1
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Lee M, Zhao K, Lee R, Lee Z, Raver M, Nguyen J, Munver R, Ahmed M, Stifelman MD, Zhao LC, Eun DD, Collaborative Of Reconstructive Robotic Ureteral Surgery Corrus. Preoperative Predictors of Surgical Success for Robotic Ureteral Reconstruction of Proximal and Middle Ureteral Strictures. Urology 2024; 184:101-104. [PMID: 38104667 DOI: 10.1016/j.urology.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To investigate predictors of surgical success for patients undergoing robotic ureteral reconstruction (RUR) for ureteropelvic junction obstruction (UPJO), proximal, and middle ureteral stricture disease. METHODS We retrospectively reviewed our multi-institutional Collaborative of Reconstructive Robotic Ureteral Surgery database to identify all consecutive patients undergoing RUR for UPJO, proximal and/or middle ureteral stricture disease between April 2012 and December 2020. The specific reconstruction technique was determined by the primary surgeon based on clinical history and intraoperative findings. Patients were grouped according to whether they were surgical successful. Preoperative variables between both groups were compared using chi-square tests. All independent variables with associations of P <.2 then underwent a binary logistic regression analysis to determine predictive variables of success for RUR (P ≤.05 was considered statistically significant). RESULTS Overall, 338 patients met inclusion criteria. Surgical success rates of RUR are shown in Table 1. Univariate analysis (Table 2) showed that there were a lower proportion of patients with diabetes (8.9% vs 25.7%, P <.01) and a higher proportion of patients who underwent ureteral rest (74.3% vs 48.6%, P <.01) in the surgical success group. Multivariate logistic regression analysis (Table 3) further revealed the odds of surgical success in patients without diabetes was 3.08 times ((confidence interval) CI 1.26-7.54, P = .01) the odds of success for patients with diabetes. The odds of surgical success in patients who underwent preoperative ureteral rest were 2.8 times (CI 1.35-5.83, P = .01) the odds of success for patients who did not undergo preoperative ureteral rest. CONCLUSION Surgical success of RUR for management of UPJO, proximal, and middle ureteral strictures may be influenced by factors including preoperative ureteral rest and presence of diabetes.
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Affiliation(s)
- Matthew Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
| | - Kelley Zhao
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Randall Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Ziho Lee
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael Raver
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ
| | - Jennifer Nguyen
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ
| | - Ravi Munver
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ
| | - Mutahar Ahmed
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ
| | | | - Lee C Zhao
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Collaborative Of Reconstructive Robotic Ureteral Surgery Corrus
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ; Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
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Gupta M, Atallah W, Molina W, Semins MJ, Munver R. Clinical Experiences Using the First Ureteroscope with Intrarenal Pressure Monitoring. J Endourol 2023; 37:i-S17. [PMID: 37774101 DOI: 10.1089/end.2023.36010.rtl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Affiliation(s)
- Mantu Gupta
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William Atallah
- Assistant Professor of Urology, Kidney Stone Center, Mount Sinai, New York, New York, USA
- Chief of Endourology at Elmhurst Hospital, Queens, New York, USA
| | - Wilson Molina
- Professor of Urologic Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Michelle Jo Semins
- Chief of the Division of Urology, West Virginia University Wheeling Hospital, Wheeling, West Virginia, USA
- Clinical Professor, West Virginia University Wheeling Hospital, Wheeling, West Virginia, USA
| | - Ravi Munver
- Vice Chair and Chief of Minimally Invasive Robotic Urologic Surgery, and Professor of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
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3
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Harrison R, Iarajuli T, Kim K, Ahmed M, Munver R, Stifelman M. A Guide to Utilizing Iris, a Segmented Three-Dimensional Model, to Improve Surgical Planning and Patient Outcomes During Robotic Partial Nephrectomy. Urology Video Journal 2022. [DOI: 10.1016/j.urolvj.2022.100196] [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: 11/16/2022] Open
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4
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Lee Z, Lee M, Lee R, Koster H, Cheng N, Siev M, Jun M, Munver R, Ahmed M, Zhao LC, Stifelman MD, Eun DD. Ureteral Rest is Associated With Improved Outcomes in Patients Undergoing Robotic Ureteral Reconstruction of Proximal and Middle Ureteral Strictures. Urology 2021; 152:160-166. [PMID: 33639184 DOI: 10.1016/j.urology.2021.01.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To evaluate the effect of ureteral rest on outcomes of robotic ureteral reconstruction. METHODS We retrospectively reviewed all patients who underwent robotic ureteral reconstruction of proximal and/or middle ureteral strictures in our multi-institutional database between 2/2012-03/2019 with ≥12 months follow-up. All patients were recommended to undergo ureteral rest, which we defined as the absence of hardware (ie. double-J stent or percutaneous nephroureteral tube) across a ureteral stricture ≥4 weeks prior to reconstruction. However, patients who refused percutaneous nephrostomy tube placement did not undergo ureteral rest. Perioperative outcomes were compared after grouping patients according to whether or not they underwent ureteral rest. Continuous and categorical variables were compared using Mann-Whitney U and 2-tailed chi-squared tests, respectively; P <.05 was considered significant. RESULTS Of 234 total patients, 194 (82.9%) underwent ureteral rest and 40 (17.1%) did not undergo ureteral rest prior to ureteral reconstruction. Patients undergoing ureteral rest were associated with a higher success rate compared to those not undergoing ureteral rest (90.7% versus 77.5%, respectively; P = .027). Also, patients undergoing ureteral rest were associated with lower estimated blood loss (50 versus 75 milliliters, respectively; p<0.001) and less likely to undergo buccal mucosa graft ureteroplasty (20.1% versus 37.5%, respectively; p=0.023). CONCLUSIONS Implementing ureteral rest prior to ureteral reconstruction may allow for stricture maturation and is associated higher surgical success rates, lower estimated blood loss, and decreased utilization of buccal mucosa graft ureteroplasty.
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Affiliation(s)
- Ziho Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
| | - Matthew Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Randall Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Helaine Koster
- Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Nathan Cheng
- Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Michael Siev
- New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Min Jun
- New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Ravi Munver
- Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Mutahar Ahmed
- Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Lee C Zhao
- New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Michael D Stifelman
- Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Daniel D Eun
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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5
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Cheng N, Velazquez N, Desroches BR, Munver R. Bioregenerative Umbilical Cord Amniotic Membrane Allograft Ureteral Wrap During Robot-Assisted Ureterolysis. J Endourol Case Rep 2021; 6:431-434. [PMID: 33457693 DOI: 10.1089/cren.2020.0185] [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] [Indexed: 11/12/2022] Open
Abstract
Omental wrap is commonly performed after ureterolysis to prevent ureteral obstruction from recurrence of periureteral adhesions and fibrosis. We present the case of a 37-year-old Caucasian woman with a history of two cesarean sections and laparotomy for the treatment of endometriosis. She subsequently developed right flank pain caused by a right distal ureteral stricture requiring a chronic indwelling ureteral stent. Diagnostic laparoscopy revealed extrinsic compression of the ureter for which robot-assisted ureterolysis was performed. Because of inadequate omentum, we report the initial use of a cryopreserved bioregenerative umbilical cord amniotic membrane allograft to perform a ureteral wrap to promote ureteral tissue healing and serve as an adhesion barrier to prevent recurrence of the fibrosis.
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Affiliation(s)
- Nathan Cheng
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Nermarie Velazquez
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Bethany R Desroches
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New Jersey, USA
| | - Ravi Munver
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA.,Department of Urology, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.,John Theurer Cancer Center, Hackensack, New Jersey, USA
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6
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Lee M, Lee Z, Strauss D, Jun MS, Koster H, Asghar AM, Lee R, Chao B, Cheng N, Ahmed M, Lovallo G, Munver R, Zhao LC, Stifelman MD, Eun DD. Multi-institutional Experience Comparing Outcomes of Adult Patients Undergoing Secondary Versus Primary Robotic Pyeloplasty. Urology 2020; 145:275-280. [PMID: 32687842 DOI: 10.1016/j.urology.2020.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To describe surgical techniques and peri-operative outcomes with secondary robotic pyeloplasty (RP), and compare them to those of primary RP. METHODS We retrospectively reviewed our multi-institutional, collaborative of reconstructive robotic ureteral surgery (CORRUS) database for all consecutive patients who underwent RP between April 2012 and September 2019. Patients were grouped according to whether they underwent a primary or secondary pyeloplasty (performed for a recurrent stricture after previously failed pyeloplasty). Perioperative outcomes and surgical techniques were compared using nonparametric independent sample median tests and chi-square tests; P < .05 was considered significant. RESULTS Of 158 patients, 28 (17.7%) and 130 (82.3%) underwent secondary and primary RP, respectively. Secondary RP, compared to primary RP, was associated with a higher median estimated blood loss (100.0 vs 50.0 milliliters, respectively; P < .01) and longer operative time (188.0 vs 136.0 minutes, respectively; P = .02). There was no difference in major (Clavien >2) complications (P = .29). At a median follow-up of 21.1 (IQR: 11.8-34.7) months, there was no difference in success between secondary and primary RP groups (85.7% vs 92.3%, respectively; P = .44). Buccal mucosa graft onlay ureteroplasty was performed more commonly (35.7% vs 0.0%, respectively, P < .01) and near-infrared fluorescence imaging with indocyanine green was utilized more frequently (67.9% vs 40.8%, respectively; P < .01) for secondary vs primary repair. CONCLUSION Although performing secondary RP is technically challenging, it is a safe and effective method for recurrent ureteropelvic junction obstruction after a previously failed pyeloplasty. Buccal mucosa graft onlay ureteroplasty and utilization of near-infrared fluorescence with indocyanine green may be particularly useful in the re-operative setting.
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Affiliation(s)
- Matthew Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
| | - Ziho Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - David Strauss
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Min Suk Jun
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Helaine Koster
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Aeen M Asghar
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Randall Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Brian Chao
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Nathan Cheng
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Mutahar Ahmed
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Gregory Lovallo
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Ravi Munver
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Lee C Zhao
- Department of Urology, New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY
| | - Michael D Stifelman
- Department of Urology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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7
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Billah MS, Stifelman M, Munver R, Tsui J, Lovallo G, Ahmed M. Single port robotic assisted reconstructive urologic surgery-with the da Vinci SP surgical system. Transl Androl Urol 2020; 9:870-878. [PMID: 32420202 PMCID: PMC7214978 DOI: 10.21037/tau.2020.01.06] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Single port (SP) robotic assisted laparoscopic surgery was approved by the FDA for urologic surgery and clinically available in 2018. This new robotic system enables a camera and 3 separate instruments, with fully wristed motions, to be placed through a single 25 mm port. This system was designed to perform complex surgery in narrow deep spaces making it very suitable for complex urinary tract reconstruction surgery. This paper will describe our early experience of using the SP system for several types of urinary reconstruction procedures and will present our lessons learned, surgical philosophy to using the SP and early data. As with all new technologies, there is an associated learning curve and nuances to be discovered and overcome. Methods The da Vinici SP™ surgical system was acquired and delivered to at our institution in January 2019. Five high volume robotic urologic surgeons at our institutions underwent certification with the da Vinci SP™ and have been adding this technology into their armamentarium. Almost all cases were recorded for quality improvement initiatives and evaluated with the goal of creating standard operating procedures in terms of access, steps of procedure and minimizing pit falls. Data from all patients undergoing SP urinary tract reconstruction that were entered into our prospective institutional database were reported. Results From 1/2019 to 8/2019 we have performed 71 urologic SP cases with the SP of which 18 were for urinary tract reconstructive procedures. These cases included 15 pyeloplasties, 1 buccal mucosa ureteroplasty, 1 ureteral implant and 1 repair of vesico-vaginal fistula. This paper outlines our standard operating procedures for table positioning, port placement, access and surgical steps for these complex SP cases. Our early data suggests that use of the SP system for urinary reconstruction is safe and reproducible. Conclusions The SP robotic surgical system has the potential to be used for nearly all robotic urologic reconstructive procedures. Advantages include a superior cosmetic result and ability to access all surgical quadrants without re-docking or repositioning. Limitations include no near infrared fluorescence imaging, smaller working space and slightly increased difficulty with retraction. We believe these obstacles will be overcome with time and experience. The da Vinci SP™ surgical system, in our initial experience, appears to be as safe and effective as its multiport counterpart for reconstructive surgeries.
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Affiliation(s)
- Mubashir Shabil Billah
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
| | - Michael Stifelman
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
| | - Ravi Munver
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
| | - Johnson Tsui
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
| | - Gregory Lovallo
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
| | - Mutahar Ahmed
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
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8
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Badani KK, Kothari PD, Okhawere KE, Eun D, Hemal A, Abaza R, Porter J, Lovallo G, Ahmed M, Munver R, Stifelman MD. Selective clamping during robot-assisted partial nephrectomy in patients with a solitary kidney: is it safe and does it help? BJU Int 2020; 125:893-897. [PMID: 32125072 DOI: 10.1111/bju.15043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To obtain the most accurate assessment of the risks and benefits of selective clamping in robot-assisted partial nephrectomy (RAPN) we evaluated outcomes of this technique vs those of full clamping in patients with a solitary kidney undergoing RAPN. PATIENTS AND METHODS Data from institutional review board-approved retrospective and prospective databases from 2006 to 2019 at multiple institutions with sharing agreements were evaluated. Patients with a solitary kidney were identified and stratified based on whether selective or full renal artery clamping was performed. Both groups were analysed with regard to demographics, risk factors, intra-operative complications, and postoperative outcomes using chi-squared tests, Fisher's exact tests, t-tests and Mann-Whitney U-tests. RESULTS Our initial cohort consisted of 4112 patients, of whom 72 had undergone RAPN in a solitary kidney (51 with full clamping and 21 with selective clamping). There were no significant differences in demographics, tumour size, baseline estimated glomerular filtration rate (eGFR), or warm ischaemia time (WIT) between the groups (Table 1). Intra-operative outcomes, including estimated blood loss, operating time, and intra-operative complications were similar in the two groups. Short- and long-term postoperative percentage change in eGFR, frequency of acute kidney injury (AKI), and frequency of de novo chronic kidney disease (CKD) were also not significantly different between the two techniques. CONCLUSION In a large cohort of patients with solitary kidney undergoing RAPN, selective clamping resulted in similar intra-operative and postoperative outcomes compared to full clamping and conferred no additional risk of harm. However, selective clamping did not appear to provide any functional advantage over full clamping as there was no difference observed in the frequency of AKI, CKD or change in eGFR. Short WIT in both groups (<15 min) may have prevented identification of benefits in the selective clamping group; a similar study analysing cases with longer WIT may elucidate any beneficial effects of selective clamping.
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Affiliation(s)
- Ketan K Badani
- Department of Urology, Mount Sinai Medical School, New York, NY, USA
| | - Pankti D Kothari
- Department of Urology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Daniel Eun
- Department of Urology, Lewis Katz School of Medicine Temple University, Philadelphia, PA, USA
| | - Ashok Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ronney Abaza
- Department of Urology, OhioHealth Dublin Methodist Hospital, Dublin, OH, USA
| | - James Porter
- Department of Urology, Swedish Urology, Seattle, WA, USA
| | - Gregory Lovallo
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Mutahar Ahmed
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Ravi Munver
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Michael D Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
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9
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Connor J, Tsui JF, He W, Munver R. Primary renal embryonal rhabdomyosarcoma in an adult patient. BMJ Case Rep 2020; 13:13/1/e231000. [PMID: 31969398 DOI: 10.1136/bcr-2019-231000] [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] [Indexed: 11/04/2022] Open
Abstract
Adult renal rhabdomyosarcoma (RMS) is a rare and aggressive entity with a paucity of data and reports in the literature. As a result, treatment guidelines for this malignancy are not well-established. Herein, we present the diagnosis, management and clinical course of a 39-year-old patient diagnosed with primary renal embryonal RMS (ERMS) following radical nephrectomy. We also review the existing literature on primary renal ERMS.
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Affiliation(s)
- Jessica Connor
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Johnson F Tsui
- Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Wenlei He
- Pathology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Ravi Munver
- Rutgers New Jersey Medical School, Newark, New Jersey, USA .,Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
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10
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Connor J, Doppalapudi SK, Wajswol E, Ragam R, Press B, Luu T, Koster H, Tamang TL, Ahmed M, Lovallo G, Munver R, Stifelman MD. Postoperative Complications After Robotic Partial Nephrectomy. J Endourol 2019; 34:42-47. [PMID: 31588795 DOI: 10.1089/end.2019.0434] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To assess the incidence of postoperative arterial malformation (AM) and urine leak/urinoma (UL) after robotic partial nephrectomy (RPN) in a contemporary series and to evaluate risk factors for these complications. Materials and Methods: All RPNs were queried from Institutional Review Board-approved retrospective and prospective nephrectomy databases. Demographics, perioperative variables, and postoperative complications were collected. Differences between cohorts were analyzed using univariate analysis. Postoperative complications were graded using the Clavien-Dindo system. UL was defined in the context of signs and symptoms of a collection with supporting evidence of urine collection through drainage or aspiration. AM was identified based on postoperative imaging indicative of arteriovenous fistula or pseudoaneurysm and/or requirement for selective embolization. Predictors of AM and UL were assessed by univariate analysis. Results: A total of 395 RPNs were performed by four urologists between January 2014 and October 2018. Tumor complexity, defined by nephrometry score, was significantly greater in the prospective cohort (p = 0.01). Overall incidence of postoperative complications was 5.6% with cohort-specific incidences of 5.3% and 5.8%. The retrospective cohort had a greater percentage of complications classified as ≥IIIa: 8/13 (61.5%) vs 2/8 (25%). Overall incidence of AM was 2.3% with cohort-specific incidence of 3.1% (7/225) vs 1.1% (2/170). Overall incidence of UL was 0.25% with cohort-specific incidence of 0.55% (1/225) and 0.0% (0/170). The difference in incidence of both complications between cohorts was significant (p < 0.05). No significant predictors for AM were identified. Conclusions: The incidence of postoperative complications after RPN remains low (5.3% vs 5.8%, overall: 5.6%). UL and AM are becoming rarer with experience, despite increasing surgical complexity (0.55% vs 0%, 3.1% vs 1.1%).
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Affiliation(s)
- Jessica Connor
- Department of Urology, Urology at MUSC Health Rutledge Tower, Charleston, South Carolina
| | - Sai K Doppalapudi
- Department of Urology, Urology at MUSC Health Rutledge Tower, Charleston, South Carolina
| | - Ethan Wajswol
- Department of Urology, Urology at MUSC Health Rutledge Tower, Charleston, South Carolina
| | - Radhika Ragam
- Department of Urology, Urology at MUSC Health Rutledge Tower, Charleston, South Carolina
| | - Benjamin Press
- Department of Urology, Urology at MUSC Health Rutledge Tower, Charleston, South Carolina
| | - Thaiphi Luu
- Department of Urology, Urology at MUSC Health Rutledge Tower, Charleston, South Carolina
| | - Helaine Koster
- Department of Urology, Hackensack University Hospital, Hackensack, New Jersey
| | - Tenzin-Lama Tamang
- Department of Urology, Hackensack University Hospital, Hackensack, New Jersey
| | - Mutahar Ahmed
- Department of Urology, Urology at MUSC Health Rutledge Tower, Charleston, South Carolina.,Department of Urology, Hackensack University Hospital, Hackensack, New Jersey
| | - Gregory Lovallo
- Department of Urology, Urology at MUSC Health Rutledge Tower, Charleston, South Carolina.,Department of Urology, Hackensack University Hospital, Hackensack, New Jersey
| | - Ravi Munver
- Department of Urology, Urology at MUSC Health Rutledge Tower, Charleston, South Carolina.,Department of Urology, Hackensack University Hospital, Hackensack, New Jersey
| | - Michael D Stifelman
- Department of Urology, Urology at MUSC Health Rutledge Tower, Charleston, South Carolina.,Department of Urology, Hackensack University Hospital, Hackensack, New Jersey
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11
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Stites J, Press B, Koster H, Lama-Tamang T, Lovallo G, Ahmed M, Munver R, Stifelman M. MP86-15 HACKENSACK MULTI-DISCIPLINARY ROBOTIC-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY (RPN) PATHWAY: IMPROVING QUALITY METRICS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Sivarajan G, Munver R. Editorial Commentary. Urol Pract 2017; 4:131. [PMID: 37592672 DOI: 10.1016/j.urpr.2016.04.012] [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: 11/17/2022]
Affiliation(s)
- Ganesh Sivarajan
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Ravi Munver
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey
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13
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Valdivieso R, Meyer CP, Hueber PA, Meskawi M, Alenizi AM, Azizi M, Trinh QD, Misrai V, Rutman M, Te AE, Chughtai B, Barber NJ, Emara AM, Munver R, Zorn KC. Assessment of energy density usage during 180W lithium triborate laser photoselective vaporization of the prostate for benign prostatic hyperplasia. Is there an optimum amount of kilo-Joules per gram of prostate? BJU Int 2016; 118:633-40. [DOI: 10.1111/bju.13479] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Roger Valdivieso
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Christian P Meyer
- Division of Urologic Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Pierre-Alain Hueber
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Malek Meskawi
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Abdullah M. Alenizi
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Mounsif Azizi
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Vincent Misrai
- Department of Urology; Clinique Pasteur Toulouse; Toulouse France
| | - Matthew Rutman
- Department of Urology; Columbia University; New York NY USA
| | - Alexis E. Te
- Department of Urology; Cornell University; New York NY USA
| | - Bilal Chughtai
- Department of Urology; Cornell University; New York NY USA
| | - Neil J. Barber
- Department of Urology; Frimley Park Hospital; Frimley Surrey UK
| | - Amr M. Emara
- Department of Urology; Frimley Park Hospital; Frimley Surrey UK
| | - Ravi Munver
- Department of Urology; Hackensack University Medical Center; Hackensack NJ USA
| | - Kevin C. Zorn
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
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Sivarajan G, Bhalodi A, Degen M, Munver R. MP37-15 SAFETY AND EFFICACY OF LAPAROSCOPIC AND ROBOT-ASSISTED RENAL SURGERY IN THE EXTREMELY OBESE (BMI > 40 KG/M
2
) AND BEYOND (BMI > 50 KG/M
2
). J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Valdivieso R, Meyer C, Hueber PA, Meskawi M, Alenizi A, Trinh QD, Misrai V, Rutman M, Te A, Chughtai B, Barber N, Emara A, Munver R, Zorn K. MP42-16 ASSESSMENT OF ENERGY DENSITY USAGE DURING 180W LITHIUM TRIBORATE LASER PHOTO-SELECTIVE VAPORIZATION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA. IS THERE AN OPTIMAL AMOUNT OF KILO-JOULES PER GRAM OF PROSTATE? J Urol 2016. [DOI: 10.1016/j.juro.2016.02.204] [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: 11/15/2022]
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16
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Meskawi M, Hueber PA, Valdivieso R, Martel T, Azizi M, Bruyère F, Misrai V, Fournier G, Munver R, Sivarajan G, Rutman M, Te A, Chughtai B, Elterman D, Zorn K. MP42-13 MULTI-CENTER INTERNATIONAL EXPERIENCE OF 180W LBO LASER PHOTO-VAPORIZATION IN MEN WITH LARGE PROSTATES (TRUS>100CC): SAFETY OUTCOMES AND PREDICTIVE FACTORS OF COMPLICATIONS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Hueber PA, Bienz MN, Valdivieso R, Lavigueur-Blouin H, Misrai V, Rutman M, Te AE, Chughtai B, Barber NJ, Emara AM, Munver R, Trinh QD, Zorn KC. Photoselective Vaporization of the Prostate for Benign Prostatic Hyperplasia Using the 180 Watt System: Multicenter Study of the Impact of Prostate Size on Safety and Outcomes. J Urol 2015; 194:462-9. [PMID: 25849599 DOI: 10.1016/j.juro.2015.03.113] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluated photoselective vaporization of the prostate using the GreenLight™ XPS™ 180 W system for benign prostatic hyperplasia treatment in a large multi-institutional cohort at 2 years. We particularly examined safety, outcomes and the re-treatment rate in larger prostates, defined as a prostate volume of 80 cc or greater, to assess the potential of photoselective vaporization of the prostate as a size independent procedure. MATERIALS AND METHODS A total of 1,196 patients were treated at 6 international centers in Canada, the United States, France and England. All parameters were collected retrospectively, including complications, I-PSS, maximum urinary flow rate, post-void residual urine, prostate volume, prostate specific antigen and the endoscopic re-intervention rate. Subgroup stratified comparative analysis was performed according to preoperative prostate volume less than 80 vs 80 cc or greater on transrectal ultrasound. RESULTS Median prostate size was 50 cc in 387 patients and 108 cc in 741 in the prostate volume groups less than 80 and 80 cc or greater, respectively. The rate of conversion to transurethral prostate resection was significantly higher in the 80 cc or greater group than in the less than 80 cc group (8.4% vs 0.6%, p <0.01). I-PSS, quality of life score, maximum urinary flow rate and post-void residual urine were significantly improved compared to baseline at 6, 12 and 24 months of followup without significant differences between the prostate size groups. The re-treatment rate at 2 years reported in 5 of 411 patients was associated with the delivery of decreased energy density (2.1 vs 4.4 kJ/cc) in the group without re-treatment. CONCLUSIONS Photoselective vaporization of the prostate using the XPS 180 W system is safe and efficacious, providing durable improvement in functional outcomes at 2 years independent of prostate size when treated with sufficient energy.
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Affiliation(s)
- Pierre-Alain Hueber
- Section of Urology, Department of Surgery, University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Marc Nicolas Bienz
- Section of Urology, Department of Surgery, University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Roger Valdivieso
- Section of Urology, Department of Surgery, University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Hugo Lavigueur-Blouin
- Section of Urology, Department of Surgery, University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur Toulouse, Toulouse, France
| | - Matthew Rutman
- Department of Urology, Columbia University, New York, New York
| | - Alexis E Te
- Department of Urology, Cornell University, New York, New York
| | - Bilal Chughtai
- Department of Urology, Cornell University, New York, New York
| | - Neil J Barber
- Department of Urology, Frimley Park Hospital, Frimley, United Kingdom
| | - Amr M Emara
- Department of Urology, Frimley Park Hospital, Frimley, United Kingdom
| | - Ravi Munver
- Department of Urology, Hackensack University Medical Center, New Jersey
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health and Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kevin C Zorn
- Section of Urology, Department of Surgery, University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada.
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18
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Hueber PA, Bienz MN, Valdivieso R, Lavigueur-Blouin H, Misrai V, Rutman M, Te A, Chughtai B, Barber N, Emara A, Munver R, Bhojani N, Zorn K. MP13-14 180W LBO LASER VAPORIZATION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA IN HIGH-RISK PATIENTS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Fumo D, Shahrour K, Munver R, Jain S. MP50-17 INCIDENCE OF HYBRID TUMORS FOUND IN EXCISED RENAL MASSES: A MULTI-INSTITUTIONAL ANALYSIS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Glickman L, Munver R. PD42-08 COMPARISION OF LOW POWER/HIGH FREQUENCY HOLMIUM LASER SETTINGS WITH CONVENTIONAL SETTINGS ON URETERAL AND RENAL STONE FRAGMENTATION EFFICIENCY. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Sivarajan G, Glickman L, Faber K, Kim M, Fromer D, Munver R. Transabdominal Robot-Assisted Laparoscopic Urethral Diverticulectomy of a Complex Anterior Horseshoe Diverticulum of the Proximal Urethra. J Endourol Case Rep 2015; 1:33-5. [PMID: 27579382 PMCID: PMC4996566 DOI: 10.1089/cren.2015.29010.gsi] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Complex, proximal, anteriorly located urethral diverticula present the reconstructive urologist with a uniquely challenging task for repair through a conventional transvaginal approach. Herein, we present the first report of urethral diverticulectomy to excise a large, anterior, horseshoe-shaped urethral diverticulum that resulted in bladder outlet obstruction, using a transabdominal robot-assisted laparoscopic approach.
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Affiliation(s)
- Ganesh Sivarajan
- Department of Urology, Hackensack University Medical Center , Hackensack, New Jersey
| | - Leonard Glickman
- Department of Urology, Hackensack University Medical Center , Hackensack, New Jersey
| | - Kenneth Faber
- Department of Urology, Hackensack University Medical Center , Hackensack, New Jersey
| | - Michelle Kim
- Department of Urology, Hackensack University Medical Center , Hackensack, New Jersey
| | - Debra Fromer
- Department of Urology, Hackensack University Medical Center , Hackensack, New Jersey
| | - Ravi Munver
- Department of Urology, Hackensack University Medical Center , Hackensack, New Jersey
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22
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Hueber P, Bienz M, Liberman D, Misrai V, Rutman M, Te A, Chughtai B, Barber N, Emara A, Gonzalez R, Munver R, Zorn K. Traitement de l’adénome par vaporisation au laser Greenlight XPS-180W : analyse multicentrique des taux de complications et des résultats fonctionnels à 2ans selon le volume prostatique. Prog Urol 2014; 24:878. [DOI: 10.1016/j.purol.2014.08.206] [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: 11/16/2022]
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23
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Jiang P, Wright C, Sawczuk I, Munver R. PD20-12 EVALUATION OF SUBJECTIVE ASSESSMENT OF NERVE-SPARING QUALITY ON POSTOPERATIVE ERECTILE FUNCTION IN PATIENTS UNDERGOING ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1702] [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: 11/15/2022]
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24
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Jain S, Nyirenda T, Yates J, Munver R. Incidence of Renal Artery Pseudoaneurysm Following Open and Minimally Invasive Partial Nephrectomy: A Systematic Review and Comparative Analysis. J Urol 2013; 189:1643-8. [DOI: 10.1016/j.juro.2012.11.170] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Samay Jain
- University of Toledo Medical Center, Toledo, Ohio
| | - Themba Nyirenda
- Hackensack University Medical Center, Hackensack, New Jersey
| | | | - Ravi Munver
- John Theurer Cancer Center, Hackensack, New Jersey
- University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey
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25
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Munver R, Abaza R, Andrews P, Badani K, Bergman A, Castle E, Dallas K, Decotiis K, Del Pizzo J, Derweesh I, Eggener S, Eun D, Figenshau RS, Ghavamian R, Golan S, Golijanin D, Hemal A, Irwin B, Jain S, Johnson D, Joseph J, Kadlec A, Lallas C, Lee B, L'Esperance J, Link R, Mottrie A, Nelsen C, Nunez R, Palese M, Pareek G, Patel A, Peterson J, Phillips J, Png KS, Quek M, Rashid H, Raynor M, Razmaria A, Shalhav A, Small A, Su LM, Sundaram C, Thiel D, Trabulsi E, Venkatesh R, Weizer A, Woods M, Wu G, Yates J. 848 ROBOT-ASSISTED PARTIAL NEPHRECTOMY IN 2500+ CONSECUTIVE CASES: A FIVE YEAR MULTI-INSTITUTIONAL EXPERIENCE FROM THE ROBOT-ASSISTED PARTIAL NEPHRECTOMY INTEGRATED DATABASE (RAPID) STUDY GROUP. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Munver R, Abaza R, Andrews P, Badani K, Bergman A, Castle E, Dallas K, Decotiis K, Del Pizzo J, Derweesh I, Eggener S, Eun D, Figenshau RS, Ghavamian R, Golan S, Golijanin D, Hemal A, Irwin B, Jain S, Johnson D, Joseph J, Kadlec A, Lallas C, Lee B, L'Esperance J, Link R, Mottrie A, Nelsen C, Nunez R, Palese M, Pareek G, Patel A, Peterson J, Phillips J, Png KS, Quek M, Rashid H, Raynor M, Razmaria A, Shalhav A, Small A, Su LM, Sundaram C, Thiel D, Trabulsi E, Venkatesh R, Weizer A, Woods M, Wu G, Yates J. 1317 INCIDENCE AND CRITICAL ANALYSIS OF POSITIVE MARGINS FOLLOWING PARTIAL NEPHRECTOMY: RESULTS FROM THE ROBOT-ASSISTED PARTIAL NEPHRECTOMY INTEGRATED DATABASE (RAPID) STUDY GROUP. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2671] [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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27
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Jain S, Yates JK, Munver R. Robot-Assisted Laparoscopic Partial Nephrectomy for Recurrent Renal-Cell Carcinoma in Patients Previously Treated with Nephron-Sparing Surgery. J Endourol 2013; 27:309-12. [PMID: 22967179 DOI: 10.1089/end.2012.0184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Samay Jain
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ 07601, USA.
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28
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Jain S, Munver R, Sawczuk IS. Vitamin E and selenium do not decrease prostate cancer incidence: vitamin E may actually increase it. Evid Based Med 2012; 17:151-152. [PMID: 22307236 DOI: 10.1136/ebmed-2011-100472] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Samay Jain
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey 07601, USA.
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29
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Mues AC, Korets R, Graversen JA, Badani KK, Bird VG, Best SL, Cadeddu JA, Clayman RV, McDougall E, Barwari K, Laguna P, de la Rosette J, Kavoussi L, Okhunov Z, Munver R, Patel SR, Nakada S, Tsivian M, Polascik TJ, Shalhav A, Shingleton WB, Johnson EK, Wolf JS, Landman J. Clinical, pathologic, and functional outcomes after nephron-sparing surgery in patients with a solitary kidney: a multicenter experience. J Endourol 2012; 26:1361-6. [PMID: 22667344 DOI: 10.1089/end.2012.0114] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [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
BACKGROUND AND PURPOSE Surgical management of a renal neoplasm in a solitary kidney is a balance between oncologic control and preservation of renal function. We analyzed patients with a renal mass in a solitary kidney undergoing nephron-sparing procedures to determine perioperative, oncologic, and renal functional outcomes. PATIENTS AND METHODS A multicenter study was performed from 12 institutions. All patients with a functional or anatomic solitary kidney who underwent nephron-sparing surgery for one or more renal masses were included. Tumor size, complications, and recurrence rates were recorded. Renal function was assessed with serum creatinine level and estimated glomerular filtration rate. RESULTS Ninety-eight patients underwent 105 ablations, and 100 patients underwent partial nephrectomy (PN). Preoperative estimated glomerular filtration rate (eGFR) was similar between the groups. Tumors managed with PN were significantly larger than those managed with ablation (P<0.001). Ablations were associated with a lower overall complication rate (9.5% vs 24%, P=0.01) and higher local recurrence rate (6.7% vs 3%, P=0.04). Eighty-four patients had a preoperative eGFR ≥60 mL/min/1.73 m(2). Among these patients, 19 (23%) fell below this threshold after 3 months and 15 (18%) at 12 months. Postoperatively, there was no significant difference in eGFR between the groups. CONCLUSIONS Extirpation and ablation are both reasonable options for treatment. Ablation is more minimally invasive, albeit with higher recurrence rates compared with PN. Postoperative renal function is similar in both groups and is not affected by surgical approach.
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Affiliation(s)
- Adam C Mues
- New York University School of Medicine, New York, NY, USA
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30
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Yates J, Smith D, Musialek S, Munver R, Sawczuk I, Jain S, Godfrey L. 1229 ROBOT-ASSISTED LAPAROSCOPIC INTRAOPERATIVE BRACHYTHERAPY: A PORCINE TRIAL. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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31
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Munver R, Yates J, Jain S. 1421 COMPARISON OF SELECTIVE ARTERIAL CLAMPING AND NON-ARTERIAL CLAMPING: RESULTS FROM THE ROBOT-ASSISTED PARTIAL NEPHRECTOMY INTEGRATED DATABASE (RAPID) STUDY GROUP. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Lucas SM, Sundaram CP, Wolf JS, Leveillee RJ, Bird VG, Aziz M, Pautler SE, Luke P, Erdeljan P, Baldwin DD, Ebrahimi K, Nadler RB, Rebuck D, Thomas R, Lee BR, Boylu U, Figenshau RS, Munver R, Averch TD, Gayed B, Shalhav AL, Gundeti MS, Castle EP, Anderson JK, Duffey BG, Landman J, Okhunov Z, Wong C, Strom KH. Factors That Impact the Outcome of Minimally Invasive Pyeloplasty: Results of the Multi-Institutional Laparoscopic and Robotic Pyeloplasty Collaborative Group. J Urol 2012; 187:522-7. [DOI: 10.1016/j.juro.2011.09.158] [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: 06/02/2011] [Indexed: 10/14/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Patrick Luke
- University of Western Ontario, London, Ontario, Canada
| | | | | | - Kamyar Ebrahimi
- Loma Linda University Medical Center, Loma Linda, California
| | | | | | | | | | - Ugur Boylu
- Tulane University, New Orleans, Louisiana
| | | | - Ravi Munver
- Hackensack University, Hackensack, New Jersey
| | | | - Bishoy Gayed
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | | | - Carson Wong
- University of Oklahoma, Oklahoma City, Oklahoma
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33
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Winston D, Yates JK, Munver R, Fromer D. A rare presentation of nephrogenic adenoma: multiple upper tract lesions in a female patient. Can J Urol 2011; 18:6064-6065. [PMID: 22166337] [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: 05/31/2023]
Abstract
Nephrogenic adenomas are rare benign lesions of the urinary tract occurring most frequently in the bladder of male patients. We report the case of a female patient presenting with gross hematuria, which lateralized to the left ureter on cystoscopy. At the time of ureteroscopy, two polypoid lesions were identified in an upper and lower pole calyx, which were found on biopsy to be nephrogenic adenomas. In addition to reporting this case, we review the literature for the pathophysiology of nephrogenic adenomas.
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Affiliation(s)
- Dock Winston
- University of Medicine and Dentistry-New Jersey Medical School, Newark, New Jersey, USA
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34
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Robertson C, Sliwinski A, Delisio J, Wallen E, Ward J, Orovan W, Locke D, Crawford E, Maroni P, Donnell R, Grunberger I, Bevan-Thomas R, Munver R, Sawczuk I, Chang S, Gill I. POD-07.08 Morbidity of High Intensity Focused Ultrasound (HIFU) as a Primary Monotherapy for Low-Risk Localized Prostate Cancer: Outcomes from the ENLIGHT Trial. Urology 2011. [DOI: 10.1016/j.urology.2011.07.458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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35
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Steinberg PL, Munver R, Ghavamian R. Impact of repeated hilar clamping on renal function during laparoscopic and robot-assisted partial nephrectomy. J Endourol 2011; 25:1525-30. [PMID: 21815808 DOI: 10.1089/end.2010.0657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
BACKGROUND AND PURPOSE Conventional wisdom and small animal studies suggest repeated hilar clamping during partial nephrectomy is deleterious to renal function. We describe the impact of repeated renal hilar clamping during laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RPN) on the overall function of the operated kidney. PATIENTS AND METHODS A retrospective analysis of all patients undergoing RPN or LPN with repeated hilar clamping was performed. Patient and tumor characteristics were recorded. All patients had preoperative and postoperative mercaptoacetyltriglycine (MAG)3 renal scans, and the change in function was calculated. Change in glomerular filtration rate (GFR) was calculated with the modified Modification of Diet in Renal Disease equation as well. RESULTS Seven patients were studied with an average age of 60 and a body mass index of 32. Tumors averaged 3.6 cm, and there were four and three right- and left-sided tumors, respectively. The reasons for repeated clamping were bleeding in three patients and either gross or microscopic positive margins in four patients, all of whom had repeated resection. The average initial clamp time was 20 minutes, and the average reclamp time was 12 minutes. The average operative time was 185 minutes. and average blood loss was 171 mL. All renal units were functioning postoperatively. The average change in absolute renal function on the operated kidney was -4.9%, and the relative loss of function was -10%, both measured on MAG3 scan. The average GFR before surgery was 61.4 (mL/min/1.73m(2)); after surgery, the average GFR was 57.1 (mL/min/1.73m(2)), for an average loss of -7%. The range of change in GFR was from 0% to -23%. CONCLUSIONS Although not optimal, repeated clamping of the renal hilum during partial nephrectomy to control bleeding or to obtain a clear surgical margin is associated with minimal loss of renal function.
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Affiliation(s)
- Peter L Steinberg
- Department of Urology, Maine Medical Partners, South Portland, Maine 04101, USA.
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36
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Hyams ES, Munver R, Bird VG, Uberoi J, Shah O. Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. J Endourol 2011; 24:1583-8. [PMID: 20629566 DOI: 10.1089/end.2009.0629] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [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] Open
Abstract
BACKGROUND AND PURPOSE Percutaneous nephrostolithotomy (PCNL) is the current standard of care for management of large renal stones (>2 cm). Recent studies have evaluated flexible ureterorenoscopy (URS)/holmium laser lithotripsy as an alternative treatment for patients with contraindications to or preference against PCNL. Stones in an intermediate size range (2-3 cm) may be most amenable to URS/laser lithotripsy as definitive treatment in a single stage. We report a multi-institutional series of URS/laser lithotripsy for renal stone burdens that measure 2 to 3 cm. PATIENTS AND METHODS Patients who underwent URS/holmium laser lithotripsy for renal stones that measured 2 to 3 cm were identified retrospectively at three tertiary care centers. Demographic information, disease characteristics, and perioperative and postoperative data were gathered. Patients with renal stone burdens of 2 to 3 cm who were treated by URS/laser lithotripsy and had at least one postoperative visit and imaging study were included. Stone clearance was evaluated using 0-2 mm and <4 mm residual stone burden on postoperative imaging. RESULTS One hundred and twenty patients underwent URS/holmium laser lithotripsy for renal stones of 2 to 3 cm. Mean stone burden was 2.4 cm, and mean body mass index was 29.3 kg/m². Indications for URS/laser lithotripsy vs PCNL included patient preference (57), technical or anatomic factors (24), patient comorbidities (17), failed shockwave lithotripsy (9), patient body habitus (3), solitary kidney (3), chronic renal insufficiency (3), and strict anticoagulation (2). Thirty-one (26%) patients had stent placement preprocedure, and 94 (78%) patients underwent outpatient surgery. A ureteral access sheath was used in 67%. One hundred and one (84%) patients underwent single-stage procedures. There was one intraoperative complication (ureteral perforation), and there were eight minor postoperative complications (6.7%). The reoperation rate through the mean 18-month follow-up was 3/120 or 2.5%. Seventy-six (63%) patients had residual stone burden of 0 to 2 mm, and 100 (83%) patients had residual burden of <4 mm. CONCLUSIONS We demonstrate that single-stage URS/holmium laser lithotripsy is effective for management of renal stones that measure 2 to 3 cm through intermediate follow-up. Staged procedures can be used selectively for technical reasons or disease factors. Although PCNL achieves superior stone clearance overall, URS/laser lithotripsy is a viable treatment option for selected patients.
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Affiliation(s)
- Elias S Hyams
- Department of Urology, New York University School of Medicine, New York, New York, USA
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Yates J, Sawczuk I, Nazmy M, Uberoi J, Gross M, Munver R. 1862 PERIOPERATIVE ENOXAPARIN IS NOT ASSOCIATED WITH AN INCREASED BLEEDING RISK IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY: A PROSPECTIVE EVALUATION. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Christiano T, Patel N, Yates J, Uberoi J, Munver R. V765 LAPAROSCOPIC ADRENALECTOMY FOR PHEOCHROMOCYTOMA ASSOCIATED WITH HORSESHOE KIDNEY. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1359] [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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Uberoi J, Brison D, Patel N, Sawczuk IS, Munver R. Robot-Assisted Laparoscopic Radical Prostatectomy in Patients with Prostate Cancer with High-Risk Features: Predictors of Favorable Pathologic Outcome. J Endourol 2010; 24:403-7. [DOI: 10.1089/end.2009.0203] [Citation(s) in RCA: 9] [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: 11/13/2022] Open
Affiliation(s)
- Jayant Uberoi
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Daniel Brison
- Division of Urology, Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Nitin Patel
- Division of Urology, Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Ihor S. Sawczuk
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey
- Touro University College of Medicine, Hackensack, New Jersey
| | - Ravi Munver
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey
- Division of Urology, Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
- Touro University College of Medicine, Hackensack, New Jersey
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Uberoi J, Disick GIS, Munver R. Minimally invasive surgical management of pelvic-ureteric junction obstruction: update on the current status of robotic-assisted pyeloplasty. BJU Int 2009; 104:1722-9. [PMID: 19519760 DOI: 10.1111/j.1464-410x.2009.08682.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pelvi-ureteric junction (PUJ) obstruction is characterized by a functionally significant impairment of urinary transport caused by intrinsic or extrinsic obstruction in the area where the ureter joins the renal pelvis. The majority of cases are congenital in origin; however, acquired conditions at the level of the ureteropelvic junction may also present with symptoms and signs of obstruction. Historically, open pyeloplasty and endoscopic techniques have been the main surgical options with the intent of complete excision or incision of the obstruction. The advent of laparoscopy and robotic-assisted applications has allowed for minimally invasive reconstructive surgery that mirrors open surgical techniques. AIMS We review the current status of robotic-assisted laparoscopic pyeloplasty and report on the result, continuing evolution, and potential role for this surgical procedure. MATERIALS AND METHODS A review of the recent literature encompassing laparoscopic and robotic-assisted pyeloplasty was conducted with particular attention to operative techniques, surgical outcomes, and complication rates. RESULTS Laparoscopic and robotic-assisted approaches are able to duplicate the open technique, and not surprisingly, are now being shown to be as efficacious as the gold standard open approach. The laparoscopic remains technically challenging due to the high proficiency level required for intracorporeal suturing, although added experience has resulted in shorter operative times. The advent of robotics has further expanded the breadth of this reconstructive procedure while preserving the benefits of decreased pain, shorter hospitalization, rapid convalescence, and an improved cosmetic result. DISCUSSION The introduction of robotics to the field of minimally invasive surgery facilitates this procedure and may allow for more widespread implementation by surgeons of varying skill levels. These benefits must be balanced against the increased costs of the robotic platform. CONCLUSION Clinical reports have demonstrated that robotic-assisted pyeloplasty is a safe, feasible, and effective technique for treating ureteropelvic junction obstruction in short term studies. Additional studies with prolonged follow-up will ultimately provide valuable information as to the long-term efficacy of robotic-assisted laparoscopic pyeloplasty.
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Affiliation(s)
- Jayant Uberoi
- Hackensack University Medical Center, Hackensack, NJ 07601, USA
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Dakwar G, Sawczuk IS, Uberoi J, Munver R. PREOPERATIVE EXPENSES FOR PATIENTS UNDERGOING ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY: ARE COSTS JUSTIFIED? J Urol 2009. [DOI: 10.1016/s0022-5347(09)60560-7] [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: 11/30/2022]
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Munver R, Disick G, Uberoi J. MINIMALLY INVASIVE PARTIAL NEPHRECTOMY: COMPARISON OF LAPAROSCOPIC, HAND-ASSISTED, AND ROBOTIC-ASSISTED TECHNIQUES. J Urol 2009. [DOI: 10.1016/s0022-5347(09)60782-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Patel MB, Munver R, Bracho JE, Moore CR, Chauhan S, Palmer KJ, Coughlin GD, Bird VG, Leveilee RJ, Patel VR. ROBOTIC ASSISTED LAPAROSCOPIC DISMEMBERED PYELOPLASTY (RALDP) FOR PRIMARY AND SECONDARY URETEROPELVIC JUNCTION OBSTRUCTION: A MULTI-INSTITUTIONAL EXPERIENCE. J Urol 2009. [DOI: 10.1016/s0022-5347(09)60897-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Disick GI, Shapiro ME, Miles RA, Munver R. Critical Analysis of Laparoscopic Donor Nephrectomy in the Setting of Complex Renal Vasculature: Initial Experience and Intermediate Outcomes. J Endourol 2009; 23:451-5. [DOI: 10.1089/end.2008.0242] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Grant I.S. Disick
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Michael E. Shapiro
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Ruth Ann Miles
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Ravi Munver
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey
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Affiliation(s)
- Jayant Uberoi
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Ravi Munver
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey
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Byler TK, Disick GI, Sawczuk IS, Munver R. Vascular anomalies during laparoscopic renal surgery: incidence and management of left-sided inferior vena cava. JSLS 2009; 13:77-9. [PMID: 19366547 PMCID: PMC3015915] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Left-sided inferior vena cava (IVC) is an unusual abnormality that may be clinically significant during renal surgery. METHODS We report the unique case of a patient with a centrally located left renal mass who underwent laparoscopic radical nephrectomy. During the hilar dissection, unusual vascular anatomy was encountered. The patient was noted to have a left-sided inferior vena cava with multiple renal veins and anomalous tributaries. Laparoscopic radical nephrectomy was performed without complication. DISCUSSION The embryology of a left-sided inferior vena cava is reviewed, and the safety and feasibility of a laparoscopic approach is discussed.
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Affiliation(s)
| | | | - Ihor S. Sawczuk
- Hackensack University Medical Center, Hackensack, New Jersey, USA.,Touro University College of Medicine, Hackensack, New Jersey, USA
| | - Ravi Munver
- Hackensack University Medical Center, Hackensack, New Jersey, USA.,Touro University College of Medicine, Hackensack, New Jersey, USA.,UMDNJ New Jersey Medical School, Newark, New Jersey, USA
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Abstract
Adrenalectomy is the standard of care for hormonally active adrenal masses. In recent years, minimally invasive laparoscopic excision has become a preferred management option. As with advances in parenchymal-sparing renal surgery, investigators have begun to examine adrenal-sparing procedures to preserve functional adrenal tissue. This article reviews the recent literature and reports on intermediate results with laparoscopic partial adrenalectomy (LPA).
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Affiliation(s)
- Grant I S Disick
- Department of Urology, The Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1272, New York, NY 10029, USA.
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Kesler SS, Pierre SA, Brison DI, Preminger GM, Munver R. Use of the Escape™ Nitinol Stone Retrieval Basket Facilitates Fragmentation and Extraction of Ureteral and Renal Calculi: A Pilot Study. J Endourol 2008; 22:1213-7. [DOI: 10.1089/end.2008.0070] [Citation(s) in RCA: 34] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stuart S. Kesler
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Sean A. Pierre
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Daniel I. Brison
- University of Medicine and Dentistry of New Jersey – New Jersey Medical School, Newark, New Jersey
| | - Glenn M. Preminger
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ravi Munver
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey
- University of Medicine and Dentistry of New Jersey – New Jersey Medical School, Newark, New Jersey
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Jayaratna I, Munver R, Disick G, Han MW, Sawczuk I. Paraneoplastic hypertension associated with renal oncocytoma: management with cryoablation. Urology 2008; 73:209.e9-11. [PMID: 18372030 DOI: 10.1016/j.urology.2008.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 12/11/2007] [Revised: 01/23/2008] [Accepted: 02/07/2008] [Indexed: 11/18/2022]
Abstract
Paraneoplastic hypertension associated with a renal oncocytoma is an unreported syndrome. We report a unique case of a patient with multidrug-resistant hypertension who was found to have a solitary renal mass. Cryoablation was performed and resulted in an immediate and dramatic decrease in blood pressure. Histologic review of intraoperative biopsy specimens revealed findings consistent with renal oncocytoma. To our knowledge, this is the first report of hypertension in the setting of a renal oncocytoma, with subsequent improvement of this paraneoplastic syndrome after cryoablation.
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Affiliation(s)
- Isuru Jayaratna
- University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA
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Volfson IA, Munver R, Esposito M, Dakwar G, Hanna M, Stock JA. Robot-Assisted Urologic Surgery: Safety and Feasibility in the Pediatric Population. J Endourol 2007; 21:1315-8. [DOI: 10.1089/end.2007.9982] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Ilya A. Volfson
- Hackensack University Medical Center, Hackensack, New Jersey
| | - Ravi Munver
- Hackensack University Medical Center, Hackensack, New Jersey
- University of Medicine & Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey
| | - Michael Esposito
- Hackensack University Medical Center, Hackensack, New Jersey
- University of Medicine & Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey
| | - George Dakwar
- Hackensack University Medical Center, Hackensack, New Jersey
- University of Medicine & Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey
| | - Moneer Hanna
- Children's Hospital of New Jersey, Newark, New Jersey
| | - Jeffrey A. Stock
- Hackensack University Medical Center, Hackensack, New Jersey
- Children's Hospital of New Jersey, Newark, New Jersey
- University of Medicine & Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey
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