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Johnson EK, Hyman MJ, Hardy C, Maizels M, Seager CM, Matoka DJ, Liu DB, Gong EM, Holl JL, Modi PK. Growth in Newborn Circumcisions Performed by Pediatric Urologists and Advanced Practice Providers Between 2010 and 2021 in the United States. Urology 2024; 184:206-211. [PMID: 37979701 DOI: 10.1016/j.urology.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE To characterize changes in the proportion of newborn circumcisions performed by pediatric urologists and advanced practiced providers (APPs) in the United States over the last decade. METHODS The Merative MarketScan Commercial Database was queried for newborn circumcision private health insurance claims (Common Procedural Terminology 54150) between 2010 and 2021. Setting (inpatient/outpatient), US Census Bureau region, clinician specialty, and patient age (days) were determined for the full study time period, and by study year. Simple linear regression assessed growth in proportion of newborn circumcisions performed by pediatric urologists and APPs (nurse practitioner/physician assistant/midwife), over time. RESULTS In total, 1,006,748 newborn circumcisions (59% inpatient) were identified; while most were performed by obstetricians (45%) or pediatricians (33%); APPs performed 0.9%, and pediatric urologists performed 0.7%. From 2010-2021, the proportion of newborn circumcisions performed by pediatric urologists increased from 0.3% to 2.0% and by APPs in from 0.5% to 2.9% (P < .001 for both). Growth for both pediatric urologists and APPs occurred APPs predominantly from 2016 to 2021. Trends in proportion of newborn circumcision performed by pediatricians was stable [31.5% (2010) and 32.5% (2021)], but decreased for obstetricians [48.8% (2014) and 38.1% (2021)]. CONCLUSION The proportion of newborn circumcisions performed by pediatric urologists and APPs increased more than 6-fold between 2010 and 2021, though both specialties still perform a minority of newborn circumcisions. These data provide important baseline information for newborn circumcision workforce planning, including evaluating collaborative care models where pediatric urologists train APPs to perform circumcision.
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Affiliation(s)
- Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Max J Hyman
- The Center for Health and the Social Sciences, The University of Chicago, Chicago, IL
| | - Camille Hardy
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Max Maizels
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Catherine M Seager
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Derek J Matoka
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dennis B Liu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Edward M Gong
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jane L Holl
- Department of Neurology, Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL
| | - Parth K Modi
- Section of Urology, Department of Surgery, The University of Chicago, Chicago, IL
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Johnson EK, Rosoklija I, Walton RF, Matoka DJ, Seager CM, Holl JL. Physician Perspectives on Performing Newborn Circumcisions: Barriers and Opportunities. Matern Child Health J 2024; 28:144-154. [PMID: 37919635 DOI: 10.1007/s10995-023-03822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Over half of infant boys born in the United States undergo newborn circumcision. However, available data indicate that boys who are publicly insured, or Black/African American, have less access to desired newborn circumcision, thus concentrating riskier, more costly operative circumcision among these populations. This study ascertains perinatal physician perspectives about barriers and facilitators to providing newborn circumcisions, with a goal of informing future strategies to ensure more equitable access. METHODS Qualitative interviews about newborn circumcision care were conducted from April-June 2020 at eleven Chicago-Area hospitals. Physicians that provide perinatal care (pediatricians, family medicine physicians, and obstetricians) participated in qualitative interviews about newborn circumcision. Inductive and deductive qualitative coding was performed to identify themes related to barriers and facilitators of newborn circumcision care. RESULTS The 23 participating physicians (78% female, 74% white, median 16 years since medical school graduation [range 5-38 years], 52% hospital leadership role, 78% currently perform circumcisions) reported multiple barriers including difficulty with procedural logistics and inconsistent clinician availability and training; corresponding suggestions for operational improvements were also provided. Regarding newborn circumcision insurance coverage and reimbursement, physicians reported limited knowledge, but noted that some insurance reimbursement policies financially disincentivize clinicians and hospitals from offering inpatient newborn circumcision. CONCLUSIONS Physicians identified logistical/operational, and reimbursement-related barriers to providing newborn circumcision for desirous families. Future studies and advocacy work should focus on developing clinical strategies and healthcare policies to ensure equitable access, and incentivize clinicians/hospitals to perform newborn circumcisions.
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Affiliation(s)
- Emilie K Johnson
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA.
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Ilina Rosoklija
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA
| | - Ryan F Walton
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA
| | - Derek J Matoka
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Catherine M Seager
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane L Holl
- Division of Biological Sciences, University of Chicago, Chicago, IL, USA
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Shaw A, Chan YY, Arora HC, Aguilar JB, Schechter J, Gong EM, Chu DI, Yerkes EB, Matoka DJ, Seager CM, Bowen DK, Lindgren BW, Liu DB, Maizels M, Cheng EY, Johnson EK. Streamlining surgical trays for common pediatric urology Procedures: A quality improvement initiative. J Pediatr Urol 2022; 18:412.e1-412.e7. [PMID: 35811279 DOI: 10.1016/j.jpurol.2022.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/16/2022] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Procedures involving the external genitalia are the most common pediatric urologic operations. Our group identified excess instrumentation for these cases to be a potential cause of operating room (OR) inefficiency at our large, freestanding pediatric hospital. This quality improvement (QI) initiative aimed to streamline surgical instrumentation for the most-performed pediatric urologic procedures at our hospital. MATERIAL AND METHODS Six Sigma DMAIC methodology (Define, Measure, Analyze, Improve, Control) guided this multidisciplinary, iterative QI effort. A stakeholder team utilized data review, direct observations, and multiple in-person discussions to create a new "Groin-Penis Tray" (GPT) to replace a larger tray for the 90 most common pediatric urologic procedures. Suture preference cards and expectations about which sutures would be opened for each case were updated. The primary outcome was estimated yearly cost-avoidance due to reduced sterile processing. Additional outcomes included: instruments opened/case, % cases with complete trays, Mayo stand set-up time, and % cases with unused sutures. Balancing measures included: total median OR time and tray weights. Baseline and post-implementation measures were characterized and compared. RESULTS A QI professional, 10 pediatric urologists, 2 pediatric urology fellows, and multiple OR and sterile processing staff members participated. The Summary Figure compares baseline and post-implementation measurements. The number of instruments opened/case decreased from 146 to 65. Annual sterile reprocessing costs decreased by >$51,000. Median Mayo stand set-up time decreased from 7.3 to 3.5 min (p < 0.001). The number of cases with complete trays increased from 7/20 (35%) to 11/20 (55%, p = 0.34). The new GPT is 2.7 kg lighter than the prior tray. Median OR time remained stable (baseline: 91 min; post-implementation: 102 min, p = 0.44). The number of cases with suture waste decreased from 78% to 0% immediately post-implementation but increased to 40% one year later. DISCUSSION This systematic, iterative QI process spanned the course of ∼2 years, including planning, building, and updating new trays, then assessing longer-term success via the control phase. The new GPT is used for most pediatric urologic procedures at our hospital, and benefits include sterile reprocessing cost savings and ergonomics. Our team gained valuable experience related to assessing QI project scope, determining key stakeholders and roles, and strategies for sustainability that we will apply to future initiatives. CONCLUSIONS Streamlining surgical trays for common pediatric urologic procedures at a large freestanding children's hospital using established QI methodology reduced OR cost by >$51,000/year and Mayo stand set-up times without compromising balancing measures.
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Affiliation(s)
- Allison Shaw
- Center for Quality & Safety, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Chicago, IL 60611, USA.
| | - Yvonne Y Chan
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA.
| | - Hans C Arora
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA.
| | - Jazmina B Aguilar
- Procedural Services, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Chicago, IL 60611, USA.
| | - Jamie Schechter
- Procedural Services, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Chicago, IL 60611, USA.
| | - Edward M Gong
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - David I Chu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Derek J Matoka
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Catherine M Seager
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Diana K Bowen
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Bruce W Lindgren
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Dennis B Liu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Max Maizels
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
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Corona LE, Rosoklija I, Walton RF, Matoka DJ, Seager CM, Holl JL, Johnson EK. COVID-19 Pandemic Adversely Affects the Provision of Desired Newborn Circumcision: Perinatal Physician Perspectives. Front Health Serv 2021; 1:799647. [PMID: 36926483 PMCID: PMC10012608 DOI: 10.3389/frhs.2021.799647] [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] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022]
Abstract
Over half of boys in the United States undergo circumcision, which has its greatest health benefits and lowest risks when performed during the newborn period under local anesthesia. The COVID-19 pandemic has affected delivery of patient care in many ways and likely also influenced the provision of newborn circumcisions. Prior to the pandemic, we planned to conduct a qualitative study to ascertain physician perspectives on providing newborn circumcision care. The interviews incidentally coincided with the onset of the pandemic and thus, pandemic-related changes emerged as a theme. We elected to analyze this theme in greater detail. Semi-structured interviews were conducted with perinatal physicians in a large urban city from 4/2020 to 7/2020. Physicians that perform or counsel regarding newborn circumcision and physicians with knowledge of or responsibility for hospital policies were eligible. Interviews were transcribed verbatim and qualitative coding was performed. Twenty-three physicians from 11 local hospitals participated. Despite no specific COVID-19 related questions in the interview guide, nearly half of physicians identified that the pandemic affected delivery of newborn circumcision care with 8 pandemic-related sub-themes. The commonest sub-themes included COVID-19 related changes in: (1) workflow processes, (2) staffing and availability of circumcision proceduralists, and (3) procedural settings. In summary, this qualitative study revealed unanticipated COVID-19 pandemic-related changes with primarily adverse effects on the provision of desired newborn circumcisions. Some of these changes may become permanent resulting in broad implications for policy makers that will likely need to adapt and redesign the processes and systems for the delivery of newborn circumcision care.
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Affiliation(s)
- Lauren E Corona
- Division of Urology, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Urology, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Ilina Rosoklija
- Division of Urology, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ryan F Walton
- Division of Urology, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Derek J Matoka
- Division of Urology, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Urology, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Catherine M Seager
- Division of Urology, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Urology, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Jane L Holl
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Emilie K Johnson
- Division of Urology, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Urology, Northwestern Feinberg School of Medicine, Chicago, IL, United States
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Kurugol S, Seager CM, Thaker H, Coll-Font J, Afacan O, Nichols RC, Warfield SK, Lee RS, Chow JS. Feed and wrap magnetic resonance urography provides anatomic and functional imaging in infants without anesthesia. J Pediatr Urol 2020; 16:116-120. [PMID: 31889687 DOI: 10.1016/j.jpurol.2019.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 11/05/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe a technique for performing magnetic resonance urogram (MRU) in infants without sedation or anesthesia. METHODS Eighteen infants underwent MRU in the absence of sedating medications using a 'feed and wrap' technique (FW-MRU). Dynamic contrast enhanced images were obtained. Dynamic radial VIBE and compressed sensing image reconstruction were used to correct for motion artifact. RESULTS Seventeen of the 18 patients had successful FW-MRU. Feed and wrap' magnetic resonance urogram provided high-quality anatomic and functional renal data. CONCLUSION Initial experience with FW-MRU demonstrates it to be a promising anesthesia-free modality for obtaining anatomic and functional imaging of the urinary tract in infants.
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Affiliation(s)
- Sila Kurugol
- Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston MA 02115, USA
| | - Catherine M Seager
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston MA 02115, USA
| | - Hatim Thaker
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston MA 02115, USA
| | - Jaume Coll-Font
- Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston MA 02115, USA
| | - Onur Afacan
- Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston MA 02115, USA
| | - Reid C Nichols
- Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston MA 02115, USA
| | - Simon K Warfield
- Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston MA 02115, USA
| | - Richard S Lee
- Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston MA 02115, USA.
| | - Jeanne S Chow
- Department of Urology, Boston Children's Hospital and Harvard Medical School, Boston MA 02115, USA; Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston MA 02115, USA
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Maurice MJ, Ramirez D, Seager CM, Haber GP. V4-04 ROBOTIC TOTAL PELVIC EXENTERATION WITH INTRACORPOREAL SIGMOID CONDUIT AND COLOSTOMY: FIRST CLINICAL REPORT. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1808] [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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Seager CM, Li J, Shoskes DA. Lack of predictive correlation between peripheral arterial tone and colour flow Doppler parameters in men with erectile dysfunction. BJU Int 2013; 112:E186-90. [DOI: 10.1111/bju.12033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Catherine M. Seager
- Department of Urology; Glickman Urological and Kidney Institute; The Cleveland Clinic; Cleveland; OH; USA
| | - Jianbo Li
- Department of Urology; Glickman Urological and Kidney Institute; The Cleveland Clinic; Cleveland; OH; USA
| | - Daniel A. Shoskes
- Department of Urology; Glickman Urological and Kidney Institute; The Cleveland Clinic; Cleveland; OH; USA
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Seager CM, Srinivas TR, Flechner SM. Development of nephrolithiasis in a renal transplant patient during treatment with Cinacalcet. Ann Transplant 2013; 18:31-5. [PMID: 23792498 DOI: 10.12659/aot.883809] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Secondary hyperparathyroidism often accompanies chronic kidney disease, which can result in severe bone abnormalities and nephrolithiasis. Renal transplantation can correct the mineral abnormalities associated with chronic kidney disease, but one year after transplantation many recipients continue to exhibit persistent hyperparathyroidism. CASE REPORT Cinacalcet, a second-generation calcimimetic, has been shown to be effective in decreasing serum calcium levels in post kidney transplant patients with hyperparathyroidism. However a question remains whether patients with hyperparathyroidism who take Cinacalcet may be at increased risk of renal calcium deposits due to hypercalciuria and subsequent renal transplant dysfunction. We report the first well-documented case in which Cinacalcet contributed to the development of new renal calculi in a post-transplant patient with hyperparathyroidism (PTH 346 pg/mL), hypercalcemia (11.3 mg/dL), and good renal function (1.45 mg/dL). Interval imaging tracks the new onset of renal allograft stone formation after initiating Cinacalcet up to 60mg daily, which was accompanied by persistent hypercalciuria (478.2 mg/24 hours). The nephrolithiases resolved after discontinuing Cinacalcet and a subtotal parathyroidectomy. CONCLUSIONS This case supports the interval monitoring of urinary calcium excretion and imaging of the transplanted kidney for those recipients treated with Cinacalcet for hyperparathyroidism after renal transplantation.
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Affiliation(s)
- Catherine M Seager
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Korets R, Seager CM, Pitman MS, Hruby GW, Benson MC, McKiernan JM. Effect of delaying surgery on radical prostatectomy outcomes: a contemporary analysis. BJU Int 2011; 110:211-6. [PMID: 22093486 DOI: 10.1111/j.1464-410x.2011.10666.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED Study Type - Therapy (case series). Level of Evidence 4. What's known on the subject? and What does the study add? For patients electing surgical treatment, the question of the effect of surgical delay on clinical outcomes in prostate cancer is controversial. In this study we examined the effect of delay from diagnosis to surgery on outcomes in men with localized prostate cancer and found no association between time to surgery and risk of biochemical recurrence, even for patients with longer delays and high-risk disease. Men with localized prostate cancer can be reassured that reasonable delays in treatment will not influence disease outcomes. OBJECTIVE • To examine the effect of time from last positive biopsy to surgery on clinical outcomes in men with localized prostate cancer undergoing radical prostatectomy (RP). PATIENTS AND METHODS • We conducted a retrospective review of 2739 men who underwent RP between 1990 and 2009 at our institution. • Clinical and pathological features were compared between men undergoing RP ≤ 60, 61-90 and >90 days from the time of prostate biopsy. • A Cox proportional hazards model was used to analyse the association between clinical features and surgical delay with biochemical progression. Biochemical recurrence (BCR)-free rates were assessed using the Kaplan-Meier method. RESULTS • Of the 1568 men meeting the inclusion criteria, 1098 (70%), 303 (19.3%) and 167 (10.7%) had a delay of ≤ 60, 61-90 and >90 days, respectively, between biopsy and RP. A delay of >60 days was not associated with adverse pathological findings at surgery. • The 5-year survival rate was similar among the three groups (78-85%, P= 0.11). • In a multivariate Cox model, men with higher PSA levels, clinical stages, Gleason sums, and those of African-American race were all at higher risk for developing BCR. • A delay to surgery of >60 days was not associated with worse biochemical outcomes in a univariate and multivariate model. CONCLUSIONS • A delay of >60 days is not associated with adverse pathological outcomes in men with localized prostate cancer, nor does it correlate with worse BCR-free survival. • Patients can be assured that delaying treatment while considering therapeutic options will not adversely affect their outcomes.
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Affiliation(s)
- Ruslan Korets
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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Seager CM, Puzio-Kuter AM, Patel T, Jain S, Cordon-Cardo C, Mc Kiernan J, Abate-Shen C. Intravesical delivery of rapamycin suppresses tumorigenesis in a mouse model of progressive bladder cancer. Cancer Prev Res (Phila) 2009; 2:1008-14. [PMID: 19952358 DOI: 10.1158/1940-6207.capr-09-0169] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Early-stage bladder cancer occurs as two distinct forms: namely, low-grade superficial disease and high-grade carcinoma in situ (CIS), which is the major precursor of muscle-invasive bladder cancer. Although the low-grade form is readily treatable, few, if any, effective treatments are currently available for preventing progression of nonmuscle-invasive CIS to invasive bladder cancer. Based on our previous findings that the mammalian target of Rapamycin (mTOR) signaling pathway is activated in muscle-invasive bladder cancer, but not superficial disease, we reasoned that suppression of this pathway might block cancer progression. To test this idea, we performed in vivo preclinical studies using a genetically engineered mouse model that we now show recapitulates progression from nonmuscle-invasive CIS to muscle-invasive bladder tumors. We find that delivery of Rapamycin, an mTOR inhibitor, subsequent to the occurrence of CIS effectively prevents progression to invasive bladder cancer. Furthermore, we show that intravesical delivery of Rapamycin directly into the bladder lumen is highly effective for suppressing bladder tumorigenesis. Thus, our findings show the potential therapeutic benefit of inhibiting mTOR signaling for treatment of patients at high risk of developing invasive bladder cancer. More broadly, our findings support a more widespread use of intravesical delivery of therapeutic agents for treatment of high-risk bladder cancer patients, and provide a mouse model for effective preclinical testing of potential novel agents.
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Affiliation(s)
- Catherine M Seager
- Departments of Urology and Pathology and Cell Biology, Herbert Irving Comprehensive Cancer Center, 1130 St. Nicholas Street, Room 217A, New York, NY 10032.
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