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Eppler MB, Ganjavi C, Davis R, Sayegh AS, Hershenhouse JS, Mokhtar D, Knudsen JE, Tran J, Bhardwaj L, Shin JJS, Hemal S, Goldenberg MG, Miranda G, Sotelo R, Desai M, Gill I, Cacciamani GE. Criteria for enhancing reporting of perioperative transfusions in surgical and anaesthesiological studies. Br J Surg 2023; 110:1655-1658. [PMID: 37494634 DOI: 10.1093/bjs/znad235] [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: 04/06/2023] [Revised: 06/09/2023] [Accepted: 07/08/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Michael B Eppler
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Conner Ganjavi
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ryan Davis
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Aref S Sayegh
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jacob S Hershenhouse
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Daniel Mokhtar
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - J Everett Knudsen
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - John Tran
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lokesh Bhardwaj
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - John J S Shin
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sij Hemal
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mitchell G Goldenberg
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Gus Miranda
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Rene Sotelo
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mihir Desai
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Inderbir Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Kaneko M, Medina LG, Lenon MSL, Hemal S, Sayegh AS, Jadvar DS, Ramacciotti LS, Paralkar D, Cacciamani GE, Lebastchi AH, Salhia B, Aron M, Hopstone M, Duddalwar V, Palmer SL, Gill IS, Abreu AL. Transperineal vs transrectal magnetic resonance and ultrasound image fusion prostate biopsy: a pair-matched comparison. Sci Rep 2023; 13:13457. [PMID: 37596374 PMCID: PMC10439224 DOI: 10.1038/s41598-023-40371-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
The objective of this study was to compare transperineal (TP) versus transrectal (TR) magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion prostate biopsy (PBx). Consecutive men who underwent prostate MRI followed by a systematic biopsy. Additional target biopsies were performed from Prostate Imaging Reporting & Data System (PIRADS) 3-5 lesions. Men who underwent TP PBx were matched 1:2 with a synchronous cohort undergoing TR PBx by PSA, Prostate volume (PV) and PIRADS score. Endpoint of the study was the detection of clinically significant prostate cancer (CSPCa; Grade Group ≥ 2). Univariate and multivariable analyses were performed. Results were considered statistically significant if p < 0.05. Overall, 504 patients met the inclusion criteria. A total of 168 TP PBx were pair-matched to 336 TR PBx patients. Baseline demographics and imaging characteristics were similar between the groups. Per patient, the CSPCa detection was 2.1% vs 6.3% (p = 0.4) for PIRADS 1-2, and 59% vs 60% (p = 0.9) for PIRADS 3-5, on TP vs TR PBx, respectively. Per lesion, the CSPCa detection for PIRADS 3 (21% vs 16%; p = 0.4), PIRADS 4 (51% vs 44%; p = 0.8) and PIRADS 5 (76% vs 84%; p = 0.3) was similar for TP vs TR PBx, respectively. However, the TP PBx showed a longer maximum cancer core length (11 vs 9 mm; p = 0.02) and higher cancer core involvement (83% vs 65%; p < 0.001) than TR PBx. Independent predictors for CSPCa detection were age, PSA, PV, abnormal digital rectal examination findings, and PIRADS 3-5. Our study demonstrated transperineal MRI/TRUS fusion PBx provides similar CSPCa detection, with larger prostate cancer core length and percent of core involvement, than transrectal PBx.
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Affiliation(s)
- Masatomo Kaneko
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Luis G Medina
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Maria Sarah L Lenon
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sij Hemal
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Aref S Sayegh
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Donya S Jadvar
- Dornsife School of Letters and Science, University of Southern California, Los Angeles, CA, USA
| | - Lorenzo Storino Ramacciotti
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Divyangi Paralkar
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amir H Lebastchi
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Bodour Salhia
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Manju Aron
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michelle Hopstone
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Vinay Duddalwar
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Suzanne L Palmer
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Inderbir S Gill
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Andre Luis Abreu
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA.
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Abou Zeinab M, Ferguson E, Kaviani A, Tuna Beksac A, Covas Moschovas M, Morgantini L, Hemal S, Josehp J, Kim M, Crivellaro S, Patel V, Nix J, Kaouk J. Single-port extraperitoneal vs. transperitoneal robotic-assisted radical prostatectomy: A multi-institutional matched-pair comparison of perioperative outcomes. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02142-5] [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: 11/07/2022] Open
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4
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Sayegh AS, Eppler M, Ballon J, Hemal S, Goldenberg M, Sotelo R, Cacciamani GE. Strategies for Improving the Standardization of Perioperative Adverse Events in Surgery and Anesthesiology: “The Long Road from Assessment to Collection, Grading and Reporting”. J Clin Med 2022; 11:jcm11175115. [PMID: 36079044 PMCID: PMC9457420 DOI: 10.3390/jcm11175115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
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Beksac AT, Carbonara U, Abou Zeinab M, Meagher MF, Hemal S, Tafuri A, Tuderti G, Antonelli A, Autorino R, Simone G, Derweesh IH, Kaouk J. Redo Robotic Partial Nephrectomy for Recurrent Renal Tumors: A Multi-Institutional Analysis. J Endourol 2022; 36:1296-1301. [PMID: 35730123 DOI: 10.1089/end.2021.0954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION As the experience with robot assisted partial nephrectomy (RAPN) grows, the indications have expanded to incorporate previously operated ipsilateral kidneys with recurrent renal masses. We sought to analyze the outcomes of redo RAPN in patients with a recurrent renal mass. METHODS Using a multi-institutional series, the data of 72 patients who underwent RAPN for a recurrent renal mass between 2010 and 2020 were retrospectively analyzed. Patients with familial renal cell carcinoma and multiple renal tumors were excluded. Major complication defined by Clavien grade ≥3. The median follow-up was 28.5 months. Baseline demographics, clinical and tumor characteristics, perioperative and postoperative outcomes are reported. RESULTS Our cohort consisted of a combination of previous thermal ablation (19.6%), laparoscopic (19.6%), open (26.1%), and robotic (34.8%) partial nephrectomy. The median RENAL score was 8. Twenty percent had hilar tumors and 9.7% had a solitary kidney. RAPN was completed in all cases. Two cases (2.8%) were converted to open surgery. None of the cases were converted to radical nephrectomy intraoperatively. One patient underwent radical nephrectomy postoperatively due to bleeding. Transfusion rate was 5.9% and major complication rate was 8.3%. Median length of stay was 3 days. eGFR preservation was 78.7% at discharge and 90.8% at one-year follow-up. Positive surgical margin rate was 8.3%. Overall, distant recurrence was seen in 11 patients (15.3%), however, only one patient had local progression (1.4%). CONCLUSION In experienced hands, RAPN is an effective approach to treat select cases of locally recurrent renal masses with promising perioperative and functional outcomes. Patients should be carefully monitored for distant recurrence.
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Affiliation(s)
- Alp Tuna Beksac
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, 9500 Euclid Avenue Q10, Cleveland, Ohio, United States, 44195-0001;
| | - Umberto Carbonara
- Virginia Commonwealth University Health System, 6887, Department of Urology, 11200 E BROAD ST, RICHMOND, Richmond, Virginia, United States, 23233.,Università degli Studi di Bari Aldo Moro, 9295, Department of Urology, Bari, Puglia, Italy;
| | - Mahmoud Abou Zeinab
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, 9500 Euclid Ave, Cleveland, OH 44195, Cleveland, Ohio, United States, 44195;
| | - Margaret F Meagher
- University of California San Diego School of Medicine, 12220, Urology, La Jolla, California, United States;
| | - Sij Hemal
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | - Alessandro Tafuri
- University of Verona School of Medicine and Surgery, 60271, Dept of Urology University of Verona, Verona, Veneto, Italy.,University of Verona School of Medicine and Surgery, 60271, Urology, Verona, Veneto, Italy.,University of Verona School of Medicine and Surgery, 60271, Dept of Urology University of Verona, Verona, Veneto, Italy.,University of Verona School of Medicine and Surgery, 60271, Urology, Verona, Veneto, Italy;
| | | | - Alessandro Antonelli
- University of Verona School of Medicine and Surgery, 60271, Urology, Verona, Veneto, Italy;
| | - Riccardo Autorino
- Virginia Commonwealth University School of Medicine, 6886, Urology, Richmond, Virginia, United States;
| | - Giuseppe Simone
- Regina Elena, urology, Roma, Italy.,Regina Elena Institute, 18658, Urology, Roma, Lazio, Italy;
| | - Ithaar H Derweesh
- University of California San Diego School of Medicine, Department of Surgery/Division of Urology, Moores UCSD Cancer Center, 3855 Health Sciences Drive, Mail Code 0987, La Jolla, California, United States, 92093;
| | - Jihad Kaouk
- Cleveland Clinic Foundation, Glickman Urologic Institute, 9500 Euclid Ave, Cleveland, Ohio, United States, 44195;
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Aminsharifi A, Hemal S, Aram P, Abou Zeinab M, Beksac T, Kaouk J. The performance and optimum cutoff value for pelvic cavity index as a predictor of early continence after extraperitoneal single-port robotic radical prostatectomy: Role of pelvic anatomical characteristics. J Endourol 2022; 36:927-933. [PMID: 35166121 DOI: 10.1089/end.2021.0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the value of pelvic cavity index (PCI), as an objective pelvimetry feature, to predict operative time, margin status and early urine continence after extraperitoneal single-port robotic radical prostatectomy (RP). We sought to define an optimal cutoff point for PCI in predicting postoperative outcomes. METHODS Data on 94 patients who underwent extraperitoneal single-port robotic RP and had preoperative cross-sectional imaging were enrolled. PCI was calculated as (Pelvic inlet diameter×Pelvic outlet diameter)/(Pelvic depth). The predictive value of PCI on operative time, surgical margin status and 3-month urinary continence recovery was assessed using regression models. To report the optimum cutoff value, on ROC analysis, we calculated the performance of PCI cutoff points ranging from 5.56 to 10.80 cm by every 0.01 increment. RESULTS No significant associations were noted between clinical characteristics (including PCI) and operative time. Similarly, other than pathological stage, no clinical variables (including PCI) were predictive of positive surgical margin. However, a higher PCI was associated with a significantly higher rates of continence 3-month after surgery (OR 2.44 (1.75 - 5.33); p= 0.01). On ROC- analysis, a PCI cutoff value=8.21 cm yielded the best accuracy (AUC= 0.733, %95 CI 0.615-0.851; p=0.001). No association was noted between variables and 6-month continence rate. CONCLUSION Using a single-port robotic system, operative time, positive surgical margin rate and long-term continence after prostatectomy would be independent of bony pelvis cavity. However, a higher PCI is associated with a higher rate of early continence after the surgery. PCI at a cutoff of 8.21 cm has the optimum performance to predict postoperative urine continence recovery. If validated, this information may be helpful regarding patient counseling before single-port robotic RP.
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Affiliation(s)
- Alireza Aminsharifi
- Pennsylvania State University Department of Surgery, 328945, Urology, Hershey, Pennsylvania, United States;
| | | | | | - Mahmoud Abou Zeinab
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, 9500 Euclid Ave, Cleveland, OH 44195, Cleveland, Ohio, United States, 44195;
| | | | - Jihad Kaouk
- Cleveland Clinic Foundation, Glickman Urologic Institute, 9500 Euclid Ave, Cleveland, Ohio, United States, 44195;
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Beksac AT, Eltemamy M, Hemal S, Schwen Z, Lenfant L, Abou Zeinab M, Aminsharifi A, Kaouk J. Single Port Donor Nephrectomy Via Modified Pfannenstiel Incision: Initial Preclinical Experience in A Cadaveric Model and Description of Technique. J Endourol 2021; 36:183-187. [PMID: 34314234 DOI: 10.1089/end.2021.0408] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the surgical technique for the single port (SP) transperitoneal donor nephrectomy through a modified Pfannenstiel incision using the da Vinci SP surgical system (Intuitive Surgical, Sunnyvale, CA, USA) on a cadaver. PATIENTS & METHODS In a male cadaver, the SP surgical system was used to perform transperitoneal donor nephrectomy. A 3 cm modified Pfannenstiel incision was made. Through the incision GelPOINT mini (Applied Medical, Rancho Santa Margarita, CA, USA) was inserted. The floating docking technique was used. Through the gel port, the dedicated 25 mm multichannel port and a 12 mm assistant port were introduced. The surgical steps for donor nephrectomy were performed in the following order. 1) Mobilization of the colon, 2) Identification of psoas muscle, ureter, and the gonadal vein, 3) hilum dissection, 4) perirenal dissection, 5) stapling the renal artery and renal vein, 6) removal of the kidney through the enlarged incision. RESULTS Transperitoneal SP donor nephrectomy was completed without any complications or capsulotomy. Additional ports were not needed. The total operative time was 63 minutes and 54 seconds. A good-quality kidney was harvested. Renal artery length was 4 cm. CONCLUSION We demonstrated the feasibility of single-port transperitoneal donor nephrectomy via modified Pfannenstiel incision, using the novel SP robotic platform. Further assessment is necessary in a clinical setting.
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Affiliation(s)
- Alp Tuna Beksac
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, 9500 Euclid Avenue Q10, Cleveland, Ohio, United States, 44195-0001;
| | - Mohamed Eltemamy
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | - Sij Hemal
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, 9500 Euclid Avenue, Glickman Urological and Kidney Institute, Cleveland, Ohio, United States, 44195-0001;
| | - Zeyad Schwen
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | - Louis Lenfant
- Cleveland Clinic's Glickman Urological and Kidney Institute Department of Urology, 537826, 9500 Euclid avenue, Cleveland, Ohio, United States, 44195-0001.,Hopital Universitaire Pitie Salpetriere, 26933, Paris, France, 75651;
| | - Mahmoud Abou Zeinab
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | | | - Jihad Kaouk
- Cleveland Clinic Foundation, Glickman Urologic Institute, 9500 Euclid Ave, Cleveland, Ohio, United States, 44195;
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Hemal S, DeWitt-Foy M, Klein EA. Management of a Prostate Cancer Patient With Inherited Germline BRCA1 and BRCA2 Mutations: A Case Report. Urology 2021; 153:129-131. [PMID: 33556450 DOI: 10.1016/j.urology.2020.11.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/15/2022]
Abstract
The Breast Cancer Gene (BRCA) confers an 8.6-fold higher risk of developing prostate cancer in men ≤ 65 years of age and portends a worse prognosis as compared to noncarriers even in patients with low volume, localized disease. The BRCA2 gene, in particular, imparts a more biologically aggressive form of prostate cancer and a higher prostate cancer specific mortality. From a treatment standpoint, this translates to worse overall clinical outcomes for such patients. The most appropriate screening and management strategy for germline BRCA mutation carriers with prostate cancer is not known. Herein, we present an incidentally discovered prostate cancer in a 61-year-old BRCA1 and BRCA2 germline mutation carrier who was screened and managed using an individualized treatment approach.
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Affiliation(s)
- Sij Hemal
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
| | - Molly DeWitt-Foy
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Eric A Klein
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
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Isharwal S, Zampini A, Agrawal S, Hemal S, Gao T, Klein E, Stephenson A. MP17-17 LONGITUDINAL ASSESSMENT OF HEALTH-RELATED QUALITY OF LIFE AND DECISIONAL REGRET IN MEN WITH LOCALIZED PROSTATE CANCER. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.572] [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: 11/25/2022]
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Ryan S, Liss M, Choi J, Millard F, Randall M, Hemal S, Zheng SL, Xu J, Kader K. PD56-05 A GERM-LINE GENETIC TEST FOR PROSTATE CANCER RISK (PGS-33) TOGETHER WITH A FAMILY HISTORY ARE ASSOCIATED WITH LETHAL PROSTATE CANCER. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Babbar P, Yerram N, Sun A, Hemal S, Murthy P, Bryk D, Nandanan N, Nyame Y, Caveney M, Nelson R, Berglund R. Robot-assisted ureteral reconstruction - current status and future directions. Urol Ann 2018; 10:7-14. [PMID: 29416268 PMCID: PMC5791461 DOI: 10.4103/ua.ua_94_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Robotic surgery in the treatment in certain urological diseases has become a mainstay. With the increasing use of the robotic platform, some surgeries which were historically performed open have transitioned to a minimally invasive technique. Recently, the robotic approach has become more utilized for ureteral reconstruction. In this article, the authors review the surgical techniques for a number of major ureteral reconstuctive surgeries and briefly discuss the outcomes reported in the literature.
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Affiliation(s)
- Paurush Babbar
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Nitin Yerram
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Andrew Sun
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Sij Hemal
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Prithvi Murthy
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Darren Bryk
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Naveen Nandanan
- Division of Urology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Yaw Nyame
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Maxx Caveney
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Ryan Nelson
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
| | - Ryan Berglund
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
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Isharwal S, Hemal S, Agrawal S, Klein E, Stephenson A. MP25-06 PRESERVATION OF EJACULATION FUNCTION WITH NERVE SPARING IN PATIENTS UNDERGOING RETROPERITONEAL LYMPH NODE DISSECTION. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gill BC, Ericson KJ, Hemal S, Babbar P, A. Shoskes D. The Digital Footprint of Academic Urologists: Where Do we Stand? Urology 2016; 90:27-31. [DOI: 10.1016/j.urology.2015.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/16/2015] [Accepted: 12/07/2015] [Indexed: 11/17/2022]
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Hemal S, Krane LS, Richards KA, Liss M, Kader AK, Davis RL. Risk factors for infectious readmissions following radical cystectomy: results from a prospective multicenter dataset. Ther Adv Urol 2016; 8:167-74. [PMID: 27247626 DOI: 10.1177/1756287216636996] [Citation(s) in RCA: 11] [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] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Radical cystectomy (RC) is the gold standard treatment for muscle-invasive bladder cancer. This procedure has a high rate of perioperative complications, many of which are infectious in nature. The objective of our study was to evaluate demographic, intrinsic and extrinsic patient variables associated with developing readmission within 30 days due to infectious complications following RC. METHODS We acquired data available from the American College of Surgeons National Surgical Quality Improvement Program. We queried this dataset to identify all patients who underwent RC for muscle-invasive malignant disease (CPT 188.x) in 2012 based on CPT coding. Logistic regression analysis was used to investigate the relationship between preoperative variables and readmissions for infectious complications. RESULTS Of the 961 patients undergoing cystectomy for malignancy, 159 (17%) required readmission for any indications at a median of 16 days (interquartile range 13-22 days) postoperatively. We identified 71 of a total of 159 (45%) readmissions, which were due to infectious complications. Smoking was more prevalent in the patient population readmitted for an infectious complication compared with the patient population readmitted for a non-infectious complication (37% versus 25%; p = 0.03). Using logistic regression analysis smoking was associated with a significant risk for readmission due to an infectious cause (odds ratio 2.28, 95% confidence interval 1.82-2.97, p = 0.02). Readmission due to an infectious etiology was not associated with other perioperative factors including type of urinary diversion, sex, duration of operation, hypertension, or recent weight loss. CONCLUSION Readmission following RC is a common occurrence and infectious complications drive readmission in almost half of the cases. Current smoking was the only independent risk factor for an infectious readmission. Counseling patients in smoking cessation prior to the procedure may provide an avenue for quality improvement to limit readmissions.
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Affiliation(s)
- Sij Hemal
- Wake Forest School of Medicine, Department of Urology, Medical Center Boulevard, Winston Salem, NC 27106, USA
| | - Louis S Krane
- Department of Urology, Wake Forest Baptist Health, Winston Salem, NC, USA
| | - Kyle A Richards
- Department of Urology, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Michael Liss
- Department of Urology, University of Texas Health Science Center, San Antonio, TX, USA
| | - A Karim Kader
- Department of Urology, University of California at San Diego, La Jolla, CA, USA
| | - Ronald L Davis
- Department of Urology, Wake Forest Baptist Health, Winston Salem, NC, USA
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Hemal S, Krane L, Richards KA, Liss M, Kader AK, Davis R. PD8-03 PREDICTORS OF READMISSION FOR INFECTIOUS COMPLICATIONS FOLLOWING RADICAL CYSTECTOMY – RESULTS FROM A MULTI INSTITUTIONAL NATIONAL DATASET. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.918] [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: 11/30/2022]
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Hemal S, Krane L, Richards KA, Liss M, Kader AK, Davis R. MP67-03 ASSOCIATION OF BODY MASS INDEX AND REOPERATION FOLLOWING RADICAL CYSTECTOMY: RESULTS FROM A MULTI-INSTITUTIONAL DATASET. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2486] [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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Liss MA, Chen H, Hemal S, Krane S, Kane CJ, Xu J, Kader AK. Impact of Family History on Prostate Cancer Mortality in White Men Undergoing Prostate Specific Antigen Based Screening. J Urol 2015; 193:75-9. [DOI: 10.1016/j.juro.2014.07.085] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 01/05/2023]
Affiliation(s)
- Michael A. Liss
- Department of Urology, University of California-San Diego Health System, San Diego, California
| | - Haitao Chen
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, People's Republic of China
- Department of Genomics and Personalized Medicine Research, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Sij Hemal
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Spencer Krane
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Christopher J. Kane
- Department of Urology, University of California-San Diego Health System, San Diego, California
| | - Jianfeng Xu
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, People's Republic of China
- Department of Genomics and Personalized Medicine Research, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - A. Karim Kader
- Department of Urology, University of California-San Diego Health System, San Diego, California
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Peloso A, Katari R, Patel T, Hemal S, Zambon JP, Salvatori M, Orlando G. Considerations on the development of a model of kidney bioengineering and regeneration in rats. Expert Rev Med Devices 2014; 10:597-601. [DOI: 10.1586/17434440.2013.827528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Geller R, Hemal S, Manny T. Lymphadenectomy for renal cell carcinoma and urothelial carcinoma of the upper urinary tract: analysis of evidence in the minimally invasive era. Minerva Med 2013; 104:261-272. [PMID: 23748280] [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: 06/02/2023]
Abstract
Although lymphnode dissection (LND) provides staging and therapeutic benefit in bladder cancer, the role of lymphadenectomy in renal cell carcinoma (RCC) and urothelial cancer of the upper urinary tract (UCUUT) remains undefined. The aim of this paper was to examine the staging and therapeutic role of LND in RCC and UCUUT with emphasis on applicability to modern minimally invasive approaches. A Pubmed search was conducted to identify literature published between January 1, 2008 and March 11, 2013 addressing the role of lymphadenectomy in renal and upper urinary tract cancer. Key words included "lymphadenectomy", lymphnode dissection", "lymphnode excision", "lymphatic metastasis", "renal cancer", "renal neoplasm", "renal cell carcinoma", "kidney cancer", "kidney neoplasm", "upper urinary tract", "urothelial carcinoma", "kidney pelvis", "ureteral neoplasm", "transitional cell", "ureter, and upper tract urothelial neoplasm". The staging benefit of LND in RCC and UCUUT remains controversial although lymphnode metastasis is an important prognostic factor in both disease processes. It is not well established whether LND improves survival in RCC and UCUUT. There is no consensus regarding the optimal lymphnode yield or template. Much of the current literature is derived from studies of open surgery. Patients with higher grade and stage may derive the most benefit from LND. LND may provide both staging and survival benefit in select patients undergoing surgery for treatment of either RCC or UTUUC. Patients with clinical stage T2 or higher, those with aggressive histologic subtypes and features, and those with clinically enlarged nodes should undergo LND. Simple LND templates based on tumor location should be used and are amenable to both open and minimally invasive approaches.
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Affiliation(s)
- R Geller
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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