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The iTind Temporarily Implanted Nitinol Device for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Multicenter, Randomized, Controlled Trial

Chughtai, Bilal; Elterman, Dean; Shore, Neal; Gittleman, Marc; Motola, Jay; Pike, Sheldon; Hermann, Craig; Terrens, William; Kohan, Alfred; Gonzalez, Ricardo R; Katz, Aaron; Schiff, Jeffery; Goldfischer, Evan; Grunberger, Ivan; Tu, Le Mai; Alshak, Mark N; Kaminetzky, Jed
OBJECTIVE:To report the results of a multicenter, randomized, controlled trial with a temporarily implanted nitinol device (iTind; Medi-Tate Ltd, Hadera, Israel) compared to sham for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS/METHODS:Men 50 years or older were randomized 2:1 between iTind and sham procedure arms. A self-expanding, temporary nitinol device was placed for 5-7 days and an 18F Foley catheter was inserted and removed for the iTind and sham group, respectively. Patients were assessed at baseline, 1.5, 3, and 12 months postoperatively using the IPSS, peak urinary flow rate, residual urine, quality of life, and the International Index of Erectile Function. Unblinding occurred at 3 months. RESULTS:A total of 175 men (mean age 61.1 ± 6.5) participated (118 iTind vs 57 sham). A total of 78.6% of patients in the iTind arm showed a reduction of ≥3 points in IPSS, vs 60% of patients in the control arm at 3 months. At 12 months, the iTind group reported a 9.25 decrease in IPSS (P< .0001), a 3.52ml/s increase in peak urinary flow rate (P < .0001) and a 1.9-point reduction in quality of life (P < .0001). Adverse events were typically mild and transient, most Clavien-Dindo grade I or II, in 38.1% of patients in the iTind arm and 17.5% in the control arm. No de novo ejaculatory or erectile dysfunction occurred. CONCLUSION/CONCLUSIONS:Treatment with the second-generation iTind provided rapid and sustained improvement in lower urinary tract symptoms for the study period while preserving sexual function.
PMID: 33373708
ISSN: 1527-9995
CID: 4770992

THE ITIND TEMPORARILY IMPLANTED NITINOL DEVICE FOR THE TREATMENT OF LOWER URINARY TRACT SYMPTOMS SECONDARY TO BENIGN PROSTATIC HYPERPLASIA: A MULTICENTER, RANDOMIZED, CONTROLLED TRIAL [Meeting Abstract]

Chughtai, Bilal; Elterman, Dean; Shore, Neal; Gittleman, Marc; Motola, Jay; Pike, Sheldon; Herman, Craig; Terens, William; Kohan, Alfred; Gonzalez, Ricardo; Katz, Aaron; Schiff, Jeffrey; Goldfischer, Evan; Grunberger, Ivan; Tu, Le Mai; Alshak, Mark; Kaminetsky, Jed
ISI:000693688000717
ISSN: 0022-5347
CID: 5403642

PRESERVATION OF EJACULATORY AND ERECTILE FUNCTION WITH ITIND SYSTEM FOR TREATMENT OF LOWER URINARY TRACT SYMPTOMS SECONDARY TO BENIGN PROSTATIC HYPERPLASIA [Meeting Abstract]

Chughtai, Bilal; Kaminetsky, Jed; Shore, Neal; Gittleman, Marc; Motola, Jay; Pike, Sheldon; Herman, Craig; Terens, William; Kohan, Alfred; Gonzalez, Ricardo; Katz, Aaron; Schiff, Jeffrey; Goldfischer, Evan; Grunberger, Ivan; Tu, Le Mai; Alshak, Mark; Elterman, Dean
ISI:000693688000007
ISSN: 0022-5347
CID: 5403592

The iTind temporarily implanted nitinol device for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: A multicenter, randomized, controlled trial [Meeting Abstract]

Chughtai, B.; Elterman, D.; Shore, N.; Gittleman, M.; Motola, J.; Pike, S.; Hermann, C.; Terens, W.; Kohan, A.; Gonzalez, R.; Katz, A.; Schiff, J.; Goldfischer, E.; Grunberger, I; Tu, L. M.; Alshak, M.; Kaminetsky, J.
ISI:000674144300045
ISSN: 0302-2838
CID: 5404272

Pathologic measures of quality compare favorably in patients undergoing robot-assisted radical cystectomy to open cystectomy cohorts: a National Cancer Database analysis

Miguel, Carla M; Kosinski, Kaitlin E; Fazzari, Melissa J; Kongnyuy, Michael; Smaldone, Marc C; Schiff, Jeffrey T; Katz, Aaron E; Corcoran, Anthony T
This study aims to assess the impact of facility characteristics on measures of surgical quality (positive surgical margin rates and lymph-node yield) in patients undergoing robot-assisted (RARC) versus open (ORC) radical cystectomy using the National Cancer Database. Patients who received RC between the years of 2010-2013 were stratified according to surgery type (ORC vs. RARC), and corresponding patient and facility-level variables (facility type and volume) were assessed. Logistic regression models for procedure type, positive surgical margins (PSMs), and LN dissection (LND) rates were estimated. Radical cystectomies (ORC = 13,236, RARC = 3687) were performed more often in academic centers (58.3%) compared to community centers (31.6%). As facility volume increased, centers performed more LNDs during ORCs (p = 0.03) and the number of nodes retrieved increased in both ORC and RARC (ORC p < 0.001; RARC p < 0.0001). Increased facility volume also resulted in significantly fewer PSMs within the RARC cohort (p = 0.01). Comparison of ORC and RARC within each facility type cohort identified improved pathological metrics for RARC with fewer PSMs (p = 0.001) as well as increased LNDs (p < 0.0001) and median number of LNs retrieved (p < 0.0001), which suggests that RARC may facilitate comparative outcomes in community centers and academic centers. Overall, higher facility volume and robot-assisted surgery resulted in more favorable pathologic metrics compared to lower facility volume and ORC.
PMID: 31583520
ISSN: 1863-2491
CID: 4116922

Evaluation of a novel cystoscopic compatible cryocatheter for the treatment of bladder cancer

Baust, John M.; Robilotto, Anthony; Santucci, Kimberly L.; Snyder, Kristi K.; van Buskirk, Robert G.; Katz, Aaron; Corcoran, Anthony; Baust, John G.
BACKGROUND: As the acceptance of cryoablative therapies for the treatment of non-metastatic cancers continues to grow, avenues for novel cryosurgical technologies and approaches have opened. Within the field of genitourinary tumors, cryosurgical treatments of bladder cancers remain largely investigational. Current modalities employ percutaneous needles or transurethral cryoballoons or sprays, and while results have been promising, each technology is limited to specific types and stages of cancers. OBJECTIVE: This study evaluated a new, self-contained transurethral cryocatheter, FrostBite-BC, for its potential to treat bladder cancer. METHODS: Thermal characteristics and ablative capacity were assessed using calorimetry, isothermal analyses, in vitro 3-dimensional tissue engineered models (TEMs), and a pilot in vivo porcine study. RESULTS: Isotherm assessment revealed surface temperatures below -20◦ C within 9 sec. In vitro TEMs studies demonstrated attainment of ≤-20◦ C at 6.1 mm and 8.2 mm in diameter following single and double 2 min freezes, respectively. Fluorescent imaging 24 hr post-thaw revealed uniform, ablative volumes of 326.2 mm3 and 397.9 mm3 following a single or double 2 min freeze. In vivo results demonstrated the consistent generation of ablative areas. Lesion depth was found to correlate with freeze time wherein 15 sec freezes resulted in ablation confined to the sub-mucosa and ≥30 sec full thickness ablation of the bladder wall. CONCLUSIONS: These studies demonstrate the potential of the FrostBite-BC cryocatheter as a treatment option for bladder cancer. Although preliminary, the outcomes of these studies were encouraging, and support the continued investigation into the potential of the FrostBite-BC cryocatheter as a next generation, minimally invasive cryoablative technology.
SCOPUS:85096342859
ISSN: 2352-3727
CID: 4683422

Prostate Fiducial Marker Placement in Patients on Anticoagulation: Feasibility Prior to Prostate SBRT

Iocolano, Michelle; Blacksburg, Seth; Carpenter, Todd; Repka, Michael; Carbone, Susan; Demircioglu, Gizem; Miccio, Maryann; Katz, Aaron; Haas, Jonathan
Background and Purpose: Fiducial marker placement is required in patients undergoing robotic-based Stereotactic Body Radiotherapy (SBRT) or image-guided radiation therapy (IGRT) for prostate cancer. Many patients take antiplatelet or anticoagulant medication due to other medical comorbidities. They are often required to temporarily discontinue these medications prior to invasive medical procedures as they are prone to bleed. Some patients are unable to discontinue therapy due to an elevated risk of thromboembolic events. The purpose of this study is to report this institution's experience placing fiducial markers in prostate cancer patients who are on chronic antiplatelet or anticoagulant medication. Materials and Methods: From August 2015-March 2019 57 patients on chronic antiplatelet or anticoagulation therapy who were not cleared to stop these medications underwent transrectal ultrasound guided (TRUS) fiducial marker placement for SBRT/IGRT. All patients were monitored by a registered nurse during the procedure for prolonged bleeding that required staff to hold pressure to the area with a 4 × 4 gauze until it resolved. All patients were also called the following day to assess for ongoing bleeding events. Treatment planning CT scan confirmed the ideal geometry of the marker placement. Results: All 57 patients on antiplatelet or anticoagulant medication who underwent fiducial marker placement were discharged home the same day of the procedure. Four patients experienced persistent bleeding that required a nurse to hold prolonged pressure to the area. No patient experienced significant bleeding the following day or any untoward cardiovascular event. Conclusions: This series suggests the use of antiplatelet or anticoagulant medication is not an absolute contraindication to fiducial marker placement in patients undergoing SBRT or IGRT for prostate cancer. These patients should be closely monitored after the procedure for bleeding complications. Practitioners may consider the patient's medical comorbidities, risk factors for thromboembolism, and overall functional status as there is no standardized protocol for discontinuing anticoagulant or antiplatelet therapy for fiducial marker placement.
PMCID:7056879
PMID: 32175274
ISSN: 2234-943x
CID: 4371092

Assessing Clinical and Dosimetric Predictors For Low PSA Nadir after Stereotactic Body Radiation Monotherapy with Intraprostatic Dose Escalation [Meeting Abstract]

Blacksburg, S. R.; Sheu, R.; Carpenter, T. J.; Demircioglu, G.; Repka, M. C.; Witten, M. R.; Mendez, C.; Shin, W.; Chieng, T.; Katz, A. E.; Haas, J. A.
ISI:000582521503084
ISSN: 0360-3016
CID: 4686362

Comparisons Between Patients at Suburban and Inner-City Facilities Treated With Prostate SBRT: Long-Term Parity in Outcomes Despite Measurable Differences in Demographic and Disease Profiles [Meeting Abstract]

Blacksburg, S. R.; Carpenter, T. J.; Marans, H.; Demircioglu, G.; Witten, M. R.; Repka, M. C.; Mendez, C.; Katz, A. E.; Haas, J. A.
ISI:000582521501385
ISSN: 0360-3016
CID: 4686232

Omission of MRI For Treatment Planning Does Not Affect Long-Term Outcomes after Prostate SBRT. [Meeting Abstract]

Blacksburg, S. R.; Sheu, R.; Carpenter, T. J.; Demircioglu, G.; Witten, M. R.; Mendez, C.; Auto, H.; Zheng, B.; Katz, A. E.; Haas, J. A.
ISI:000582521503115
ISSN: 0360-3016
CID: 4686372