Browsing by Author "Heiman, Joshua M."

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    Percutaneous Nephrolithotomy in the 80 Years of Age and Older Population
    (Elsevier, 2019) Abedali, Zain A.; Large, Tim; Heiman, Joshua M.; Bandali, Elhaam; Anderson, Blake B.; Lingeman, James E.; Krambeck, Amy E.; Urology, School of Medicine
    Objective To evaluate feasibility of percutaneous nephrolithotomy (PCNL) for complex nephrolithiasis in patients 80 years of age and older compared to younger individuals. Methods From an institutional IRB-approved database, 1,647 patients were identified who underwent PCNL from 1999 to 2019. Patients were stratified by age: group 1 (20-59), group 2 (60-79), and group 3 (>80). Statistics were performed using chi-square and ANOVA to compare outcomes. Results Of the 1,647 patients, median age was 46, 66, and 83, respectively ( P <0.0001). Three patients within group 3 were 90 or older. Females made up 54%, 46%, 56% of patients ( P = 0.02). Average stone size with SD was 2.6 ± 2.2, 2.5 ± 2.3, 2.2± 1.9 cm for each group ( P = 0.06). Mean preoperative hemoglobin (Hgb) was significantly lower in the 80+ group (13.8, 13.4, 13.1 g/dL, P <.0001). Change in Hgb was not significantly different. There were more Clavien II-IV complications (10.4, 14.4, 28.8%; P = 0.02) and transfusions (2.3, 4.7, 10.2%; P <0.001) in the elderly. The most common complications in the 80+ group were bleeding related (10.1%). No difference in readmission rates or ICU admissions was noted. Conclusion PCNL is feasible in the extremely elderly; however with a higher rate of complications and longer hospitalizations. No long-term sequelae or deaths in the 80 and older cohort were seen. This study allows us to appropriately counsel older patients on a realistic postoperative course and supports use of PCNL as the best means of long-term survival.
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    Real-World Experience of Holmium Laser Enucleation of the Prostate with Patients on Anticoagulation Therapy
    (Liebert, 2021) Agarwal, Deepak K.; Large, Tim; Stoughton, Christa L.; Heiman, Joshua M.; Nottingham, Charles U.; Rivera, Marcelino E.; Krambeck, Amy E.; Urology, School of Medicine
    Background: Holmium laser enucleation of the prostate (HoLEP) is a highly effective procedure for benign prostatic hyperplasia that is size independent and has been recommended for patients necessitating antiplatelet (AP) and anticoagulant (AC) medications. Although HoLEP is feasible in AP/AC patients, there is a lack of published results on real-world outcomes of patients on AP/AC therapy undergoing HoLEP. Patients and Methods: We performed a retrospective review of our institutional HoLEP database of demographics, perioperative and postoperative data, and outcomes of patients on AP and AC therapy compared with none. We also further stratified patients on warfarin compared with direct oral anticoagulants (DOACs). Results: Of 472 patients who underwent HoLEP at our institution from July 2018 to December 2019 with data on AP/AC drugs, 30 (6.3%) were on AP and 65 (17.2%) were on AC. One patient continued AP (3.3%), six patients (9.2%) were bridged on AC, and one patient (1.5%) continued AC through the time of HoLEP at the discretion of the prescribing provider. Preoperatively, only age was significantly different among the three groups (p < 0.001). There were no intraoperative differences. Postoperatively, there was a higher 90-day complication rate in AP and AC groups (p = 0.035), but not an increase in emergency department (ED) visits (p = 0.557) or Clavien ≥3 complications (p = 0.16). In comparison of patients on warfarin with DOAC, there was a lower rate of successful voiding trial (p = 0.009), higher 90-day complications (p = 0.003), and more ED visits (p = 0.003) in the warfarin group. Conclusions: HoLEP is safe and effective for patients who require AP or AC therapy. There is no increase in serious complications or worsened postoperative voiding parameters. Of patients on AC, those on DOAC have better outcomes compared with warfarin.