103 results on '"Jeffrey Gahan"'
Search Results
2. A low-cost PVC-based dual-modality kidney phantom.
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Jeff Young, Maysam Shahedi, James D. Dormer, Brett Johnson, Jeffrey Gahan, and Baowei Fei
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- 2022
- Full Text
- View/download PDF
3. Renal biopsy under augmented reality guidance.
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Matthew Pfefferle, Sarah Shahub, Maysam Shahedi, Jeffrey Gahan, Brett Johnson, Phuc Le, Jose Vargas, Blake O. Judson, Yasmeen Alshara, Qinmei Li, and Baowei Fei
- Published
- 2020
- Full Text
- View/download PDF
4. Phase 2 Trial of Stereotactic Ablative Radiotherapy for Patients with Primary Renal Cancer
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Raquibul Hannan, Mark F. McLaughlin, Laurentiu M. Pop, Ivan Pedrosa, Payal Kapur, Aurelie Garant, Chul Ahn, Alana Christie, James Zhu, Tao Wang, Liliana Robles, Deniz Durakoglugil, Solomon Woldu, Vitaly Margulis, Jeffrey Gahan, James Brugarolas, Robert Timmerman, and Jeffrey Cadeddu
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Urology - Published
- 2023
5. Clinical Outcomes of Robotic Assisted Partial Nephrectomy for Pathologic T3a Renal Masses With Venous Tumor Thrombus
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Alaina Garbens, Jessica C. Dai, Jeffrey Gahan, Tara Nikonow Morgan, Jeffrey A. Cadeddu, Sam Kusin, and Vineeth Kommidi
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medicine.medical_specialty ,business.industry ,Urology ,medicine.medical_treatment ,medicine.disease ,Nephrectomy ,Surgery ,medicine.anatomical_structure ,Renal cell carcinoma ,medicine ,Robotic surgery ,Embolization ,business ,Vein ,Kidney cancer ,Survival analysis ,Clear cell - Abstract
Objective To evaluate the safety, efficacy, and early oncologic outcomes of pT3a renal cell carcinoma (RCC) with venous involvement treated with robotic partial nephrectomy (RPN), given that experience and outcomes in this group is limited. Methods A retrospective chart review of patients undergoing RPN from 9/2009-7/2020 was performed. Outcomes were captured from patients with pathologic T3a disease with vein involvement. Clinical characteristics were analyzed using SPSS (IBM, Armonk, NY). Local recurrence-free survival (LRFS) and metastasis-free survival (MFS) at 2 years were calculated from Kaplan-Meier survival curves. Results For 45 included patients, mean operative and warm ischemia times were 199.6 min ± 47.3 and 30.5 min ± 10.5, with mean estimated blood loss of 324.9 cc ±209.5. Rates of transfusion, embolization, re-admission, and re-operation at 30 days were 8.9% (4/45), 2.2% (1/45), 11.1% (5/45), and 6.7% (3/45; cystoscopic stent placement), respectively. All tumors were malignant on pathology, with clear cell RCC being the most common (91.0%, n=41). The positive margin rate was 6.7% (n=3). Local recurrence occurred in 4.4% (n=2) at a mean time of 5.2 months ± 2.3. Four patients (8.9%) progressed to metastatic disease at a mean of 22.2 months ± 23.0. At 2 years, LRFS was 95.4% and MFS was 95.3%. Conclusions We present the largest known series of patients RPN for pT3a renal masses with venous tumor involvement. We found it both feasible and safe in the appropriate hands. Short term oncologic outcomes for these patients appear more favorable than historic literature suggested. Sources of Funding none
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- 2022
6. Evaluating robotic-assisted surgery training videos with multi-task convolutional neural networks
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Jeffrey Gahan, Ryan L. Steinberg, Alaina Garbens, Eric C. Larson, Xingming Qu, Tara Nikonow Morgan, Yihao Wang, Mohamed Elsaied, and Jessica C. Dai
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Male ,Matching (statistics) ,ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION ,Health Informatics ,Machine learning ,computer.software_genre ,Convolutional neural network ,Dreyfus model of skill acquisition ,Robotic Surgical Procedures ,Humans ,Medicine ,CLIPS ,computer.programming_language ,Prostatectomy ,Surgeons ,Artificial neural network ,business.industry ,Deep learning ,Robotic assisted surgery ,Surgical instrument ,Surgery ,Clinical Competence ,Neural Networks, Computer ,Artificial intelligence ,business ,computer - Abstract
We seek to understand if an automated algorithm can replace human scoring of surgical trainees performing the urethrovesical anastomosis in radical prostatectomy with synthetic tissue. Specifically, we investigate neural networks for predicting the surgical proficiency score (GEARS score) from video clips. We evaluate videos of surgeons performing the urethral anastomosis using synthetic tissue. The algorithm tracks surgical instrument locations from video, saving the positions of key points on the instruments over time. These positional features are used to train a multi-task convolutional network to infer each sub-category of the GEARS score to determine the proficiency level of trainees. Experimental results demonstrate that the proposed method achieves good performance with scores matching manual inspection in 86.1% of all GEARS sub-categories. Furthermore, the model can detect the difference between proficiency (novice to expert) in 83.3% of videos. Evaluation of GEARS sub-categories with artificial neural networks is possible for novice and intermediate surgeons, but additional research is needed to understand if expert surgeons can be evaluated with a similar automated system.
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- 2021
7. Use of Pre-operative Pharmacologic Venous Thromboembolism Prophylaxis for Robotic Partial Nephrectomy
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Tara Nikonow Morgan, Alaina Garbens, Samuel B. Kusin, Jeffrey Gahan, Jessica C. Dai, Vineeth Kommidi, and Jeffrey A. Cadeddu
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Adult ,Male ,Reoperation ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Postoperative Hemorrhage ,Logistic regression ,Nephrectomy ,Patient Readmission ,03 medical and health sciences ,0302 clinical medicine ,Robotic Surgical Procedures ,Preoperative Care ,medicine ,Humans ,Blood Transfusion ,Enoxaparin ,Aged ,Retrospective Studies ,business.industry ,Anticoagulants ,Retrospective cohort study ,Venous Thromboembolism ,Perioperative ,Middle Aged ,Kidney Neoplasms ,Pre operative ,Surgery ,030220 oncology & carcinogenesis ,Hemorrhagic complication ,Cohort ,Female ,business ,Venous thromboembolism ,Follow-Up Studies - Abstract
To determine whether a single dose of preoperative enoxaparin for venous thromboembolism (VTE) prophylaxis impacts rates of thrombotic and bleeding events after robotic partial nephrectomy (RPNx).A retrospective cohort study of RPNx patients from 2009 to 2020 was performed. Clinical characteristics and perioperative outcomes were compared between patients receiving a single dose of preoperative enoxaparin and those who did not. The primary outcome was 30-day hemorrhagic complications (transfusion ≥2 units, embolization, or reoperation for bleeding). Secondary outcomes were 30-day VTE events. Multivariable logistic regression was performed to control for significant differences between groups and to identify predictors of hemorrhagic complications among patients.Among 945 RPNx procedures, 794 (84%) received preoperative enoxaparin (PPx) and 151 (16%) did not (NPPx). The PPx cohort was older (P = .004), had lower BMI (P = .03), lower ASA class (P = .049), and fewer smokers (P = .03). Warm ischemia time was longer for PPx patients (P.001). 4.9% and 2.6% of the PPx and NPPx cohorts, respectively, developed postoperative hemorrhagic complications (P = .29). After adjustment for potential covariates, pharmacologic prophylaxis was not associated with 30-day hemorrhagic complications (P = .39). On multivariable regression, longer warm ischemia time (OR 1.05, 95% CI 1.01-1.10, P = .02) and greater tumor size (OR 1.27, 95% CI 1.03-1.56, P = .02) were predictors of hemorrhagic complications. 30-day readmissions, VTE events, and mortality were similar between groups (all P0.05).Similar rates of thrombotic and bleeding events occurred between patients receiving pharmacologic prophylaxis and those who did not. Single dose of preoperative enoxaparin did not significantly alter perioperative outcomes after RPNx.
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- 2021
8. Neoadjuvant SABR for Renal Cell Carcinoma Inferior Vena Cava Tumor Thrombus—Safety Lead-in Results of a Phase 2 Trial
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Nirmish Singla, Aditya Bagrodia, Vitaly Margulis, James Brugarolas, Ivan Pedrosa, Solomon L. Woldu, Laurentiu M. Pop, Samantha Mannala, Jeffrey Gahan, Raquibul Hannan, Yuval Freifeld, Robert Timmerman, Subrata Manna, Alana Christie, Michael A. Wait, Payal Kapur, and Osama Mohamad
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Male ,Cancer Research ,Kidney Disease ,Vena Cava ,medicine.medical_treatment ,SABR volatility model ,030218 nuclear medicine & medical imaging ,Metastasis ,0302 clinical medicine ,Renal cell carcinoma ,Clinical endpoint ,Cancer ,Venous Thrombosis ,Radiation ,Middle Aged ,Kidney Neoplasms ,Neoadjuvant Therapy ,Nephrectomy ,Other Physical Sciences ,Oncology ,medicine.vein ,030220 oncology & carcinogenesis ,Female ,Patient Safety ,Safety ,Inferior ,medicine.medical_specialty ,Clinical Sciences ,Oncology and Carcinogenesis ,Urology ,Vena Cava, Inferior ,Radiosurgery ,Inferior vena cava ,Article ,03 medical and health sciences ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Oncology & Carcinogenesis ,Adverse effect ,Carcinoma, Renal Cell ,Aged ,Retrospective Studies ,business.industry ,Carcinoma ,Renal Cell ,medicine.disease ,business ,Kidney cancer - Abstract
Purpose To evaluate the feasibility, safety, oncologic outcomes, and immune effect of neoadjuvant stereotactic radiation (Neo-SAbR) followed by radical nephrectomy and thrombectomy (RN-IVCT). Methods and Materials These are results from the safety lead-in portion of a single-arm phase 1 and 2 trial. Patients with kidney cancer (renal cell carcinoma [RCC]) and inferior vena cava (IVC) tumor thrombus (TT) underwent Neo-SAbR (40 Gy in 5 fractions) to the IVC-TT followed by open RN-IVCT. Absence of grade 4 to 5 adverse events (AEs) within 90 days of RN-IVCT was the primary endpoint. Exploratory studies included pathologic and immunologic alterations attributable to SAbR. Results Six patients were included in the final analysis. No grade 4 to 5 AEs were observed. A total of 81 AEs were reported within 90 days of surgery: 73% (59/81) were grade 1, 23% (19/81) were grade 2, and 4% (3/81) were grade 3. After a median follow-up of 24 months, all patients are alive. One patient developed de novo metastatic disease. Of 3 patients with metastasis at diagnosis, 1 had a complete and another had a partial abscopal response without the concurrent use of systemic therapy. Neo-SABR led to decreased Ki-67 and increased PD-L1 expression in the IVC-TT. Inflammatory cytokines and autoantibody titers reflecting better host immune status were observed in patients with nonprogressive disease. Conclusions Neo-SAbR followed by RN-IVCT for RCC IVC-TT is feasible and safe. Favorable host immune environment correlated with abscopal response to SABR and RCC relapse-free survival, though direct causal relation to SABR has yet to be established.
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- 2021
9. Rethinking Autonomous Surgery: Focusing on Enhancement over Autonomy
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Jacob R. Boehm, Jeffrey Gahan, Edoardo Battaglia, Andrew R. Jamieson, Yi Zheng, and Ann Majewicz Fey
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Laparoscopic surgery ,medicine.medical_specialty ,Requirements engineering ,business.industry ,Urology ,medicine.medical_treatment ,Context (language use) ,Robotics ,Human behavior ,Automation ,Surgery ,Task (project management) ,Machine Learning ,03 medical and health sciences ,0302 clinical medicine ,Workflow ,Robotic Surgical Procedures ,Artificial Intelligence ,030220 oncology & carcinogenesis ,medicine ,Humans ,Laparoscopy ,030211 gastroenterology & hepatology ,Robotic surgery ,business - Abstract
Context As robot-assisted surgery is increasingly used in surgical care, the engineering research effort towards surgical automation has also increased significantly. Automation promises to enhance surgical outcomes, offload mundane or repetitive tasks, and improve workflow. However, we must ask an important question: should autonomous surgery be our long-term goal? Objective To provide an overview of the engineering requirements for automating control systems, summarize technical challenges in automated robotic surgery, and review sensing and modeling techniques to capture real-time human behaviors for integration into the robotic control loop for enhanced shared or collaborative control. Evidence acquisition We performed a nonsystematic search of the English language literature up to March 25, 2021. We included original studies related to automation in robot-assisted laparoscopic surgery and human-centered sensing and modeling. Evidence synthesis We identified four comprehensive review papers that present techniques for automating portions of surgical tasks. Sixteen studies relate to human-centered sensing technologies and 23 to computer vision and/or advanced artificial intelligence or machine learning methods for skill assessment. Twenty-two studies evaluate or review the role of haptic or adaptive guidance during some learning task, with only a few applied to robotic surgery. Finally, only three studies discuss the role of some form of training in patient outcomes and none evaluated the effects of full or semi-autonomy on patient outcomes. Conclusions Rather than focusing on autonomy, which eliminates the surgeon from the loop, research centered on more fully understanding the surgeon’s behaviors, goals, and limitations could facilitate a superior class of collaborative surgical robots that could be more effective and intelligent than automation alone. Patient summary We reviewed the literature for studies on automation in surgical robotics and on modeling of human behavior in human-machine interaction. The main application is to enhance the ability of surgical robotic systems to collaborate more effectively and intelligently with human surgeon operators.
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- 2021
10. MP41-17 USING A MULTI-TASK CONVOLUTIONAL NEURAL NETWORK TO PREDICT SURGEON SKILL IN ROBOT-ASSISTED PARTIAL NEPHRECTOMY
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Hal Kominsky, Yihao Wang, Jessica Dai, Tara Morgan, Alaina Garbens, Jeffrey Gahan, and Eric Larson
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Urology - Published
- 2022
11. Single-port robotic-assisted simple prostatectomy is associated with decreased post-operative narcotic use in a propensity score matched analysis
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Igor Sorokin, Vishnu Ganesan, Claus A. Roehrborn, Hersh Trivedi, Ryan L. Steinberg, Alaina Garbens, Brett A. Johnson, and Jeffrey Gahan
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medicine.medical_specialty ,Narcotic ,business.industry ,Prostatectomy ,medicine.medical_treatment ,Rasp ,030232 urology & nephrology ,Health Informatics ,Surgery ,Ketorolac ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Port (medical) ,Prostate ,030220 oncology & carcinogenesis ,Propensity score matching ,medicine ,business ,Body mass index ,medicine.drug - Abstract
Robotic-assisted simple prostatectomy (RASP) has proven to be an effective minimally invasive option for benign prostatic enlargement (BPE) in recent years. Single-site surgery is theorized to reduce post-operative pain beyond traditional minimally invasive approaches. We sought to assess whether use of a single-port robotic platform decreases post-operative opioid use in patients undergoing robotic-assisted simple prostatectomy (RASP). A retrospective review was performed of all patients undergoing RASP our institution from November 2017 to July 2019. Demographic, intraoperative, and post-operative data, including morphine equivalent (ME) use, were collected. Patients were stratified by robotic platform utilized. Propensity score matching using nearest neighbor method was performed using prostate volume, Charlson comorbidity index (CCI), and post-op ketorolac use in 4:1 fashion. Chi-squared analysis and Kruskal–Wallis analyses were utilized. Two-hundred-and-seven men underwent RASP. After matching, 80 patients (64 multi-port, 16 single-port) were included in the analysis. Groups were comparable for age, body mass index, CCI, prostate volume, prior opioid use, and use of scheduled ketorolac post op. The single-port approach was associated with a reduction in MEs once admitted to the floor (5 vs. 11 mg, p = 0.025) and an increase in the proportion of patients who did not require any narcotics post-operatively (44 vs. 19%, p = 0.036). In a propensity matched cohort of patients undergoing RASP at a single institution, use of the single-port robotic system conferred a significant decrease in post-operative narcotic use by approximately 50%.
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- 2021
12. Feasibility and Safety of Robotic Excision of Ipsilateral Retroperitoneal Recurrence After Nephrectomy for Renal Cell Carcinoma
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Nirmish Singla, Andre Miranda, Xiaosong Meng, Aditya Bagrodia, Jeffrey A. Cadeddu, Vitaly Margulis, Dmitry Enikeev, Rashed Ghandour, Jeffrey Gahan, and Solomon L. Woldu
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Male ,Surgical resection ,medicine.medical_specialty ,Demographics ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Nephrectomy ,03 medical and health sciences ,0302 clinical medicine ,Robotic Surgical Procedures ,Renal cell carcinoma ,Interquartile range ,medicine ,Humans ,Retroperitoneal Neoplasms ,Retroperitoneal Space ,Carcinoma, Renal Cell ,Aged ,business.industry ,Patient Selection ,Margins of Excision ,Mean age ,Middle Aged ,medicine.disease ,Kidney Neoplasms ,Surgery ,Treatment Outcome ,Subsequent Recurrence ,030220 oncology & carcinogenesis ,Feasibility Studies ,Female ,business ,Follow-Up Studies - Abstract
Objective To determine feasibility and safety of robotic excision of local ipsilateral recurrences after nephrectomy for renal cell carcinoma (RCC). Surgical resection is an option for treatment of low burden locally recurrent RCC, potentially delaying the use of systemic therapy. This has historically been performed by open technique, which can impart significant morbidity. We present our experience with robotic excision. Methods We reviewed our institutional experience of patients with surgically excised RCC who underwent robotic excision of ipsilateral retroperitoneal recurrence in 2015-2018. Demographics and clinicopathological variables, including operative and postoperative outcomes, were examined. Results Twelve robotic excisions of ipsilateral local recurrences were performed in our hospital in 2015-2018. Mean age was 65.48 years (± standard deviation, SD: 9.51), 10 patients were male, and mean BMI 34.75 kg/m2 (± 6.71). Nine patients recurred after radical nephrectomy, and 3 after partial nephrectomy. Mean size of recurrence was 2.97 cm (±1.69). Mean anesthesia time, EBL, and LOS were 213 minutes (± 38.92), 152 mL (± 130.75), and 43 hours (± 12.64), respectively. All surgical margins were negative. No surgical complications were reported. Median follow-up was 19.0 months [interquartile range, IQR 12.7-30.0]. Five patients out of 12 recurred following robotic excision, these were treated with either systemic therapy, radiation, or palliative surgeries. Mean time for subsequent recurrence was 26.5 months. Conclusion In this small case series, robotic excision of ipsilateral RCC retroperitoneal recurrence appears safe, technically feasible, and oncologically sound in expert hands and carefully selected patients.
- Published
- 2020
13. MRI Features Associated with Histology of Benign Prostatic Hyperplasia Nodules: Generation of a Predictive Model
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Tara Nikonow Morgan, Douglas W. Strand, Daniel Parrott, Jessica C. Dai, Ramy Goueli, Ryan Mauck, Daniel N. Costa, Jeffrey Gahan, Claus G. Roehrborn, and Alexander P. Kenigsberg
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Male ,medicine.medical_specialty ,Adenoma ,Urology ,medicine.medical_treatment ,Prostatic Hyperplasia ,Prostate ,medicine ,Humans ,Retrospective Studies ,Univariate analysis ,medicine.diagnostic_test ,business.industry ,Prostatectomy ,Prostatic Neoplasms ,Magnetic resonance imaging ,Nodule (medicine) ,Histology ,Imaging and Noninvasive Therapy ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Histopathology ,medicine.symptom ,business ,Nuclear medicine - Abstract
BACKGROUND: Histologic phenotypic variation of benign prostatic hyperplasia (BPH) has been hypothesized to underlie response to medical therapy. We evaluate preoperative MRI of robot-assisted simple prostatectomy (RASP) specimens and determine imaging features associated with histologic phenotype. MATERIALS AND METHODS: All patients undergoing RASP from November 2015 to November 2019 with a multiparametric MRI ≤1 year before RASP were included. Patients without identifiable BPH nodules on histologic specimens were excluded. Histology slides were obtained from whole mount adenoma specimens and corresponding MRI were reviewed and graded independently by a blinded expert in BPH histopathology (D.W.S.) and an experienced radiologist specializing in prostate imaging (D.N.C.), respectively. Each nodule was assigned a phenotypic score on a 5-point Likert scale (1 = predominantly glandular; 5 = predominantly stromal) by each reviewer. Scores were compared using the sign test and univariate analysis. Signal intensity relative to background transition zone and nodule texture were noted on T2, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging sequences. Univariate and multivariate stepwise linear regression analysis were conducted to identify MRI features associated with histology score. All analyses were performed using Statistical Analysis System (version 9.4). RESULTS: A total of 99 prostate nodules in 29 patients were included. Median phenotypic scores by histology and MRI were comparable (2, interquartile range [IQR] 2–3 vs 2, IQR 2–4, respectively; p = 0.63). Histology scores were positively correlated with MRI scores (Pearson's correlation 0.84, p
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- 2022
14. Extracorporeal ureter handling during laparoscopic pyeloplasty: tips and tricks for beginners
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Mikhail Enikeev, Jeffrey Gahan, Mark Taratkin, Petr Glybochko, Dmitry Enikeev, Margarita Gaas, Ofer Yossepowitch, Abdusalam Abdusalamov, Leonid Chuvalov, Mikhail Vladimirovich Lobanov, Stanislav Ali, V.A. Grigoryan, and Leonid Rapoport
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Laparoscopic surgery ,Pyeloplasty ,medicine.medical_specialty ,Original Paper ,business.industry ,medicine.medical_treatment ,Retrospective cohort study ,ureteropelvic junction obstruction ,General Medicine ,medicine.disease ,laparoscopic pyeloplasty ,Extracorporeal ,Surgery ,Ureter ,medicine.anatomical_structure ,hydronephrosis ,medicine ,extracorporeal ureter handling ,Stage (cooking) ,business ,Hydronephrosis ,Upper urinary tract - Abstract
Introduction Laparoscopic preparation of the ureter is a challenging part of upper urinary tract reconstruction, due to limited depth perception provided by the camera and lack of wristed motion of most laparoscopic instruments needed for adequate spatulation and scar tissue removal. One solution has been to perform the more difficult portions of the surgery in an extracorporeal manner. A hybrid intracorporeal-extracorporeal approach to upper tract ureteral reconstruction facilitates ureteral preparation at the stage of mastering the technique. Material and methods This retrospective study included 100 patients with primary ureteropelvic junction obstruction, who underwent laparoscopic pyeloplasty from 2014 to 2017. The patients were stratified into 2 groups: those who underwent conventional laparoscopic surgery and those who were managed with the hybrid approach. For the hybrid approach, externalizing the ureter to skin level required additional mobilization of the upper urinary tract. Results A total of 47 patients underwent conventional laparoscopic pyeloplasty and 53 - hybrid surgery. The maximum body mass index was 32. The hybrid approach was 8.5 minutes shorter compared to the conventional approach (p
- Published
- 2019
15. Clinical and radiographic outcomes following salvage intervention for ureteropelvic junction obstruction
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Jodi Antonelli, Allen F. Morey, Margaret S. Pearle, Brett A. Johnson, Joseph J. Crivelli, Jeffrey Gahan, Jeffrey A. Cadeddu, and Ryan L. Steinberg
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Adult ,Male ,medicine.medical_specialty ,Pyeloplasty ,Urology ,medicine.medical_treatment ,Radiography ,Salvage therapy ,Ureteropelvic junction ,Renal function ,Retrograde pyelography ,Kidney Function Tests ,Primary outcome ,medicine ,Humans ,Kidney Pelvis ,Retrospective Studies ,Salvage Therapy ,Adult patients ,business.industry ,Diseases of the genitourinary system. Urology ,Surgery ,medicine.anatomical_structure ,Cakut [Supplementary Concept] ,Urologic Surgical Procedures ,Original Article ,Female ,Laparoscopy ,RC870-923 ,business ,Ureteral Obstruction - Abstract
Purpose: We aimed to assess failure rates of salvage interventions and changes in split kidney function (SKF) following failed primary repair of ureteropelvic junction obstruction (UPJO). Materials and Methods: A retrospective review of adult patients at an academic medical center who underwent salvage intervention following primary treatment for UPJO was performed. Symptomatic failure was defined as significant flank pain. Radiographic failure was defined as no improvement in drainage or a decrease in SKF by ≥7%. Overall failure, the primary outcome, was defined as symptomatic failure, radiographic failure, or both. Results: Between 2008-2017, 34 patients (median age 38 years, 50% men) met study criteria. UPJO management was primary pyeloplasty/secondary endopyelotomy for 21/34 (62%), primary pyeloplasty/secondary pyeloplasty for 6/34 (18%), and primary endopyelotomy/secondary pyeloplasty for 7/34 (21%). Median follow-up was 3.3 years following secondary intervention. Patients undergoing primary pyeloplasty/secondary endopyelotomy had significantly higher overall failure than those undergoing primary pyeloplasty/secondary pyeloplasty (16/21 [76%] vs. 1/6 [17%], p=0.015). Among patients undergoing secondary endopyelotomy, presence of a stricture on retrograde pyelogram, stricture length, and SKF were not associated with symptomatic, radiographic, or overall failure. Serial renography was performed for 28/34 (82%) patients and 2/28 (7%) had a significant decline in SKF. Conclusions: Following failed primary pyeloplasty, secondary endopyelotomy had a greater overall failure rate than secondary pyeloplasty. No radiographic features assessed were associated with secondary endopyelotomy failure. Secondary intervention overall failure rates were higher than reported in the literature. Unique to this study, serial renography demonstrated that significant functional loss was overall infrequent.
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- 2021
16. MP22-12 MAGNETIC RESONANCE IMAGING FEATURES ASSOCIATED WITH HISTOLOGY OF BENIGN PROSTATIC HYPERPLASIA NODULES: A PREDICTIVE MODEL
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Jessica Dai, Douglas W. Strand, Jeffrey Gahan, Ramy Goueli, Daniel Parrott, Tara Morgan, Claus G. Roehrborn, and Daniel P. Costa
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Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Urology ,medicine ,Magnetic resonance imaging ,Histology ,Hyperplasia ,urologic and male genital diseases ,medicine.disease ,business ,Medical therapy - Abstract
INTRODUCTION AND OBJECTIVE:Histologic phenotypic variation of benign prostatic hyperplasia (BPH) has been previously described and is hypothesized to underlie response to medical therapy. In this s...
- Published
- 2021
17. PD28-03 PREOPERATIVE TELEHEALTH EVALUATION ALONE PRIOR TO UROLOGIC SURGERY: SAFETY, FEASIBILITY, SURGICAL OUTCOMES
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Solomon L. Woldu, Jeffrey Gahan, Yair Lotan, Jeffrey A. Cadeddu, Claus G. Roehrborn, Vitaly Margulis, Gianpaolo Carpinito, Aditya Bagrodia, and Raj Bhanvadia
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Selection bias ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Urology ,General surgery ,media_common.quotation_subject ,Perioperative ,Telehealth ,Single Center ,Urologic surgery ,Medicine ,Major complication ,business ,Abdominal surgery ,media_common - Abstract
INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic prompted a transition to telehealth in Urology. No study has analyzed urologic surgical outcomes among patients evaluated preoperatively via telehealth only. We compared surgical outcomes between patients who had telehealth only versus in-person preoperative visits prior to urologic surgery. METHODS: Retrospective single center review of all urologic surgeries from April-December 2020. Cases were classified based on whether patients visited preoperatively in person or via telehealth. Major exclusion criteria included having both preoperative in person and telehealth visits. Cases were stratified into four categories for analysis based on CPT coding: Upper Tract Endoscopic (UTE), Lower Tract Endoscopic (LTE), Major Abdominal (MA) (Open/ Laparoscopic/Robotic), and Lower Tract Reconstructive (LTR). Covariates of interest included age, sex, race, ASA status, and distance from hospital. Outcomes included need for blood products, complications, operative time, and length of stay (LOS). Complications were identified using reported morbidity and mortality data and organized based on the Clavien-Dindo scale;scores >2 were considered major complications. RESULTS: Table 1 displays demographic and outcomes of interest. 1,405 patients met inclusion criteria with 101 visits being telehealth only. There was no difference in sex, race, and ASA status. Telehealth patients were younger and lived farther away from the hospital and more likely to undergo UTE or MA surgeries compared to in person visits. There was no difference in perioperative complications or transfusion events between groups. Stratified by procedure type, there was no difference operative time or LOS between cohorts for UTE, MA, or LTE surgeries. LTR surgeries were associated with shorter operative times for telehealth patients, but no difference in LOS. CONCLUSIONS: Patients seen preoperatively by telehealth alone experienced no difference in complications or length of stay when undergoing urologic surgery, including major abdominal surgery. Despite limitations in selection bias and its retrospective nature, our study suggests that telehealth based preoperative evaluation is feasible and safe in appropriately selected patients undergoing urologic surgery.
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- 2021
18. PD11-09 CELLULAR MECHANISMS OF 5-ALPHA REDUCTASE INHIBITOR TREATMENT RESISTANCE IN BENIGN PROSTATIC HYPERPLASIA
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Claus G. Roehrborn, James L. Mohler, Jeff Reese, Ryan Mauck, Diya B. Joseph, Douglas W. Strand, Ryan Hutchinson, Jeffrey Gahan, Alicia Malewska, and Gervaise H. Henry
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medicine.medical_specialty ,business.industry ,Urology ,Reductase ,Hyperplasia ,urologic and male genital diseases ,medicine.disease ,5 Alpha-Reductase Inhibitor ,medicine.anatomical_structure ,Lower urinary tract symptoms ,Prostate ,medicine ,Treatment resistance ,business - Abstract
INTRODUCTION AND OBJECTIVE:5-alpha reductase inhibitors (5ARIs) are prescribed to reduce prostate volume and alleviate lower urinary tract symptoms due to Benign Prostatic Hyperplasia (BPH). In som...
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- 2021
19. MP49-03 ROBOTIC-ASSISTED PARTIAL NEPHRECTOMY (RAPN) FOR MULTIFOCAL SOLID RENAL CELL MASSES (SRM): PATHOLOGIC CONCORDANCE RATES AND SURGICAL OUTCOMES
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Jessica Dai, Vineeth Kommidi, Sam Kusin, Tara Morgan, Jeffrey Gahan, and Jeffrey A. Cadeddu
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medicine.medical_specialty ,business.industry ,Robotic assisted ,Urology ,medicine.medical_treatment ,Concordance ,medicine ,Radiology ,business ,Complication ,medicine.disease ,Kidney cancer ,Nephrectomy - Abstract
INTRODUCTION AND OBJECTIVE:Treatment of patients with multifocal kidney cancer requires forward thinking care, as they are at risk for recurrent surgeries with higher complication rates and progres...
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- 2021
20. MP49-01 CLINICAL OUTCOMES OF ROBOTIC ASSISTED PARTIAL NEPHRECTOMY FOR PATHOLOGIC T3A RENAL MASSES WITH VENOUS TUMORS THROMBUS
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Tara Morgan, Jessica Dai, Sam Kusin, Vineeth Kommidi, Alaina Garbens, Jeffrey Gahan, and Jeffrey Cadeddu
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Urology - Published
- 2021
21. Design and Validation of a Low-Cost, High-Fidelity Model for Urethrovesical Anastomosis in Radical Prostatectomy
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Ryan L. Steinberg, Bradly Mueller, Matthew D. Timberlake, Matthew Kosemund, Brett A. Johnson, and Jeffrey Gahan
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Adult ,Male ,Models, Anatomic ,medicine.medical_specialty ,Urologists ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Anastomosis ,03 medical and health sciences ,0302 clinical medicine ,High fidelity ,Robotic Surgical Procedures ,Component (UML) ,medicine ,Humans ,Computer Simulation ,Robotic prostatectomy ,Prostatectomy ,business.industry ,Anastomosis, Surgical ,Prostate ,Virtual Reality ,technology, industry, and agriculture ,Reproducibility of Results ,Equipment Design ,Middle Aged ,Surgery ,body regions ,surgical procedures, operative ,030220 oncology & carcinogenesis ,Printing, Three-Dimensional ,Female ,Clinical Competence ,Surgical simulation ,Tomography, X-Ray Computed ,business ,human activities - Abstract
We sought to develop and validate a low-cost, high-fidelity robotic surgical model for the urethrovesical anastomosis component of the robot-assisted laparoscopic radical prostatectomy.A novel simulation model was constructed using a 3D-printed model of the male bony pelvis from CT scan data and silicone molds to recreate the soft tissue aspects. Using a da Vinci Si surgical robot, urology faculty and trainees performed simulated urethrovesical anastomosis. Each participant was given 12 minutes to complete the simulation. A survey established face validity, content validity, and acceptability. Simulation runs were evaluated by three blinded reviewers. The anastomosis was graded by two reviewers for suture placement accuracy and anastomosis quality. These factors were compared with robotic experience to establish construct validity.Twenty participants took part in the initial validation of this model. Groups were defined as experts (surgical faculty), intermediate (fellows and chief residents), and novices (junior residents). Likert scores (1-5 scale, top score 5) examining face validity, content validity, and acceptability were 3.49 ± 0.43, 4.15 ± 0.23, and 4.02 ± 0.19, respectively. Construct validity was excellent based on the model's ability to stratify groups. All evaluated metrics were statistically different between the three levels of training. Total material cost was $2.50 per model.We developed a novel low-cost robotic simulation of the urethrovesical anastomosis for robot-assisted radical prostatectomy. The model discerns robotic skill level across all levels of training and was found favorable by participants showing excellent face, content, and construct validities.
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- 2019
22. Surgical Outcomes of Three vs Four Arm Robotic Partial Nephrectomy: Is the Fourth Arm Necessary?
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Igor Sorokin, Jeffrey Gahan, Jeffrey A. Cadeddu, Joseph J. Crivelli, and Brett A. Johnson
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Male ,medicine.medical_specialty ,Blood transfusion ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Nephrectomy ,03 medical and health sciences ,0302 clinical medicine ,Robotic Surgical Procedures ,medicine ,Humans ,Clinical significance ,Aged ,Retrospective Studies ,Tumor size ,business.industry ,Significant difference ,Equipment Design ,Middle Aged ,Readmission rate ,medicine.disease ,Kidney Neoplasms ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Costs and Cost Analysis ,Operative time ,Female ,business ,Kidney cancer - Abstract
Objective To compare the cost, efficacy, and safety of 3-arm versus 4-arm technique in robotic partial nephrectomy (RPN). Surgeons may either elect to utilize three vs four robotic instruments depending on preference. The purpose of this study is to compare the outcomes between the two techniques. Methods RPNs from June 2016 to August 2017 were retrospectively reviewed. Tumor features, surgical parameters, and operative outcomes were evaluated. The number of arms used was determined. Statistical analysis was performed with the Student's t test, chi-squared, and Mann-Whitney test. Results A total of 61 consecutive 3-arm RPNs and 59 consecutive 4-arm RPNs were evaluated. Mean tumor diameter and median nephrometry score were 3.4 cm (± 1.1 SD) and 7 (6-8 IQR) for the 3-arm group and 3.3 cm (±1.2 SD) and 6 (5-8 IQR) for the 4-arm group, respectively (size: p = 0.7, nephrometry: p = 0.07). Hospital length of stay, operative time, estimated blood loss, complication rate, blood transfusion rate, and readmission rate all demonstrated no statistically significant difference between 3-arm and 4-arm groups (p >0.05). Mean ischemia time was shorter by 5.1 minutes in the 4-arm group (p = 0.02). Rate of margin positivity was higher in the 4-arm group (0% vs 10%, p = 0.03). Conclusion RPN can be safely and effectively completed with 3-robotic arms. While there was increased ischemia time, the difference was small and likely not of clinical significance. The routine addition of the fourth robotic arm in RPN is not necessary.
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- 2019
23. Development and Evaluation of a Novel Endoscopic Sack to Facilitate Tissue Prostate Adenoma Morcellation
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Jeffrey Gahan, Heather Beardsley, Igor Sorokin, Brett A. Johnson, and Jeffrey A. Cadeddu
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Adenoma ,Male ,medicine.medical_specialty ,Urology ,Urinary Bladder ,education ,Enucleation ,Prostatic Hyperplasia ,Silicones ,030232 urology & nephrology ,Morcellation ,Models, Biological ,03 medical and health sciences ,0302 clinical medicine ,Laser therapy ,Prostate ,Cadaver ,medicine ,Animals ,Humans ,Urinary bladder ,medicine.diagnostic_test ,business.industry ,Prostatic Neoplasms ,Endoscopy ,Prostate Adenoma ,Equipment Design ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Sack ,Polyethylene ,030220 oncology & carcinogenesis ,Urologic Surgical Procedures ,Laser Therapy ,Patient Safety ,business ,Chickens ,hormones, hormone substitutes, and hormone antagonists - Abstract
Morcellation of the adenoma after laser enucleation of the prostate (LEP) is both time-consuming and prone to complications. We have designed a novel polyethylene sack (ProSac) to improve the morcellation process following LEP. Both silicone and cadaver models were utilized to evaluate the safety and efficacy of ProSac.The inanimate model used tissue-mimicking silicone to accurately approximate bladder volume and compliance. The second model was developed using a fresh cadaver. Heat-fixed chicken breast was used to mimic enucleated prostatic adenoma. Morcellation of the simulated adenoma tissue was tested in both models with and without the ProSac. Morcellated tissue was removed from the filter, desiccated, and weighed after each run to establish morcellation efficiency. Visual inspection was used to evaluate for mucosal injury or bladder perforation. A hydromanometer was placed in the cadaveric bladder to measure bladder pressure.The device was able to capture up to 30 g of tissue with good closure while maintaining good distention and visualization during morcellation. In the silicone model, morcellation efficiency with the device was 4.6 g/minute, while efficiency without the device was 2.6 g/minute (p = 0.03). In the cadaveric model, mean entrapment time was 22 ± 11 seconds. Morcellation efficiency with the device was 2.1 g/minute when excluding entrapment time and 1.9 g/minute including entrapment time. Without the ProSac, morcellation efficiency was 1.2 g/minute (p = 0.05). In both models, multiple mucosal injuries occurred without the device, while none occurred with the device. Bladder pressure was similar between study arms.The ProSac is a novel device that can provide additional safety during adenoma morcellation. It may also achieve clinically and statistically significant improvement in morcellation efficiency without increasing bladder pressure.
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- 2018
24. A Randomized Trial Comparing The Learning Curve of 3 Endoscopic Enucleation Techniques (HoLEP, ThuFLEP, and MEP) for BPH Using Mentoring Approach—Initial Results
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Jeffrey Gahan, Petr Glybochko, Dmitry Enikeev, Mark Taratkin, M A Gazimiev, Spivak Lg, Leonid Rapoport, and Mikhail Enikeev
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Male ,medicine.medical_specialty ,Urology ,Operative Time ,Enucleation ,Prostatic Hyperplasia ,030232 urology & nephrology ,Mentoring approach ,Outcome assessment ,Perioperative Care ,Russia ,law.invention ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Randomized controlled trial ,Prostate ,law ,Outcome Assessment, Health Care ,Ureteroscopy ,Humans ,Medicine ,Aged ,business.industry ,Patient Selection ,Significant difference ,Transurethral Resection of Prostate ,Organ Size ,Middle Aged ,medicine.anatomical_structure ,Learning curve ,030220 oncology & carcinogenesis ,Prostate surgery ,business ,Learning Curve - Abstract
To assess the differences in the learning curve associated with different techniques of endoscopic enucleation of the prostate.Ninety patients were randomly assigned into 3 groups (30 patients in each): HoLEP, ThuFLEP or MEP. Inclusion criteria for the study included prostate volume80 cc, IPSS20, or Qmax10. The EEPs were performed by 3 surgeons experienced in transurethral resection of the prostate. Assignment of surgeons to surgical technique was also randomized. None of the surgeons had prior experience in EEP.ThuFLEP was slightly superior (with no significant difference [P.05]) to HoLEP and MEP in terms of overall enucleation rate-1.0 g/min vs 0.8 g/min and 0.7 g/min, respectively. We observed similar enucleation rates at the initial stages of training (first 20 surgeries) with insignificant increase in ThuFLEP efficiency. At next 10 surgeries ThuFLEP and HoLEP efficiency were higher than of MEP (P.001) without significant difference between techniques of laser EEP (P = .07).Endoscopic enucleation of the prostate can be adopted safely and effectively within 30 surgeries if the technique is learned with a mentoring approach. EEP is shown to be safe and effective even in the initial stages of learning. Laser EEP (HoLEP, ThuFLEP) appears to lend itself to quicker adaptation compared MEP.
- Published
- 2018
25. Urethral luminal epithelia are castration-insensitive cells of the proximal prostate
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Chad M. Vezina, Hannah Ruetten, Mark Cadena, Simran K. Sandhu, Ryan Mauck, Jeffrey C. Reese, Claus G. Roehrborn, Diya B. Joseph, Nida S. Iqbal, Anne E. Turco, Venkat S. Malladi, Jeffrey Gahan, Ryan Hutchinson, Linda A. Baker, Lisa L. Abler, Alicia Malewska, Douglas W. Strand, and Gervaise H. Henry
- Subjects
0301 basic medicine ,Adult ,Male ,Cell type ,Pathology ,medicine.medical_specialty ,Adolescent ,Urology ,Biology ,Article ,03 medical and health sciences ,Mice ,Young Adult ,0302 clinical medicine ,Urethra ,Prostatic urethra ,Prostate ,Antigens, Neoplasm ,medicine ,Animals ,Humans ,Progenitor cell ,Cluster of differentiation ,Stem Cells ,Epithelial Cells ,Hyperplasia ,medicine.disease ,Mice, Inbred C57BL ,030104 developmental biology ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Cell Adhesion Molecules ,Immunostaining - Abstract
Background Castration-insensitive epithelial progenitors capable of regenerating the prostate have been proposed to be concentrated in the proximal region based on facultative assays. Functional characterization of prostate epithelial populations isolated with individual cell surface markers has failed to provide a consensus on the anatomical and transcriptional identity of proximal prostate progenitors. Methods Here, we use single-cell RNA sequencing to obtain a complete transcriptomic profile of all epithelial cells in the mouse prostate and urethra to objectively identify cellular subtypes. Pan-transcriptomic comparison to human prostate cell types identified a mouse equivalent of human urethral luminal cells, which highly expressed putative prostate progenitor markers. Validation of the urethral luminal cell cluster was performed using immunostaining and flow cytometry. Results Our data reveal that previously identified facultative progenitors marked by Trop2, Sca-1, KRT4, and PSCA are actually luminal epithelial cells of the urethra that extend into the proximal region of the prostate, and are resistant to castration-induced androgen deprivation. Mouse urethral luminal cells were identified to be the equivalent of previously identified human club and hillock cells that similarly extend into proximal prostate ducts. Benign prostatic hyperplasia (BPH) has long been considered an "embryonic reawakening," but the cellular origin of the hyperplastic growth concentrated in the periurethral region is unclear. We demonstrate an increase in urethral luminal cells within glandular nodules from BPH patients. Urethral luminal cells are further increased in patients treated with a 5-α reductase inhibitor. Conclusions Our data demonstrate that cells of the proximal prostate that express putative progenitor markers, and are enriched by castration in the proximal prostate, are urethral luminal cells and that these cells may play an important role in the etiology of human BPH.
- Published
- 2020
26. MP34-06 MACHINE LEARNING USING A MULTI-TASK CONVOLUTIONAL NEURAL NETWORKS CAN ACCURATELY ASSESS ROBOTIC SKILLS
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Eric Larson, Ryan L. Steinberg, Alaina Garbens, Xingming Qu, and Jeffrey Gahan
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Scale (ratio) ,business.industry ,Urology ,Direct observation ,Surgical skills ,Medicine ,Artificial intelligence ,business ,Machine learning ,computer.software_genre ,Convolutional neural network ,computer ,Task (project management) - Abstract
INTRODUCTION AND OBJECTIVE:Surgical skill evaluation relies on either direct observation or video review by humans. Both are time consuming, costly and difficult to perform at a large scale. Machin...
- Published
- 2020
27. PD56-11 SINGLE PORT ROBOTIC ASSISTED SIMPLE PROSTATECTOMY IS ASSOCIATED WITH DECREASED POST-OPERATIVE NARCOTIC USE
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Claus G. Roehrborn, Vitaly Margulis, Alaina Garbens, Ryan L. Steinberg, Hersh Trivedi, Vishnu Ganesan, and Jeffrey Gahan
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medicine.medical_specialty ,Port (medical) ,business.industry ,Robotic assisted ,Prostatectomy ,Urology ,medicine.medical_treatment ,medicine ,Post operative ,business ,NARCOTIC USE ,Surgery - Published
- 2020
28. MP42-09 CHARACTERIZING AND CONTRASTING HEMORRHAGE FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY AND ROBOTIC ASSISTED PARTIAL NEPHRECTOMY
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Joseph J. Crivelli, Vitaly Margulis, Jodi Antonelli, Anil Pillai, Yair Lotan, Margaret S. Pearle, Jeffrey Gahan, and Jeffrey A. Cadeddu
- Subjects
medicine.medical_specialty ,business.industry ,Robotic assisted ,Urology ,medicine.medical_treatment ,medicine ,business ,Percutaneous nephrolithotomy ,Nephrectomy ,Surgery - Published
- 2020
29. MP06-01 IDENTIFICATION OF COGNATE PROXIMAL CELL TYPES OF THE MOUSE AND HUMAN PROSTATE AND THEIR ENRICHMENT IN HUMAN BENIGN PROSTATIC HYPERPLASIA
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Alicia Malewska, Chad M. Vezina, Kyle A Wegner, Ryan Mauck, Diya B. Joseph, Douglas W. Strand, Claus G. Roehrborn, Jeff Reese, Ryan Hutchinson, Gervaise H. Henry, and Jeffrey Gahan
- Subjects
Cell type ,Pathology ,medicine.medical_specialty ,business.industry ,Urology ,Urinary system ,Medicine ,Identification (biology) ,Hyperplasia ,urologic and male genital diseases ,business ,medicine.disease ,Human prostate - Abstract
INTRODUCTION AND OBJECTIVE:Benign prostatic hyperplasia (BPH) is highly prevalent in aging men and poses a significant healthcare burden associated with the treatment of Lower Urinary Tract Symptom...
- Published
- 2020
30. Renal biopsy under augmented reality guidance
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Qinmei Li, Jeffrey Gahan, Sarah Shahub, Yasmeen Alshara, Matthew Pfefferle, Maysam Shahedi, Jose M. Vargas, Brett A. Johnson, Blake O. Judson, Phuc Le, and Baowei Fei
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Reproducibility ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Image registration ,medicine.disease ,Article ,Imaging phantom ,Lesion ,Biopsy ,medicine ,Augmented reality ,Renal biopsy ,Radiology ,medicine.symptom ,business ,Kidney cancer - Abstract
Kidney biopsies are currently performed using preoperative imaging to identify the lesion of interest and intraoperative imaging used to guide the biopsy needle to the tissue of interest. Often, these are not the same modalities forcing the physician to perform a mental cross-modality fusion of the preoperative and intraoperative scans. This limits the accuracy and reproducibility of the biopsy procedure. In this study, we developed an augmented reality system to display holographic representations of lesions superimposed on a phantom. This system allows the integration of preoperative CT scans with intraoperative ultrasound scans to better determine the lesion's real-time location. An automated deformable registration algorithm was used to increase the accuracy of the holographic lesion locations, and a magnetic tracking system was developed to provide guidance for the biopsy procedure. Our method achieved a targeting accuracy of 2.9 ± 1.5 mm in a renal phantom study.
- Published
- 2020
31. Urethral luminal epithelia are castration-insensitive progenitors of the proximal prostate
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Chad M. Vezina, Mark Cadena, Simran K. Sandhu, Ryan Mauck, Claus G. Roehrborn, Linda A. Baker, Hannah Ruetten, Anne E. Turco, Lisa L. Abler, Douglas W. Strand, Venkat S. Malladi, Ryan Hutchinson, Gervaise H. Henry, Diya B. Joseph, Nida S. Iqbal, Alicia Malewska, Jeffrey C. Reese, and Jeffrey Gahan
- Subjects
0303 health sciences ,Cluster of differentiation ,Cell ,Biology ,Hyperplasia ,medicine.disease ,urologic and male genital diseases ,Embryonic stem cell ,03 medical and health sciences ,5 Alpha-Reductase Inhibitor ,0302 clinical medicine ,Urethra ,medicine.anatomical_structure ,Prostate ,030220 oncology & carcinogenesis ,medicine ,Cancer research ,Progenitor cell ,030304 developmental biology - Abstract
Castration-insensitive epithelial progenitors capable of regenerating the prostate are concentrated in the proximal region close to the urethra, but the identification of these cells has been limited to individual cell surface markers. Here, we use single cell RNA sequencing (scRNA-seq) to obtain a cellular anatomy of the mouse prostate and urethra and create a comparative map with the human. These data reveal that previously identified facultative progenitors marked by TROP2, Sca-1, KRT4, and PSCA are actually luminal epithelia of the urethra that extend into the proximal prostate. These mouse urethral cells are the human equivalent of previously identified club and hillock urethral cells. Castration decreases androgen-dependent prostate luminal epithelia as expected, but TROP2+ urethral luminal epithelia survive and expand into the prostate. Benign prostatic hyperplasia (BPH) has long been considered an ‘embryonic reawakening’, but the cellular origin of peri-urethral growth is unclear. We use scRNA-seq and flow cytometry to demonstrate an increase in urethral luminal epithelia within glandular nodules from patients with BPH, which are further enriched in patients treated with a 5 alpha reductase inhibitor. These data demonstrate that the putative prostate progenitors enriched by castration in the proximal prostate are an expansion of urethral luminal epithelia and that these cells may play an important role in the etiology of human BPH.Significance StatementThe prostate involutes after castration, but regrows to its original size with androgen replenishment. This observation prompted the search for a castration-insensitive prostate progenitor. Here, Joseph et al. produce a comparative cellular atlas of the prostate and urethra in the mouse vs. human, discovering an equivalent urethral luminal epithelial cell type that extends into the proximal prostatic ducts and expresses previously identified markers of facultative prostate progenitors. Urethral luminal epithelia are established before prostate budding in human and mouse development, and expand after castration in the mouse and after 5 alpha reductase inhibitor treatment in human BPH. These data suggest that luminal epithelia of the urethra are castration-insensitive cells of proximal ducts that may act as progenitors in human BPH.
- Published
- 2020
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32. Determining the Learning Curve for Robot-Assisted Simple Prostatectomy in Surgeons Familiar with Robotic Surgery
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Igor Sorokin, Jeffrey Gahan, Brett A. Johnson, Claus G. Roehrborn, and Nirmish Singla
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Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Operative Time ,education ,Blood Loss, Surgical ,Prostatic Hyperplasia ,030232 urology & nephrology ,03 medical and health sciences ,0302 clinical medicine ,Robotic Surgical Procedures ,Simple (abstract algebra) ,Humans ,Medicine ,Medical physics ,Robotic surgery ,Aged ,Retrospective Studies ,Prostatectomy ,Surgeons ,business.industry ,Rasp ,technology, industry, and agriculture ,Middle Aged ,body regions ,surgical procedures, operative ,Learning curve ,030220 oncology & carcinogenesis ,Robot ,business ,human activities ,Learning Curve - Abstract
Robot-assisted simple prostatectomy (RASP) has excellent outcomes when treating large volume prostates and incorporates the already familiar skills to most robotic surgeons. Our objective was to determine the learning curve for RASP.A retrospective review of RASP on 120 consecutive cases performed by two experienced robotic surgeons from 2014 to 2017 was conducted. We defined "learning curve" as the point at which operative parameters transition from logarithmic to linear improvement. Scatter plots of operative outcomes were constructed and logarithmic and linear best-fit line were estimated to determine the point of transition from logarithmic to linear improvement.Surgeon 1 operated on 76 cases and surgeon 2 on 44 cases. The median age of the 120 patients who underwent RASP was 70.0 years (interquartile range [IQR] 65.0-74.0 years) and median prostate mass was 121.5 g (IQR = 102.0-149.3). Overall, high-grade complication rate was 7.5%; median hematocrit change was 5.4% (IQR = 3.2-7.7) and tissue yield was 61.2 g (IQR = 49.7-76.9). Tissue yield demonstrated logarithmic improvement over the first 12 cases and then transitioned to a linear patter for one surgeon. Operative time in the last 10 cases was statistically different from the first 10 cases (p 0.01). Drop in hematocrit (ΔHct) for surgeon 2 demonstrated logarithmic improvement for the first 10 cases and then transitioned to a linear pattern.The learning curve for RASP varied depending on the variable examined. Blood loss (ΔHct) and tissue yield showed the greatest improvement over time, but neither showed significant improvement beyond 12 cases. We estimated the learning curve for RASP to be ∼10 to 12 cases for experienced robotic surgeons.
- Published
- 2018
33. Axial Abdominal Imaging after Partial Nephrectomy for T1 Renal Cell Carcinoma Surveillance
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Yair Lotan, Ganesh V. Raj, Jeffrey Gahan, Vitaly Margulis, Igor Sorokin, Noah Canvasser, Jeffrey A. Cadeddu, and Arthur I. Sagalowsky
- Subjects
Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Nephrectomy ,03 medical and health sciences ,0302 clinical medicine ,Renal cell carcinoma ,medicine ,Carcinoma ,Medical imaging ,Humans ,Stage (cooking) ,Carcinoma, Renal Cell ,Aged ,Neoplasm Staging ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Kidney Neoplasms ,Surgery ,Population Surveillance ,030220 oncology & carcinogenesis ,Female ,Neoplasm Recurrence, Local ,business ,Watchful waiting - Abstract
The overall recurrence rate of T1 renal cell carcinoma is low. We evaluated abdominal imaging after partial nephrectomy based on current guidelines for T1 renal cell carcinoma surveillance.We retrospectively reviewed the records of patients with T1 renal cell carcinoma who underwent partial nephrectomy between 2006 and 2012 followed by abdominal imaging at our institution. Primary and secondary outcomes were the incidence and timing, respectively, of imaging diagnosed abdominal recurrences. A literature review was performed to summarize prior reports of recurrence incidence and timing after partial nephrectomy for T1 disease.A total of 160 patients with stage T1a and 37 with T1b underwent partial nephrectomy. Seven patients had an abdominal recurrence, including 3 with local and distant recurrences, and 4 with a metachronous contralateral kidney recurrence. The incidence of abdominal recurrence detected by imaging was higher in the T1b than in the T1a group (10.8% vs 1.9%, p = 0.024). Although it was not significant, median time to recurrence was earlier in T1b vs T1a cases (13 vs 37 months, p = 0.480). In each group recurrences developed after 3 years of suggested guideline surveillance. In the literature combined with the current study the time to median recurrence for T1b vs T1a was 24 vs 29 months (p = 0.226).Recurrences detected by abdominal imaging developed earlier and more frequently in T1b than in T1a cases. Future recommendations for surveillance strategies after partial nephrectomy should distinguish T1a from T1b with less intense frequency of imaging for T1a. A longer period of surveillance should be considered since recurrences can develop beyond 3 years.
- Published
- 2017
34. A Phase II Trial of Stereotactic Ablative Radiotherapy for Patients with Primary Renal Cell Cancer
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Aditya Bagrodia, Chul Ahn, Payal Kapur, Solomon L. Woldu, Jeffrey A. Cadeddu, Vitaly Margulis, M. McLaughlin, James Brugarolas, Jeffrey Gahan, R.D. Timmerman, Ivan Pedrosa, Raquibul Hannan, L. Robles, Aurelie Garant, and Hak Choy
- Subjects
Radiation therapy ,Cancer Research ,medicine.medical_specialty ,Radiation ,Oncology ,business.industry ,medicine.medical_treatment ,Ablative case ,medicine ,Radiology, Nuclear Medicine and imaging ,Cell cancer ,Radiology ,business - Published
- 2020
35. Safety and Efficacy of Stereotactic Ablative Radiation Therapy for Renal Cell Carcinoma Extracranial Metastases
- Author
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Jeffrey A. Cadeddu, Derek Weix, Aaron Laine, Hak Choy, Raquibul Hannan, Jeffrey Gahan, James Brugarolas, Alana Christie, Vitaly Margulis, Ivan Pedrosa, Mu-Han Lin, D. W Nathan Kim, Matthew Jung, Lorel Huelsmann, Arthur I. Sagalowsky, Robert Timmerman, Kristin Kuhn, Chiachien Jake Wang, Xian Jin Xie, Jeffrey J Meyer, and Neil Desai
- Subjects
Cancer Research ,medicine.medical_specialty ,Lung Neoplasms ,medicine.medical_treatment ,030232 urology & nephrology ,Bone Neoplasms ,Soft Tissue Neoplasms ,Kaplan-Meier Estimate ,Radiosurgery ,SABR volatility model ,Article ,03 medical and health sciences ,0302 clinical medicine ,Renal cell carcinoma ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Treatment Failure ,Carcinoma, Renal Cell ,Prior Radiation Therapy ,Response Evaluation Criteria in Solid Tumors ,Aged ,Retrospective Studies ,Analysis of Variance ,Chi-Square Distribution ,Spinal Neoplasms ,Radiation ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Dose fractionation ,Common Terminology Criteria for Adverse Events ,Middle Aged ,medicine.disease ,Kidney Neoplasms ,Surgery ,Radiation therapy ,Oncology ,030220 oncology & carcinogenesis ,Linear Models ,Dose Fractionation, Radiation ,Radiology ,business ,Relative Biological Effectiveness - Abstract
Purpose Renal cell carcinoma is refractory to conventional radiation therapy but responds to higher doses per fraction. However, the dosimetric data and clinical factors affecting local control (LC) are largely unknown. We aimed to evaluate the safety and efficacy of stereotactic ablative radiation therapy (SAbR) for extracranial renal cell carcinoma metastases. Methods and Materials We reviewed 175 metastatic lesions from 84 patients treated with SAbR between 2005 and 2015. LC and toxicity after SAbR were assessed with Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Predictors of local failure were analyzed with χ 2 , Kaplan-Meier, and log-rank tests. Results In most cases (74%), SAbR was delivered with total doses of 40 to 60 Gy, 30 to 54 Gy, and 20 to 40 Gy in 5 fractions, 3 fractions, and a single fraction, respectively. The median biologically effective dose (BED) using the universal survival model was 134.5 Gy. The 1-year LC rate after SAbR was 91.2% (95% confidence interval, 84.9%-95.0%; median follow-up, 16.7 months). Local failures were associated with prior radiation therapy (hazard ratio [HR], 10.49; P P =.0189), spinal location (HR, 5.36; P =.0041), previous systemic therapy status (0-1 vs >1; HR, 3.52; P =.0217), and BED P =.0254). Dose received by 99% of the target volume was the strongest dosimetric predictor for LC. Upon multivariate analysis, dose received by 99% of the target volume greater than BED of 98.7 Gy and systemic therapy status remained significant (HR, 0.12 and 3.64, with P =.0014 and P =.0472, respectively). Acute and late grade 3 toxicities attributed to SAbR were observed in 3 patients (1.7%) and 5 patients (2.9%), respectively. Conclusions SAbR demonstrated excellent LC of metastatic renal cell carcinoma with a favorable safety profile when an adequate dose and coverage were applied. Multimodality treatment with surgery should be considered for reirradiation or vertebral metastasis. A higher radiation dose may be required in patients who received previous systemic therapies.
- Published
- 2017
36. Initial experience with extraperitoneal robotic-assisted simple prostatectomy using the da Vinci SP surgical system
- Author
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Niccolo Passoni, Ryan L. Steinberg, Alaina Garbens, Brett A. Johnson, and Jeffrey Gahan
- Subjects
Male ,medicine.medical_specialty ,Robotic assisted ,medicine.medical_treatment ,Operative Time ,030232 urology & nephrology ,Prostatic Hyperplasia ,Health Informatics ,Urinary incontinence ,03 medical and health sciences ,0302 clinical medicine ,Robotic Surgical Procedures ,Prostate ,Lower urinary tract symptoms ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,Aged ,Retrospective Studies ,Prostatectomy ,business.industry ,Rasp ,Prostatic Neoplasms ,medicine.disease ,Cannula ,Surgery ,Catheter ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,medicine.symptom ,business - Abstract
Robotic-assisted simple prostatectomy (RASP) has emerged as a safe and effective treatment option for symptomatic patients with lower urinary tract symptoms related to significant benign prostatic enlargement (BPE) above 80 g. The recent release of the da Vinci SP robotic system (Intuitive, Sunnyvale, CA, USA) continues to advance the minimally invasive nature of robotic surgical technology. We now report our institution’s initial experience performing RASP using the da Vinci SP robotic system. An IRB-approved, retrospective chart review was performed of all patients undergoing robotic-assisted simple prostatectomy using the da Vinci SP surgical system in the treatment of benign prostatic enlargement by a single surgeon from March to June 2019. Pre-operative, intraoperative, and post-operative data were collected for descriptive analysis. A total of 10 men, mean age of 69 ± 4 years, with mean prostate volume of 104 ± 11 g underwent surgery. The robotic cannula and a single assistant port were utilized in all cases. No cases required conversion to a multi-port robotic platform or open approach, nor required the placement of additional assistant ports. No intraoperative or immediate post-operative complications were noted. Mean estimated blood loss was 141 ± 98 mL and operative time was 172 ± 19 min. Mean catheter time was 1.9 ± 1.8 days. One patient reported transient de novo stress urinary incontinence. Single-port RASP is a safe and effective intervention for BPE. The smaller surgical footprint from the device appears to make earlier catheter removal possible. Comparative evaluation with multi-port RASP and other modalities is warranted.
- Published
- 2019
37. Pathologic response and surgical outcomes in patients undergoing nephrectomy following receipt of immune checkpoint inhibitors for renal cell carcinoma
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Nirmish Singla, Solomon L. Woldu, Rashed Ghandour, Roy Elias, Aditya Bagrodia, Hans J. Hammers, Jay Lohrey, Jeffrey Gahan, James Brugarolas, Mikhail Enikeev, Isaac Bowman, Leonid Rapoport, Vitaly Margulis, and Yuval Freifeld
- Subjects
Adult ,Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Biopsy ,Programmed Cell Death 1 Receptor ,030232 urology & nephrology ,Ipilimumab ,Kidney ,Nephrectomy ,Time-to-Treatment ,03 medical and health sciences ,0302 clinical medicine ,Antineoplastic Agents, Immunological ,Renal cell carcinoma ,Antineoplastic Combined Chemotherapy Protocols ,Medicine ,Humans ,CTLA-4 Antigen ,Carcinoma, Renal Cell ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,Middle Aged ,medicine.disease ,Kidney Neoplasms ,Neoadjuvant Therapy ,Surgery ,Nivolumab ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Feasibility Studies ,Female ,Metastasectomy ,business ,Complication ,Progressive disease ,medicine.drug - Abstract
Objective To evaluate the pathologic response, safety, and feasibility of nephrectomy following receipt of immune checkpoint inhibition (ICI) for renal cell carcinoma (RCC). Methods Patients who underwent nephrectomy for RCC after exposure to nivolumab monotherapy or combination ipilimumab/nivolumab were reviewed. Primary surgical outcomes included operative time (OT), estimated blood loss (EBL), length of stay (LOS), readmission rates, and complication rates. Pathologic response in the primary and metastatic sites constituted secondary outcomes. Results Eleven nephrectomies (10 radical, 1 partial) were performed in 10 patients after ICI with median postoperative follow-up 180 days. Six patients received 1 to 4 cycles of ipilimumab/nivolumab, while 5 received 2 to 12 infusions of nivolumab preoperatively. Five surgeries were performed laparoscopically, and 4 patients underwent concomitant thrombectomy. One patient exhibited complete response (pT0) to ICI, and 3/4 patients who underwent metastasectomy for hepatic, pulmonary, or adrenal lesions exhibited no detectable malignancy in any of the metastases resected. No patients experienced any major intraoperative complications, and all surgical margins were negative. Median OT, EBL, and LOS were 180 minutes, 100 ml, and 4 days, respectively. Four patients experienced a complication, including 3 that were addressed with interventional radiology procedures. One patient died of progressive disease >3 months after surgery, and 1 patient succumbed to pulmonary embolism complicated by sepsis. No complications or readmissions were noted in 6 patients. Conclusion Nephrectomy following ICI for RCC is safe and technically feasible with favorable surgical outcomes and pathologic response. Timing of the nephrectomy relative to checkpoint dosing did not seem to impact outcome. Biopsies of lesions responding radiographically to ICI may warrant attention prior to surgical excision.
- Published
- 2019
38. PD03-09 SAFETY AND FEASIBILITY OF NEPHRECTOMY AFTER RECEIPT OF IMMUNE CHECKPOINT INHIBITORS FOR RENAL CELL CARCINOMA
- Author
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Solomon L. Woldu, Rashed Ghandour, Roy Elias, Isaac Bowman, Jeffrey Gahan, Aditya Bagrodia, Vitaly Margulis, Nirmish Singla, James Brugarolas, Yuval Freifeld, and Hans J. Hammers
- Subjects
business.industry ,Renal cell carcinoma ,Urology ,medicine.medical_treatment ,Immune checkpoint inhibitors ,medicine ,Cancer research ,urologic and male genital diseases ,business ,medicine.disease ,Primary tumor ,Nephrectomy - Abstract
INTRODUCTION AND OBJECTIVES:With the approval of immune checkpoint inhibitors (ICI) for metastatic renal cell carcinoma (RCC), the role, timing, and safety of surgically excising the primary tumor ...
- Published
- 2019
39. MP06-14 CHARACTERIZING THE CELLULAR PATHOGENESIS OF BPH THROUGH SINGLE CELL RNA SEQUENCING OF NORMAL AND HYPERPLASTIC HUMAN PROSTATE
- Author
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Chad M. Vezina, Jeffrey Gahan, Ryan Mauck, Claus G. Roehrborn, Diya B. Joseph, Ganesh V. Raj, Gervaise H. Henry, Venkat S. Malladi, Ryan Hutchinson, Alicia Malewska, and Douglas W. Strand
- Subjects
Cell specific ,business.industry ,Urology ,Cell ,RNA ,Disease ,Hyperplasia ,medicine.disease ,Human prostate ,Pathogenesis ,medicine.anatomical_structure ,Cancer research ,Medicine ,business - Abstract
INTRODUCTION AND OBJECTIVES:The cellular pathogenesis of human benign prostatic hyperplasia is poorly understood. To understand the functional contribution of specific cell types in disease, a cell...
- Published
- 2019
40. MP21-06 LEVERAGING A ROBUST PATIENT-DERIVED XENOGRAFT PLATFORM TO CHARACTERIZE PREDICTORS FOR ENGRAFTMENT AND ONCOLOGIC OUTCOMES IN RENAL CELL CARCINOMA PATIENTS
- Author
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Nirmish Singla, Layton Woolford, Christina Stevens, Vanina Tcheuyap, Oreoluwa Onabolu, Zhiqun Xie, Renee McKay, Tao Wang, Alana Christie, Jeffrey Gahan, Aditya Bagrodia, Ganesh Raj, Arthur Sagalowsky, Yair Lotan, Jeffrey Cadeddu, Vitaly Margulis, Payal Kapur, and James Brugarolas
- Subjects
Urology - Published
- 2019
41. PD44-07 PENOSCROTAL DECOMPRESSION AS A GLANS SPARING ALTERNATIVE TO SHUNT PROCEDURES FOR SURGICAL RELIEF OF REFRACTORY ISCHEMIC PRIAPISM
- Author
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Billy H. Cordon, Allen F. Morey, Yooni Yi, Jeffrey Gahan, Rachel L. Bergeson, and Michael Davenport
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,Ischemic priapism ,Refractory ,business.industry ,Decompression ,Urology ,medicine ,Glans ,business ,Surgery ,Shunt (medical) - Published
- 2019
42. PD10-07 MULTI-INSTITUTIONAL PROPENSITY MATCHED COMPARISON OF ROBOTIC-ASSISTED SIMPLE PROSTATECTOMY AND THULIUM LASER ENUCLEATION OF THE PROSTATE
- Author
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Ryan L. Steinberg, Petr Glybochko, Dmitry Enikeev, Leonid Rapoport, Claus G. Roehrborn, Brett A. Johnson, and Jeffrey Gahan
- Subjects
medicine.medical_specialty ,Prostatectomy ,Robotic assisted ,business.industry ,Urology ,medicine.medical_treatment ,Enucleation ,medicine.disease ,Prostatic enlargement ,Thulium laser ,medicine.anatomical_structure ,Quality of life ,Lower urinary tract symptoms ,Prostate ,medicine ,business - Abstract
INTRODUCTION AND OBJECTIVES:Lower urinary tract symptoms due to benign prostatic enlargement are a significant detractor from quality of life in aging men. Robotic assisted simple prostatectomy (RA...
- Published
- 2019
43. MP45-09 PROSTATE VOLUME DOES NOT SIGNIFICANTLY AFFECT THE RISK OF POST-SURGICAL COMPLICATIONS AFTER ROBOT-ASSISTED SIMPLE PROSTATECTOMY
- Author
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Claus G. Roehrborn, Ryan L. Steinberg, Brett A. Johnson, and Jeffrey Gahan
- Subjects
Post surgical ,medicine.medical_specialty ,business.industry ,Prostatectomy ,Urology ,medicine.medical_treatment ,Affect (psychology) ,medicine.anatomical_structure ,Prostate ,Medicine ,business ,Volume (compression) ,Simple (philosophy) - Published
- 2019
44. New technologies in tumor ablation
- Author
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Nirmish Singla and Jeffrey Gahan
- Subjects
Ablation Techniques ,medicine.medical_specialty ,Modalities ,Emerging technologies ,business.industry ,Urology ,Treatment outcome ,Microwave ablation ,030232 urology & nephrology ,Irreversible electroporation ,Radiosurgery ,Kidney Neoplasms ,Tumor ablation ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Electroporation ,Treatment Outcome ,0302 clinical medicine ,Animals ,Humans ,Medicine ,Medical physics ,business ,Carcinoma, Renal Cell - Abstract
The application of ablative modalities for small renal masses continues to increase. In addition, multiple technologies continue to be studied for the treatment of these renal masses. This review focuses on new and emerging technologies so that the clinician can become more familiar with these modalities as they become available in clinical practice.Radiofrequency ablation (RFA) and cryoablation (cryo) continue to be the most often used ablative modalities for the treatment of small renal masses. In addition, they are the most thoroughly studied modalities leading to a set of well defined variables predicting successful ablation. Microwave ablation (MWA) and irreversible electroporation are newer modalities that offer theoretical advantages to RFA and cryo, although each differs in the specific advantage provided. Multiple animal studies have been performed with each modality; however, in both cases, the optimal device settings are not well defined. For MWA in particular, there are a significant number of systems available and within each system, there are an array of variables that can be modified, which influences the ablation zone size and shape. Other emerging technologies include stereotactic body radiation and high-intensity focused ultrasound, although each has limited data supporting their efficacy to date.Ablation technology continues to multiply and evolve. Newer technologies such as MWA and irreversible electroporation are promising as they offer theoretical advantages to RFA and cryo. However, both require further studies to identify the optimal tumor characteristics and device settings leading to successful ablation.
- Published
- 2016
45. Radiation Exposure During Percutaneous Ablation of Small Renal Masses: A Multi-Institutional Multimodality Analysis
- Author
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Amit Gupta, Igor Lobko, Nithin Theckumparampil, Jaime Landman, Shiliang Sun, Chandana Lall, Louis R Kavoussi, Sammy Elsamra, Jeffrey Gahan, Jeffrey A. Cadeddu, Zhamshid Okunov, Paul Kogan, and Chad R. Tracy
- Subjects
Male ,Percutaneous ,Radiofrequency ablation ,Urology ,medicine.medical_treatment ,Cryosurgery ,Body Mass Index ,law.invention ,law ,medicine ,Humans ,Carcinoma, Renal Cell ,Aged ,Retrospective Studies ,Aged, 80 and over ,Univariate analysis ,business.industry ,Cancer ,Retrospective cohort study ,Number needed to harm ,Middle Aged ,Radiation Exposure ,medicine.disease ,Ablation ,Kidney Neoplasms ,Tumor Burden ,Surgery, Computer-Assisted ,Attributable risk ,Catheter Ablation ,Female ,Tomography, X-Ray Computed ,Nuclear medicine ,business - Abstract
To understand the effective radiation dose during percutaneous cryoablation (CA) and radiofrequency ablation (RFA) and characterize variables that may affect the individual dose.The effective radiation dose was determined by conversion of the dose-length product from CT scans performed during percutaneous CA or RFA for patients with solitary renal masses (4 cm) at four academic centers. Radiation dose per case was compared between patients and institutions using multivariate and univariate analysis. Lifetime attributable risk of cancer was calculated for each institution and utilized to determine the number needed to harm for a range of ages at the time of exposure.One hundred twenty-three patients met the inclusion criteria with a mean age of 71 years. Sixty-nine percent of patients were male, mean body-mass index (BMI) was 29.4, and mean tumor size was 2.2 cm. The mean effective radiation dose per ablation was 40 mSv (range 3.7-147). On multivariate analysis, only BMI and institution were associated with the radiation dose. No significant difference in radiation exposure was seen for RFA or CA procedures.Radiation exposure during percutaneous ablation is similar to a multiphase CT scan. However, there is wide variability in individual treatment exposure, varying from 3.7 to 147 mSv, depending primarily on institution and BMI. Standardization of protocols is required to achieve as low as reasonably achievable levels of radiation.
- Published
- 2015
46. PD05-12 SCHEDULED KETOROLAC REDUCES POST-OPERATIVE NARCOTIC NEEDS WITHOUT INCREASED RISK OF COMPLICATIONS IN PATIENTS UNDERGOING ROBOTIC ASSISTED SIMPLE PROSTATECTOMY
- Author
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Ryan L. Steinberg, Alaina Garbens, Vitaly Margulis, Claus G. Roehrborn, Jeffrey Gahan, Hersh Trivedi, and Vishnu Ganesan
- Subjects
medicine.medical_specialty ,Narcotic ,business.industry ,Prostatectomy ,Robotic assisted ,Urology ,medicine.medical_treatment ,Surgery ,Ketorolac ,Increased risk ,medicine ,In patient ,Post operative ,business ,medicine.drug - Published
- 2020
47. A Cellular Anatomy of the Normal Adult Human Prostate and Prostatic Urethra
- Author
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Jeon Lee, Chad M. Vezina, Jose R. Torrealba, Jeffrey Gahan, Jeffrey C. Reese, Ryan Mauck, Diya B. Joseph, Gary C. Hon, Douglas W. Strand, Gervaise H. Henry, Ganesh V. Raj, Venkat S. Malladi, Ryan Hutchinson, Malcolm MacConmara, Claus G. Roehrborn, and Alicia Malewska
- Subjects
0301 basic medicine ,Adult ,Male ,Cell type ,Pathology ,medicine.medical_specialty ,Stromal cell ,Cell ,Biology ,General Biochemistry, Genetics and Molecular Biology ,Article ,Flow cytometry ,03 medical and health sciences ,Prostate cancer ,Urethra ,Prostatic urethra ,Prostate ,medicine ,Humans ,lcsh:QH301-705.5 ,Cluster of differentiation ,medicine.diagnostic_test ,Sequence Analysis, RNA ,Epithelial Cells ,Hyperplasia ,medicine.disease ,Epithelium ,3. Good health ,030104 developmental biology ,medicine.anatomical_structure ,lcsh:Biology (General) ,biology.protein ,Immunohistochemistry ,Antibody ,Single-Cell Analysis ,Stromal Cells - Abstract
SUMMARY A comprehensive cellular anatomy of normal human prostate is essential for solving the cellular origins of benign prostatic hyperplasia and prostate cancer. The tools used to analyze the contribution of individual cell types are not robust. We provide a cellular atlas of the young adult human prostate and prostatic urethra using an iterative process of single-cell RNA sequencing (scRNA-seq) and flow cytometry on ~98,000 cells taken from different anatomical regions. Immunohistochemistry with newly derived cell type-specific markers revealed the distribution of each epithelial and stromal cell type on whole mounts, revising our understanding of zonal anatomy. Based on discovered cell surface markers, flow cytometry antibody panels were designed to improve the purification of each cell type, with each gate confirmed by scRNA-seq. The molecular classification, anatomical distribution, and purification tools for each cell type in the human prostate create a powerful resource for experimental design in human prostate disease., In Brief Using single-cell RNA sequencing, immunofluorescence, and flow cytometry, Henry et al. create a cellular anatomy of the normal human prostate and provide the tools to identify, isolate, and localize every cell type. They identify two additional epithelial cell types enriched in the prostatic urethra and proximal prostatic ducts., Graphical Abstract
- Published
- 2018
48. Comparison of Robot-Assisted Versus Open Simple Prostatectomy for Benign Prostatic Hyperplasia
- Author
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Jeffrey Gahan, Ankur Shah, and Igor Sorokin
- Subjects
Nephrology ,Male ,medicine.medical_specialty ,Adenoma ,Urology ,medicine.medical_treatment ,Operative Time ,030232 urology & nephrology ,Prostatic Hyperplasia ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Humans ,Major complication ,Prostatectomy ,business.industry ,General surgery ,Rasp ,Gold standard ,General Medicine ,Robotics ,Hyperplasia ,Length of Stay ,medicine.disease ,Treatment Outcome ,030220 oncology & carcinogenesis ,Prostate surgery ,business - Abstract
Recent advancements in minimally invasive approaches for prostate surgery have provided numerous options for surgical management of benign prostatic hyperplasia (BPH). In the setting of a large prostate, an open simple prostatectomy was previously considered the gold standard surgical treatment. However, the recently updated American Urological Association (AUA) guidelines on surgical management of BPH now consider both open and minimally invasive approaches to simple prostatectomy viable alternatives for treating large glands, depending on expertise with the techniques. The purpose of our review is to discuss the minimally invasive robot-assisted approach and compare it to the classic open approach to simple prostatectomy. Despite longer operative times, the robotic approach is associated with shorter hospital stay and lower morbidity profile. The morbidity of an open approach remains significant. Blood transfusions are 3–4 times as likely compared to a robotic approach and major complications are twice as likely. Consistent with previous literature, our review shows functional outcome improvements like flow rate and symptom score to be comparable between the robotic and open approach. The amount of adenoma resected and PSA decline is also similar among robotic and open cases. Robot-assisted simple prostatectomy is a safe and effective procedure for BPH secondary to a large prostate gland. Appropriately, it is no longer deemed “investigational” by the latest AUA guidelines on BPH and recommended as an alternative to the open approach.
- Published
- 2018
49. MP49-18 CLINICAL AND RADIOGRAPHIC OUTCOMES FOLLOWING SALVAGE TREATMENT FOR URETEROPELVIC JUNCTION OBSTRUCTION
- Author
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Jeffrey Gahan, Allen F. Morey, Margaret S. Pearle, Brett A. Johnson, Joseph J. Crivelli, Jeffrey A. Cadeddu, and Jodi Antonelli
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Urology ,Radiography ,Salvage treatment ,medicine ,Ureteropelvic junction ,business ,Surgery - Published
- 2018
50. V02-06 UTILIZING A NOVEL BLADDER MODEL TO EVALUATE THE PROSAC: FACILITATING SAFE AND EFFICIENT TISSUE MORCELLATION DURING HOLEP
- Author
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Brett A. Johnson, Jeffrey Gahan, Igor Sorokin, Heather Beardsley, Jeffrey A. Cadeddu, and Jodi Antonelli
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,Medicine ,business - Published
- 2018
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