UPMC Physician Resources

Urology Research Publications

Benoit:

1. Corcoran AT, Peele PB, Benoit RM: Cost comparison between watchful waiting with active surveillance and active treatment of clinically localized prostaet cancer.  Urology 2010 Apr 8. [Epub ahead of print]

2. Jacobs BL, Smith RP, Beriwal S, Benoit RM: Acute lower urinary tract symptoms after prostate brachytherapy with Cesium-131.  Urology 2010 Jun 3. [Epub ahead of print]

Averch:

1.Natural orifice transluminal endoscopic surgery (NOTES): current experience and urologic applications.

Casella DP, Smaldone MC, Averch TD.

Can J Urol. 2010 Jun;17(3):5151-61.PMID: 20566006 [PubMed - in process] Related citations

Abstract

Natural orifice transluminal endoscopic surgery (NOTES) has attracted considerable recent attention for its potential to allow traditional abdominal procedures to be performed without a transabdominal incision. With considerable experience in the development and application of minimally invasive techniques, urologists have played a significant role in early experimental NOTES efforts and have contributed to early investigations in human subjects accordingly. However, adoption of these techniques has been limited due to cumbersome endoscopic equipment and concerns regarding peritonitis from failed viscerotomy closure. Experience with use of NOTES in human subjects is limited, and studies comparing NOTES to conventional minimally invasive techniques are lacking. Until adequate endoscopes are developed to facilitate a pure NOTES approach, multiple portals of entry will be necessary to facilitate both urologic and non-urologic reconstructive and extirpative procedures. Our aim is to evaluate NOTES techniques, portals of entry, early clinical experiences, and the application of NOTES to urologic surgery.

 2. Outcomes of percutaneous nephrolithotomy stratified by body mass index.

Tomaszewski JJ, Smaldone MC, Schuster T, Jackman SV, Averch TD.

J Endourol. 2010 Apr;24(4):547-50.PMID: 20192612 [PubMed - indexed for MEDLINE]Related citations

Abstract

BACKGROUND: Obesity places surgical patients at a greater risk of complications. The effects of obesity on outcomes and complications from percutaneous nephrolithotomy (PCNL) are not well defined.

OBJECTIVE: The objective of this study was to stratify outcome and morbidity of PCNL with respect to body mass index (BMI) in a large contemporary series.

METHODS: The charts of 234 patients who underwent PCNL were reviewed retrospectively. Patients were divided into four groups depending on their BMIs: ideal body weight (IBW) <25 kg/m(2), overweight 25 to 29.9 kg/m(2), obese >or=30 to 34.9 kg/m(2), and morbidly obese >or=35 kg/m(2). Kidney stone diameter was measured on preoperative computerized tomography scans. Hemorrhage was estimated using hematocrit. Univariate analysis was performed with respect to hospital length of stay (HLOS), stone size, complication rate, hemorrhage, and stone-free rate.

RESULTS: Of the 234 patients undergoing PCNL (mean age, 54.3 +/- 13.6 years; 54% male), height and weight data were available for 187 (80%) with a mean BMI of 29.3 +/- 8.0 (range 14.1-57.2); 38 (20.3%) were morbidly obese, 43 (23%) obese, 45 (24.1%) overweight, and 61 (32.6%) were within or below their IBW. Mean stone sizes were comparable: 3.9 +/- 2.0 cm (morbidly obese), 3.7 +/- 2.0 cm (obese), 3.1 +/- 1.4 cm (overweight), and 3.6 +/- 1.9 cm (IBW). Mean HLOS (days) was similar between groups: 2.6 +/- 1.7 (morbidly obese), 2.8 +/- 2.0 (obese), 2.5 +/- 1.2 (overweight), and 3.4 +/- 4.7 (IBW). The largest interval decreases in hematocrit (mg/dL) were also comparable: 5.3 +/- 3.8 (morbidly obese), 5.9 +/- 4.3 (obese), 7.2 +/- 4.1 (overweight), and 6.2 +/- 4.3 (IBW). Using strict imaging criteria, the overall stone-free rate was 80%. No statistically significant differences among the three groups were seen with respect to HLOS, stone-free rate, complication rate, or change in hematocrit when stratified by BMI.

CONCLUSION: Stone-free rate, complication rate, hemorrhage, and HLOS are independent of BMI in a retrospective review of patients undergoing PCNL.

3. Preliminary experience with laparoscopic ureteropelvic junction release in the treatment of ureteropelvic junction obstruction.

Schuster TK, Jacobs BL, Gayed BA, Averch TD.

J Endourol. 2010 Mar;24(3):393-6.PMID: 20059351 [PubMed - indexed for MEDLINE]Related citations

Abstract

OBJECTIVE: To review our experience with laparoscopic ureteropelvic junction (UPJ) release in the treatment of UPJ obstruction (UPJO) in adults.

PATIENTS AND METHODS: We retrospectively reviewed 44 consecutive patients who underwent laparoscopic treatment of UPJO at our institution between December 2000 and April 2008. Patient characteristics, perioperative data, intraoperative findings leading to a decision to perform UPJ release, and outcomes were recorded. Mean patient age was 47.4 years (range 20-60 years).

RESULTS: UPJ release was performed as definitive treatment in 9 of 47 laparoscopic procedures for UPJO. The obstruction was right-sided in five and left-sided in four patients. Three (33%) patients were previously treated with either balloon dilation or endopyelotomy, or both. Intraoperative findings included (1) significant scarring, inflammation, or fibrosis, (2) adherent bands between a crossing vessel and the UPJ, or (3) obvious constricting periureteral bands. A crossing vessel was observed in seven patients (78%). Mean operative time, estimated blood loss, and length of stay were 370.1 +/- 76.9 minutes, 24.4 +/- 31.3 mL, and 1.4 +/- 0.5 days, respectively. At a mean follow-up of 25.1 +/- 17.3 months, a 78% overall success rate was achieved. UPJ release was most successful in the patients in the "significant scarring, inflammation, or fibrosis" category (100%).

CONCLUSION: Although pyeloplasty remains the preferred treatment for UPJO, UPJ release can be successful in certain circumstances, particularly when significant scarring, inflammation, or fibrosis appears to be the primary etiology of the obstruction. Further investigation is warranted to help define the specific clinical situations in which UPJ release may be beneficial.

4. Factors affecting blood loss during percutaneous nephrolithotomy using balloon dilation in a large contemporary series.

Tomaszewski JJ, Smaldone MC, Schuster T, Jackman SV, Averch TD.

J Endourol. 2010 Feb;24(2):207-11.PMID: 20039798 [PubMed - indexed for MEDLINE]

Abstract

OBJECTIVE: Renal hemorrhage is a common and worrisome complication of percutaneous nephrolithotomy (PNL). We review factors affecting blood loss and transfusion requirements in a large contemporary series of patients undergoing PNL utilizing balloon dilation.

METHODS: We retrospectively reviewed all patients undergoing PNL at one institution from July 2000 to January 2008. Demographics, stone parameters, perioperative factors, complications, and stone-free rates were evaluated. Hemorrhage was estimated using hematocrit and blood transfusion requirement. Various factors were assessed for their association with blood loss using univariate models.

RESULTS: The 225 patients reviewed had a mean stone size of 3.5 +/- 1.8 cm (range, 0.6-9.0 cm), with 54 (23.4%) staghorn and 93 (40.3%) partial staghorn calculi. One hundred and seventy-five (75.8%), 173 (74.9%), and 80 (34.6%) had pelvic, lower pole, and upper pole calculi, respectively. Multiple access tracts were used in 12 (5.2%) patients, with overall stone-free and complication rates of 80.4% and 14.1%. Complications included postoperative fever in 15 patients (6.4%), clinically insignificant pleural effusion in 8 patients (3.4%), 2 (0.8%) renal artery pseudoaneurysms requiring angioembolization, and 1 (0.4%) urinoma requiring stent placement. Mean hematocrit decrease was 6.1 +/- 4.3%, with three (1.3%) patients receiving blood transfusions. On univariate analysis no other statistically significant differences were found between hematocrit decrease and stone size or location, presence of partial or complete staghorn calculi, diabetes, or number of access tracts.

CONCLUSIONS: We report a comparable stone-free rate and a lower incidence of blood transfusion among patients undergoing PNL using balloon dilation.