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Lepine HL, Vicentini FC, Mazzucchi E, Molina WR, Marchini GS, Torricelli FC, Batagello CA, Danilovic A, Nahas WC. Intraoperative computed tomography for detection of residual stones in endourology procedures: systematic review and meta-analysis. Int Braz J Urol 2024; 50:250-260. [PMID: 38598828 DOI: 10.1590/s1677-5538.ibju.2024.0092] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Success rates in endourological procedures, notably percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), have demonstrated suboptimal outcomes, leading to more reinterventions and radiation exposure. Recently, the use of intraoperative computed tomography (ICT) scans has been hypothesized as a promising solution for improving outcomes in endourology procedures. With this considered, we conducted a comprehensive systematic review and meta-analysis encompassing all available studies that evaluate the impact of the use of intraoperative CT scans on surgical outcomes compared to conventional fluoroscopic-guided procedures. METHODS This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were systematically searched up to December of 2023. This study aimed to directly compare the use of an ICT scan with the standard non-ICT-guided procedure. The primary endpoint of interest was success rate, and the secondary endpoints were complications and reintervention rates, while radiation exposure was also evaluated. Data extraction and quality assessment were performed following Cochrane recommendations. Data was presented as an Odds ratio with 95%CI across trials and a random-effects model was selected for pooling of data. RESULTS A comprehensive search yielded 533 studies, resulting in the selection of 3 cohorts including 327 patients (103 ICT vs 224 in non-ICT). Primary outcome was significantly higher in the experimental group versus the control group (84.5% vs 41.4% respectively, 307 patients; 95% CI [3.61, 12.72]; p<0.00001; I2=0). Reintervention rates also decreased from 32.6% in the control to 12.6% in the ICT group (OR 0.34; 95%CI [0.12,0.94]; p =0.04; I2= 48%), whereas complication rates did not exhibit significant differences. Radiation exposure was also significantly reduced in two of the included studies. CONCLUSION This meta-analysis highlights a favorable outcome with intraoperative CT scan use in PCNL procedures, showing a considerable increase in SFR when compared to standard fluoroscopy and nephroscopy. Despite limited studies, our synthesis underscores the potential of ICT scans to significantly reduce residual stones and their consequences for endourology patients, as reinterventions and follow-up ionizing radiation studies.
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Affiliation(s)
- Henrique L Lepine
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fabio C Vicentini
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Wilson R Molina
- Department of Urology, Endourology Section, University of Kansas, Kansas City, KS, USA
| | - Giovanni S Marchini
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fabio C Torricelli
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Carlos A Batagello
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alexandre Danilovic
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - William C Nahas
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Ito W, Choi N, Letner G, Genz N, Prokop D, Valadon C, Sardiu ME, Smith H, Whiles BB, Molina WR. Preoperative urine culture with contaminants is not associated with increased risk for urinary tract infection after ureteroscopic stone treatment. World J Urol 2024; 42:159. [PMID: 38488875 DOI: 10.1007/s00345-024-04793-w] [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: 04/21/2023] [Accepted: 01/16/2024] [Indexed: 03/17/2024] Open
Abstract
PURPOSE We aimed to assess whether the presence of contaminants in the pre-operative urine culture (preop-UC) predicts postoperative urinary tract infection (postop-UTI) in patients undergoing elective ureteroscopy with laser lithotripsy. METHODS A retrospective chart review was performed from 01/2019 to 12/2021 examining patients with unilateral stone burden ≤ 2 cm who underwent ureteroscopy with laser lithotripsy and had a preop-UC within 3 months. Positive, negative, contaminated, and polymicrobial definitions for UCs were established in accordance with current guidelines. Patients with positive and polymicrobial cultures were excluded. Postop-UTI was defined as the presence of urinary symptoms and a positive UC within 30 days of the procedure. Multivariable logistic regression models were utilized to evaluate risk factors for contamination in the preop-UC and the risk of postop-UTI. RESULTS A total of 201 patients met the inclusion-exclusion criteria. Preop-UC was negative in 153 patients and contaminated in 48 patients. Significant contaminant-related factors included female gender and increased BMI. Postop-UTI was diagnosed in 3.2% of patients with negative preop-UCs and 4.2% of patients with contaminants, with no difference between groups (p = 0.67). The regression model determined that the presence of contaminants in preop-UC failed to predict postop-UTI (OR 0.69, p = 0.64). CONCLUSION The presence of contaminants in preop-UCs is not associated with an increased risk of postop-UTIs after ureteroscopy. Our study supports that contaminants in the preop-UC can be interpreted as a negative UC in terms of postop-UTI risk stratification. Preoperative antibiotics should not be prescribed for patients undergoing uncomplicated ureteroscopy for stone surgery in the setting of a contaminated preop-UC.
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Affiliation(s)
- Willian Ito
- Department of Urology, The University of Kansas Health System, Kansas City, KS, USA
| | - Nicholas Choi
- School of Medicine, The University of Kansas, Kansas City, KS, USA
| | - George Letner
- School of Medicine, The University of Kansas, Kansas City, KS, USA
| | - Nicholas Genz
- School of Medicine, The University of Kansas, Kansas City, KS, USA
| | - Dillon Prokop
- School of Medicine, The University of Kansas, Kansas City, KS, USA
| | - Crystal Valadon
- Department of Urology, The University of Kansas Health System, Kansas City, KS, USA
| | - Mihaela E Sardiu
- Department of Biostatistics and Data Science, University of Kansas, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, 66160, USA
| | - Holly Smith
- Department of Biostatistics and Data Science, University of Kansas, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, 66160, USA
| | - Bristol B Whiles
- Department of Urology, The University of Kansas Health System, Kansas City, KS, USA
| | - Wilson R Molina
- Department of Urology, The University of Kansas Health System, Kansas City, KS, USA.
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Ito WE, Prokop DJ, Whiles BB, Sardiu ME, Smith H, Neff DA, Duchene DA, Molina WR. Impact of Renal Access Angle and Speed of Nephroscope Retrieval Movements on the Vortex Effect. Urology 2024; 183:50-56. [PMID: 37951359 DOI: 10.1016/j.urology.2023.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/05/2023] [Accepted: 10/31/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVE To analyze the influence of different renal access angles (AAs) and nephroscope retrieval speeds on the efficacy of the vortex effect (VE) in mini-percutaneous nephrolithotomy (mini-PCNL). This study aimed to understand the poorly understood physical components of the VE. MATERIALS AND METHODS A Pexiglas™ (KUS®) model was built based on the dimensions of a 15/16 F mini-PCNL set (Karl Storz). The flow rate was continuous via an automatic pump and calibrated to achieve hydrodynamic equivalence to the real equipment. One experiment consisted of manually retrieving all 30 stone phantoms (3 mm diameter) utilizing only the VE. Cumulative time to retrieve all stones was measured. An accelerometer recorded instant speeds of the nephroscope every 0.08 seconds (s), and 3 experiments were performed at each angle (0°, 45°, and 90°). A logistic regression model was built utilizing maximum speeds and access angles to predict the effectiveness of the VE. RESULTS Mean cumulative time for complete stone retrieval was 28.1 seconds at 0° vs 116.5 seconds at 45° vs 101.4 seconds at 90° (P < .01). We noted significantly higher speeds at 0° compared to 45° and 90° (P < .01); however, differences in average and maximum speed between 45° and 90° were not statistically significant (P = .21 and P = .25, respectively). The regression model demonstrated a negative association between increasing maximum speed and VE's effectiveness (OR 0.547, CI 95% 0.350-0.855, P < .01). When controlling for maximum speed, the 0° angle had significantly higher chances of achieving at least a partially effective VE. CONCLUSION Increasing the renal access angle or nephroscope extraction speed negatively impacts the effectiveness of the VE. This significantly increased procedure time in the laboratory model, suggesting that the VE is less effective at higher sheath angles.
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Affiliation(s)
- Willian E Ito
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Dillon J Prokop
- The University of Kansas School of Medicine, Kansas City, KS
| | - Bristol B Whiles
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Mihaela E Sardiu
- Department of Biostatistics and Data Science, The University of Kansas Health System, Kansas City, KS
| | - Holly Smith
- Department of Biostatistics and Data Science, The University of Kansas Health System, Kansas City, KS
| | - Donald A Neff
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - David A Duchene
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Wilson R Molina
- Department of Urology, The University of Kansas Health System, Kansas City, KS.
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Ito WE, Prokop DJ, Ito MC, Whiles BB, Neff DA, Duchene DA, Molina WR. The Vortex Effect in Minimally Invasive Percutaneous Nephrolithotomy. Urology 2023; 180:74-80. [PMID: 37482100 DOI: 10.1016/j.urology.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To describe the physical principles of the vortex effect to better understand its applicability in minimally invasive percutaneous nephrolithotomy (MIP) procedures. METHODS Two acrylic phantom models were built based on the cross-sectional area (CSA) ratio of a MIP nephroscope and access sheaths (15/16F and 21/22F MIP-M, Karl Storz). The nephroscope phantom was 10 mm in diameter. The access sheaths had diameters of 14 mm (CSA ratio: 0.69) and 20 mm (CSA ratio: 0.30). The models were adapted to generate hydrolysis, and hydrogen bubbles enhanced flow visualization on a green laser background. After calibration, the experimental flow rate was set to 12.0 mL/s. Three 30-second trials assessing the flow were performed with each model. Computational fluid dynamic simulations were completed to determine the speed and pressure profiles. RESULTS In both models, as the incoming fluid from the nephroscope phantom attempted to move toward the collecting system, a stagnation point was demonstrated. No fluid entered the collecting system phantom. Utilizing the 14 mm sheath, we observed a random generation of several vortices and a pressure gradient (PG) of 114.4 N/m2 between the nephroscope's tip and stagnation point. In contrast, examining the 20 mm sheath revealed a significantly smaller PG (19.4 N/m2) and no noticeable vortices were noted. CONCLUSION The speed of the fluid and equipment geometry regulate the PG and the vortices field, which are responsible for the production of the vortex effect. Considering the same flow rate, a higher ratio between the CSA of the nephroscope and access sheath results in improved efficacy of the vortex effect.
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Affiliation(s)
- Willian E Ito
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Dillon J Prokop
- The University of Kansas School of Medicine, Kansas City, KS
| | - Mario C Ito
- State University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Bristol B Whiles
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Donald A Neff
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - David A Duchene
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Wilson R Molina
- Department of Urology, The University of Kansas Health System, Kansas City, KS.
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Wu CHW, Badreddine J, Chang J, Huang YRM, Kim FJ, Wild T, Tsai ACH, Meeks N, Donalisio Da Silva R, Molina WR, Schumacher FR. Population genetics analysis of SLC3A1 and SLC7A9 revealed the etiology of cystine stone may be more than what our current genetic knowledge can explain. Urolithiasis 2023; 51:101. [PMID: 37561200 DOI: 10.1007/s00240-023-01473-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/24/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Cystine stone is a Mendelian genetic disease caused by SLC3A1 or SLC7A9. In this study, we aimed to estimate the genetic prevalence of cystine stones and compare it with the clinical prevalence to better understand the disease etiology. METHODS We analyzed genetic variants in the general population using the 1000 Genomes project and the Human Gene Mutation Database to extract all SLC3A1 and SLC7A9 pathogenic variants. All variants procured from both databases were intersected. Pathogenic allele frequency, carrier rate, and affected rate were calculated and estimated based on Hardy-Weinberg equilibrium. RESULTS We found that 9 unique SLC3A1 pathogenic variants were carried by 26 people and 5 unique SLC7A9 pathogenic variants were carried by 12 people, all of whom were heterozygote carriers. No homozygote, compoun d heterozygote, or double heterozygote was identified in the 1000 Genome database. Based on the Hardy-Weinberg equilibrium, the calculated genetic prevalence of cystine stone disease is 1 in 30,585. CONCLUSION The clinical prevalence of cystine stone has been previously reported as 1 in 7,000, a notably higher figure than the genetic prevalence of 1 in 30,585 calculated in this study. This suggests that the etiology of cystine stone is more complex than what our current genetic knowledge can explain. Possible factors that may contribute to this difference include novel causal genes, undiscovered pathogenic variants, alternative inheritance models, founder effects, epigenetic modifications, environmental factors, or other modifying factors. Further investigation is needed to fully understand the etiology of cystine stone.
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Affiliation(s)
- Chen-Han Wilfred Wu
- Department of Genetics and Genome Sciences, Department of Urology, Case Western Reserve University School of Medicine and University Hospitals, Cleveland, OH, USA.
| | - Jad Badreddine
- Department of Genetics and Genome Sciences, Department of Urology, Case Western Reserve University School of Medicine and University Hospitals, Cleveland, OH, USA
| | - Joshua Chang
- Department of Genetics and Genome Sciences, Department of Urology, Case Western Reserve University School of Medicine and University Hospitals, Cleveland, OH, USA
| | - Yu-Ren Mike Huang
- Department of Genetics and Genome Sciences, Department of Urology, Case Western Reserve University School of Medicine and University Hospitals, Cleveland, OH, USA
| | - Fernando J Kim
- Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Trevor Wild
- Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anne Chun-Hui Tsai
- Section of Genetics, Department of Pediatrics, University of Illinois Chicago, Chicago, IL, USA
| | - Naomi Meeks
- Division of Clinical Genetics and Metabolism, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | | | - Wilson R Molina
- Department of Urology, School of Medicine, University of Kansas, Kansas City, KS, USA
| | - Fredrick R Schumacher
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Chew BH, Koo KC, Halawani A, Lundeen CJ, Knudsen BE, Molina WR. Comparing dusting and fragmenting efficiency using the new SuperPulsed thulium fiber laser versus a 120 W Holmium:YAG laser. Investig Clin Urol 2023; 64:265-271. [PMID: 37341006 DOI: 10.4111/icu.20230071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Holmium:YAG laser lithotripsy requires high amperage power and has an upper limit of frequency and a minimal fiber size. The technology utilizing thulium-doped fiber offers low pulse energy settings and high pulse frequencies up to 2,400 Hz. We compared the novel SuperPulsed thulium fiber laser (SOLTIVE™; Olympus) to a commercially available 120 W Ho:YAG laser. MATERIALS AND METHODS Bench-top testing was conducted with 125 mm3 standardized BegoStones (Bego USA). Time to ablate the stone into particles <1 mm was recorded for efficiency calculations. Finite energy was delivered, and resulting particle sizes were measured to determine fragmentation (0.5 kJ) and dusting (2 kJ) efficiencies. Remaining mass or number of fragments were measured to compare efficacy. RESULTS SOLTIVE™ was faster at ablating stones to particles <1 mm (2.23±0.22 mg/s, 0.6 J 30 Hz short pulse) compared to Ho:YAG laser (1.78±0.44 mg/s, 0.8 J 10 Hz short pulse) (p<0.001). Following 0.5 kJ of energy in fragmentation testing, fewer particles >2 mm remained using SOLTIVE™ than Ho:YAG laser (2.10 vs. 7.20 fragments). After delivering 2 kJ, dusting (1.05±0.08 mg/s) was faster using SOLTIVE™ (0.1 J 200 Hz short pulse) than 120 W 0.46±0.09 mg/s (0.3 J 70 Hz Moses) (p=0.005). SOLTIVE™ (0.1 J 200 Hz) produced more dust particles <0.5 mm (40%) compared to 24% produced by the P120 W laser at 0.3 J 70 Hz Moses and 14% at 0.3 J 70 Hz long pulse (p=0.015). CONCLUSIONS The efficacy of SOLTIVE™ is superior to the 120 W Ho:YAG laser by producing smaller dust particles and fewer fragments. Further studies are warranted.
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Affiliation(s)
- Ben H Chew
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, BC, Canada.
| | - Kyo Chul Koo
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | | | - Colin J Lundeen
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, BC, Canada
| | - Bodo E Knudsen
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Wilson R Molina
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA
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Ito WE, Igel DA, Whiles BB, Sardiu M, Neff DA, Duchene DA, Molina WR. Breakage Costs in Flexible Ureteroscopy: Digital vs. Fiberoptic Modalities. Urology 2023; 173:68-74. [PMID: 36400269 DOI: 10.1016/j.urology.2022.10.027] [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: 07/13/2022] [Revised: 09/18/2022] [Accepted: 10/30/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the maintenance costs of digital flexible ureteroscopes (DFU) versus fiberoptic flexible ureteroscopes (FFU) to understand the long-term financial impact associated with breakage in a flexible ureteroscopy (f-URS) program. METHODS Data for breakage of FFU and DFU at an academic institution from 2019 to 2021 were obtained from our vendor (Karl Storz) and analyzed by month. Correlation test was used to evaluate significant differences in number of procedures, number of breakage events, breakage rates, and repair cost per month. Cumulative analyses were utilized to examine the number of procedures before failure (time to failure - TTF) and repair costs per procedure (RCpP). RESULTS We performed a total of 2,154 f-URS, including 1,355 with FFU and 799 with DFU (P<.001). Although we found a higher number of breakage events in FFU (n=124) than DFU (n=73) (P<.001), the overall breakage rate was similar, 9.9% vs. 8.8%, respectively (P=0.86). On cumulative analysis, both modalities reached the same TTF plateau (11 cases) after 18 months. After 400 cases, the RCpP for DFU was 1.25 times higher than for FFU (P=0.04). CONCLUSION Overall, we found no difference in overall scope breakage rates between DFU and FFU. Although there was no difference in TTF over time, at the beginning DFU displayed considerable higher durability, leading to lower RCpP. Furthermore, DFU's endurance leveled off to FFU over time, resulting in higher RCpP after 400 cases. This finding may be explained by the presence of renewed scopes after repair.
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Affiliation(s)
- Willian E Ito
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Daniel A Igel
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Bristol B Whiles
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Mihaela Sardiu
- Department of Biostatistics, The University of Kansas Health System, Kansas City, KS
| | - Donald A Neff
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - David A Duchene
- Department of Urology, The University of Kansas Health System, Kansas City, KS
| | - Wilson R Molina
- Department of Urology, The University of Kansas Health System, Kansas City, KS.
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Randall JH, Whiles BB, Carrera RV, Ito WE, Thompson JA, Duchene DA, Neff DA, Molina WR. On the rocks: can urologists identify stone composition based on endoscopic images alone? A worldwide survey of urologists. World J Urol 2023; 41:575-579. [PMID: 36607392 DOI: 10.1007/s00345-022-04269-9] [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: 07/11/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
PURPOSE As part of the management of nephrolithiasis, determination of chemical composition of stones is important. Our objective in this study is to assess urologists' accuracy in making visual, intraoperative determinations of stone composition. MATERIALS AND METHODS We conducted a REDCap survey asking urologists to predict stone composition based on intraoperative images of 10 different pure-composition kidney stones of 7 different types: calcium oxalate monohydrate (COM), calcium oxalate dihydrate (COD), calcium phosphate (CP) apatite, CP brushite, uric acid (UA), struvite (ST) and cystine (CY). To evaluate experience, we examined specific endourologic training, years of experience, and number of ureteroscopy (URS) cases/week. A self-assessment of ability to identify stone composition was also required. RESULTS With a response rate of 26% (366 completed surveys out of 1,370 deliveries), the overall accuracy of our cohort was 44%. COM, ST, and COD obtained the most successful identification rates (65.9%, 55.7%, and 52.0%, respectively). The most frequent misidentified stones were CP apatite (10.7%) and CY (14.2%). Predictors of increased overall accuracy included self-perceived ability to determine composition and number of ureteroscopies per week, while years of experience did not show a positive correlation. CONCLUSIONS Although endoscopic stone recognition can be an important tool for surgeons, it is not reliable enough to be utilized as a single method for stone identification, suggesting that urologists need to refine their ability to successfully recognize specific stone compositions intraoperatively.
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Affiliation(s)
- Joseph H Randall
- Department of Urology, The University of Kansas Health System, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, 66160, USA
| | - Bristol B Whiles
- Department of Urology, The University of Kansas Health System, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, 66160, USA
| | - Raphael V Carrera
- Department of Urology, The University of Kansas Health System, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, 66160, USA
| | - Willian E Ito
- Department of Urology, The University of Kansas Health System, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, 66160, USA
| | - Jeffrey A Thompson
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - David A Duchene
- Department of Urology, The University of Kansas Health System, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, 66160, USA
| | - Donald A Neff
- Department of Urology, The University of Kansas Health System, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, 66160, USA
| | - Wilson R Molina
- Department of Urology, The University of Kansas Health System, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, 66160, USA.
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Miller CS, Whiles BB, Ito WE, Machen E, Thompson JA, Duchene DA, Neff DA, Molina WR. Image Distortion During Flexible Ureteroscopy: A Laboratory Model Comparing Super Pulsed Thulium Fiber Laser vs High-Power Ho:YAG Laser. J Endourol 2023; 37:99-104. [PMID: 36106599 PMCID: PMC10623464 DOI: 10.1089/end.2022.0195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose: Digital ureteroscopes employ "chip-on-the-tip" technology that allows for significant improvement in image resolution. However, image distortion often occurs during laser lithotripsy owing to acoustic wave production. We sought to compare image distortion using different laser power settings and distances from the laser fiber tip to the scope for the Super Pulsed Thulium Fiber (SPTF) laser and high-power Holmium:YAG (Ho:YAG) laser. Materials and Methods: Ureteroscopy was simulated using a silicon kidney-ureter-bladder model fitted with a 12F/14F access sheath and the Lithovue™ (Boston Scientific), disposable digital flexible ureteroscope. At defined laser parameters (10, 20, 30 and 40 W, short pulse), a 200-μm laser fiber was slowly retracted toward the tip of the ureteroscope during laser activation. Image distortion was identified, and distance from the laser tip to the scope tip was determined. Data from the two lasers were compared utilizing t-tests. Results: After controlling for frequency, power, and laser mode, utilizing 1.0 J of energy was significantly associated with less feedback than 0.5 J (-0.091 mm, p ≤ 0.05). Increased power was associated with larger feedback distance (0.016 mm, p ≤ 0.05); however, increase in frequency did not have a significant effect (-0.001 mm, p = 0.39). The SPFT laser had significantly less feedback when compared with all Holmium laser modes. Conclusions: Increased total power results in image distortion occurring at greater distances from the tip of the ureteroscope during laser activation. Image distortion occurs further from the ureteroscope with Ho:YAG laser than with SPTF fibers at the same laser settings. In clinical practice, the tip of the laser fiber should be kept further away from the tip of the scope during ureteroscopy as the power increases as well as when utilizing the Ho:YAG system compared with the SPTF laser platform. The SPTF laser may have a better safety profile in terms of potential scope damage.
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Affiliation(s)
- Caleb S. Miller
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Bristol B. Whiles
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Willian E. Ito
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Edward Machen
- University of Kansas, School of Medicine, Kansas City, Kansas, USA
| | - Jeffrey A. Thompson
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - David A. Duchene
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Donald A. Neff
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Wilson R. Molina
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
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Carrera RV, Randall JH, Garcia-Gil M, Knudsen BE, Chew BH, Thompson JA, Humphreys MR, Molina WR. Ureteroscopic Performance of High Power Super Pulse Thulium Fiber Laser for the Treatment of Urolithiasis: Results of the First Case Series in North America. Urology 2021; 153:87-92. [PMID: 33621583 DOI: 10.1016/j.urology.2020.12.054] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/30/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To report the first case series of ureterorenoscopy in North America using the High Power Super Pulse Thulium Fiber Laser for the treatment of upper urinary tract stones. METHODS After Institutional Review Board approval, a multicentric retrospective chart review of patients treated with the High Power Super Pulse Thulium Fiber Laser from October 2019 to March 2020 was conducted. Basic demographic information, pre-operative, and peri-operative data were recorded. RESULTS Seventy-six patients were included with a mean age of 60.9 ± 13.3 years. 118 stones were treated including 32 within the ureter, 49 in the lower pole, 37 in mid or upper poles. Dusting technique was commonly used (67.1%) with pulse frequencies up to 2400 Hz. Mean operative time was 59.4 ± 31.5 minutes. Mean laser time and total laser energy were 10.8 ± 14.1 minutes and 12.5 ± 19.1 KJ, respectively. Intraoperative complications were limited to 7 grade 1, 3 grade 2, and 1 grade 3 ureteral injuries and one case of renal collecting system bleeding that was adequately managed with laser coagulation settings (1J-20Hz). CONCLUSION This initial case series in North America of the High Power Super Pulse Thulium Fiber Laser is promising for the treatment of urolithiasis. Sub-200 μm fibers and dusting settings up to 2400 Hz were utilized successfully. No specific complications related to use of the laser were seen.
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Affiliation(s)
- Raphael V Carrera
- University of Kansas Medical Center, Department of Urology, Kansas City, KS, United States
| | - J Hogan Randall
- University of Kansas Medical Center, Department of Urology, Kansas City, KS, United States
| | - Maurilio Garcia-Gil
- The Ohio State University Wexner Medical Center, Department of Urology, Columbus, OH, United States
| | - Bodo E Knudsen
- The Ohio State University Wexner Medical Center, Department of Urology, Columbus, OH, United States
| | - Ben H Chew
- University of British Columbia, Department of Urologic Sciences, Vancouver, BC, Canada
| | - Jeffrey A Thompson
- Department of Biostatistics & Data Science, Kansas City, KS, United States
| | | | - Wilson R Molina
- University of Kansas Medical Center, Department of Urology, Kansas City, KS, United States.
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Lopes AC, Dall'Aqua V, Carrera RV, Molina WR, Glina S. Intra-renal pressure and temperature during ureteroscopy: Does it matter? Int Braz J Urol 2021; 47:436-442. [PMID: 33284547 PMCID: PMC7857755 DOI: 10.1590/s1677-5538.ibju.2020.0428] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Antonio Corrêa Lopes
- Departamento de Urologia, Divisão de Endourologia, Faculdade de Medicina do ABC, Santo Andre, SP, Brasil
| | - Vinícius Dall'Aqua
- Departamento de Urologia, Divisão de Endourologia, Faculdade de Medicina do ABC, Santo Andre, SP, Brasil
| | - Raphael V Carrera
- Department of Urology, Endourology Group Kansas University Medical Center, Kansas, US
| | - Wilson R Molina
- Department of Urology, Endourology Group Kansas University Medical Center, Kansas, US
| | - Sidney Glina
- Departamento de Urologia, Divisão de Endourologia, Faculdade de Medicina do ABC, Santo Andre, SP, Brasil
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Whiles BB, Martin AJ, Brevik A, Carrera RV, Thompson JA, Molina WR, Thurmon KL. Utilization of MOSES Modulated Pulse Mode Results in Improved Efficiency in Holmium:YAG Laser Ablation of the Prostate. Urology 2021; 149:187-192. [PMID: 33412223 DOI: 10.1016/j.urology.2020.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/06/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine if MOSES technology improves efficiency and short-term outcomes in holmium laser ablation of the prostate (HoLAP). METHODS A retrospective review of patients who underwent HoLAP between August 2016 and November 2019 was conducted. All procedures before and after the implementation of MOSES technology at our institution were evaluated. Preoperative patient characteristics and intraoperative data were collected. Postoperative International Prostate Symptom Score, quality of life, and postvoid residual measurements at 6 weeks and 3 months postoperatively were analyzed. RESULTS This cohort included 65 males who underwent HoLAP, 32 without and 33 with MOSES. Patients in the MOSES group were slightly older, but no other differences in baseline characteristics were observed between the two groups. Ablation time was similar at 49.6 ± 26.1 minutes without and 40.7 ± 41.2 minutes with MOSES (P = .38). However, HoLAP with MOSES had significantly higher ablation efficiency (0.59 ± 0.24 g/min without vs 0.86 0.5 g/min with MOSES, P = .01). On multivariable regression modeling, HoLAP without MOSES added 12 minutes to operating time (estimate 12.3, standard error 3.44, P < .01) after controlling for prostate size and laser energy usage. Duration of catheterization, urinary incontinence and need for reoperation within 3 months were similar. There were no differences between groups in International Prostate Symptom Score, quality of life, or postvoid residual at 3 months postoperatively. CONCLUSION Utilization of MOSES technology resulted in improved efficiency in HoLAP, translating into time savings in the operating room. Postoperative outcomes out to 3 months were similar among patients who underwent the procedure utilizing either laser pulse mode. Further studies are needed to investigate long-term outcomes as the use of MOSES is likely to become more commonly utilized.
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Affiliation(s)
- Bristol B Whiles
- Department of Urology, The University of Kansas Health System, Kansas City, MO
| | | | - Andrew Brevik
- Kansas City University of Medicine and Bioscience, Kansas City, MO
| | - Raphael V Carrera
- Department of Urology, The University of Kansas Health System, Kansas City, MO
| | - Jeffrey A Thompson
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, MO
| | - Wilson R Molina
- Department of Urology, The University of Kansas Health System, Kansas City, MO
| | - Kerri L Thurmon
- Department of Urology, The University of Kansas Health System, Kansas City, MO.
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Affiliation(s)
- Wilson R Molina
- Division of Urology, Department of Surgery, University of Colorado, Denver, CO; Denver Health Hospital and Authority, Denver, CO
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Pessoa RR, Autorino R, Laguna MP, Molina WR, Gustafson D, Nogueira L, da Silva RD, Werahera PN, Kim FJ. Laparoscopic Versus Percutaneous Cryoablation of Small Renal Mass: Systematic Review and Cumulative Analysis of Comparative Studies. Clin Genitourin Cancer 2017; 15:513-519.e5. [DOI: 10.1016/j.clgc.2017.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/01/2017] [Accepted: 02/19/2017] [Indexed: 01/24/2023]
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15
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Molina WR, Pessoa R, Donalisio da Silva R, Kenny MC, Gustafson D, Nogueira L, Leo ME, Yu MK, Kim FJ. A new patient safety smartphone application for prevention of "forgotten" ureteral stents: results from a clinical pilot study in 194 patients. Patient Saf Surg 2017; 11:10. [PMID: 28396695 PMCID: PMC5381069 DOI: 10.1186/s13037-017-0123-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 01/12/2017] [Accepted: 03/25/2017] [Indexed: 11/30/2022] Open
Abstract
Background Approximately 12% of all ureteral stents placed are retained or “forgotten.” Forgotten stents are associated with significant safety concerns as well as increased costs and legal issues. Retained ureteral stents (RUS) often occur due to lack of clinical follow-up, communication or language barriers, and economic concerns. Methods We describe a multiplatform application that facilitates data collection to prevent RUS. The “Stent Tracker” application can be installed on mobile devices and computers. The encrypted and password-protected information is accessible from any device and provides information about each procedure, stent placement and removal dates, as well as product description. This multicenter retrospective study included 194 patients who underwent stent placement between July and October 2015. Nominal data was tallied and ordinal data was divided into quartiles of 25, 50, and 75%. Results A total of 194 patients from three institutions underwent ureteral stent placement. Reasons for stent placement include 122 cases post ureteroscopy (63%), 8 cases post percutaneous nephrolithotomy (PCNL) (4%), 14 cases post extracorporeal shock wave lithotripsy (SWL) (7%), 18 cases of cancer-related ureteral obstruction (9%), 21 cases of hydronephrosis (11%), and 11 for other reasons (6%). Of these patients, only one patient was lost to follow-up (0.5%). On average, ureteral stents were removed within 14 days of placement (IQR: 8-26 days). Conclusions The “Stent Tracker” is a patient safety application that provides a secure and simplified interface, which can significantly reduce the incidence of RUS. Further developments could include automated notifications to patients and staff, color-coding, and integrated information with electronic patient charts.
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Affiliation(s)
- Wilson R Molina
- Denver Health Medical Center, Denver, USA.,University of Colorado Denver, Denver, USA
| | - Rodrigo Pessoa
- Denver Health Medical Center, Denver, USA.,University of Colorado Denver, Denver, USA
| | | | - McCabe C Kenny
- Denver Health Medical Center, Denver, USA.,University of Colorado Denver, Denver, USA
| | - Diedra Gustafson
- Denver Health Medical Center, Denver, USA.,University of Colorado Denver, Denver, USA
| | - Leticia Nogueira
- Denver Health Medical Center, Denver, USA.,University of Colorado Denver, Denver, USA
| | - Mark E Leo
- Urology Specialists of Nevada, Las Vegas, USA
| | | | - Fernando J Kim
- Denver Health Medical Center, Denver, USA.,University of Colorado Denver, Denver, USA
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Pessoa RR, Autorino R, Laguna MDP, Molina WR, Donalisio da Silva RR, Gustafson D, Werahera PN, Kim FJ. MP100-19 LAPAROSCOPIC VERSUS PERCUTANEOUS CRYOABLATION OF SMALL RENAL MASS: A META-ANALYSIS OF 1725 CASES. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3126] [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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17
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Paiva MM, da Silva RD, Jaworski P, Kim FJ, Molina WR. Subcapsular hematoma after ureteroscopy and laser lithotripsy. Can J Urol 2016; 23:8385-8387. [PMID: 27544565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Subcapsular hematoma is an uncommon complication after ureteroscopy and laser lithotripsy. We report on a 38-year-old male with an 8 mm lower pole stone who underwent a left ureteroscopy and laser lithotripsy. The stone was successfully fragmented. Several hours after being discharged home, the patient returned complaining of back pain and hematuria. He was hemodynamically stable. Laboratory exams were normal. A CT study showed a crescent renal subcapsular hematoma surrounding the left kidney. The patient was admitted to the ward for conservative treatment. No additional intervention was necessary. Most subcapsular hematomas tend to resolve spontaneously.
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Affiliation(s)
- Matheus Miranda Paiva
- Division of Urology, Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado, USA
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18
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Abstract
With the advent of laparoscopic surgery, the need of optimal visualization and efficient instrumentation has created a need for better understanding of the characteristics of the surgical plume. Despite the technological advances of digital imaging and dissector technology (ultrasonic, radiofrequency electrical, and bipolar), the inconvenient and sometimes harmful generation of a surgical plume decreases visualization, often requiring the surgeon to remove the scope from the surgical field and remove the obstructing particles. If visualization is suboptimal or lost during bleeding, the outcome can be deadly. Therefore, we reviewed the available reports in the literature focused on the quantification of surgical plumes.
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Affiliation(s)
| | - David Sehrt
- Urology Division, Denver Health Medical Center/University of Colorado, Colorado, Denver, USA
| | - Wilson R Molina
- Urology Division, Denver Health Medical Center/University of Colorado, Colorado, Denver, USA
| | - Jake Moss
- Urology Division, Denver Health Medical Center/University of Colorado, Colorado, Denver, USA
| | - Sang Hyun Park
- Department of Urology, Haeundae Paik Hospital, College of Medicine, Inje University, Gimhae, South Korea
| | - Fernando J Kim
- University of Colorado Cancer Center, University of Colorado, Colorado, Denver, USA
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da Silva RD, Bidikov L, Michaels W, Gustafson D, Molina WR, Kim FJ. Bipolar energy in the treatment of benign prostatic hyperplasia: a current systematic review of the literature. Can J Urol 2015; 22 Suppl 1:30-44. [PMID: 26497342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION For decades, the monopolar transurethral resection of the prostate has been established as the minimally invasive surgical treatment for patients with benign prostatic hyperplasia (BPH). In recent years, new technologies and devices emerged to reduce the morbidity and improve outcomes for this treatment approach. Bipolar energy introduced the use of saline irrigation and laser technology increased the urological armamentarium to treat BPH. We performed a systematic review of the literature regarding bipolar technology for the treatment of BPH. MATERIALS AND METHODS A MEDLINE database search using the PRISMA methodology. Selected literature was restricted to articles published in English and published between 2005 and 2015. Articles regarding techniques using bipolar energy were included, while manuscripts that used a different technique, hybrid techniques, or techniques other than bipolar resection, bipolar vaporization, and bipolar enucleation were excluded. RESULTS The use of bipolar energy in the endoscopic treatment of BPH presented a significant reduction in operative time, perioperative complications, shorter catheterization time, reduced number of blood products transfused, and shorter hospital stay compared to standard techniques. Postoperative outcomes showed that bipolar energy was safe and offered significant outcome improvement when compared to traditional monopolar transurethral resection of the prostate (TURP). CONCLUSION The use of bipolar energy in the surgical treatment of patients with BPH is safe and is associated with improvements in perioperative outcomes. Short and mid-term functional outcomes are comparable to standard techniques, but long term functional outcomes need better clinical evaluation.
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20
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Li S, Zhang X, Kim FJ, Donalisio da Silva R, Gustafson D, Molina WR. Attention-Aware Robotic Laparoscope Based on Fuzzy Interpretation of Eye-Gaze Patterns. J Med Device 2015. [DOI: 10.1115/1.4030608] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Laparoscopic robots have been widely adopted in modern medical practice. However, explicitly interacting with these robots may increase the physical and cognitive load on the surgeon. An attention-aware robotic laparoscope system has been developed to free the surgeon from the technical limitations of visualization through the laparoscope. This system can implicitly recognize the surgeon's visual attention by interpreting the surgeon's natural eye movements using fuzzy logic and then automatically steer the laparoscope to focus on that viewing target. Experimental results show that this system can make the surgeon–robot interaction more effective, intuitive, and has the potential to make the execution of the surgery smoother and faster.
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Affiliation(s)
- Songpo Li
- Department of Mechanical Engineering, Colorado School of Mines, Golden, CO 80401 e-mail:
| | - Xiaoli Zhang
- Mem. ASME Department of Mechanical Engineering, Colorado School of Mines, Golden, CO 80401 e-mail:
| | - Fernando J. Kim
- Department of Urology, Denver Health Medical Center, Denver, CO 80204 e-mail:
| | | | - Diedra Gustafson
- Department of Urology, Denver Health Medical Center, Denver, CO 80204 e-mail:
| | - Wilson R. Molina
- Department of Urology, Denver Health Medical Center, Denver, CO 80204 e-mail:
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21
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Autorino R, Zargar H, Mariano MB, Sanchez-Salas R, Sotelo RJ, Chlosta PL, Castillo O, Matei DV, Celia A, Koc G, Vora A, Aron M, Parsons JK, Pini G, Jensen JC, Sutherland D, Cathelineau X, Nuñez Bragayrac LA, Varkarakis IM, Amparore D, Ferro M, Gallo G, Volpe A, Vuruskan H, Bandi G, Hwang J, Nething J, Muruve N, Chopra S, Patel ND, Derweesh I, Champ Weeks D, Spier R, Kowalczyk K, Lynch J, Harbin A, Verghese M, Samavedi S, Molina WR, Dias E, Ahallal Y, Laydner H, Cherullo E, De Cobelli O, Thiel DD, Lagerkvist M, Haber GP, Kaouk J, Kim FJ, Lima E, Patel V, White W, Mottrie A, Porpiglia F. Perioperative Outcomes of Robotic and Laparoscopic Simple Prostatectomy: A European–American Multi-institutional Analysis. Eur Urol 2015; 68:86-94. [DOI: 10.1016/j.eururo.2014.11.044] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/21/2014] [Indexed: 12/17/2022]
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22
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Donalsio da Silva R, Jaworski P, Gustafson D, Nogueira L, Martins Lopes N, R. Molina W, J. Kim F. MP18-10 LACTATE LEVELS AT ADMISSION CAN PREDICT NEPHRECTOMY AND MORTALITY IN PATIENTS WITH HIGH GRADE RENAL TRAUMA (AAST III-V). J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1042] [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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Da Silva RD, Gustafson D, Nogueira L, Molina WR, Kim FJ. Renal cancer management in a patient with chronic kidney disease. Oncology (Williston Park) 2015; 29:206-C3. [PMID: 25772458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
With the advent of laparoscopic surgery, the need of optimal visualization and efficient instrumentation has created a need for better understanding of the characteristics of the surgical plume. Despite the technological advances of digital imaging and dissector technology (ultrasonic, radiofrequency electrical, and bipolar), the inconvenient and sometimes harmful generation of a surgical plume decreases visualization, often requiring the surgeon to remove the scope from the surgical field and remove the obstructing particles. If visualization is suboptimal or lost during bleeding, the outcome can be deadly. Therefore, we reviewed the available reports in the literature focused on the quantification of surgical plumes.
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Affiliation(s)
| | - David Sehrt
- Urology Division, Denver Health Medical Center/University of Colorado, Colorado, Denver, USA
| | - Wilson R Molina
- Urology Division, Denver Health Medical Center/University of Colorado, Colorado, Denver, USA
| | - Jake Moss
- Urology Division, Denver Health Medical Center/University of Colorado, Colorado, Denver, USA
| | - Sang Hyun Park
- Department of Urology, Haeundae Paik Hospital, College of Medicine, Inje University, Gimhae, South Korea
| | - Fernando J Kim
- University of Colorado Cancer Center, University of Colorado, Colorado, Denver, USA
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Abstract
OBJECTIVE On April 25, 2012, the first laparoscopic cordless ultrasonic device (Sonicision, Covidien, Mansfield, Massachusetts) was used in a clinical setting. We describe our initial experience. METHODS The cordless device is assembled with a reusable battery and generator on a base hand-piece. It has a minimum and maximum power setting controlled by a single trigger for both coagulation and cutting. A laparoscopic radical nephrectomy was performed on a 56-year-old man with a 7-cm right renal mass. A laparoscopic pelvic lymphadenectomy was performed in a 51-year-old man with high-risk prostate cancer. Data on surgical team satisfaction, operative time, number of activations, and times the laparoscope was removed as a result of plume were collected. RESULTS The surgical technician successfully assembled the device at the beginning of the cases with verbal instructions from the surgeon. Operative time for nephrectomy was 77 minutes, with 143 total activations (minimum = 86, maximum = 57). The operative time for the pelvic lymphadenectomy was 27 minutes, with 38 total activations (minimum = 27, maximum = 11). One battery was used in each case. The laparoscope was removed twice during the nephrectomy and once during the lymphadenectomy. Surgical staff satisfaction survey results revealed easier and faster assembly, more space in the operating room, ergonomic handle, and comparable cutting/coagulation, weight, and plume generation with other devices (Table 1). [Table: see text]. CONCLUSION The first clinical application of the pioneering cordless dissector was successfully performed, resulting in surgeons' perceptions of comparable results with other devices of easier and safer use and faster assembly.
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Affiliation(s)
- Fernando J Kim
- Division of Urology, Department of Surgery, Denver Health Medical Center, Denver, CO
| | - David Sehrt
- Division of Urology, Department of Surgery, Denver Health Medical Center, Denver, CO
| | - Wilson R Molina
- Division of Urology, Department of Surgery, Denver Health Medical Center, Denver, CO
| | - Alexandre Pompeo
- Division of Urology, Department of Surgery, Denver Health Medical Center, Denver, CO
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Abstract
Objective: On April 25, 2012, the first laparoscopic cordless ultrasonic device (Sonicision, Covidien, Mansfield, Massachusetts) was used in a clinical setting. We describe our initial experience. Methods: The cordless device is assembled with a reusable battery and generator on a base hand-piece. It has a minimum and maximum power setting controlled by a single trigger for both coagulation and cutting. A laparoscopic radical nephrectomy was performed on a 56-year-old man with a 7-cm right renal mass. A laparoscopic pelvic lymphadenectomy was performed in a 51-year-old man with high-risk prostate cancer. Data on surgical team satisfaction, operative time, number of activations, and times the laparoscope was removed as a result of plume were collected. Results: The surgical technician successfully assembled the device at the beginning of the cases with verbal instructions from the surgeon. Operative time for nephrectomy was 77 minutes, with 143 total activations (minimum = 86, maximum = 57). The operative time for the pelvic lymphadenectomy was 27 minutes, with 38 total activations (minimum = 27, maximum = 11). One battery was used in each case. The laparoscope was removed twice during the nephrectomy and once during the lymphadenectomy. Surgical staff satisfaction survey results revealed easier and faster assembly, more space in the operating room, ergonomic handle, and comparable cutting/coagulation, weight, and plume generation with other devices (Table 1). Conclusion: The first clinical application of the pioneering cordless dissector was successfully performed, resulting in surgeons' perceptions of comparable results with other devices of easier and safer use and faster assembly.
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Affiliation(s)
- Fernando J Kim
- Division of Urology, Department of Surgery, Denver Health Medical Center, Denver, CO
| | - David Sehrt
- Division of Urology, Department of Surgery, Denver Health Medical Center, Denver, CO
| | - Wilson R Molina
- Division of Urology, Department of Surgery, Denver Health Medical Center, Denver, CO
| | - Alexandre Pompeo
- Division of Urology, Department of Surgery, Denver Health Medical Center, Denver, CO
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Molina WR, Silva IN, Donalisio da Silva R, Gustafson D, Sehrt D, Kim FJ. Influence of saline on temperature profile of laser lithotripsy activation. J Endourol 2014; 29:235-9. [PMID: 25154455 DOI: 10.1089/end.2014.0305] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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 We established an ex vivo model to evaluate the temperature profile of the ureter during laser lithotripsy, the influence of irrigation on temperature, and thermal spread during lithotripsy with the holmium:yttrium-aluminum-garnet (Ho:YAG) laser. MATERIALS AND METHODS Two ex vivo models of Ovis aries urinary tract and human calcium oxalate calculi were used. The Open Ureteral Model was opened longitudinally to measure the thermal profile of the urothelium. On the Clinical Model, anterograde ureteroscopy was performed in an intact urinary system. Temperatures were measured on the external portion of the ureter and the urothelium during lithotripsy and intentional perforation. The lithotripsy group (n=20) was divided into irrigated (n=10) and nonirrigated (n=10), which were compared for thermal spread length and values during laser activation. The intentional perforation group (n=10) was evaluated under saline flow. The Ho:YAG laser with a 365 μm laser fiber and power at 10W was used (1J/Pulse at 10 Hz). Infrared Fluke Ti55 Thermal Imager was used for evaluation. Maximum temperature values were recorded and compared. RESULTS On the Clinical Model, the external ureteral wall obtained a temperature of 37.4°C±2.5° and 49.5°C±2.3° (P=0.003) and in the Open Ureteral Model, 49.7°C and 112.4°C with and without irrigation, respectively (P<0.05). The thermal spread along the external ureter wall was not statically significant with or without irrigation (P=0.065). During intentional perforation, differences in temperatures were found between groups (opened with and without irrigation): 81.8°±8.8° and 145.0°±15.0°, respectively (P<0.005). CONCLUSION There is an increase in the external ureteral temperature during laser activation, but ureteral thermal values decreased when saline flow was applied. Ureter thermal spread showed no difference between irrigated and nonirrigated subgroups. This is the first laser lithotripsy thermography study establishing the framework to evaluate the temperature profile in the future.
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Affiliation(s)
- Wilson R Molina
- Division of Urology, Department of Surgery, Denver Health Medical Center, University of Colorado , School of Medicine, Denver, Colorado
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Molina WR, Kim FJ, Spendlove J, Pompeo AS, Sillau S, Sehrt DE. The S.T.O.N.E. Score: a new assessment tool to predict stone free rates in ureteroscopy from pre-operative radiological features. Int Braz J Urol 2014; 40:23-9. [PMID: 24642147 DOI: 10.1590/s1677-5538.ibju.2014.01.04] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 09/09/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To develop a user friendly system (S.T.O.N.E. Score) to quantify and describe stone characteristics provided by computed axial tomography scan to predict ureteroscopy outcomes and to evaluate the characteristics that are thought to affect stone free rates. MATERIALS AND METHODS The S.T.O.N.E. score consists of 5 stone characteristics: (S) ize, (T)opography (location of stone), (O)bstruction, (N)umber of stones present, and (E)valuation of Hounsfield Units. Each component is scored on a 1-3 point scale. The S.T.O.N.E. Score was applied to 200 rigid and flexible ureteroscopies performed at our institution. A logistic model was applied to evaluate our data for stone free rates (SFR). RESULTS SFR were found to be correlated to S.T.O.N.E. Score. As S.T.O.N.E. Score increased, the SFR decreased with a logical regression trend (p < 0.001). The logistic model found was SFR=1/(1+e^(-z)), where z=7.02-0.57•Score with an area under the curve of 0.764. A S.T.O.N.E. Score ≤ 9 points obtains stone free rates > 90% and typically falls off by 10% per point thereafter. CONCLUSIONS The S.T.O.N.E. Score is a novel assessment tool to predict SFR in patients who require URS for the surgical therapy of ureteral and renal stone disease. The features of S.T.O.N.E. are relevant in predicting SFR with URS. Size, location, and degree of hydronephrosis were statistically significant factors in multivariate analysis. The S.T.O.N.E. Score establishes the framework for future analysis of the treatment of urolithiasis.
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Affiliation(s)
- Wilson R Molina
- Department of Urology, Denver Health Medical Center, Denver, CO, USA and Department of Urology, University of Colorado, Aurora, CO, USA
| | - F J Kim
- Department of Urology, Denver Health Medical Center, Denver, CO, USA and Department of Urology, University of Colorado, Aurora, CO, USA
| | | | - Alexandre S Pompeo
- Department of Urology, Denver Health Medical Center, Denver, CO, USA and Department of Urology (ASP), ABC Medical School, Sao Paulo, Brazil
| | - Stefan Sillau
- Department of Statistics, University of Colorado, Aurora, CO, USA
| | - David E Sehrt
- Department of Urology, Denver Health Medical Center, Denver, CO, USA
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Kim FJ, Sehrt D, da Silva RD, Gustafson D, Nogueira L, Molina WR. Evaluation of emissivity and temperature profile of laparoscopic ultrasonic devices (blades and passive jaws). Surg Endosc 2014; 29:1179-84. [PMID: 25159635 DOI: 10.1007/s00464-014-3787-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/23/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We examined the emissivity and temperature profile of passive and active jaws of various laparoscopic ultrasonic devices during cutting, coagulation, and cooling time. METHODS The Harmonic ACE™ (ACE), Covidien Sonicision™ (SNC), and Olympus SonoSurg™ (SS) were applied using pre-set factory cutting and coagulation settings to Bovine mesentery and Lamb renal veins, respectively. The maximum temperature and cooling time to reach 60 °C were recorded using an infrared Fluke Ti55 thermal imager. Histological examination was evaluated after application of energy. RESULTS The ACE, Sonicision, and SonoSurg had emissivity measurements of 0.49 ± 0.01, 0.40 ± 0.00, and 0.39 ± 0.01, respectively. Maximum cutting temperatures were: ACE = 191.1°, SNC = 227.1°, and SNS 184.8° * (*p < 0.001). Maximum coagulation temperatures did not differ significantly among devices (p = 0.490). The cooling time to reach 60 °C after activation were 35.7 s (ACE), 38.7 s (SNC), and 27.4 s* (SS) (*p < 0.001). The cooling time of passive jaws to reach 60 °C after activation were 25.4 s* (ACE), 5.7 s (SNC), and 15.4 s (SS) (*p < 0.001). CONCLUSION Laparoscopic ultrasonic instruments obtain the same cutting and coagulation objectives but in different manners. The Sonicision improves cutting by getting the blade hotter while the SonoSurg has more precise coagulation effects by heating slower. Emissivity values varied among instruments, providing equally varied results. Depending on the purpose of the devices, a certain device may be more appropriate. Based on emissivity, more studies are needed to identify the ideal material that can predictably and effectively perform in clinical settings. Although different blade geometry is apparent between instruments, the jaws are also designed differently between the generations of instruments.
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Affiliation(s)
- Fernando J Kim
- Denver Health Medical Center and University of Colorado Denver, 777 Bannock Street (Urology) Mail Code 0206, Denver, CO, 80246, USA,
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De S, Autorino R, Kim FJ, Zargar H, Laydner H, Balsamo R, Torricelli FC, Di Palma C, Molina WR, Monga M, De Sio M. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol 2014; 67:125-137. [PMID: 25064687 DOI: 10.1016/j.eururo.2014.07.003] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/03/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT Recent advances in technology have led to the implementation of mini- and micro-percutaneous nephrolithotomy (PCNL) as well as retrograde intrarenal surgery (RIRS) in the management of kidney stones. OBJECTIVE To provide a systematic review and meta-analysis of studies comparing RIRS with PCNL techniques for the treatment of kidney stones. EVIDENCE ACQUISITION A systematic literature review was performed in March 2014 using the PubMed, Scopus, and Web of Science databases to identify relevant studies. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria. A subgroup analysis was performed comparing standard PCNL and minimally invasive percutaneous procedures (MIPPs) including mini-PCNL and micro-PCNL with RIRS, separately. EVIDENCE SYNTHESIS Two randomised and eight nonrandomised studies were analysed. PCNL techniques provided a significantly higher stone-free rate (weighted mean difference [WMD]: 2.19; 95% confidence interval [CI], 1.53-3.13; p<0.00001) but also higher complication rates (odds ratio [OR]: 1.61; 95% CI, 1.11-2.35; p<0.01) and a larger postoperative decrease in haemoglobin levels (WMD: 0.87; 95% CI, 0.51-1.22; p<0.00001). In contrast, RIRS led to a shorter hospital stay (WMD: 1.28; 95% CI, 0.79-1.77; p<0.0001). At subgroup analysis, RIRS provided a significantly higher stone-free rate than MIPPs (WMD: 1.70; 95% CI, 1.07-2.70; p=0.03) but less than standard PCNL (OR: 4.32; 95% CI, 1.99-9.37; p=0.0002). Hospital stay was shorter for RIRS compared with both MIPPs (WMD: 1.11; 95% CI, 0.39-1.83; p=0.003) and standard PCNL (WMD: 1.84 d; 95% CI, 0.64-3.04; p=0.003). CONCLUSIONS PCNL is associated with higher stone-free rates at the expense of higher complication rates, blood loss, and admission times. Standard PCNL offers stone-free rates superior to those of RIRS, whereas RIRS provides higher stone free rates than MIPPs. Given the added morbidity and lower efficacy of MIPPs, RIRS should be considered standard therapy for stones <2 cm until appropriate randomised studies are performed. When flexible instruments are not available, standard PCNL should be considered due to the lower efficacy of MIPPs. PATIENT SUMMARY We searched the literature for studies comparing new minimally invasive techniques for the treatment of kidney stones. The analysis of 10 available studies shows that treatment can be tailored to the patient by balancing the advantages and disadvantages of each technique.
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Affiliation(s)
- Shuba De
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Riccardo Autorino
- Urology Service, Second University of Naples, Naples, Italy; Urology Institute, University Hospitals Case Medical Center, Cleveland, OH, USA.
| | - Fernando J Kim
- Department of Urology, Denver Health Medical Center, Denver, CO, USA
| | - Homayoun Zargar
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Humberto Laydner
- Urology Institute, University Hospitals Case Medical Center, Cleveland, OH, USA
| | | | - Fabio C Torricelli
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Division of Urology, Hospital das Clinicas, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Wilson R Molina
- Department of Urology, Denver Health Medical Center, Denver, CO, USA
| | - Manoj Monga
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Marco De Sio
- Urology Service, Second University of Naples, Naples, Italy
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Kim FJ, Werahera PN, Sehrt DE, Gustafson D, Silva RD, Molina WR. Ethnic minorities (African American and Hispanic) males prefer prostate cryoablation as aggressive treatment of localized prostate cancer. Can J Urol 2014; 21:7305-7311. [PMID: 24978362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Our safety net hospital offers minimally invasive, traditional open and perineal radical prostatectomies, as well as radiation therapy and medical oncological services when appropriate. Historically, only few African American and Hispanic patients elected surgical procedures due to unknown reasons. Interestingly, after initiation of the prostate cryoablation program (Whole Gland) in 2003 at Denver Health Medical Center (DHMC) we noticed a trend towards cryotherapy in these specific patient populations for the treatment of localized prostate cancer. We analyzed the profile of ethnic minority men evaluated for localized prostate cancer and evaluated the associated factors in the decision making for the treatment of localized prostate cancer. MATERIALS AND METHODS A retrospective review of 524 patients seen for prostate cancer from January 2003 to January 2012 in our safety net hospital was conducted. The treatment selected by the patient after oncologic consultation was then recorded. The health insurance status, demographic data, and personal statements of reasons for elected procedure were obtained. A multivariate logistic regression for associated factors influencing treatment decisions was then formed. Patients were categorized by using the D'Amico risk stratification criteria. RESULTS The insurance status revealed that only 1% of African American patients had private health insurance versus 5% Hispanic and 26% of Caucasians. African American men were at higher D'Amico risk with more positive metastasis evaluation yet were less likely to undergo surgery and instead often elected for radiation therapy. Conversely, Hispanic and Caucasian men often elected cryoablation and radical prostatectomy for their treatment. Referrals for surgery were primarily Caucasian males with private health insurance. Most minority patients had indigent health coverage. Statistical analysis further revealed that age, marital status, indigent enrollment, D'Amico risk, and the option of cryoablation may influence patient's selection for surgical management of localized prostate cancer. CONCLUSION Many factors influence treatment selection including race, age, marital status, enrollment in an indigent program, and a high D'Amico risk. The less invasive nature of cryoablation appeared to influence patients' opinion regarding surgery for the treatment of localized prostate cancer, especially in African American men.
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Pompeo A, Molina WR, Juliano C, Sehrt D, Kim FJ. Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD) in obese and morbid patients. Int Braz J Urol 2014; 39:702-9; discussion 710-1. [PMID: 24267113 DOI: 10.1590/s1677-5538.ibju.2013.05.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 06/14/2013] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The purpose of this study is to determine if body mass index (BMI) and stone skin distance (SSD) affect stone free rate (SFR) in obese and morbid obese patients who underwent flexible URS for proximal ureteral or renal stones < 20 mm. MATERIALS AND METHODS A retrospective chart review was performed of consecutive patients that underwent flexible URS. Inclusion criteria were: proximal ureteral stones and renal stones less than 20 mm in the preoperative computed tomography (CT). SFR were then compared according to SSD and BMI. RESULTS A total of 153 patients were eligible for this analysis, 49 (32.02%) with SSD < 10 cm and 104 (67.97%) with SSD ≥ 10 cm. The mean stone size was 10.5 ± 6.4 mm. The overall SFR in our study was 82.4%. The SFR for the SSD < 10 and ≥ 10 were 79.6% and 83.7% respectively (p = 0.698) and for BMI < 30, ≥ 30 and < 40 and ≥ 40 were 82.9%, 81.7% and 90.9% respectively. Regression analysis showed no affect between BMI or SSD regarding SFR. CONCLUSION Ureteroscopy should be considered as a first-line of treatment for renal/proximal stones in obese and morbid obese patients. URS may be preferable to SWL in obese patients independently of the SSD, BMI or the location of proximal stones.
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Affiliation(s)
- Alexandre Pompeo
- Department of Urology, Denver Health Medical Center, Denver, CO, USA
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Da Silva RD, Molina WR, Gustafson D, Nogueira L, Tayal S, La Rosa FG, Kim FJ. Large renal mass: a challenge for the urologist. Oncology (Williston Park) 2014; 28:320-324. [PMID: 24839805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Mattei J, da Silva RD, Sehrt D, Molina WR, Kim FJ. Targeted therapy in metastatic renal carcinoma. Cancer Lett 2014; 343:156-60. [DOI: 10.1016/j.canlet.2013.09.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 09/23/2013] [Accepted: 09/26/2013] [Indexed: 01/10/2023]
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Molina WR, Marchini GS, Pompeo A, Sehrt D, Kim FJ, Monga M. Determinants of holmium:yttrium-aluminum-garnet laser time and energy during ureteroscopic laser lithotripsy. Urology 2014; 83:738-44. [PMID: 24486000 DOI: 10.1016/j.urology.2013.11.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/01/2013] [Accepted: 11/16/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the association of preoperative noncontrast computed tomography stone characteristics, laser settings, and stone composition with cumulative holmium:yttrium-aluminum-garnet (Ho:YAG) laser time/energy. MATERIALS AND METHODS We retrospectively reviewed patients who underwent semirigid/flexible ureteroscopy and Ho:YAG laser lithotripsy (200 or 365 μm laser fiber; 0.8-1.0 J energy; and 8-10 Hz rate) at 2 tertiary care centers (April 2010-May 2012). Studied parameters were as follows: patient's characteristics; stone characteristics (location, burden, hardness, and composition); total laser time and energy; and surgical outcomes. RESULTS One hundred patients met our inclusion criteria. Mean stone size was 1.01 ± 0.42 cm and volume 0.33 ± 0.04 cm(3). Mean stone radiodensity was 990 ± 296 HU, and Hounsfield units density 13.8 ± 6.0 HU/mm. All patients were considered stone free. Stone size and volume had a significant positive correlation with laser energy (R = 0.516, P <.001; R = 0.621, P <.001) and laser time (R = 0.477, P <.001; R = 0.567, P <.001). When controlling for stone size, only the correlation between HU and laser time was significant (R = 0.262, P = .011). In the multivariate analysis, with exception of stone composition (P = .103), all parameters significantly increased laser energy (R(2) = 0.524). Multivariate analysis revealed a positive significant association of laser time with stone volume (P <.001) and Hounsfield units density (P <.001; R(2) = 0.512). In multivariate analysis for laser energy, only calcium phosphate stones required less energy to fragment compared with uric acid stones. No significant differences were found in the multivariate laser time model. CONCLUSION Ho:YAG laser cumulative energy and total time are significantly affected by stone dimensions, hardness location, fiber size, and power. Kidney location, laser fiber size, and laser power have more influence on the final laser energy than on the total laser time. Calcium phosphate stones require less laser energy to fragment.
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Affiliation(s)
- Wilson R Molina
- Department of Surgery, University of Colorado School of Medicine, Denver, CO
| | - Giovanni S Marchini
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Alexandre Pompeo
- Department of Surgery, University of Colorado School of Medicine, Denver, CO
| | - David Sehrt
- Department of Surgery, University of Colorado School of Medicine, Denver, CO
| | - Fernando J Kim
- Department of Surgery, University of Colorado School of Medicine, Denver, CO
| | - Manoj Monga
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
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Kim FJ, Sehrt D, Pompeo A, Molina WR. Laminar and turbulent surgical plume characteristics generated from curved- and straight-blade laparoscopic ultrasonic dissectors. Surg Endosc 2014; 28:1674-7. [PMID: 24399523 DOI: 10.1007/s00464-013-3369-6] [Citation(s) in RCA: 3] [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] [Received: 08/26/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To characterize laparoscopic ultrasonic dissector surgical plume emission (laminar or turbulent) and investigate plume settlement time between curved and straight blades. MATERIALS AND METHODS A straight and a curved blade laparoscopic ultrasonic dissector were activated on tissue and in a liquid environment to evaluate plume emission. Plume emission was characterized as either laminar or turbulent and the plume settlement times were compared. Devices were then placed in liquid to observed consistency in the fluid disruption. RESULTS Two types of plume emission were identified generating different directions of plume: laminar flow causes minimal visual obstruction by directing the aerosol downwards, while turbulent flow directs plume erratically across the cavity. Laminar plume dissipates immediately while turbulent plume reaches a second maximum obstruction approximately 0.3 s after activation and clears after 2 s. Turbulent plume was observed with the straight blade in 10 % of activations, and from the curved blade in 47 % of activations. The straight blade emitted less obstructive plume. CONCLUSION Turbulent flow is disruptive to laparoscopic visibility with greater field obstruction and requires longer settling than laminar plume. Ultrasonic dissectors with straight blades have more consistent oscillations and generate more laminar flow compared with curved blades. Surgeons may avoid laparoscope smearing from maximum plume generation depending on blade geometry.
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Affiliation(s)
- Fernando J Kim
- Division of Urology, Denver Health Medical Center, University of Colorado Cancer Center Denver (UCCCD), 777 Bannock St, MC0206, Denver, CO, 80204, USA,
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Pompeo A, Tobias-Machado M, Molina WR, Lucio J, Sehrt D, Pompeo ACL, Kim FJ. Extending boundaries in minimally invasive procedures with simultaneous bilateral video endoscopic inguinal lymphadenectomy (veil) for penile cancer: initial Denver health medical center and ABC school of medicine experience and surgical considerations. Int Braz J Urol 2013; 39:587-92. [PMID: 24054388 DOI: 10.1590/s1677-5538.ibju.2013.04.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 06/14/2013] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To report the surgical technique, procedural outcomes, and feasibility of simultaneous bilateral Video Endoscopic Inguinal Lymphadenectomy (VEIL) in the management of patients with indication for inguinal lymphadenectomy. SURGICAL TECHNIQUE VEIL was applied in all patients using the oncological landmarks (the adductor longus muscle medially, the sartorius muscle laterally and the inguinal ligament superiorly). A 1.5 cm incision was made 2 cm distally to the lower vertex of the femoral triangle. A second incision was made 2 cm proximally and 6 cm medially. Two 10 mm Hasson trocars were inserted in these incisions and the working space was insufflated with CO2 at 5-15 mmHg. The final trocar was placed 2 cm proximally and 6 cm laterally from the first port. RESULTS A total of 5 VEIL procedures in 3 patients were performed. Two patients underwent simultaneous bilateral VEIL while another underwent simultaneous bilateral surgery with VEIL on the right and open lymphadenectomy on the left side due to an enlarged node. All laparoscopic procedures were successfully performed without conversion and maintained the oncological templates. One lymphocele occurred in the patient who underwent the open procedure. None of the patients presented with skin necrosis after the procedure. Mean number of nodes retrieved was 6 from each side and 2 patients presented with positive inguinal nodes. After one year of follow-up no recurrences were observed. CONCLUSION Simultaneous lymphadenectomy procedures are feasible. Improvement in operative and anesthesia time could decrease the morbidity associated with inguinal lymphadenectomy while maintaining the oncological principles.
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Affiliation(s)
- Alexandre Pompeo
- Division of Urology, Department of Surgery, Denver Health Medical Center and University of Colorado Health Sciences Center, Denver, Colorado, USA
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Mattei J, Kim FJ, Phillips J, Zhelnin KE, Said S, Sehrt D, Molina WR. Male primary retroperitoneal mucinous cystadenoma. Urology 2013; 82:e1-2. [PMID: 23806409 DOI: 10.1016/j.urology.2013.03.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 03/01/2013] [Revised: 03/08/2013] [Accepted: 03/18/2013] [Indexed: 12/26/2022]
Abstract
Primary retroperitoneal mucinous cystadenoma of borderline malignancy is a rare disease, especially in male patients. Often these tumors are not incidentally found due to abdominal symptoms. We present the radiologic abdominal computed tomography scan, surgical, and pathologic images of this unique, rare condition in a male patient. Surgical treatment is recommended to establish diagnosis and treatment.
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Affiliation(s)
- Jane Mattei
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
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Akilov O, Pompeo A, Sehrt D, Bowlin P, Molina WR, Kim FJ. Early scrotal approximation after hemiscrotectomy in patients with Fournier's gangrene prevents scrotal reconstruction with skin graft. Can Urol Assoc J 2013; 7:E481-5. [PMID: 23914264 DOI: 10.5489/cuaj.1405] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We report the outcomes of an early loose closure of the scrotum with a modified U-stitch to minimize use of split thickens skin graft for patients with hemiscrotal tissue loss after surgical debridement. METHODS From January 2006 to August 2011, 28 male patients presented with Fournier's gangrene, requiring major urological surgical care and scrotal debridement at Denver Health Medical Center. Surgical outcomes were compared between patients receiving a novel U-Stitch approximation and those treated by traditional management. RESULTS The mean age of the patients was 47.1 ± 10.2 years. In total 8 patients (2.2%) developed bacteremia and 3 (0.1%) had methicillin-resistant staphylococcus aureus (MRSA) infection. There was conversion from the U-Stitch approximation patients to traditional management. U-stitch patients required less hospitalization than patients requiring split-thickness skin graft (STSG) due to loss of >50% of the total scrotal tissue (11 vs. 35 days, p = 0.081). The U-stitch demonstrated non-inferiority to traditional treatment. CONCLUSION Immediate loose scrotal wound approximation with efficient surgical debridement for Fournier's gangrene may prevent testis exposure facilitating local wound treatment, decreasing the length of hospital stay in patients with Fournier's gangrene involving the scrotum. Future randomized trials may validate these findings.
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Affiliation(s)
- Oleg Akilov
- Department of Surgery, University of Colorado School of Medicine, Denver, CO
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Abstract
This report suggests that laparoscopic ureteral reimplantation offers an alternative surgical approach to open surgery after distal ureteral injuries. Objectives: To examine the feasibility of early laparoscopic ureteroneocystostomy for ureteral obstruction due to hysterectomy injury. Methods: We retrospectively reviewed a 10-y experience from 2 institutions in patients who underwent early (<30 d) or late (>30 d) laparoscopic ureteroneocystostomy for ureteral injury after hysterectomy. Evaluation of the surgery included the cause of the stricture and intraoperative and postoperative outcomes. Results: A total of 9 patients with distal ureteral injury after hysterectomy were identified. All injuries were identified and treated as early as 21 d after hysterectomy. Seven of 9 patients underwent open hysterectomy, and the remaining patients had vaginal and laparoscopic radical hysterectomy. All ureteroneocystostomy cases were managed laparoscopically without conversion to open surgery and without any intraoperative complications. The Lich-Gregoir reimplantation technique was applied in all patients, and 2 patients required a psoas hitch. The mean operative time was 206.6 min (range, 120–280 min), the mean estimated blood loss was 122.2 cc (range, 25–350 cc), and the mean admission time was 3.3 d (range, 1–7 d). Cystography showed no urine leak when the ureteral stent was removed at 4 to 6 wk after the procedure. Ureteroneocystostomy patency was followed up with cystography at 6 mo and at least 10 y after ureteroneocystostomy. Conclusion: Early laparoscopic ureteral reimplantation may offer an alternative surgical approach to open surgery for the management of distal ureteral injuries, with favorable cosmetic results and recovery time from ureteral obstruction due to hysterectomy injury.
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Affiliation(s)
- Alexandre Pompeo
- Department of Surgery, University of Colorado Health Sciences Center, Denver, CO, USA
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Abstract
Scrotal calcinosis is a rare condition with presentation including intradermal nodules varying in size and number. Differentials include calcification of epidermal or pilar cysts noted by the presence of keratinaceous debris. We present 2 cases of scrotal calcinosis at our institution.
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Affiliation(s)
- Alexandre Pompeo
- Denver Health Medical Center, University of Colorado, Denver, CO
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Kim FJ, Sehrt D, Pompeo A, Molina WR. Comparison of surgical plume among laparoscopic ultrasonic dissectors using a real-time digital quantitative technology. Surg Endosc 2012; 26:3408-12. [PMID: 22660839 PMCID: PMC3505554 DOI: 10.1007/s00464-012-2351-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aimed to analyze the effect of surgical plume generation from various ultrasonic dissectors on laparoscopic visibility, including the first cordless ultrasonic dissector, using a novel real-time digital quantification technique. METHODS The Covidien Cordless Sonicision, the Harmonic ACE, and the Olympus SonoSurg were applied to bovine liver with industry-specified settings. Consecutive activations were digitally captured from a laparoscope positioned to replicate the clinical setting. Plume was recognized by ImageJ software, and the percentage of pixels containing plume in each video frame was calculated. Analysis of variance statistical multi-analysis and Welch's t test were computed for all p values. RESULTS The average maximum plume produced by the Sonicision, ACE, and SonoSurg with the maximum setting were respectively 8.76% (range, 4.32-17.41%), 18.04% (range, 9.07-55.12%), and 9.46% (range, 5.68-22.12%) (p = 0.026). The deviations between the ACE and the other devices were significant (p < 0.05). The average maximum plumes produced with the coagulation setting were 4.80% (range, 0.24-19.83%) for the Sonicision, 26.63% (range, 8.12-73.50%) for the ACE, and 0.21% (range, 0.06-1.05%) for the SonoSurg (p < 0.001). The differences between all the instruments in the coagulation setting were significant. CONCLUSION To the authors' knowledge, this is the first report on a real-time digital analysis of surgical plume generation using ImageJ software. In the coagulation setting, the SonoSurg generated minimal plume. The Sonicision obstructed approximately 4%, whereas the ACE generated plume that obstructed 25% of the laparoscopic field. In the cutting setting, the SonoSurg and Sonicision generated the least obstruction, whereas the ACE caused the most obstruction.
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Affiliation(s)
- Fernando J. Kim
- Division of Urology, Denver Health Medical Center, 777 Bannock Street, MC0206, Denver, CO 80204 USA
- Division of Urology, University of Colorado Health Sciences Center, Aurora, CO USA
| | - David Sehrt
- Division of Urology, Denver Health Medical Center, 777 Bannock Street, MC0206, Denver, CO 80204 USA
| | - Alexandre Pompeo
- Division of Urology, Denver Health Medical Center, 777 Bannock Street, MC0206, Denver, CO 80204 USA
| | - Wilson R. Molina
- Division of Urology, Denver Health Medical Center, 777 Bannock Street, MC0206, Denver, CO 80204 USA
- Division of Urology, University of Colorado Health Sciences Center, Aurora, CO USA
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Kim FJ, Cerqueira MA, Almeida JC, Pompeo A, Sehrt D, Calheiros JM, Martins FA, Molina WR. Initial brazilian experience in the treatment of localized prostate cancer using a new generation cryotechnology: feasibility study. Int Braz J Urol 2012; 38:620-6. [PMID: 23131504 DOI: 10.1590/s1677-55382012000500006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The objective of our study is to present the first Brazilian cryoablation experience in the treatment of low and intermediate risk localized prostate cancer using 3rd generation cryoablation and real-time biplanar transrectal ultrasonography. MATERIALS AND METHODS Ten Brazilian patients underwent primary cryoablation for localized prostate cancer between October 2010 and June 2011. All patients consented for whole gland primary cryotherapy. The procedures were performed by 3rd generation cryoablation with the Cryocare System ® (Endocare, Irvine, California). Preoperative data collection included patient demographics along with prostate gland size, Gleason score, serum prostate specific antigen, and erectile function status. Operative and post--operative assessment involved estimated blood loss, operative time, complications, serum PSA level, erectile function status, urinary incontinence, biochemical disease free survival (BDFS), and follow-up time. RESULTS All patients in the study successfully underwent whole gland cryoablation. The mean of: age, prostate size, PSA level, and Gleason score, was 66.2 years old; 40.7 g; 7.8 ng/mL; and 6 respectively. All patients were classified as low or moderate D' Amico risk (5 low and 5 moderate). Erectile dysfunction was present in 50% of patients. The estimated blood loss was minimal, operative time was 46.1 minutes. All patients that developed erectile dysfunction post-treatment responded to oral or intracavernosal medications with early penile rehabilitation. All patients maintained urinary continence by the end of a 10 months evaluation period and none had biochemical relapse within the mean follow-up of 13 months (7-15 months). CONCLUSION Our initial experience shows that cryoablation is a minimally invasive option for the treatment of localized prostate cancer. Short term data seems to be promising but longer follow-up is necessary to verify oncological and functional results.
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Autorino R, Kaouk JH, Yakoubi R, Rha KH, Stein RJ, White WM, Stolzenburg JU, Cindolo L, Liatsikos E, Rais-Bahrami S, Volpe A, Han DH, Derweesh IH, Lee SW, Abdel-Karim AM, Branco A, Greco F, Allaf M, Sotelo R, Kallidonis P, Jeong BC, Best S, Bazzi W, Pierorazio P, Elsalmy S, Rane A, Han WK, Yang B, Schips L, Molina WR, Fornara P, Terrone C, Giedelman C, Lee JY, Crouzet S, Haber GP, Richstone L, Yinghao S, Kim FJ, Cadeddu JA. Urological Laparoendoscopic Single Site Surgery: Multi-Institutional Analysis of Risk Factors for Conversion and Postoperative Complications. J Urol 2012; 187:1989-94. [DOI: 10.1016/j.juro.2012.01.062] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Indexed: 12/27/2022]
Affiliation(s)
- Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H. Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rachid Yakoubi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Koon Ho Rha
- Department of Urology, Yonsei University College of Medicine, Seoul, South Korea
| | - Robert J. Stein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wesley M. White
- Urology Cancer Center, University of Tennessee Medical Center, Knoxville, Tennessee
| | | | - Luca Cindolo
- Urology Unit, S. Pio da Pietralcina Hospital, Vasto, Italy
| | - Evangelos Liatsikos
- Department of Urology, University of Patras, School of Medicine, Patras, Greece
| | - Soroush Rais-Bahrami
- Smith Institute for Urology, Hofstra-North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ithaar H. Derweesh
- Division of Urology, University of California San Diego, La Jolla, California
| | - Seung Wook Lee
- Department of Urology, Hanyang University College of Medicine, Seoul, South Korea
| | | | - Anibal Branco
- Department of Urology, Cruz Vermelha Hospital, Curitiba, Brazil
| | - Francesco Greco
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle/Saale, Germany
| | - Mohamad Allaf
- The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Rene Sotelo
- Unidad de Urología, Instituto Médico La Floresta, Caracas, Venezuela
| | | | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sara Best
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Wassim Bazzi
- Division of Urology, University of California San Diego, La Jolla, California
| | - Phillip Pierorazio
- The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Salah Elsalmy
- Department of Urology, Alexandria University, Alexandria, Egypt
| | - Abhay Rane
- Department of Urology, East Surrey Hospital, Redhill, United Kingdom
| | - Woong Kyu Han
- Department of Urology, Yonsei University College of Medicine, Seoul, South Korea
| | - Bo Yang
- Department of Urology, Changhai Hospital, Shanghai, People's Republic of China
| | - Luigi Schips
- Urology Unit, S. Pio da Pietralcina Hospital, Vasto, Italy
| | - Wilson R. Molina
- Denver Health Medical Center, University of Colorado Health Science Center, Denver, Colorado
| | - Paolo Fornara
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle/Saale, Germany
| | - Carlo Terrone
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Camilo Giedelman
- Unidad de Urología, Instituto Médico La Floresta, Caracas, Venezuela
| | - Joo Yong Lee
- Department of Urology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sebastien Crouzet
- Service d'Urologie et Chirurgie de la Transplantation, Hôpital Edouard-Herriot, Lyon, France
| | | | - Lee Richstone
- Smith Institute for Urology, Hofstra-North Shore-Long Island Jewish School of Medicine, New Hyde Park, New York
| | - Sun Yinghao
- Department of Urology, Changhai Hospital, Shanghai, People's Republic of China
| | - Fernando J. Kim
- Denver Health Medical Center, University of Colorado Health Science Center, Denver, Colorado
| | - Jeffrey A. Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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Maccini M, Sehrt D, Pompeo A, Chicoli FA, Molina WR, Kim FJ. Biophysiologic considerations in cryoablation: a practical mechanistic molecular review. Int Braz J Urol 2011; 37:693-6. [DOI: 10.1590/s1677-55382011000600002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2011] [Indexed: 11/22/2022] Open
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Kaouk JH, Autorino R, Kim FJ, Han DH, Lee SW, Yinghao S, Cadeddu JA, Derweesh IH, Richstone L, Cindolo L, Branco A, Greco F, Allaf M, Sotelo R, Liatsikos E, Stolzenburg JU, Rane A, White WM, Han WK, Haber GP, White MA, Molina WR, Jeong BC, Lee JY, Linhui W, Best S, Stroup SP, Rais-Bahrami S, Schips L, Fornara P, Pierorazio P, Giedelman C, Lee JW, Stein RJ, Rha KH. Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases. Int Braz J Urol 2011. [DOI: 10.1590/s1677-55382011000500017] [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: 11/22/2022] Open
Affiliation(s)
- JH Kaouk
- Glickman Urological & Kidney Institute, USA
| | - R Autorino
- Glickman Urological & Kidney Institute, USA
| | - FJ Kim
- Glickman Urological & Kidney Institute, USA
| | - DH Han
- Glickman Urological & Kidney Institute, USA
| | - SW Lee
- Glickman Urological & Kidney Institute, USA
| | - S Yinghao
- Glickman Urological & Kidney Institute, USA
| | - JA Cadeddu
- Glickman Urological & Kidney Institute, USA
| | | | | | - L Cindolo
- Glickman Urological & Kidney Institute, USA
| | - A Branco
- Glickman Urological & Kidney Institute, USA
| | - F Greco
- Glickman Urological & Kidney Institute, USA
| | - M Allaf
- Glickman Urological & Kidney Institute, USA
| | - R Sotelo
- Glickman Urological & Kidney Institute, USA
| | | | | | - A Rane
- Glickman Urological & Kidney Institute, USA
| | - WM White
- Glickman Urological & Kidney Institute, USA
| | - WK Han
- Glickman Urological & Kidney Institute, USA
| | - GP Haber
- Glickman Urological & Kidney Institute, USA
| | - MA White
- Glickman Urological & Kidney Institute, USA
| | - WR Molina
- Glickman Urological & Kidney Institute, USA
| | - BC Jeong
- Glickman Urological & Kidney Institute, USA
| | - JY Lee
- Glickman Urological & Kidney Institute, USA
| | - W Linhui
- Glickman Urological & Kidney Institute, USA
| | - S Best
- Glickman Urological & Kidney Institute, USA
| | - SP Stroup
- Glickman Urological & Kidney Institute, USA
| | | | - L Schips
- Glickman Urological & Kidney Institute, USA
| | - P Fornara
- Glickman Urological & Kidney Institute, USA
| | | | | | - JW Lee
- Glickman Urological & Kidney Institute, USA
| | - RJ Stein
- Glickman Urological & Kidney Institute, USA
| | - KH Rha
- Glickman Urological & Kidney Institute, USA
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Kim FJ, Sehrt DE, Molina WR, Huh JS, Rassweiler J, Turner C. Initial experience of a novel ergonomic surgical chair for laparoscopic pelvic surgery. Int Braz J Urol 2011; 37:455-60. [DOI: 10.1590/s1677-55382011000400003] [Citation(s) in RCA: 11] [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] [Accepted: 05/05/2011] [Indexed: 11/21/2022] Open
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Kaouk JH, Autorino R, Kim FJ, Han DH, Lee SW, Yinghao S, Cadeddu JA, Derweesh IH, Richstone L, Cindolo L, Branco A, Greco F, Allaf M, Sotelo R, Liatsikos E, Stolzenburg JU, Rane A, White WM, Han WK, Haber GP, White MA, Molina WR, Jeong BC, Lee JY, Linhui W, Best S, Stroup SP, Rais-Bahrami S, Schips L, Fornara P, Pierorazio P, Giedelman C, Lee JW, Stein RJ, Rha KH. Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases. Eur Urol 2011; 60:998-1005. [PMID: 21684069 DOI: 10.1016/j.eururo.2011.06.002] [Citation(s) in RCA: 196] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 06/03/2011] [Indexed: 12/24/2022]
Abstract
BACKGROUND Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years. OBJECTIVE To report a large multi-institutional worldwide series of LESS in urology. DESIGN, SETTING, AND PARTICIPANTS Consecutive cases of LESS done between August 2007 and November 2010 at 18 participating institutions were included in this retrospective analysis. INTERVENTION Each group performed a variety of LESS procedures according to its own protocols, entry criteria, and techniques. MEASUREMENTS Demographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed. Conversions to reduced-port laparoscopy, conventional laparoscopy, or open surgery were evaluated, as were intraoperative and postoperative complications. RESULTS AND LIMITATIONS Overall, 1076 patients were included in the analysis. The most common procedures were extirpative or ablative operations in the upper urinary tract. The da Vinci robot was used to operate on 143 patients (13%). A single-port technique was most commonly used and the umbilicus represented the most common access site. Overall, operative time was 160±93 min and estimated blood loss was 148±234 ml. Skin incision length at closure was 3.5±1.5 cm. Mean hospital stay was 3.6±2.7 d with a visual analog pain score at discharge of 1.5±1.4. An additional port was used in 23% of cases. The overall conversion rate was 20.8%; 15.8% of patients were converted to reduced-port laparoscopy, 4% to conventional laparoscopy/robotic surgery, and 1% to open surgery. The intraoperative complication rate was 3.3%. Postoperative complications, mostly low grade, were encountered in 9.5% of cases. CONCLUSIONS This study provides a global view of the evolution of LESS in the field of minimally invasive urologic surgery. A broad range of procedures have been effectively performed, primarily in the academic setting, within diverse health care systems around the world. Since LESS is performed by experienced laparoscopic surgeons, the risk of complications remains low when stringent patient-selection criteria are applied.
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Affiliation(s)
- Jihad H Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Irwin BH, Cadeddu JA, Tracy CR, Kim FJ, Molina WR, Rane A, Sundaram CP, Raybourn IJH, Stein RJ, Gill IS, Kavoussi LR, Richstone L, Desai MM. Complications and conversions of upper tract urological laparoendoscopic single-site surgery (less): multicentre experience: results from the NOTES Working Group. Int Braz J Urol 2011. [DOI: 10.1590/s1677-55382011000300017] [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: 11/22/2022] Open
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Irwin BH, Cadeddu JA, Tracy CR, Kim FJ, Molina WR, Rane A, Sundaram CP, Raybourn III JH, Stein RJ, Gill IS, Kavoussi LR, Richstone L, Desai MM. Complications and conversions of upper tract urological laparoendoscopic single-site surgery (LESS): multicentre experience: results from the NOTES Working Group. BJU Int 2010; 107:1284-9. [DOI: 10.1111/j.1464-410x.2010.09663.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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