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[PMID]: 27107196
[Au] Autor:Lorenzo AJ; Romao RL
[Ad] Address:Department of Surgery, Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. Electronic address: armando.lorenzo@sickkids.ca.
[Ti] Title:The Evolving Role of Minimally Invasive Surgery in Pediatric and Adolescent Urologic Oncology.
[So] Source:Urology;91:180-9, 2016 May.
[Is] ISSN:1527-9995
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: This review aims at evaluating the current status of minimally invasive surgery at the difficult crossroad between the attractiveness of innovation faced against the solid outcomes offered by the current gold standard, specifically concerning pediatric and adolescent urologic oncology conditions. METHODS: This is a critical review of the literature and current paradigms on the use of minimally invasive surgery for pediatric and adolescent urologic oncology cancers. Focus is mainly on the use of laparoscopy for the treatment of Wilms' tumors but other neoplasms are also discussed. RESULTS: We draw parallels with other similar pathologies, respecting critical lessons from international cooperative study groups. We discuss various aspects of the pros and cons of minimally invasive surgery in this patient population and make a case for the development of dedicated pediatric surgeons for urologic cancer. CONCLUSION: Herein we draft a proposal suggesting a way forward with the adoption of reasonable paradigm shifts founded on carefully conducted studies for the introduction of minimally invasive surgery in the care of pediatric and adolescent urologic cancer.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1604
[Js] Journal subset:IM
[St] Status:In-Data-Review

  2 / 1552650 MEDLINE  
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[PMID]: 26940153
[Au] Autor:Silvestre J; Agarwal D; Lee DI
[Ad] Address:The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
[Ti] Title:Analysis of National Institutes of Health Funding to Departments of Urology.
[So] Source:Urology;91:6-11, 2016 May.
[Is] ISSN:1527-9995
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To elucidate the current portfolio of National Institutes of Health (NIH) funding to departments of urology at U.S. medical schools. MATERIALS AND METHODS: The NIH Research Portfolio Online Reporting Tools Expenditures and Results was used to generate a comprehensive analysis of NIH research grants awarded to urology departments during 2014. Costs, mechanisms, and institutes were summarized with descriptive statistics. Demographic data were obtained for principal investigators and project abstracts were categorized by research type and area. Fiscal totals were calculated for 2005-2014 and compared with other surgical departments during 2014. RESULTS: One hundred one investigators at 36 urology departments received $55,564,952 in NIH funding during 2014. NIH-funded investigators were predominately male (79%) and PhD scientists (52%). Funding totals did not vary by terminal degree or sex, but increased with higher academic rank (P < .001). The National Cancer Institute (54.7%) and National Institute of Diabetes and Digestive and Kidney Diseases (32.2%) supported the majority of NIH-funded urologic research. The R01 grant accounted for 41.0% of all costs. The top 3 NIH-funded clinical areas were urologic oncology (62.1%), urinary tract infection (8.8%), and neurourology (7.6%). A minority of costs supported clinical research (12.9%). In 2014, urology had the least number of NIH grants relative to general surgery, ophthalmology, obstetrics & gynecology, otolaryngology, and orthopedic surgery. CONCLUSION: NIH funding to urology departments lags behind awards to departments of other surgical disciplines. Future interventions may be warranted to increase NIH grant procurement in urology.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1604
[Js] Journal subset:IM
[St] Status:In-Data-Review

  3 / 1552650 MEDLINE  
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[PMID]: 26921643
[Au] Autor:Karabulut I; Keskin E; Bedir F; Yilmazel FK; Ziypak T; Doluoglu OG; Resorlu B; Germiyanoglu C
[Ad] Address:Department of Urology, Erzurum Training and Research Hospital, Ankara, Turkey....
[Ti] Title:Rigid Ureteroscope Aided Insertion of Ureteral Access Sheath in Retrograde Intrarenal Surgery.
[So] Source:Urology;91:222-5, 2016 May.
[Is] ISSN:1527-9995
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To compare the outcomes of the ureteral access sheath (UAS) placement techniques in patients undergoing retrograde intrarenal surgery. MATERIALS AND METHODS: The patients were divided into two groups with respect to placement method of UAS. UAS was placed with the classical method, through the guidewire, in the first group of the patients (group I). The outer sheath of UAS was worn on the semirigid endoscope and placed into the ureter under direct vision in the second group (group II). The number of patients was the same in two groups (n = 42). RESULTS: Overall, 70 of 84 (83.3%) patients were stone free after the initial treatment. The success rates were comparable between the two groups (80.9% vs 85.7%, P = .859) 1 month after surgery. Fluoroscopy screening time (11.7 ± 5.7 seconds vs 0 second), UAS placement time (245 ± 138.4 seconds vs 40 ± 17.9 seconds; P < .001), and operation time (58.7 ± 17.1 minutes vs 51.2 ± 16.7 minutes; P = .046) were significantly longer in group I when compared to group II. The complication rate was higher in group I when compared to group II (23.8% vs 9.5%), but the difference was not statistically significant (P = .079). CONCLUSION: Introducing UAS into ureter under direct vision while it was precisely worn on ureteroscope makes this step safer, and protects the surgeon and patient from radiation exposure by shortening fluoroscopy and operation times.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1604
[Js] Journal subset:IM
[St] Status:In-Data-Review

  4 / 1552650 MEDLINE  
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[PMID]: 26919965
[Au] Autor:Komai Y; Sugimoto M; Gotohda N; Matsubara N; Kobayashi T; Sakai Y; Shiga Y; Saito N
[Ad] Address:Department of Urology, National Cancer Center Hospital East, Chiba, Japan. Electronic address: yokomai@east.ncc.go.jp....
[Ti] Title:Patient-specific 3-dimensional Printed Kidney Designed for "4D" Surgical Navigation: A Novel Aid to Facilitate Minimally Invasive Off-clamp Partial Nephrectomy in Complex Tumor Cases.
[So] Source:Urology;91:226-33, 2016 May.
[Is] ISSN:1527-9995
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To report our initial experience with a novel style of 3-dimensional (3D) printed kidney, which we call "4D" surgical navigation in minimally invasive off-clamp partial nephrectomy (PN). MATERIALS AND METHODS: Ten patients with a R.E.N.A.L. nephrometry score ≥8 renal mass underwent minimally invasive off-clamp PN navigated with the aid of a patient-specific 3D printed kidney. To enhance the advantage of a 3D printed organ, we herein designed our 3D printed kidneys so that the tumor and its margin could be removed. This tumor removability allowed surgeons and patients to preoperatively visualize both the pre- and posttumor-resection kidney status, which we termed "4D" surgical navigation. Before patients consented to surgery, the surgical procedure and perioperative risks were explained to each patient using the patient-specific 3D printed kidney; subsequently, surgeons asked patients whether the 3D printed kidney model had helped them better understand their surgery than they would have without the model. RESULTS: All minimally invasive off-clamp PNs were successfully completed with acceptable perioperative outcomes and negative surgical margins. The 3D printed tumors together with their margins were nearly identical to the surgical specimens. All patients responded that their specific 3D printed kidney models had helped them understand their disease and the operations they underwent. CONCLUSION: This is the first report of a novel 3D printed organ style, which we termed "4D" surgical navigation. Use of the current 3D printed kidney models helped surgeons to perform minimally invasive off-clamp PN in complex tumor cases and also helped patients to more fully understand the operation.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1604
[Js] Journal subset:IM
[St] Status:In-Data-Review

  5 / 1552650 MEDLINE  
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[PMID]: 26919963
[Au] Autor:Mamut AE; Violette PD; Rowe NE; Cui F; Luke PP
[Ad] Address:Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Surgery, Division of Urology, London Health Sciences Center, Western University, London, Ontario, Canada....
[Ti] Title:Measuring the Impact of Medical Chronic Kidney Disease and Diabetes Mellitus on Renal Functional Decline Following Surgical Management of Renal Masses.
[So] Source:Urology;91:124-8, 2016 May.
[Is] ISSN:1527-9995
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To identify risk factors for renal functional decline following extirpative renal surgery, and establish the relative impact of these factors on glomerular filtration rate (GFR). METHODS: We reviewed 224 consecutive patients with a normal contralateral kidney who underwent radical nephrectomy for a renal mass at a tertiary care center between 2002 and 2010. Multivariate linear regression was used to identify independent predictors of renal function. RESULTS: Mean patient age at time of surgery was 62.6 years and 58% of patients were male. On multivariate analysis, preoperative GFR and diabetes mellitus (DM) were independent predictors of 1-year postoperative renal function. Every 1.0 mL/min/1.73 m(2) of preoperative GFR corresponded to a loss of 0.50 mL/min/1.73 m(2) following extirpative renal surgery. Diabetic patients had a further decrease in GFR of 4.5 mL/min/1.73 m(2) (95% confidence interval 1.5-7.6) compared to patients without DM. CONCLUSION: Preoperative GFR and DM were independent predictors of postoperative renal function. This may represent a proportion of patients with medical renal disease that is not identified on the basis of preoperative GFR alone.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1604
[Js] Journal subset:IM
[St] Status:In-Data-Review

  6 / 1552650 MEDLINE  
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[PMID]: 26905031
[Au] Autor:Dal Moro F; Zattoni F
[Ad] Address:Department of Surgery, Oncology and Gastroenterology-Urology, University of Padova, Padova, Italy. Electronic address: fabrizio.dalmoro@unipd.it.
[Ti] Title:Ves.Pa.-Designing a Novel Robotic Intracorporeal Orthotopic Ileal Neobladder.
[So] Source:Urology;91:99-103, 2016 May.
[Is] ISSN:1527-9995
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To present a detailed description of the "Ves.Pa." procedure to create a novel robotic intracorporeal ileal orthotopic neobladder, together with technical tips for the creation of a time-efficient robotic intracorporeal neobladder. MATERIALS AND METHODS: We evaluated the presumed volume of the final Ves.Pa. in silico, exploring ex vivo the anatomical and technical feasibility of reconfiguring the bowel. During tests performed in a robotic pelvic model, procedures were recorded to identify possible improvements in operating times. RESULTS: After initial evaluation of the anatomical feasibility of the technique, its practicability was confirmed during ex vivo tests. It is also possible to create two different versions of the pouch, in cases of short right or short left ureter ("Ves.Pa. Reverse"). Tests on our robotic pelvic model confirmed the feasibility of the technique, and some details to improve its time efficiency were identified, for example, further simplification of the suturing of the neobladder. CONCLUSION: Despite the increasing use of robotic radical cystectomy, most urological departments do not perform "ideal" intracorporeal urinary diversion due to perceived technical difficulties in reconfiguring the ileum and operating times in comparison with open surgery. An idea for a novel intracorporeal robotic orthotopic neobladder (with many characteristics for creating a feasible test pouch) has been designed. Clinical studies are needed to confirm these findings.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1604
[Js] Journal subset:IM
[St] Status:In-Data-Review

  7 / 1552650 MEDLINE  
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[PMID]: 26879735
[Au] Autor:Jackson MA; Bellas N; Siegrist T; Haddock P; Staff I; Laudone V; Wagner JR
[Ad] Address:Urology Division, Hartford Hospital, Hartford, CT....
[Ti] Title:Experienced Open vs Early Robotic-assisted Laparoscopic Radical Prostatectomy: A 10-year Prospective and Retrospective Comparison.
[So] Source:Urology;91:111-8, 2016 May.
[Is] ISSN:1527-9995
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To undertake a prospective/retrospective comparison of longer-term oncologic and quality of life outcomes in open radical prostatectomy (ORP) or robotic-assisted laparoscopic radical prostatectomy (RALP) patients. MATERIALS AND METHODS: The clinical progression of ORP and RALP patients who underwent surgery during 2004 was followed over an extended (10 year) period. Pre- and perioperative parameters, oncologic outcomes, recurrence, mortality, and quality of life were compared between surgical modalities. Follow-up time was calculated from the time of surgery to the latest contact. Postoperative quality of life data were obtained from Expanded Prostate Cancer Index Composite survey questionnaires. Recurrence rates, times to recurrence, surgical time, length of stay, hematocrit, follow-up time, and sexual and urinary bother scores were compared between surgical groups. Multivariate analyses were used to predict positive surgical margins and biochemical recurrence. RESULTS: 63 ORP and 116 RALP patients were included (mean age of 60.4 ± 6.4 and 58.6 ± 5.8 years; P = .067), with follow-up times of 10.3 and 10.1 years (P = .191). RALP patients had longer operative times (P < .001), shorter hospital stays (P < .001), and higher discharge hematocrits (P < .001). With prostate-specific antigen, Gleason score, and T-stage as covariates, time to recurrence (P = .365) and positive margin rate (P = .230) were not statistically different between groups. Ninety-five percent of RALP patients were continent and 48.0% were potent vs 92.6% and 41.5% of ORP patients (P = .720; .497). Urinary and sexual bother were not significantly different between groups (P = .392; .985). CONCLUSION: Our longer-term follow-up data suggest that ORP and RALP patients have comparable oncologic and quality of life outcomes.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1604
[Js] Journal subset:IM
[St] Status:In-Data-Review

  8 / 1552650 MEDLINE  
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[PMID]: 26879733
[Au] Autor:Cho MC; Ha SB; Park J; Son H; Oh SJ; Kim SW; Paick JS
[Ad] Address:Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea....
[Ti] Title:Impact of Detrusor Underactivity on Surgical Outcomes of Laser Prostatectomy: Comparison in Serial 12-Month Follow-Up Outcomes Between Potassium-Titanyl-Phosphate Photoselective Vaporization of the Prostate (PVP) and Holmium Laser Enucleation of the Prostate (HoLEP).
[So] Source:Urology;91:158-66, 2016 May.
[Is] ISSN:1527-9995
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To evaluate impacts of preoperative detrusor underactivity (DU) on outcomes of photoselective vaporization of the prostate (PVP) or holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia, and to compare them between the two surgeries. MATERIALS AND METHODS: A total of 1423 men, who underwent PVP (group A) or HoLEP (group B), were categorized into four groups: A1 (239 without DU), A2 (432 with DU), B1 (329 without DU), and B2 (423 with DU). DU was defined as bladder contractility index of <100. Outcomes were assessed at 1, 3, 6, and 12 months postoperatively using International Prostate Symptom Score (IPSS), uroflowmetry, and prostate-specific antigen. Successful outcome was defined as reductions by ≥50% of total IPSS at 12 months postoperatively. RESULTS: In all four groups, almost all parameters of IPSS and uroflowmetry improved starting from 1 month. A1 or B1 had greater increases in maximum flow rate than A2 or B2. Decreases of total IPSS in A2 were less than in A1 starting from 1 month after PVP, whereas those in B2 were less than those in B1 as late as 12 months after HoLEP. B2 showed greater improvements in maximum flow rate, subtotal voiding symptom score, bladder voiding efficiency, and total IPSS than A2. In all patients, multivariate regression analysis revealed that the absence of DU, presence of bladder outlet obstruction, and higher baseline total IPSS were independent predictors of successful outcome after surgery, but the type of laser surgery (PVP vs HoLEP) was not. CONCLUSION: Our data suggest that micturition symptoms, maximum flow rate, bladder voiding efficiency, and quality of life improve starting from the early period after PVP or HoLEP, irrespective of DU. However, patients with DU may have less degree of improvement in micturition after PVP or HoLEP than those without DU.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1604
[Js] Journal subset:IM
[St] Status:In-Data-Review

  9 / 1552650 MEDLINE  
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[PMID]: 26845051
[Au] Autor:Younger A; Rac G; Clemens JQ; Kobashi K; Khan A; Nitti V; Jacobs I; Lemack GE; Brown ET; Dmochowski R; Maclachlan L; Mourtzinos A; Ginsberg D; Koski M; Rames R; Rovner E
[Ad] Address:Department of Urology, Medical University of South Carolina, Charleston, SC....
[Ti] Title:Pelvic Organ Prolapse Surgery in Academic Female Pelvic Medicine and Reconstructive Surgery Urology Practice in the Setting of the Food and Drug Administration Public Health Notifications.
[So] Source:Urology;91:46-51, 2016 May.
[Is] ISSN:1527-9995
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To understand the effect of the Food and Drug Administration (FDA) public health notifications regarding transvaginal placement of surgical mesh for pelvic organ prolapsed (POP) on surgeon practice patterns in tertiary care academic medical centers. MATERIALS AND METHODS: Surgical volume for procedures performed primarily by fellowship trained Female Pelvic Medicine and Reconstructive Surgery at a sampling of 8 academic institutions across the US were collected using current procedural technology codes for POP repair and revision surgeries from 2007 to 2013. SAS statistical software was used to analyze data for trends and to assess differences in number of procedures across years by performing Spearman correlation analysis and Pearson's chi-squared test. Significance of trend was defined as P <.05 for both analysis methods. RESULTS: There has been a substantial reduction in transvaginal mesh-augmented repair of POP since the FDA warning statements of 2008 and 2011. Mesh revision surgery has increased over this same period. However, the total number of interventions for POP has remained stable over the study period. Abdominal sacrocolpopexy has increased as a whole but represents only a small percentage of total cases. CONCLUSION: Surgical correction of POP comprises a large portion of Female Pelvic Medicine and Reconstructive Surgery practice that continues to evolve in the aftermath of the FDA public health notifications. The utilization of transvaginal placement of surgical mesh augmented POP repair has decreased among practicing urologists at a sampling of academic institutions across the United States. Indications for surgery, complications, and outcomes were not evaluated during this retrospective study; however, such data may provide alternative insights into the reasons for the observed trends.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1604
[Js] Journal subset:IM
[St] Status:In-Data-Review

  10 / 1552650 MEDLINE  
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[PMID]: 26826590
[Au] Autor:Yoshida T; Kinoshita H; Yoshida K; Mishima T; Taniguchi H; Yanishi M; Komai Y; Yasuda K; Sugi M; Matsuda T
[Ad] Address:Department of Urology and Andrology, Kansai Medical University, Osaka, Japan....
[Ti] Title:Intravesical Prostatic Protrusion as a Predicting Factor for the Adverse Clinical Outcome in Patients With Symptomatic Benign Prostatic Enlargement Treated With Dutasteride.
[So] Source:Urology;91:154-7, 2016 May.
[Is] ISSN:1527-9995
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To evaluate the role of intravesical prostatic protrusion (IPP) as a predictive factor for adverse clinical outcomes in patients treated with dutasteride for lower urinary tract symptoms secondary to benign prostatic enlargement (BPE). METHODS: In total, 111 patients treated with dutasteride for symptomatic BPE were analyzed. Stepwise multivariate logistic regression was applied to evaluate predictors for acute urinary retention (AUR) or benign prostatic hyperplasia (BPH)-related surgery. We applied an IPP cutoff value of 10 mm. The clinical variables were assessed using univariate analysis. RESULTS: Of 111 patients, 27 (24.3%) developed AUR or required surgical intervention. On multivariate analysis, IPP remained as the independent predictor for AUR and need for BPH-related surgery (odds ratio, 1.27; P < .001). Both international prostate symptom score and maximum urinary flow rate significantly improved in patients with low IPP (P = .03 and P < .001, respectively), but not in those with high IPP. No significant reduction was found in the degree of IPP despite the significant reduction in prostate volume after dutasteride treatment (P = .84 and P < .001, respectively). The 3-year cumulative incidence of AUR or BPH-related surgery in the low IPP group vs the high IPP group was 9.9% vs 71.5%, respectively (P < .001). CONCLUSION: High IPP is associated with a higher risk of treatment resistance, AUR, or the need for prostatic surgery in patients receiving dutasteride treatment for symptomatic BPE. Dutasteride might not be effective for IPP reduction.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1604
[Js] Journal subset:IM
[St] Status:In-Data-Review


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