; Camberley UK
| | - Richard G. Hindley
- Department of Urology; Frimley Park Hospital NHS Foundation Trust; Camberley UK
| | - Neil J. Barber
- Department of Urology; Frimley Park Hospital NHS Foundation Trust; Camberley UK
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Parker SG, Kommu SS. Post-intravesical BCG epididymo-orchitis: Case report and a review of the literature. Int J Surg Case Rep 2013; 4:768-70. [PMID: 23856256 DOI: 10.1016/j.ijscr.2013.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/12/2013] [Accepted: 05/26/2013] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Bladder cancer is a significant epidemiological disease. It is managed by primary resection and on-going surveillance for recurrent disease. Intravesical BCG therapy is used in superficial carcinomas to lower the incidence of recurrence and prolong the time to recurrence. BCG therapy is not without its rare but serious side effects. PRESENTATION OF CASE A 75-year-old man presented to the urologist with right testicular pain, after four previous TURBT operations, two courses of intravesical BCG therapy and one STAT dose of intravesical mitomycin. The patient's USS testis showed hypoechoic lesions in the right testis. An orchiectomy was carried out due to the possibility of the USS showing a malignancy. Histology confirmed BCG epididymo-orchitis. DISCUSSION This patient presented with testicular pain fifteen months after the cessation of BCG therapy. Clinicians need to be aware of the potentially long dormancy periods for BCG infections, and their complications, as well as the acute infective BCG presentations. The literature is reviewed and shows the wide range of infective BCG presentations from acute disseminated sepsis to insidious focal infections such as parotiditis and discitis. CONCLUSION This case report demonstrates that due to the delayed and gradual onset of symptoms, BCG infections are difficult to diagnose. The report and the review remind surgeons to keep BCG infection amongst their differentials when treating patients who present after BCG therapy.
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Affiliation(s)
- S G Parker
- Princess Royal University Hospital, Bromley BR6 8ND, UK.
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Kommu SS, Emara AM, James P, Finnigan T, Cartlidge D, Chakravarti A, Golash A, Luscombe CJ, Nair, for the STILUS Academic Resea MA. An Objective Scoring System for Laparoscopic Nephrectomy. J Endourol 2011; 25:1497-502. [DOI: 10.1089/end.2010.0659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sashi S. Kommu
- STILUS Academic Research Group (SARG) Section of The Surgical Trainees Interested in Laparoscopic and Robotic Urological Surgery Group. London, United Kingdom
| | - Amr M. Emara
- STILUS Academic Research Group (SARG) Section of The Surgical Trainees Interested in Laparoscopic and Robotic Urological Surgery Group. London, United Kingdom
| | - Philip James
- STILUS Academic Research Group (SARG) Section of The Surgical Trainees Interested in Laparoscopic and Robotic Urological Surgery Group. London, United Kingdom
| | - Thomas Finnigan
- STILUS Academic Research Group (SARG) Section of The Surgical Trainees Interested in Laparoscopic and Robotic Urological Surgery Group. London, United Kingdom
| | - David Cartlidge
- STILUS Academic Research Group (SARG) Section of The Surgical Trainees Interested in Laparoscopic and Robotic Urological Surgery Group. London, United Kingdom
| | - Aniruddha Chakravarti
- STILUS Academic Research Group (SARG) Section of The Surgical Trainees Interested in Laparoscopic and Robotic Urological Surgery Group. London, United Kingdom
| | - Anurag Golash
- STILUS Academic Research Group (SARG) Section of The Surgical Trainees Interested in Laparoscopic and Robotic Urological Surgery Group. London, United Kingdom
| | - Christopher J. Luscombe
- STILUS Academic Research Group (SARG) Section of The Surgical Trainees Interested in Laparoscopic and Robotic Urological Surgery Group. London, United Kingdom
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Abstract
BACKGROUND: Laparoendoscopic single-site surgery (LESS) has recently been applied successfully in the performance of a host of surgical procedures. Preliminary consensus from the experts is that this mode of surgery is technically challenging and requires expertise. The transition from trainee to practicing surgeon, especially in complex procedures with challenging learning curves, takes time and mentor-guided nurturing. However, the trainee needs to use platforms of training to gain the skills that are deemed necessary for undertaking the live human case. OBJECTIVE: This article aims to demonstrate a step-by-step means of how to acquire the necessary instrumentation and build a training model for practicing steeplechase exercises in LESS for urological surgeons and trainees. The tool built as a result of this could set the platform for performance of basic and advanced skills uptake using conventional, bent and articulated instruments. A preliminary construct validity of the platform was conducted. MATERIALS AND METHODS: A box model was fitted with an R-Port™ and camera. Articulated and conventional instruments were used to demonstrate basic exercises (e.g. glove pattern cutting, loop stacking and suturing) and advanced exercises (e.g. pyeloplasty). The validation included medical students (M), final year laparoscopic fellows (F) and experienced consultant laparoscopic surgeons (C) with at least 50 LESS cases experience in total, were tested on eight basic skill tasks (S) including manipulation of the flexible cystoscope (S1), hand eye coordination (S2), cutting with flexible scissors (S3), grasping with flexible needle holders (S4), two-handed maneuvers (S5), object translocation (S6), cross hand suturing with flexible instruments (S7) and conduction of an ex-vivo pyeloplasty. RESULTS: The successful application of the box model was demonstrated by trainee based exercises. The cost of the kit with circulated materials was less than £150 (Pounds Sterling). The noncamera handling skills (S2–S8) of the ex-vivo training model for LESS can distinguish between laparoscopically naïve fellows and experienced consultants in LESS. S4–S8 showed the highest level of construct validity, by accurately differentiating among the M, F and C groups. CONCLUSION: LESS requires a significant amount of skill and has an inherent steep learning curve. The ex-vivo model described provides a cost-effective means that a trainee or training unit can build for optimising preliminary skill acquisition in LESS for urological trainees. It has construct validity in several tasks. Such platform models should be tested further with an emphasis on rapid sequence uptake of optimal skills, prior to undertaking the live human case.
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Affiliation(s)
- Sashi S Kommu
- Department of Urology, University Hospital North Staffordshire, Stoke-on-Trent, U.K
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Kommu SS, Somani B, James P, Finnigan T, Cartlidge D, Zafar H, Chakravarti A. 1493 PERIPHERAL VISUAL CUE SUPPLEMENTED TARGET TASK FOCUS – ADVANCED EXERCISE REGIME FOR GAZE CONTROL IN LAPAROSCOPIC UROLOGICAL SURGERY. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1451] [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]
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Somani B, Kommu SS, Cohen N, McClinton S. 1936 OUTCOME OF URETEROSCOPY FOR STONE DISEASE IN PATIENTS WITH BLEEDING DIATHESIS: RESULTS FROM A SYSTEMATIC REVIEW OF LITERATURE. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.2117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
With the increasing prevalence of prostate cancer and evolving methods for the definitive treatment of OCPCa, health economic analyses will be critically important, albeit difficult to carry out. Preliminary studies point to RPP as the most cost-effective treatment for OCPCa. The quickest postoperative recovery, in experienced hands, occurs in RARP and RPP, with ORPP having a slightly, but statistically in significant, shorter hospital stay. It should be stressed that initial treatment costs are not the only important factor in healthcare costs. Readmission for early and late complications and the loss of productivity resulting from variation in time to return to work, need also to be considered. Loss of productivity may also vary in cost between different institutions and countries depending upon the proportion of patients employed. Further large-scale multicentre studies are necessary to assess this.
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Affiliation(s)
- Sashi S Kommu
- Urology Centre, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Kumar P, Kommu SS, Challacombe BJ, Dasgup-Ta P. Laparoendoscopic single-site surgery (LESS) prostatectomy--robotic and conventional approach. MINERVA UROL NEFROL 2010; 62:425-430. [PMID: 20944542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This review deals with the preliminary advances in laparoendoscopic single-site surgery (LESS) as applied to prostate surgery including the simple and radical prostatectomy approaches both robot assisted and robot independent. It analyzed current publications based on animal models and human patients. The authors searched published reports in major urological meeting abstracts, Embase and Medline (1966 to 25 August 2008), with no language restrictions. Key word searches included: "prostate", "prostatectomy", "radical", "surgery", "robot", "da Vinci", "scarless", "scar free", "single port/trocar/incision", "intraumbilical", and "transumbilical", "natural orifice transluminal endoscopic surgery" (NOTES), "SILS", "OPUS" and "LESS". The role of LESS prostatectomy with or without robotic aid has been proven to be technically feasible; however, it is important to note that the approach has significant technical challenges. The da Vinci Surgical System allows some of these ergonomic challenges to be obviated with potentially reduced instrument clash, reduced surgeon and assistant fatigue and better precision with target tasking such as performing the vesicourethral anastomosis. Preliminary consensus regarding oncological control is not yet available on a large scale. Currently, no specific advantage of the LESS approach has been convincingly proven apart from the intuitive improvement in cosmesis. The development, and soon to be launched, flexible robotic platforms towards the end of 2010 will usher with it further refinements making the LESS approach to radical prostatectomy potentially more feasible ergonomically and could see the approach gain a more widespread acceptance.
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Affiliation(s)
- P Kumar
- Urology Centre, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
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Kommu SS, Dasgupta R, Rané A. Psychosocial and marketing challenges for Natural Orifice Transluminal Endoscopic Surgery and Laparoendoscopic Single-site Surgery. BJU Int 2010; 106:928-33. [PMID: 20883247 DOI: 10.1111/j.1464-410x.2010.09672.x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sashi S Kommu
- The Urology Centre, Guy's and St Thomas' NHS Foundation Trust, London Department of Urology, East Surrey Hospital, Redhill, Surrey, UK
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Kommu SS. Hydroflotation magnetic-aided endolumenal navigation-preliminary platform in ex-vivo setting for the next paradigm in minimally invasive urologic surgery. J Endourol 2010; 24:1161-4. [PMID: 20624085 DOI: 10.1089/end.2010.0134] [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: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Navigation of endolumenal devices, such as image rendering capsules, have been described for diagnostic purposes in the animal, and more recently, human models. In urology, the ureter is a prime lumenal structure that often needs to be explored for diagnostic and therapeutic purposes. A novel device using a flotation mechanism in a water-filled environment was developed and its navigation achieved with magnetic-aided guidance. The device was tested for propulsion and real-time control in the ex-vivo setting. MATERIALS AND METHODS An endolumenal bionic worm (EBW) with a magnetic core was developed and introduced into synthetic lumens (SL) and supermarket chicken lumenal structures. The latter involved the gastrointestinal lumenal tissue of supermarket chickens; ie, the ex-vivo equivalent of a ureteral substitute lumen (USL). Navigation was graded by achievement of the EBW in propulsion to premarked sites, ability to remain static when necessary, and trauma to the USL. The structures were observed under the microscope for breech after the exercises. Navigation was observed in 10 SLs and 10 USLs. RESULTS The EBW was successfully steered using the magnetic guidance system with hydroflotation. Observation of endolumenal surfaces did not reveal evidence of trauma in either model. CONCLUSION Hydroflotation magnetic-aided endolumenal navigation (HMAEN) of a microdevice was achieved endolumenally with targeted real-time control and with no observed trauma to the structures. HMAEN could potentially be used to guide devices like the EBW to permit diagnostic and therapeutic ureteroscopy including biopsy of ureteral and renal pelvis lesions, thus ushering in the platform for the next paradigm in endolumenal urologic procedures.
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Affiliation(s)
- Sashi S Kommu
- Section of Laparoscopic Urological Surgery, Department of Urology, The University Hospital, North Staffordshire NHS Trust, Stoke-on-Trent, United Kingdom.
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Kommu SS, Hashim Z, Cartlidge D, Finnigan T, Golash A, Luscombe CJ, Liu S, Saxby MF, Emtage JB. Bladder Sphincter Verge Urethral Pressure Reduces Pain Scores in Men Undergoing First Ever Flexible Cystoscopy. Int J Surg 2010. [DOI: 10.1016/j.ijsu.2010.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rane A, Ahmed S, Kommu SS, Anderson CJ, Rimington PD. Single-port ‘scarless’ laparoscopic nephrectomies: the United Kingdom experience. BJU Int 2009; 104:230-3. [DOI: 10.1111/j.1464-410x.2009.08399.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sooriakumaran P, Kommu SS, Cooke J, Gordon S, Brown C, Eddy B, Rimington PD, Rane A. Evaluation of a commercial vascular clip: risk factors and predictors of failure fromin vitrostudies. BJU Int 2009; 103:1410-2. [DOI: 10.1111/j.1464-410x.2008.08211.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
The quest to make minimally invasive techniques even more 'minimal' has generated a drive within the surgical community to explore novel ways of achieving this. This has led to surgeons attempting to either decrease the number of trocars placed through the abdominal wall or eliminate them completely. This led to the evolution of several approaches, including natural orifice translumenal endoscopic surgery (NOTES), single incision laparoscopic surgery (SILS), single port access surgery and one port umbilical surgery (OPUS) or E-NOTES. The most recent consensus on nomenclature involves the term laparoendoscopic single-site surgery (LESS). The transition from multiple port access surgery to single port access surgery represents a paradigm shift in reconstructive and extirpative surgery and is a testament to the recent advances in surgical technology. Successful LESS involves the use of articulating or bent instrumentation via a single large-caliber trocar or small, adjacent trocars. Advances in technology have led to the development of new laparoscopic access ports (R-Port and Quadriport by Advanced Surgical Concepts, Wicklow, Ireland; and Uni-X Single Port, PNavel Systems, Cleveland, OH, USA) capable of permitting several instruments to be inserted through multiple channels incorporated in, and as part of, a larger single port. The development of articulating and bent instrumentation permits triangulation intracorporeally despite the close proximity of several instruments via a single port. Currently, commercially available instruments can be broadly divided into articulating laparoscopic graspers and shears (Real Hand, Novare Surgical Systems, Cupertino, CA, USA; and Autonomy Laparo-angle, Cambridge Endo, Framingham, MA, USA), endoshears (Cambridge Endo), and laparoscopic needle drivers (Cambridge Endo). Despite the preliminary optimistic results in the outcomes of LESS, an experienced laparoscopic skill set is essential for the safe and effective completion of surgery.
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Affiliation(s)
- Sashi S Kommu
- Department of Urology, University Hospital North Staffordshire, Newcastle Road, Stoke-on-Trent, West Midlands Deanery, ST4 6QG, UK.
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Rane A, Dasgupta R, Kommu SS, Grange P, Rimington P. SOLO SURGEON LAPARO ENDOSCOPIC SINGLE SITE LAPAROSCOPIC SURGERY (SS-LESS): INITIAL UROLOGIC EXPERIENCE. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61498-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chakravarti A, Kommu SS, Luscombe CJ, Golash A. DAY CASE LAPAROSCOPIC PYELOPLASTY - A SAFE AND FEASIBLE OPTION. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61308-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rane A, Kommu SS, Ahmed S, Anderson C, Rimington P. LESS (LAPARO-ENDOSCOPIC SINGLE SITE SURGERY) IS MORE: ‘SCARLESS SURGERY' IS A REALITY FOR EXTIRPATIVE PROCEDURES. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61219-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sooriakumaran P, Kommu SS, Anderson C, Rane A. Port-site metastasis after laparoscopic surgery: what causes them and what can be done to reduce their incidence? BJU Int 2009; 103:1150-3. [PMID: 19220268 DOI: 10.1111/j.1464-410x.2009.08363.x] [Citation(s) in RCA: 8] [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] [Indexed: 12/22/2022]
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Kommu SS, O'Neill C, Kommu A, Rane A, WPU-SIMISAD. INDICATORS OF OPTIMAL LAPAROSCOPIC UROLOGICAL TRAINING PROGRAMMES – PRELIMINARY RESULTS OF A TRAINER/TRAINEE BASED RANK SCORING SYSTEM. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61828-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kommu SS, Kommu KK, Pillai R, Valliattu A, Kannanchery RC, Forde A, Lewis IE, Dickinson AJ, Mumtaz FH, Ghulam N, Eden CG, Rane A. THE IMPACT OF A DUAL-FOCUS MONITOR SYSTEM ON INITIAL LAPAROSCOPIC SKILL ACQUISITION – PRELIMINARY RESULTS USING THE RADICAL PROSTATECTOMY MODEL. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61932-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
We reviewed the preliminary advances in laparo-endoscopic single-site surgery (LESS) as applied to renal surgery, and analyzed current publications based on animal models and human patients. We searched published reports in major urological meeting abstracts, Embase and Medline (1966 to 25 August 2008), with no language restrictions. Keyword searches included: 'scarless', 'scar free', 'single port/trocar/incision', 'intraumbilical', and 'transumbilical', 'natural orifice transluminal endoscopic surgery' (NOTES), 'SILS', 'OPUS' and 'LESS'. The lessons learnt from the studies using the porcine model are that further advances in instrumentation are essential to achieve optimum results, and that testing survival in animals is also necessary to further expand the NOTES and LESS techniques. Further advances in instrument technology together with increasing experience in NOTES and LESS approaches have driven the transition from porcine models to human patients. In the latter, studies show that the techniques are feasible provided that both optimal surgical technical expertise with advanced skills, and optimal instrumentation, are available. The next step towards minimal access/minimally invasive urological surgery is NOTES and LESS. It is inevitable that LESS will be extended to involve more complex and technically demanding procedures such as laparoscopic radical prostatectomy and partial nephrectomy.
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Affiliation(s)
- Sashi S Kommu
- Department of Urology, City General Hospital, The University Hospital North Staffordshire, Stoke-on-Trent, UK.
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Kommu SS, Sooriakumaran P, Eddy B, Cooke J, Brown C, Rimington P, Anderson C, Rane A. Factors leading to failure of the self-locking vascular clips: preliminary findings of the WPU-SIMISAD Group. BJU Int 2007; 101:129. [PMID: 18086104 DOI: 10.1111/j.1464-410x.2007.07380_4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE To test the clinical efficacy of the StoneBreaker (LMA Urology, Gland, Switzerland), a novel device which is much more compact and ergonomic than other current intracorporeal pneumatic lithotripters, and more powerful, generating contact pressures of up to 2.9 MPa, thereby enabling better pneumatic fragmentation and removal of stones during percutaneous nephrostolithotomy (PCNL), ureteroscopic stone fragmentation (USF) and vesical stone lithotripsy (VL). PATIENTS AND METHODS We prospectively evaluated 102 patients, comprising 49 PCNLs, 48 USFs and 5 VLs, treated using the StoneBreaker. The stone size, position, number of shocks required to fragment the stone to effect complete clearance, and degree of retropulsion were documented in each case; any evidence of urothelial trauma was noted. RESULTS All stones were satisfactorily fragmented and all patients rendered stone-free. Very few shocks were required, and documented retropulsion was minor. There was no evidence of consequential urothelial trauma at the end of any procedure. CONCLUSION The StoneBreaker appears to be a safe, effective, robust and compact device for intracorporeal lithotripsy.
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Affiliation(s)
- Abhay Rané
- Department of Urology, East Surrey Hosptial, Redhill, Surrey, UK.
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Kommu SS, Mumtaz FH, Rane A, Persad RA, Eden CG. Multifocal nonmetastatic renal cell carcinoma in laparoscopic and open partial nephrectomy. BJU Int 2007; 100:219. [PMID: 17552971 DOI: 10.1111/j.1464-410x.2007.07026_5.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hellawell GO, Kommu SS, Mumtaz F. MODERNISING UROLOGICAL CAREERS: THE ?NUMBERS GAME? BJU Int 2007; 99:969-71. [PMID: 17233809 DOI: 10.1111/j.1464-410x.2006.06692.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND AND PURPOSE Laparoscopic urologic surgery (LUS) is one of the fastest growing subspecialties in the surgical world. The procedures require technical expertise and finesse; unlike their open counterparts, there is significant limitation in the margin for error. Various ethical, medicolegal, and health economy demands have made training in laparoscopic urologic surgery challenging. Whereas several groups have sought solutions through models, there remains a lack of consensus on the optimal training program. We review the current LUS programs with a conscious effort to decipher the basic tenets of an optimal training program and propose training models based on published evidence, in conjunction with current trends in LUS. METHODS A literature search of MEDLINE, Pubmed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Google Scholar was performed, seeking publications from January 1970 to July 2006 on laparoscopic surgical training pertaining to urology. Additionally, we looked at pertinent abstracts of the annual meetings of the American Urological Association, the European Association of Urology, and the World Congress of Endourology for the period January 1996 to and inclusive of August 2006. RESULTS AND CONCLUSIONS To date, no study has documented a global consensus on optimal LUS training programs. Our search identified several models, some of which were applied successfully in the form of minifellowships. There remain no clear guidelines on the optimum LUS training program. The optimal program may need to be tailored to individual units, based on resources (this includes country-specific health economics, mentor availability, and caseload). Further studies are needed to help elucidate how individual programs can be initiated with a global minimum standard applicable to all training programs.
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Affiliation(s)
- Sashi S Kommu
- Department of Urology, Derriford Hospital, Plymouth, Devon, UK
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Affiliation(s)
- Sashi S Kommu
- St. Anthony's Hospital, Department of Urology, East Surrey Hospital, Redhill, UK.
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Abstract
Current available treatment options for erectile dysfunction (ED) are effective but not without failure and/or side effects. Although the development of phosphodiesterase type 5 (PDE5) inhibitors (i.e. sildenafil, tadalafil and vardenafil) has revolutionized the treatment of ED, these oral medications require on-demand access and are not as effective in treating ED related to diabetic, post-prostatectomy and severe veno-occlusive disease states. Improvement in the treatment of ED is dependent on understanding the regulation of human corporal smooth muscle tone and on the identification of relevant molecular targets. Future ED therapies might consider the application of molecular technologies such as gene therapy. As a potential therapeutic tool, gene therapy might provide an effective and specific means for altering intracavernous pressure "on demand" without affecting resting penile function. However, the safety of gene therapy remains a major hurdle to overcome before being accepted as a mainstream treatment for ED. Gene therapy aims to cure the underlying conditions in ED, including fibrosis. Furthermore, gene therapy might help prolong the efficacy of the PDE5 inhibitors by improving penile nitric oxide bioactivity. It is feasible to apply gene therapy to the penis because of its location and accessibility, low penile circulatory flow in the flaccid state and the presence of endothelial lined (lacunar) spaces. This review provides a brief insight of the current role of gene therapy in the management of ED.
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Affiliation(s)
- David H W Lau
- Department of Urology, Royal Free Hospital and University College Medical School, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2QG, UK.
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Affiliation(s)
- Sashi S Kommu
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
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Mumtaz FH, Kommu SS, Siddiqui E, Le Roux PJ, Hellawell G, Hemal AK. Minimally Invasive Treatment of Ureteropelvic Junction Obstruction: Optimizing Outcomes with Concomitant Cost Reduction. J Endourol 2006; 20:663-8. [PMID: 16999621 DOI: 10.1089/end.2006.20.663] [Citation(s) in RCA: 5] [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] [Indexed: 11/13/2022] Open
Abstract
With the seemingly exponential increase in the use of minimally invasive techniques in urology, cost-benefit comparisons will continue to play a major part in establishing services and in improving those that already exist. The management of ureteropelvic junction obstruction is a focus of significant attention. An effective way of optimizing the economy of management is to understand the implications in terms of the success of each mode of treatment. Subsequently, costing models should be developed and applied in large-scale multicenter studies with the aid of health economists. The long-term benefits can then be assessed by also including patient's perceived quality of life. Economic assessment will not be enough to promote cost-effective practices. The take-up of any techniques will always be influenced not only by patient preference and surgeon expertise but also, perhaps ironically, by the way hospitals and surgeons are remunerated. In addition, the impact of the time taken to train a surgeon to carry out laparoscopic dismembered pyeloplasty competently may play a significant role. Until these issues are resolved, definitive recommendation for the treatment of ureteropelvic junction obstruction will continue to be made on an individual basis.
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Affiliation(s)
- Faiz H Mumtaz
- Barnet and Chase Farm NHS Trust, Chase Farm Hospital, Enfield, UK.
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Affiliation(s)
- Sashi S Kommu
- The Institute of Cancer Research, Urology and Cancer Genetics, London, UK.
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Kommu SS. Re: A Novel Computer Based Expert Decision Making Model for Prostate Cancer Disease Management. J Urol 2006; 175:1961-2; author reply 1962. [PMID: 16600807 DOI: 10.1016/s0022-5347(05)00962-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Indexed: 11/29/2022]
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Lau DH, Metcalfe MJ, Siddiqui EJ, Kommu SS, Mikhailidis DP, Thompson CS, Morgan RJ, Mumtaz FH. 1009: P2Y6 Receptor Mediates Corpus Cavernosal Relaxation via Non-Neuronal and Non-Nitric Oxide Dependent Mechanisms. J Urol 2006. [DOI: 10.1016/s0022-5347(18)33234-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kommu SS, Reiss S. Endotoxins in the prostatic secretions of chronic prostatitis patients: a need for further biomarkers through the use of proteomics. Asian J Androl 2006; 8:123-4. [PMID: 16372131 DOI: 10.1111/j.1745-7262.2006.00098.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Affiliation(s)
- Sashi S. Kommu
- Department of Urology; Royal Marsden Hospital; London, United Kingdom
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Kommu SS. Re: individualization of the biopsy protocol according to the prostate gland volume for prostate cancer detection. J Urol 2005; 174:2068; author reply 2068. [PMID: 16217404 DOI: 10.1097/00005392-200511000-00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kommu SS. Re: Laparoscopic retropubic simple prostatectomy. J Urol 2005; 174:1500; author reply 1500. [PMID: 16145488 DOI: 10.1097/01.ju.0000173139.30187.6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zaman ZR, Kommu SS, Watkin NA. Role of computed tomography with no contrast medium enhancement in predicting the outcome of extracorporeal shock wave lithotripsy for urinary calculi. BJU Int 2005; 96:685-6. [PMID: 16104934 DOI: 10.1111/j.1464-410x.2005.05788_2.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kommu SS, Lewis IE, Watkin NA, Emtage JB. A prospective randomized trial comparing transurethral prostatic resection and clean intermittent self-catheterization in men with chronic urinary retention. BJU Int 2005; 96:687. [PMID: 16104937 DOI: 10.1111/j.1464-410x.2005.05788_5.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hadway P, Pietrzak P, Kommu SS, Corbishley CM, Watkin NA. 728: Penile Preserving Surgery for Invasive Penile Cancer. The First 100 Cases from a UK Centre. J Urol 2005. [DOI: 10.1016/s0022-5347(18)35960-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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