Searched for: person:sm5229
Medium-Term Real-World Outcomes of Minimally Invasive Surgical Therapies for Benign Prostatic Hyperplasia: Water Vapor Thermal Therapy (Rezum) vs Prostatic Urethral Lift (UroLift) in a High-Volume Urban Academic Center
Chin, Chih Peng; Garden, Evan B; Ravivarapu, Krishna T; Shukla, Devki; Omidele, Olamide; Levy, Micah; Qian, Daniel; Araya, Joseph Sewell; Valenzuela, Robert; Reddy, Avinash; Marshall, Susan; Motola, Jay; Nobert, Craig; Gupta, Mantu; Small, Alexander C; Kaplan, Steven A; Palese, Michael A
PMID: 36039926
ISSN: 1557-900x
CID: 5403502
UROLIFT VERSUS REZUM FOR BENIGN PROSTATIC HYPERPLASIA: A REAL-WORLD SINGLE-INSTITUTION ANALYSIS [Meeting Abstract]
Chin, Chih Peng; Garden, Evan; Ravivarapu, Krishna; Shukla, Devki; Omidele, Olamide; Levy, Micah; Araya, Joseph Sewell; Small, Alexander; Kaplan, Steven; Valenzuela, Robert; Reddy, Avinash; Marshall, Susan; Motola, Jay; Nobert, Craig; Gupta, Mantu; Palese, Michael
ISI:000836935507005
ISSN: 0022-5347
CID: 5403682
REZUM FOR MEN WITH LARGE PROSTATES >= 80 CC VERSUS SMALL PROSTATES < 80 CC: UPDATED OUTCOMES AND LONG-TERM RESULTS [Meeting Abstract]
Garden, Evan; Ravivarapu, Krishna; Levy, Micah; Omidele, Olamide; Shukla, Devki; Al-Alao, Osama; Coleburn, Norman; Gupta, Mantu; Nobert, Craig; Marshall, Susan; Motola, Jay; Reddy, Avinash; Valenzuela, Robert; Kaplan, Steven; Small, Alexander; Palese, Michael
ISI:000693688000310
ISSN: 0022-5347
CID: 5403602
Are older drivers' on-road driving error rates related to functional performance and/or self-reported driving experiences?
Koppel, S; Charlton, J L; Richter, N; Di Stefano, M; Macdonald, W; Darzins, P; Newstead, S V; D'Elia, A; Mazer, B; Gelinas, I; Vrkljan, B; Eliasz, K; Myers, A; Marshall, S
PMID: 28365398
ISSN: 1879-2057
CID: 5230122
Relationship Between Prebiopsy Multiparametric Magnetic Resonance Imaging (MRI), Biopsy Indication, and MRI-ultrasound Fusion-targeted Prostate Biopsy Outcomes
Meng, Xiaosong; Rosenkrantz, Andrew B; Mendhiratta, Neil; Fenstermaker, Michael; Huang, Richard; Wysock, James S; Bjurlin, Marc A; Marshall, Susan; Deng, Fang-Ming; Zhou, Ming; Melamed, Jonathan; Huang, William C; Lepor, Herbert; Taneja, Samir S
BACKGROUND: Increasing evidence supports the use of magnetic resonance imaging (MRI)-ultrasound fusion-targeted prostate biopsy (MRF-TB) to improve the detection of clinically significant prostate cancer (PCa) while limiting detection of indolent disease compared to systematic 12-core biopsy (SB). OBJECTIVE: To compare MRF-TB and SB results and investigate the relationship between biopsy outcomes and prebiopsy MRI. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of a prospectively acquired cohort of men presenting for prostate biopsy over a 26-mo period. A total of 601 of 803 consecutively eligible men were included. INTERVENTIONS: All men were offered prebiopsy MRI and assigned a maximum MRI suspicion score (mSS). Men with an MRI abnormality underwent combined MRF-TB and SB. OUTCOMES: Detection rates for all PCa and high-grade PCa (Gleason score [GS] >/=7) were compared using the McNemar test. RESULTS AND LIMITATIONS: MRF-TB detected fewer GS 6 PCas (75 vs 121; p<0.001) and more GS >/=7 PCas (158 vs 117; p<0.001) than SB. Higher mSS was associated with higher detection of GS >/=7 PCa (p<0.001) but was not correlated with detection of GS 6 PCa. Prediction of GS >/=7 disease by mSS varied according to biopsy history. Compared to SB, MRF-TB identified more GS >/=7 PCas in men with no prior biopsy (88 vs 72; p=0.012), in men with a prior negative biopsy (28 vs 16; p=0.010), and in men with a prior cancer diagnosis (42 vs 29; p=0.043). MRF-TB detected fewer GS 6 PCas in men with no prior biopsy (32 vs 60; p<0.001) and men with prior cancer (30 vs 46; p=0.034). Limitations include the retrospective design and the potential for selection bias given a referral population. CONCLUSIONS: MRF-TB detects more high-grade PCas than SB while limiting detection of GS 6 PCa in men presenting for prostate biopsy. These findings suggest that prebiopsy multiparametric MRI and MRF-TB should be considered for all men undergoing prostate biopsy. In addition, mSS in conjunction with biopsy indications may ultimately help in identifying men at low risk of high-grade cancer for whom prostate biopsy may not be warranted. PATIENT SUMMARY: We examined how magnetic resonance imaging (MRI)-targeted prostate biopsy compares to traditional systematic biopsy in detecting prostate cancer among men with suspicion of prostate cancer. We found that MRI-targeted biopsy detected more high-grade cancers than systematic biopsy, and that MRI performed before biopsy can predict the risk of high-grade cancer.
PMCID:5104338
PMID: 26112001
ISSN: 1873-7560
CID: 1641022
Trifecta and optimal perioperative outcomes of robotic and laparoscopic partial nephrectomy in surgical treatment of small renal masses: a multi-institutional study
Zargar, Homayoun; Allaf, Mohamad E; Bhayani, Sam; Stifelman, Michael; Rogers, Craig; Ball, Mark W; Larson, Jeffrey; Marshall, Susan; Kumar, Ramesh; Kaouk, Jihad H
OBJECTIVE: To compare the perioperative outcomes of robotic partial nephrectomy (RPN) with laparoscopic PN (LPN) performed for small renal masses (SRMs), in a large multi-institutional series and to define a new composite outcome measure, termed 'optimal outcome' for the RPN group. PATIENTS AND METHODS: Retrospective review of 2392 consecutive cases of RPN and LPN performed in five high-volume centres from 2004 to mid-2013. We limited our study to SRMs and cases performed by surgeons with significant expertise with the technique. The Trifecta was defined as negative surgical margin, zero perioperative complications and a warm ischaemia time of =25 min. The 'optimal outcome' was defined as achievement of Trifecta with addition of 90% estimated glomerular filtration rate preservation and no chronic kidney disease stage upgrading. Univariable and multivariable analysis were used to identify factors predicting Trifecta and 'optimal outcome' achievement. RESULTS: In all, 1185 RPN and 646 LPN met our inclusion criteria. Patients in the RPN group were older and had a higher median Charlson comorbidity index and higher R.E.N.A.L. nephrometry score. The RPN group had lower warm ischaemia time (18 vs 26 min), overall complication rate (16.2% vs 25.9%), and positive surgical margin rate (3.2% vs. 9.7%). There was a significantly higher Trifecta rate for RPN (70% vs 33%) and the rate of achievement of 'optimal outcome' for the RPN group was 38.5%. CONCLUSIONS: In this large multi-institutional series RPN was superior to LPN for perioperative surgical outcomes measured by Trifecta. Patients in the RPN group had better outcomes for all three components of Trifecta compared with their LPN counterparts. Our more strict definition for 'optimal outcome' might be a better tool for assessing perioperative and functional outcomes after minimally invasive PN. This tool needs to be externally validated.
PMID: 25220543
ISSN: 1464-410x
CID: 1720562
Focal therapy for prostate cancer: The current status
Marshall, Susan; Taneja, Samir
PURPOSE: In an era of increasing prostate cancer incidence and earlier detection, the assessment of clinical significance of prostate cancer is critical. Minimally invasive therapies are increasingly being investigated in localized prostate cancer. METHODS AND RESULTS: In this review, we discuss the current status of magnetic resonance imaging targeted fusion prostate biopsy and focal therapy for prostate cancer, its rationale, and techniques. CONCLUSION: Focal therapy offers a promising outlook for prostate cancer treatment, with the goal of effectively achieving cancer control while minimizing morbidity. Long term studies are needed.
PMCID:4494637
PMID: 26157765
ISSN: 2287-8882
CID: 1663222
Non-modifiable factors and complications contribute to length of stay in Robot-Assisted Partial Nephrectomy
Larson, Jeffrey A; Kaouk, Jihad; Stifelman, Michael D; Rogers, Craig G; Allaf, Mohamad E; Potretzke, Aaron; Marshall, Susan; Zargar, Homayoun; Ball, Mark W; Bhayani, Sam
INTRODUCTION/OBJECTIVE: Robotic-assisted partial nephrectomy (RPN) offers a mean length of stay (LOS) of 2-3 days. The purpose of this study is to determine the impact of modifiable and non-modifiable risk factors on hospital length of stay after RPN. PATIENTS AND METHODS: We retrospectively reviewed a prospectively maintained database to identify all patients undergoing RPN for localized tumors at 5 US centers from 2007 to 2013. Patient and tumor characteristics were compared among hospital length of stay groups. Associated factors were modeled using univariate and multivariate cumulative logistic regression to determine factors predictive of hospital length of stay. RESULTS: 1532 patients were grouped into LOS 1 to 3 days (1298, 84.1%), LOS=4 days (133, 8.6%) and LOS>4 days (110, 7.2%). Patients in the LOS=4 and LOS>4 day groups were more likely to have a higher Charlson Comorbidity Index score (mean 2.2, 3.1 and 3.8; P<0.001), higher nephrometry score (mean 7.1, 7.6, 7.8; p=0.0002), and larger tumors (mean 2.9, 3.6 and 3.7cm; p<.0001) than those in the LOS 1 to 3 day group. Significant differences in complication rates were observed when comparing LOS 1-3 (116, 8.9%), LOS=4 (40, 30%), and LOS>4 (59, 54%). According to the Clavien-Dindo classification of surgical complications, 11 grade 3, and 11 grade 4 complications occurred in patients with a LOS of 4 or more days (p<.0001). Post-operative transfusion, deep vein thrombosis, pulmonary embolism, atrial fibrillation, dyspnea/atelectasis, ileus and acute renal failure each significantly predicted a hospital LOS >4 days (p<.001). CONCLUSION: 15.8% of patients undergoing RPN have a LOS of 4 days or more. Longer LOS was associated with higher Charlson index, nephrometry score and perioperative complications. This data may be useful in counseling and payer precertification. Surgeons and hospitals working with higher comorbidity patients and more complex tumors should not be penalized by payers or quality reviewers for longer lengths of stay.
PMID: 25286232
ISSN: 0892-7790
CID: 1299752
Preoperative predictors of malignancy and unfavorable pathology for clinical T1a tumors treated with partial nephrectomy: A multi-institutional analysis
Ball, Mark W; Gorin, Michael A; Bhayani, Sam B; Rogers, Craig G; Stifelman, Michael D; Kaouk, Jihad H; Zargar, Homayoun; Marshall, Susan; Larson, Jeffrey A; Rahbar, Haider M; Trock, Bruce J; Pierorazio, Phillip M; Allaf, Mohamad E
PURPOSE: To determine preoperative predictors associated with renal cell carcinoma (RCC) and unfavorable pathology in small renal masses treated with partial nephrectomy (PN). MATERIALS AND METHODS: PN records from 5 centers were retrospectively queried for patients with a clinically localized single tumor <4cm on imaging (clinical T1a). Between 2007 and 2013, 1,009 patients met the inclusion criteria. Unfavorable pathology was defined as any grade III or IV RCC or tumors upstaged to pathologic T3a disease. Logistic regression models were used to determine preoperative characteristics associated with RCC and with unfavorable pathology. RESULTS: A total of 771 (76.4%) patients were found to have RCC and 198 (19.6%) had unfavorable pathology. On multivariate, bootstrap-adjusted logistic regression analysis, factors associated with the presence of malignancy were imaging tumor size>/=3cm (odds ratio [OR] = 1.46; P = 0.040), male sex (OR = 1.88; P<0.0001), and nephrometry score>/=8 (OR = 1.64; P = 0.005). These same factors were independently associated with risk of unfavorable pathology: size>/=3cm (OR = 1.46; P = 0.021), male sex (OR = 2.35; P<0.0001), and nephrometry score>/=8 (OR = 1.49; P = 0.015). The c statistic was 0.62 for the predicting malignancy and 0.63 for unfavorable pathology. CONCLUSIONS: In this multi-institutional cohort, male sex, imaging tumor size>/=3cm, and nephrometry score>/=8 were predictors of RCC and adverse pathology following PN. These factors may assist in risk stratification and selective renal mass biopsy before decision making. Further studies are necessary to validate these findings.
PMCID:4380792
PMID: 25499258
ISSN: 1078-1439
CID: 1410742
COMPARISON OF MRI-US FUSION TARGETED BIOPSY AND SYSTEMATIC PROSTATE BIOPSY: SINGLE INSTITUTION EXPERIENCE IN 604 PATIENTS. [Meeting Abstract]
Meng, Xiaosong; Rosenkrantz, Andrew B; Mendhiratta, Neil; Fenstermaker, Michael; Huang, Richard; Wysock, James; Bjurlin, Marc; Marshall, Susan; Deng, Fang-Ming; Melamed, Jonathan; Zhou, Ming; Huang, William C; Lepor, Herbert; Taneja, Samir S
ISI:000362826500362
ISSN: 1527-3792
CID: 1871612