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Wang Y, Wilder S, Van Til M, Qi J, Mirza M, Gadzinski A, Maatman T, Lane BR, Rogers CG. Reply by Authors. Urol Pract 2024; 11:134. [PMID: 38117966 DOI: 10.1097/upj.0000000000000478.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/05/2023] [Indexed: 12/22/2023]
Affiliation(s)
- Yuzhi Wang
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
| | - Samantha Wilder
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
| | - Monica Van Til
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ji Qi
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mahin Mirza
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Adam Gadzinski
- Comprehensive Urology, Beaumont Hospital, Royal Oak, Michigan
| | | | - Brian R Lane
- Corewell Health Hospital System, Grand Rapids, Michigan
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
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Wang Y, Wilder S, Van Til M, Qi J, Mirza M, Gadzinski A, Maatman T, Lane BR, Rogers CG. Practice-Level Variation in Opioid-Free Discharge Following Surgery for T1 Renal Masses: A MUSIC-KIDNEY Analysis. Urol Pract 2024; 11:126-132. [PMID: 37987620 DOI: 10.1097/upj.0000000000000478] [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: 07/07/2023] [Accepted: 10/05/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Opioid prescription following surgery has played a role in the current opioid epidemic. We evaluated practice-level variation in opioid prescribing following surgery for cT1 renal masses and examined the relationships between opioid-free discharge and postoperative emergency department (ED) visits and readmissions. METHODS We retrospectively examined all T1 renal mass (RM) patients with data regarding postoperative opioid prescriptions within the Michigan Urological Surgery Improvement Collaborative-Kidney Mass: Identifying and Defining Necessary Evaluation and Therapy (MUSIC-KIDNEY) registry from April 2021 to March 2023. Patients were stratified into those who received opioids at discharge and those with opioid-free discharge. Associations with patient, tumor, and surgical factors were evaluated. Rates of postoperative ED visits and readmissions within 30 days were compared between cohorts. Practice-level variation was assessed. RESULTS Of 414 patients who underwent surgery for T1 RM across 15 practices in MUSIC-KIDNEY, 23.7% had opioid-free discharge. Practice-level variation in rates of opioid-free discharge ranged from 6.7% to 55.0%. For patients prescribed opioids, the median number of pills was 10 (IQR 6-12). Patients with cT1b masses were more likely to have opioid-free discharge (44.9% vs 32%, OR 0.44; 95% CI 0.22-0.89). Rates of 30-day ED visits (7.0% vs 3.1%) and readmissions (4.1% vs 2.0%) were lower in the opioid-free discharge group but did not reach statistical significance. CONCLUSIONS MUSIC-KIDNEY data suggest opioid-free discharge is not associated with increased rates of postoperative ED visits or readmissions. There exists wide practice-level variation in opioid prescriptions following surgery for T1 RM in the state of Michigan. Similar variation likely exists throughout the United States, and best surgical practice suggests reduction in opioid prescribing after nephrectomy.
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Affiliation(s)
- Yuzhi Wang
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
| | - Samantha Wilder
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
| | - Monica Van Til
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ji Qi
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mahin Mirza
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Adam Gadzinski
- Comprehensive Urology, Beaumont Hospital, Royal Oak, Michigan
| | | | - Brian R Lane
- Corewell Health Hospital System, Grand Rapids, Michigan
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
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Patel AK, Butaney M, Lane BR, Wilder S, Johnson A, Qi J, Wang Y, DiBianco J, Herrel L, Maatman T, Peabody J, Rosenberg B, Seifman B, Semerjian A, Shetty S, Schervish E, Collins J, Tandogdu Z, Rogers CG. Building a Roadmap for Surveillance of Renal Masses Using a Modified Delphi Method to Help Achieve Consensus. Urology 2023; 180:168-175. [PMID: 37353086 DOI: 10.1016/j.urology.2023.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To establish a consensus for initial evaluation and follow-up of patients on active surveillance (AS) for T1 renal masses (T1RM). METHODS A modified Delphi method was used to gather information about AS of T1RM, with a focus on patient selection, timing/type of imaging modality, and triggers for intervention. A consensus panel of Michigan Urological Surgery Improvement Collaborative-affiliated urologists who routinely manage renal masses was formed. Areas of consensus (defined >80% agreement) about T1RM AS were established iteratively via 3 rounds of online questionnaires. RESULTS Twenty-six Michigan Urological Surgery Improvement Collaborative urologists formed the panel. Consensus was achieved for 321/587 scenarios (54.7%) administered through 124 questions. Life expectancy, age, comorbidity, and renal function were most important for patient selection, with life expectancy ranking first. All tumors <3 cm and all patients with life expectancy <1 year were considered appropriate for AS. Appropriateness also increased with elevated perioperative risk, increasing tumor complexity, and/or declining renal function. Consensus was for multiphasic axial imaging initially (contrast CT for GFR >60 or MRI for GFR >30) with first repeat imaging at 3-6 months and subsequent imaging timing determined by tumor size. Consensus was for chest imaging for tumors >3 cm initially and >5 cm at follow up. Renal biopsy was not felt to be a requirement for entering AS, but useful in several scenarios. Consensus indicated rapid tumor growth as an appropriate trigger for intervention. CONCLUSION Our consensus panel was able to achieve areas of consensus to help define a clinically useful and specific roadmap for AS of T1RM and areas for further discussion where consensus was not achieved.
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Affiliation(s)
| | | | - Brian R Lane
- Spectrum Health Hospital System, Grand Rapids, MI; Michigan State University College of Human Medicine, Grand Rapids, MI
| | | | - Anna Johnson
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Ji Qi
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | | | - John DiBianco
- University of Florida, Department of Urology, Gainesville, FL
| | - Lindsey Herrel
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Thomas Maatman
- Michigan Urological Clinic, University of Michigan/West, Grand Rapids, MI
| | | | - Bradley Rosenberg
- Oakland University William Beaumont School of Medicine, Auburn Hills, MI
| | | | | | - Sugandh Shetty
- Comprehensive Urology, Royal Oak, MI; Wayne State University School of Medicine, Detroit, MI
| | | | - Justin Collins
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - Zafer Tandogdu
- Department of Urology, University College London Hospital, London, UK
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Pulford C, Keating K, Eames R, Holdren C, Peifer D, Maatman T. Adolescent male with bilateral succinate dehydrogenase-deficient renal cell carcinoma in a horseshoe kidney managed successfully with staged bilateral robotic-assisted partial nephrectomies: A case report. Urol Case Rep 2023; 49:102412. [PMID: 37275562 PMCID: PMC10238833 DOI: 10.1016/j.eucr.2023.102412] [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: 03/14/2023] [Accepted: 04/30/2023] [Indexed: 06/07/2023] Open
Abstract
Succinate dehydrogenase (SDH) deficient renal cell carcinoma (RCC) is a rare subset of familial RCC with only 59 cases reported. SDH deficiency is associated with hereditary paraganglioma/pheochromocytoma syndrome. Most of the cases are solitary tumors with only two reported cases of bilateral tumor. The identification of SDH deficient RCC is often the sentinel event of patient's syndromic diagnosis. We present a case of an adolescent male with bilateral tumors in a horseshoe kidney who was treated with staged robotic-assisted partial nephrectomies without complication. Both tumors were SDH negative on immunohistochemical staining.
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Affiliation(s)
- Christopher Pulford
- Corresponding author. University of Michigan Health – West, Department of Medical Education, 5900 Byron Center Ave SW, Wyoming, MI, 49519, USA.
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Paudel R, Ferrante S, Woodford J, Maitland C, Stockall E, Maatman T, Lane GI, Berry DL, Sales AE, Montie JE. Correction: Implementation of prostate cancer treatment decision aid in Michigan: a qualitative study. Implement Sci Commun 2023; 4:30. [PMID: 36941684 PMCID: PMC10026502 DOI: 10.1186/s43058-023-00410-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Affiliation(s)
- Roshan Paudel
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA.
| | - Stephanie Ferrante
- Michigan Urological Surgery Improvement Collaborative, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | | | - Giulia I Lane
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Donna L Berry
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Anne E Sales
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - James E Montie
- Michigan Urological Surgery Improvement Collaborative, University of Michigan, Ann Arbor, MI, USA
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Singhal U, Daignault-Newton S, Dunn R, Spratt DE, Okoth L, Feng FY, Johnson A, Lane BR, Linsell S, Khurshid G, Mehra R, Davicioni E, Maatman T, Burks F, Rodriguez P, Kleer E, Sarle R, Miller DC, Cher ML, Morgan TM. Determining the impact of genomic classifier testing on patient-reported quality of life after prostatectomy: Results from the G-MINOR randomized trial. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.345] [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: 03/16/2023] Open
Abstract
345 Background: Decipher is a tissue-based genomic classifier (GC) developed and validated in the post-radical prostatectomy (RP) setting to help guide adjuvant treatment decisions for prostate cancer (PCa). We conducted the first prospective, randomized trial assessing the impact of GC testing on adjuvant therapy use. Here, we determine the impact of GC testing on patient reported (PRO) quality of life outcomes (QoL) in men at high-risk of post-RP recurrence. Methods: The G-MINOR trial is a prospective, unblinded, randomized trial which enrolled 356 patients from 12 centers in the Michigan Urological Surgery Improvement Collaborative (MUSIC). Patients were enrolled between Aug 2016-July 2018. Eligible patients had undergone RP within 9 months of enrollment, had pT3-4 disease and/or positive surgical margins, and a post-RP PSA <0.1ng/mL. Patients were assigned to either the GC or usual-care (UC) group using cluster-crossover block randomization assignments. Evaluable patients (338) were followed for at least 18 months. PROs were obtained using the Expanded Prostate Cancer Index Composite (EPIC-26) survey at baseline (before RP), 3, 6, 12, and 24 months after RP. Results: A total of 226/338 evaluable men (67%) had PRO data for this analysis (116 UC arm/110 GC arm). Median age was 65 years. Of the 226 men included in the PRO analysis, a total of 23 (9 UC arm/14 GC arm) had adjuvant treatment (p = 0.22). At 12 months follow-up, those in the GC arm had no significant change in adjusted mean difference in domain score from baseline compared to those in the UC arm for urinary irritative (UIR) function (1.0, 95% CI [-2.9– 4.9], p=0.6), urinary incontinence (UI) (0.8, 95% CI [-5.1– 6.7], p=0.8), or sexual function (SF) (0.5, 95% CI [-6.9– 7.9], p=0.9). This remained true at 24 months for all three domains [UIR; (2.3, 95% CI [-2.1– 6.6], p=0.3)], [UI; (-0.3, 95% CI [-7.3– 6.7], p=0.9)], [SF; (1.5, 95% CI [-6.8– 9.7], p=0.7)]. Conclusions: In the first ever randomized trial testing the clinical utility of a GC test in localized PCa, longitudinal patient reported QOL outcomes were not significantly different between men who underwent risk stratification with or without Decipher. Clinical trial information: NCT02783950 .
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Affiliation(s)
- Udit Singhal
- University of Michigan (Ann Arbor, MI), Ann Arbor, MI
| | | | | | - Daniel Eidelberg Spratt
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | | | - Felix Y Feng
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | | | | | | | | | - Paul Rodriguez
- Urology Associates of Grand Rapids P.C, Grand Rapids, MI
| | | | - Richard Sarle
- Sparrow Regional Cancer Ctr. - Sparrow Medical Oncology, Lansing, MI
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Singhal U, Qi J, Ginsberg K, Semerjian A, Maatman T, Dibianco J, Morgan TM, Montgomery JS, Nowlin M, Johnson A, Ferrante S, Montie JE, Johnston W, Jafri M, Rosenberg B, Sarle R, George AK. PD54-01 REDEFINING OPIOID USE AFTER PROSTATECTOMY: RESULTS FROM THE IMPLEMENTATION OF A STATEWIDE OPIOID-FREE PAIN OPTIMIZATION PATHWAY. J Urol 2022. [DOI: 10.1097/ju.0000000000002631.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Butaney M, Johnson A, Qi J, Patel A, Noyes S, Brede C, Seifman B, Maatman T, Rogers C, Lane B. Evaluation of an uncomplicated recovery after nephrectomy: MUSIC-KIDNEY NOTES (Notable Outcomes and Trackable Events after Surgery). Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00230-5] [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: 11/04/2022]
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Pulford C, Keating K, Rohloff M, Peifer D, Eames R, Shakuri-Rad J, Maatman T. Robotic-assisted nephrectomy with level II IVC thrombectomy using Rummel Tourniquets. Int Braz J Urol 2021; 48:196-197. [PMID: 34735093 PMCID: PMC8691254 DOI: 10.1590/s1677-5538.ibju.2021.0393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Inferior vena cava (IVC) invasion from renal cell carcinoma (RCC) occurs at a rate of 4-10% (1). IVC thrombectomy (IVC-TE) can be an open procedure because of the need for handling of the IVC (2). The first reported series of robotic management of IVC-TE started in 2011 for the management of Level I - II thrombi with subsequent case reports in recent years (2-5). Materials and Methods: The following is a patient in his 50’s with no significant medical history. Magnetic resonance imaging and IR venogram were performed preoperatively. The tumor was clinical stage T3b with a 4.3cm inferior vena cava thrombus. The patient underwent robotic assisted nephrectomy and IVC-TE. Rummel tourniquets were used for the contralateral kidney and the IVC. The tourniquets were created using vessel loops, a 24 French foley catheter and hem-o-lock clips. Results: The patient tolerated the surgical procedure well with no intraoperative complications. Total surgical time was 274 min with 200 minutes of console time and 22 minutes of IVC occlusion. Total blood loss in the surgery was 850cc. The patient was discharged from the hospital on post-operative day 3 without any complications. The final pathology of the specimen was pT3b clear cell renal cell carcinoma Fuhrman grade 2. The patient followed up post-operatively at both four months and six months without disease recurrence. The patient continues annual follow-up with no recurrence. Conclusions: Surgeon experience is a key factor in radical nephrectomy with thrombectomy as patients have a reported 50-65% survival rate after IVC-TE (4).
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Affiliation(s)
- Christopher Pulford
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, US
| | - Kevin Keating
- Department of Urology, Metro Health, University of Michigan, Wyoming, MI, USA
| | - Matthew Rohloff
- Department of Urology, Metro Health, University of Michigan, Wyoming, MI, USA
| | - David Peifer
- Department of Urology, Metro Health, University of Michigan, Wyoming, MI, USA
| | - Richard Eames
- Department of Urology, Metro Health, University of Michigan, Wyoming, MI, USA
| | - Jaschar Shakuri-Rad
- Department of Urology, Metro Health, University of Michigan, Wyoming, MI, USA
| | - Thomas Maatman
- Department of Urology, Metro Health, University of Michigan, Wyoming, MI, USA
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Pulford C, Keating K, Rohloff M, Peifer D, Eames R, Maatman T. How we do it: robotic-assisted distal ureterectomy with ureteral reimplantation. Int Braz J Urol 2021; 47:1277-1278. [PMID: 34156191 PMCID: PMC8486464 DOI: 10.1590/s1677-5538.ibju.2021.0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background: High risk upper tract urothelial carcinoma (UTUC) is typically managed with radical nephroureterectomy, however, renal preservation can be attempted when UTUC is localized to the distal ureter in the presence of chronic kidney disease (1–3). Distal ureterectomy is typically managed with a ureteral reimplantation and psoas hitch in order to maintain urothelial continuity, to avoid comprising the contralateral ureter, and reducing risk of chronic urinary tract infections and electrolyte abnormalities (4). We present our case of distal ureteral UTUC managed robotically with a distal ureterectomy with ureteral reimplantation. Technique and Follow-Up: Initially, an Orandi needle on a resectoscope circumscribed the left ureteral orifice. Next, robotically, the retroperitoneum was exposed and a left sided pelvic lymphadenectomy was completed. The left ureter was mobilized and the diseased ureteral segment was transected. The mobilized bladder was sutured to psoas fascia. After a cystotomy, the ureter was re-anastomosed to the bladder. The patient was discharged on postoperative day three and re-evaluated one week later with a cystogram. Final pathology was downgraded to non-invasive low-grade papillary urothelial carcinoma with negative lymph nodes and margins. Conclusion: High risk UTUC localized to the distal ureter in the setting of chronic kidney disease can be managed with a distal ureterectomy (3). Robotic distal ureterectomy with ureteral reimplantation can be assisted by an Orandi needle to achieve negative margins. Utilizing a robotic technique can offer challenges with the ureteral spatulation and reanastomosis (5–7). By fixating the ureter to the bladder prior to reanastomosis, our technique offers a solution for these difficulties.
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Affiliation(s)
| | - Kevin Keating
- Department of Urology, Metro Health, University of Michigan, MI, USA
| | - Matthew Rohloff
- Department of Urology, Metro Health, University of Michigan, MI, USA
| | - David Peifer
- Department of Urology, Metro Health, University of Michigan, MI, USA
| | - Richard Eames
- Department of Urology, Metro Health, University of Michigan, MI, USA
| | - Thomas Maatman
- Department of Urology, Metro Health, University of Michigan, MI, USA
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Iqbal U, Elsayed AS, Jing Z, Stoeckle M, Wijburg C, Wiklund P, Hosseini A, Dasgupta P, Khan MS, Hemal A, Kim EH, Wagner AA, Gaboardi F, Rha KH, Maatman T, Balbay D, Li Q, Hussein A, Guru KA. Upstaging and Survival Outcomes for Non-Muscle Invasive Bladder Cancer After Radical Cystectomy: Results from the International Robotic Cystectomy Consortium. J Endourol 2021; 35:1541-1547. [PMID: 34139890 DOI: 10.1089/end.2021.0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
INTRODUCTION We sought to describe the incidence, risk factors, and survival outcomes associated with pathological upstaging from non-muscle invasive bladder cancer (NMIBC) to muscle invasive bladder cancer (MIBC) after robot-assisted radical cystectomy (RARC). METHODS We reviewed the International Robotic Cystectomy Consortium database between 2004 and 2020. Upstaging was defined as ≥pT2 or pN+ at final pathology from clinical <T2N0M0. Descriptive statistics were used to summarize data. Cochran-Armitage test was used to depict upstaging trend over time. Multivariate regression models were used to depict variables associated with upstaging. Kaplan Meier curves were used to describe disease-specific (DSS), recurrence-free (RFS), and overall survival (OS). RESULTS 463 patients underwent RARC for NMIBC. Upstaging occurred in 145 (31%) patients. Upstaged patients were older (70 vs 67 years, p <0.01), more likely to have American Society of Anesthesiologists score (≥3) (55% vs 44%, p=0.04) and had higher rate of preoperative hydronephrosis (26% vs 10%, p <0.01). They were more likely to have positive surgical margins (10% vs 3%, p= 0.01), recurrences (28% vs 9%, p<0.01), and to receive adjuvant/salvage treatment (26% vs none, p <0.01). On multivariate analysis, upstaging was associated with older age (OR 1.04; CI 1.01-1.07, p<0.01), cT1 vs cTis (OR 4.25; CI 1.57-11.48, p <0.01), cT1 vs cTa (OR 2.92; CI 1.40-6.06, p<0.01), and preoperative hydronephrosis (OR 3.18; CI 1.60-6.32, p<0.01). Upstaged patients had worse 5-year RFS (53 % vs 85%, log rank p<0.01), DSS (66% vs 93%, log rank p<0.01), and OS (49% vs 74%, log rank p<0.01). The rate of upstaging did not significantly change over time (38% in 2004 to 27% in 2019, p=0.17). CONCLUSION Upstaging to MIBC occurred in a significant proportion of patients after RARC for NMIBC and was associated with worse survival outcomes. Older patients, those with cT1 disease and hydronephrosis were more likely to upstage.
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Affiliation(s)
- Umar Iqbal
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States;
| | - Ahmed S Elsayed
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States.,Cairo University Kasr Alainy Faculty of Medicine, 63527, Cairo, United States;
| | - Zhe Jing
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States;
| | - Michael Stoeckle
- Universitat des Saarlandes, 9379, Urologie, Saarbrucken, Germany;
| | | | | | - Abolfazl Hosseini
- Karolinska Institutet, Urology, 171 76 Stockholm, Stockholm, Sweden, 171 76 Stockhol;
| | - Prokar Dasgupta
- King's College London, 4616, MRC Centre for Transplantation, Guy's Hospital, London, United Kingdom of Great Britain and Northern Ireland, SE19RT.,Guy's and St Thomas' NHS Trust, Department of Urology, Guy's Hospital, London, United Kingdom of Great Britain and Northern Ireland, SE19RT;
| | | | - Ashok Hemal
- Wake Foresty University Baptist Medical Center, Urology, Medical Center Blvd, Winston-Salem, North Carolina, United States, 27157.,United States;
| | - Eric H Kim
- Washington University School of Medicine, Urology, 4960 Children's Place, Box 8242, St. Louis, Missouri, United States, 63110;
| | - Andrew A Wagner
- Beth Israel Deaconess Medical Center and Harvard Medical School, Urology, 330 Brookline Ave., Boston, Massachusetts, United States, 02215;
| | | | - Koon Ho Rha
- Severance Hospital, Yonsei University, Urology, Yonseiro 50-1, Seodaemun-gu, Seoul, Korea, Seoul, Korea (the Republic of);
| | - Thomas Maatman
- Metro Health: University of Michigan Health, Urological Surgery, Wyoming, Michigan, United States;
| | | | - Qiang Li
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States;
| | | | - Khurshid A Guru
- Roswell Park Cancer Insitute, Urologic Oncology, Elm and Carlton Streets, Buffalo, New York, United States, 14263.,Roswell Park Cancer Institute, Urologic Oncology, Elm and Carlton Streets, Buffalo, United States, 14263;
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Paudel R, Ferrante S, Woodford J, Maitland C, Stockall E, Maatman T, Lane GI, Berry DL, Sales AE, Montie JE. Implementation of prostate cancer treatment decision aid in Michigan: a qualitative study. Implement Sci Commun 2021; 2:27. [PMID: 33676583 PMCID: PMC7936475 DOI: 10.1186/s43058-021-00125-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 02/05/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The American Urological Association White Paper on Implementation of Shared Decision Making (SDM) into Urological Practice suggested SDM represents the state of the art in counseling for patients who are faced with difficult or uncertain medical decisions. The Michigan Urological Surgery Improvement Collaborative (MUSIC) implemented a decision aid, Personal Patient Profile-Prostate (P3P), in 2018 to help newly diagnosed prostate cancer patients make shared decisions with their clinicians. We conducted a qualitative study to assess statewide implementation of P3P throughout MUSIC. METHODS We recruited urologists and staff from 17 MUSIC practices (8 implementation and 9 comparator practices) to understand how practices engaged patients on treatment discussions and to assess facilitators and barriers to implementing P3P. Interview guides were developed based on the Tailored Interventions for Chronic Disease (TICD) Framework. Interviews were transcribed for analysis and coded independently by two investigators in NVivo, PRO 12. Additionally, quantitative program data were integrated into thematic analyses. RESULTS We interviewed 15 urologists and 11 staff from 16 practices. Thematic analysis of interview transcripts indicated three key themes including the following: (i) P3P is compatible as a SDM tool as over 80% of implementation urologists asked patients to complete the P3P questionnaire routinely and used P3P reports during treatment discussions; (ii) patient receptivity was demonstrated by 370 (50%) of newly diagnosed patients (n = 737) from 8 practices enrolled in P3P with 78% completion rate, which accounts for 39% of all newly diagnosed patients in these practices; and (iii) urologists' attitudes towards SDM varied. Over a third of urologists stated they did not rely on a decision aid. Comparator practices indicated habit, inertia, or concerns about clinic flow as reasons for not adopting P3P and some were unconvinced a decision aid is needed in their practice. CONCLUSION Urologists and staff affiliated with MUSIC implementation sites indicated that P3P focuses the treatment discussion on items that are important to patients. Experiences of implementation practices indicate that once initiated, there were no negative effects on clinic flow and urologists indicated P3P saves time during patient counseling, as patients were better prepared for focused discussions. Lack of awareness, personal habits, and inertia are reasons for not implementing P3P among the comparator practices.
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Affiliation(s)
- Roshan Paudel
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI USA
| | - Stephanie Ferrante
- Michigan Urological Surgery Improvement Collaborative, University of Michigan, Ann Arbor, MI USA
| | | | | | | | | | - Giulia I. Lane
- Department of Urology, University of Michigan, Ann Arbor, MI USA
| | - Donna L. Berry
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA USA
| | - Anne E. Sales
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI USA
| | - James E. Montie
- Michigan Urological Surgery Improvement Collaborative, University of Michigan, Ann Arbor, MI USA
| | - for the Michigan Urological Surgery Improvement Collaborative (MUSIC), Ann Arbor, Michigan, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI USA
- Michigan Urological Surgery Improvement Collaborative, University of Michigan, Ann Arbor, MI USA
- University of Michigan, Ann Arbor, MI USA
- Sherwood Medical Center, Detroit, MI USA
- Capital Urological Associates, Okemos, MI USA
- Michigan Urological Clinic, Grand Rapids, MI USA
- Department of Urology, University of Michigan, Ann Arbor, MI USA
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA USA
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13
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Hafezi N, Heimberger MA, Lewellen KA, Maatman T, Montgomery GS, Markel TA. Lung biopsy in children's interstitial and diffuse lung disease: Does it alter management? Pediatr Pulmonol 2020; 55:1050-1060. [PMID: 32040887 DOI: 10.1002/ppul.24683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/27/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Pediatric patients with acute life-threatening consequences of interstitial and diffuse lung disease are often treated with empiric systemic corticosteroids, immune modulators, and/or broad antibiotic therapy. Histological evaluation of lung tissue represents the final necessary step in diagnosis-however, a definitive diagnosis may still remain elusive and medical therapies may not be changed following biopsy. We hypothesized that lung biopsy from pediatric patients with children's interstitial and diffuse lung disease (chILD) without a defined lesion on computed tomography (CT) imaging would guide diagnosis, but not substantially alter clinical management. METHODS After IRB approval, patients who underwent a lung biopsy at a single large children's hospital between 2013 and 2018 were retrospectively reviewed. Patients without a defined lesion were included. Demographics, length of stay, oxygen-requirements, steroid, unique number of immune modulators, and antibiotics prebiopsy and postbiopsy were reviewed. Nonparametric data were compared by the Mann Whitney U and Kruskal Wallace tests and expressed as median with interquartile range. Decision tree alterations were analyzed by t test. P < .05 was significant. RESULTS Sixty-four patients underwent lung biopsy during the period. Nineteen (30%) did not have a defined lesion on CT scan, and were included. A significant difference was seen between prebiopsy, 2 weeks, and 2 months postbiopsy prednisone dosing (P = .03), while the number of unique immune modulators, antibiotics, type of oxygen support and FiO2 were not significantly different before or after obtaining biopsy results. Pathology results provided additional information in 12 of 19 (63%) patients which resulted in management changes. CONCLUSIONS Lung biopsy in chILD may guide clinical management, especially influencing the management of steroid dosing. Although on aggregate the number of antibiotics, immune modulators, mode of oxygen support and FiO2 did not differ significantly before and after biopsy, the pathologic evaluation provided diagnostic information that led to a variety of changes in therapeutic management in greater than half of the population.
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Affiliation(s)
- Niloufar Hafezi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mark A Heimberger
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kyle A Lewellen
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas Maatman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gregory S Montgomery
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.,Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
| | - Troy A Markel
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
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Peifer D, Rohloff M, Maatman T. A rare case of metastatic sigmoid adenocarcinoma to the ureter. Urol Case Rep 2019; 26:100972. [PMID: 31388493 PMCID: PMC6669371 DOI: 10.1016/j.eucr.2019.100972] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 11/24/2022] Open
Abstract
Colorectal cancer is a very common disease process, as is ureteral obstruction, but the two are typically mutually exclusive. The case report presented details a 35-year-old male with left sided flank pain and hydroureteronephrosis caused by metastatic spread of previously diagnosed and treated sigmoid adenocarcinoma. About two years previously, he had been diagnosed with Stage IV, T4a sigmoid colon cancer with liver metastasis and had resection of his primary tumor as well as metastatic sites and several rounds of chemotherapy. This case is an example of the different ways that cancer can grow, evading detection by spreading in atypical patterns.
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Affiliation(s)
- David Peifer
- Metro Health-University of Michigan Health, 5900 Byron Center Ave SW, Wyoming, MI, 49519, USA
| | - Matthew Rohloff
- Metro Health-University of Michigan Health, 5900 Byron Center Ave SW, Wyoming, MI, 49519, USA
| | - Thomas Maatman
- Metro Health-University of Michigan Health, 5900 Byron Center Ave SW, Wyoming, MI, 49519, USA
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Rohloff M, Shakuri-Rad J, McElrath C, Dehaan A, Steinhardt G, Maatman T, Shockley K. Which Objective Parameters Are Associated with a Positive Urine Culture in the Setting of Ureteral Calculi: The Ureteral Calculi Urinary Culture Calculator. J Endourol 2018; 32:1168-1172. [DOI: 10.1089/end.2018.0668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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)
- Matthew Rohloff
- Department of Urological Surgery, Metro Health: University of Michigan Health, Wyoming, Michigan
| | - Jaschar Shakuri-Rad
- Department of Urological Surgery, Metro Health: University of Michigan Health, Wyoming, Michigan
| | - Cameron McElrath
- Department of Urological Surgery, Metro Health: University of Michigan Health, Wyoming, Michigan
| | - Alexander Dehaan
- Department of Urological Surgery, Metro Health: University of Michigan Health, Wyoming, Michigan
| | - George Steinhardt
- Department of Urological Surgery, Metro Health: University of Michigan Health, Wyoming, Michigan
| | - Thomas Maatman
- Department of Urological Surgery, Metro Health: University of Michigan Health, Wyoming, Michigan
| | - Kenneth Shockley
- Department of Urological Surgery, Metro Health: University of Michigan Health, Wyoming, Michigan
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16
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Al Adas Z, Shepard AD, Nypaver TJ, Weaver MR, Maatman T, Yessayan LT, Balraj P, Kabbani LS. Long-term decline in renal function is more significant after endovascular repair of infrarenal abdominal aortic aneurysms. J Vasc Surg 2018; 68:739-748. [DOI: 10.1016/j.jvs.2017.12.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 12/14/2017] [Indexed: 01/08/2023]
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17
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Hussein AA, May P, Jing Z, Ahmed Y, Wijburg C, Richstone L, Wagner A, Redorta JP, Badani K, Khan H, Saar M, Stockle M, Dasgupta P, Kawa O, Khan MS, Menon M, Peabody J, Hosseini A, Gaboardi F, Pini G, Schanne F, Poulakis V, Weizer A, Kelly J, Tan WS, Maatman T, Canda AE, Mottrie A, Kaouk J, Yuh B, Rha KH, Hemal A, Peak T, Wiklund P, Guru K. MP49-01 OUTCOMES OF INTRACORPOREAL URINARY DIVERSION AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE INTERNATIONAL ROBOTIC CYSTECTOMY CONSORTIUM. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1592] [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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18
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Roch AM, Maatman T, Carr RA, Easler JJ, Schmidt CM, House MG, Nakeeb A, Ceppa EP, Zyromski NJ. Evolving treatment of necrotizing pancreatitis. Am J Surg 2017; 215:526-529. [PMID: 29167024 DOI: 10.1016/j.amjsurg.2017.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 11/12/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Over the past decade, the treatment of necrotizing pancreatitis (NP) has incorporated greater use of minimally invasive techniques, including percutaneous drainage and endoscopic debridement. No study has yet compared outcomes of patients treated with all available techniques. We sought to evaluate the evolution of NP treatment at our high volume pancreas center. We hypothesized that minimally invasive techniques (medical only, percutaneous, and endoscopic) were used more frequently in later years. METHODS Treatment strategy of NP patients at a single academic medical center between 2005 and 2014 was reviewed. Definitive management of pancreatic necrosis was categorized as: 1) medical treatment only; 2) surgical only; 3) percutaneous (interventional radiology - IR) only; 4) endoscopic only; and 5) combination (Surgery ± IR ± Endoscopy). RESULTS 526 NP patients included biliary (45%), alcoholic (17%), and idiopathic (20%) etiology. Select patients were managed exclusively by medical, IR, or endoscopic treatment; use of these therapies remained relatively consistent over time. A combination of therapies was used in about 30% of patients. Over time, the percentage of NP patients managed without operation increased from 28% to 41%. 247 (47%) of patients had operation as the only NP treatment; an additional 143 (27%) required surgery as part of a multidisciplinary management. CONCLUSION Select NP patients may be managed exclusively by medical, IR, or endoscopic treatment. Combination treatment is necessary in many NP patients, and surgical treatment continues to play an important role in the definitive therapy of necrotizing pancreatitis patients.
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Affiliation(s)
- Alexandra M Roch
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thomas Maatman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rose A Carr
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jeffrey J Easler
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael G House
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Attila Nakeeb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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Al Adas Z, Shepard AD, Nypaver T, Weaver MR, Maatman T, Yessayan L, Kabbani L. VESS23. Long-Term Decline in Renal Function Is More Significant After Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.03.055] [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: 10/19/2022]
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20
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Raza SJ, Field E, Kibel AS, Mottrie A, Weizer AZ, Wagner A, Hemal AK, Scherr DS, Schanne F, Gaboardi F, Wu G, Peabody JO, Koauk J, Redorta JP, Pattaras JG, Rha KH, Richstone L, Balbay MD, Menon M, Hayn M, Stoeckle M, Wiklund P, Dasgupta P, Pruthi R, Ghavamian R, Khan S, Siemer S, Maatman T, Wilson T, Poulakis V, Wilding G, Guru KA. International Robotic Radical Cystectomy Consortium: A way forward. Indian J Urol 2014; 30:314-7. [PMID: 25097319 PMCID: PMC4120220 DOI: 10.4103/0970-1591.134253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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] [Indexed: 11/04/2022] Open
Abstract
Robot-assisted radical cystectomy (RARC) is an emerging operative alternative to open surgery for the management of invasive bladder cancer. Studies from single institutions provide limited data due to the small number of patients. In order to better understand the related outcomes, a world-wide consortium was established in 2006 of patients undergoing RARC, called the International Robotic Cystectomy Consortium (IRCC). Thus far, the IRCC has reported its findings on various areas of operative interest and continues to expand its capacity to include other operative modalities and transform it into the International Radical Cystectomy Consortium. This article summarizes the findings of the IRCC and highlights the future direction of the consortium.
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Affiliation(s)
- Syed Johar Raza
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Erinn Field
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Adam S Kibel
- Washington University School of Medicine, St. Louis, MO, USA
| | - Alex Mottrie
- Deaprtment of Urology, Onze-Lieve-Vrouw Ziekenhuis, Aalast, Belgium
| | | | - Andrew Wagner
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ashok K Hemal
- Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | | | | | | | - Guan Wu
- University of Rochester Medical Center, Rochester, NY
| | | | - Jihad Koauk
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | | - Koon-Ho Rha
- Yonsei University Health System Severance Hospital, Seoul, Korea
| | - Lee Richstone
- The Arthur Smith Institute for Urology, New York, NY, USA
| | | | - Mani Menon
- Henry Ford Health System, Detroit, MI, USA
| | | | | | | | - Prokar Dasgupta
- Guy's Hospital and King's College London School of Medicine, London, UK
| | - Raj Pruthi
- University of North Carolina, Wilmington, NC, USA
| | | | - Shamim Khan
- Guy's Hospital and King's College London School of Medicine, London, UK
| | | | | | | | | | - Greg Wilding
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Khurshid A Guru
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
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21
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Al-Daghmin A, Kauffman EC, Shi Y, Badani K, Balbay MD, Canda E, Dasgupta P, Ghavamian R, Grubb R, Hemal A, Kaouk J, Kibel AS, Maatman T, Menon M, Mottrie A, Nepple K, Pattaras JG, Peabody JO, Poulakis V, Pruthi R, Palou Redorta J, Rha KH, Richstone L, Schanne F, Scherr DS, Siemer S, Stöckle M, Wallen EM, Weizer A, Wiklund P, Wilson T, Wilding G, Woods M, Guru KA. Efficacy of robot-assisted radical cystectomy (RARC) in advanced bladder cancer: results from the International Radical Cystectomy Consortium (IRCC). BJU Int 2014; 114:98-103. [PMID: 24219170 DOI: 10.1111/bju.12569] [Citation(s) in RCA: 14] [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: 11/28/2022]
Abstract
OBJECTIVE To characterise the surgical feasibility and outcomes of robot-assisted radical cystectomy (RARC) for pathological T4 bladder cancer. PATIENTS AND METHODS Retrospective evaluation of a prospectively maintained International Radical Cystectomy Consortium database was conducted for 1118 patients who underwent RARC between 2003 and 2012. We dichotomised patients based on pathological stage (≤pT3 vs pT4) and evaluated demographic, operative and pathological variables in relation to morbidity and mortality. RESULTS In all, 1000 ≤pT3 and 118 pT4 patients were evaluated. The pT4 patients were older than the ≤pT3 patients (P = 0.001). The median operating time and blood loss were 386 min and 350 mL vs 396 min and 350 mL for p T4 and ≤pT3, respectively. The complication rate was similar (54% vs 58%; P = 0.64) among ≤pT3 and pT4 patients, respectively. The overall 30- and 90-day mortality rate was 0.4% and 1.8% vs 4.2% and 8.5% for ≤pT3 vs pT4 patients (P < 0.001), respectively. The body mass index (BMI), American Society of Anesthesiology score, length of hospital stay (LOS) >10 days, and 90-day readmission were significantly associated with complications in pT4 patients. Meanwhile, BMI, LOS >10 days, grade 3-5 complications, 90-day readmission, smoking, previous abdominal surgery and neoadjuvant chemotherapy were significantly associated with mortality in pT4 patients. On multivariate analysis, BMI was an independent predictor of complications in pT4 patients, but not for mortality. CONCLUSIONS RARC for pT4 bladder cancer is surgically feasible but entails significant morbidity and mortality. BMI was independent predictor of complications in pT4 patients.
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DeHaan A, Bigham D, Maatman T. 1155 ASSESSING THE EFFICACY OF TOPICAL ESTROGEN CREAM IN POST-MENOPAUSAL WOMEN WITH URINARY INCONTINENCE. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.765] [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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Abstract
From 1974 to 1989, 18 patients underwent surgical treatment for isolated dissection of the renal artery causing high grade stenosis, including 2 patients with bilateral renal involvement. The causes of renal artery dissection were blunt trauma (1 patient), unsuccessful percutaneous transluminal angioplasty (5) and atherosclerosis (5) or intimal fibroplasia (7) of the renal artery. The most common presenting signs or symptoms of a dissection were hypertension (94%), an abdominal bruit (44%), headache (44%), minimal proteinuria (44%), microscopic hematuria (38%) and flank pain (38%). Renal artery dissection led to segmental or total renal infarction in 8 of 20 involved kidneys (40%). Seventeen patients underwent unilateral surgical revascularization with amelioration of hypertension and preservation of renal function. Three kidneys were lost due to irreversible ischemic damage from an occlusive dissection. Isolated renal artery dissection is an uncommon lesion that can cause hypertension and threaten renal function.
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Affiliation(s)
- S A Slavis
- Department of Urology, Cleveland Clinic Foundation, Ohio 44195
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Abstract
Three patients (aged 56, 40, and 38 years, respectively) presenting with large retroperitoneal masses 10 to 18 years after prior orchiectomy for testicular neoplasms (seminoma and embryonal carcinoma) are presented. Despite aggressive chemotherapy in all three patients and surgical excision of the tumor in two, two of the men subsequently died 11 to 16 months after initial diagnosis of the retroperitoneal tumors, and one is living with the disease. Theoretic etiologic mechanisms for the development of late retroperitoneal tumors in these men are discussed, including (1) metastatic disease from a second primary tumor in the remaining testicle, (2) a primary extragonadal retroperitoneal tumor, and (3) delayed transformation of metastatic teratomatous retroperitoneal tumor from the original primary into malignant neoplasm.
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Maatman T, Kay R. The Benign Appearance of Wilms’ Tumor. J Urol 1984. [DOI: 10.1016/s0022-5347(17)49529-2] [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]
Affiliation(s)
- T. Maatman
- Department of Pediatric and Adolescent Medicine, Section of Pediatric Urology, Department of Urology, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - R. Kay
- Department of Pediatric and Adolescent Medicine, Section of Pediatric Urology, Department of Urology, The Cleveland Clinic Foundation, Cleveland, Ohio
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