Browsing by Subject "Urology"

Now showing 1 - 10 of 10
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    Catheter Removal on the Same Day of Holmium Laser Enucleation of the Prostate: Outcomes of a Pilot Study
    (Elsevier, 2020-10-09) Agarwal, Deepak K.; Rivera, Marcelino E.; Nottingham, Charles U.; Large, Tim; Krambeck, Amy E.; Urology, School of Medicine
    Objectives: To determine if same day catheter removal is feasible in select population after holmium laser enucleation of the prostate (HoLEP). Methods: We performed an analysis of patients undergoing HoLEP at our institution who underwent same-day catheter removal after HoLEP. All HoLEPs were performed with Moses Optimized for BPH. Patients were dismissed from postoperative recovery unit (POCU) to the clinic for catheter removal and voiding trial. Results: To date, 30 patients have undergone same day catheter removal. Median age is 68.6 years (IQR 61.8-73.3) and preoperative prostate volume 81 ml (IQR 53-114.8). Median enucleation time was 39.5 min (IQR 30.5-53), morcellation time was 5 min (IQR 4-12 min) and enucleated specimen weight was 52.5 g (IQR 33-81). 27 (90%) patients successfully voided on the same day without requiring catheter replacement. All patients were catheter free by POD1. For patients who successfully passed their voiding trial, the median time from the end of the procedure to hospital discharge was 2.6 hours (IQR (2.1-2.9) and from the end of the HoLEP to catheter removal was 4.9 hours (IQR 3.5-6.0). Conclusions: We present for the first time that same day catheter removal is a feasible option in a select population of patients undergoing HoLEP. With more study, this has the potential for transforming the management of BPH, especially larger glands.
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    Comparing transition of care from adolescence to adulthood for patients with congenital urological conditions in Canada and the U.S.
    (CUA, 2016-10) Misseri, Rosalia; Department of Pediatrics, IU School of Medicine
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    Delaying Cancer Cases in Urology during COVID-19: Review of the Literature
    (Wolters Kluwer, 2020-05-28) Tachibana, Isamu; Ferguson, Ethan L.; Mahenthiran, Ashorne; Natarajan, Jay P.; Masterson, Timothy A.; Bahler, Clinton D.; Sundaram, Chandru P.; Urology, School of Medicine
    Purpose: Coronavirus Disease 2019 (COVID-19) is a global pandemic affecting hospital systems and the availability of resources for surgical procedures. Our aim is to provide guidance for urologists to help prioritize urologic cancer surgeries. Material and Methods: We reviewed published literature on bladder cancer, upper tract urothelial carcinoma (UTUC), penile cancer, testis cancer, prostate cancer, renal cancer, and adrenal cancer. Results: For muscle invasive bladder cancer (MIBC), delays should be less than roughly 10 weeks and neoadjuvant chemotherapy should be considered. For non-MIBC, patients should be counseled appropriately based on risk and intravesical therapies can continue. UTUC should also be treated with minimal delays for high risk patients, especially with ureteral tumors. Surgery for T1 renal cancers when indicated can be delayed until adequate resources are available. Patients with T2 renal cancer should be considered for early surgery if there are unfavorable pre-operative characteristics. Higher stage renal tumors should be considered for early surgery. Early multi-disciplinary approach is recommended for metastatic renal cancers. High risk prostate cancer may need preferential treatment and consideration of neoadjuvant hormonal therapy. Penile cancer can have worse sexual or oncologic outcome with prolonged surgical delay. Likewise, adrenal cancer is aggressive and needs early surgical treatment. Testicular cancer should be treated in a timely manner with surgery or chemotherapy, as indicated. Conclusions: This review should further assist urologists in recognizing patients with potentially aggressive tumor biology that warrant early treatment.
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    Delaying Cancer Cases in Urology during COVID-19: Review of the Literature. Reply.
    (AUA, 2021-05) Tachibana, Isamu; Sundaram, Chandru P.; Urology, School of Medicine
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    Incidence of Venous Thromboembolism and Hematoma Following Placement of Inflatable Penile Prosthetic: Safety of Perioperative Subcutaneous Heparin
    (2023-07-28) Good, Jacob; Bernie, Helen
    BACKGROUND/OBJECTIVE: Patients undergoing inflatable penile prosthetic (IPP) surgery are at an increased risk for cardiovascular complications such as venous thromboembolism (VTE) following surgery due to pre-existing comorbidities associated with erectile dysfunction. The use of perioperative subcutaneous heparin (SqH) along with a surgical drain has been shown to be effective in preventing VTE in IPP patients, without increasing hematoma formation. Not all prosthetic surgeons utilize surgical drains postoperatively. In this study we aim to assess the safety and efficacy of perioperative SqH in preventing VTE in IPP patients without the use of a surgical drain. METHODS: This was a retrospective review from January 2021-July 2023 of patients who underwent IPP placement or explant and replacement at a single institution. Patient demographics, comorbidities, Caprini risk factor scores, VTE risk factors, and 90-day post-operative complications, including hematoma formation, were reviewed. Statistical analyses were performed comparing these variables in men who received SqH and those who did not. RESULTS: We reviewed data for 240 patients; 53% (n=127) received perioperative SqH. The incidence of VTE was 0.9% (1/113) in the non-SqH group, and no VTE was recorded in the group receiving SqH. There was no statistical significance in hematoma formation between groups (SqH 5.5% vs. non-SqH 6.2% p=.898). Beyond hypertension prevalence (SqH 74.8% vs. non-SqH 62.8% p=.045), there was no difference between comorbidities or Caprini risk factor scores (SqH 6.79 vs. non-SqH 6.82 p=.474) between groups (Table 1). 94% of the patients in this study were considered high risk for VTE. CONCLUSIONS: Perioperative SqH use without placement of a surgical drain was found to be safe and effective in preventing VTE in patients undergoing IPP surgery. There was no increased risk of hematoma formation or post-operative complications between the groups. Perioperative SqH should be considered in all patients undergoing IPP surgery.
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    Inflammation by Toxoplasma gondii Infection Induces Prostatic Hyperplasia and Accompanying Urinary Dysfunction
    (2024-08) Stanczak, Emily F.; Arrizabalaga, Gustavo; Bauer, Margaret; Jerde, Travis; Nakshatri, Harikrishna
    Benign prostatic hyperplasia is the non-cancerous enlargement of the prostate. This syndrome develops as men age and affects 50% of men by the age of 50 and 80% of men by the age of 80. BPH is associated with a pattern of symptoms and pathology in patients that can be painful, problematic, and lower the quality of life. BPH is a multifactorial disease which may develop due to lifestyle choices, genetics, metabolic disorder, and potentially infection of the organ. Interestingly, previous work from our research group showed that the common parasite T. gondii can infect and establish a chronic infection in the prostate of mice resulting in histological hyperplasia and glandular nodule formation, reminiscent of that observed in men with BPH. This leads to the hypothesis that T. gondii contributes to BPH in humans. In this work, we investigated whether there is a correlation between T. gondii infection and BPH using a cohort of age matched BPH diagnosed and non-BPH diagnosed control donors. My data show that men diagnosed with BPH are significantly more likely to have evidence of T. gondii infection than undiagnosed controls. Additionally, men with antibodies against T. gondii and BPH had significantly more severe pathology in several categories including and most notably in epithelial and glandular nodules seen only in a steroid hormone model of the disease. Moreover, I have determined that mice infected with parasites demonstrated abnormal urination pattern behavior indicating lower urinary tract dysfunction. Based on these results, we conclude that T. gondii can contribute to the development and severity of BPH and BPH pathology in humans. In addition, T. gondii can potentially be used as a model for BPH and BPH-like symptoms and pathology in mice and other model organisms.
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    Molecular Studies on Calcium Oxalate Kidney Stones: A Window into the Pathogenesis of Nephrolithiasis
    (2022-05) Canela, Victor Hugo; Williams, James C.; Ashkar, Tarek M.; Blum, Janice S.; Sankar, Uma
    Nephrolithiasis will affect one-in-eleven people, and more than half of those individuals will have stone recurrence within a decade of their first episode. Despite decades of biomedical research on nephrolithiasis and extraordinary advances in molecular and cell biology, the precise mechanisms of kidney stone formation are not fully understood. Currently, there are limited treatments or preventative measures for nephrolithiasis. Therefore, it is crucial to scrutinize kidney stones from a molecular and cell biology perspective to better understand its pathogenesis and pathophysiology; and to, hereafter, contribute to effective therapeutic targets and preventative strategies. Kidney stones are composed of an admixture of crystal aggregated material and an organic matrix. 80% of all kidney stones are composed of calcium oxalate (CaOx) and half of all CaOx patients grow their stones on to Randall’s plaques (RP). RP are interstitial calcium phosphate mineral deposits in the renal papilla. Thus, we developed and optimized methodologies to directly interrogate CaOx stones. CaOx stones were demineralized, sectioned, and imaged by microscopy, utilizing micro CT for precise orientation. Laser microdissection (LMD) of specific regions of stone matrix analyzed by proteomics revealed various proteins involved in inflammation and the immune response. Analyses on jackstone calculi, having arm protrusions that extend out from the body of the stone, revealed that they are a rare subtype of CaOx stone formation. Micro CT analyses on 98 jackstones showed a radiolucent, organic-rich core in the arm protrusions. Fluorescence imaging on RP stones showed consistent differences in autofluorescence patterns between RP and CaOx overgrowth regions. Moreover, cell nuclei were discovered with preserved morphology in RP regions, along with variable expressions of vimentin and CD45. In comparing spatial transcriptomic expression of reference and CaOx kidney papillae, CaOx patients differentially expressed genes associated with pathways of immune cell activation, reactive oxygen damage and injury, extracellular remodeling, and ossification. Our findings provide novel methodologies to better understand the role of molecules and cells in CaOx stone matrix. Several of the proteins and cells identified in these studies may serve as potential biomarkers, and future therapeutic targets in preventing kidney stone disease.
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    Ribonuclease 7 polymorphism rs1263872 reduces antimicrobial activity and associates with pediatric urinary tract infections
    (The American Society for Clinical Investigation, 2021) Pierce, Keith R.; Eichler, Tad; Mosquera Vasquez, Claudia; Schwaderer, Andrew L.; Simoni, Aaron; Creacy, Steven; Hains, David S.; Spencer, John D.; Pediatrics, School of Medicine
    Ribonuclease 7 (RNase 7) is an antimicrobial peptide that prevents urinary tract infections (UTI); however, it is yet unknown how RNASE7 genetic variations affect its antimicrobial activity and its mitigation of UTI risk. This study determined whether the RNASE7 SNP rs1263872 is more prevalent in children with UTI and defined how rs1263872 affects RNase 7’s antimicrobial activity against uropathogenic E. coli (UPEC). We performed genotyping for rs1263872 in 2 national UTI cohorts, including children enrolled in the Randomized Intervention for Children with Vesicoureteral Reflux trial or the Careful Urinary Tract Infection Evaluation study. Genotypes from these cohorts were compared with those of female controls with no UTI. To assess whether rs1263872 affects RNase 7’s antimicrobial activity, we generated RNase 7 peptides and genetically modified urothelial cultures encoding wild-type RNase 7 and its variant. Compared with controls, girls in both UTI cohorts had an increased prevalence of the RNASE7 variant. Compared with the missense variant, wild-type RNase 7 peptide showed greater bactericidal activity against UPEC. Wild-type RNase 7 overexpression in human urothelial cultures reduced UPEC invasive infection compared with mutant overexpression. These results show that children with UTI have an increased prevalence of RNASE7 rs1263872, which may increase UTI susceptibility by suppressing RNase 7’s antibacterial activity.
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    Urologic surgery and COVID-19: How the pandemic is changing the way we operate
    (Mary Ann Liebert, Inc, 2020-04-25) Steward, James E.; Kitley, Weston R.; Schmidt, C Max; Sundaram, Chandru P.; Urology, School of Medicine
    The coronavirus disease 2019 (COVID-19) pandemic has had a global impact on all aspects of healthcare, including surgical procedures. For urologists, it has affected and will continue to influence how we approach the care of patients pre-operatively, intra-operatively, and post-operatively. A risk-benefit assessment of each patient undergoing surgery should be performed during the COVID-19 pandemic based on the urgency of the surgery and the risk of viral illness and transmission. Patients with advanced age and comorbidities have a higher incidence of mortality. Routine preoperative testing and symptom screening is recommended to identify those with COVID-19. Adequate personal protective equipment (PPE) for the surgical team is essential to protect healthcare workers and ensure an adequate workforce. For COVID-19 positive or suspected patients, the use of N95 respirators is recommended if available. The anesthesia method chosen should attempt to minimize aerosolization of the virus. Negative pressure rooms are strongly preferred for intubation/extubation and other aerosolizing procedures. Although transmission has not yet been shown during laparoscopic and robotic procedures, efforts should be made to minimize the risk of aerosolization. Ultra low particulate air filters are recommended for use during minimally invasive procedures to decrease the risk of viral transmission. Thorough cleaning and sterilization should be performed post-operatively with adequate time allowed for the operating room air to be cycled after procedures. COVID-19 patients should be separated from non-infected patients at all levels of care including recovery to decrease the risk of infection. Future directions will be guided by outcomes and infection rates as social distancing guidelines are relaxed and more surgical procedures are reintroduced. Recommendations should be adapted to the local environment and will continue to evolve as more data becomes available, the shortage of testing and PPE is resolved, and a vaccine and therapeutics for COVID-19 are developed.
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    Uropathologists During the COVID-19 Pandemic: What Can Be Learned in Terms of Social Interaction, Visibility, and Social Distance
    (Elsevier, 2020-05-11) Montironi, Rodolfo; Cheng, Liang; Cimadamore, Alessia; Lopez-Beltran, Antonio; Scarpelli, Marina; Pathology and Laboratory Medicine, School of Medicine