41 results on '"Vishnu Ganesan"'
Search Results
2. Preference Signaling and Virtual Interviews: The New Urology Residency Match
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Gianpaolo P, Carpinito, Rohit R, Badia, Roger K, Khouri, Vishnu, Ganesan, Alexander P, Kenigsberg, Steven J, Hudak, and Gary E, Lemack
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Urology - Abstract
To define applicant response to the preference signaling program and continuing virtual aspects of the 2022 Urology Residency Match to guide future decisions surrounding this process.We emailed an anonymous, de-identified 20-question, multiple choice survey to all applicants to our institution for the 2022 Urology Residency Match (RedCap). Where appropriate, comparisons were made to already published data collected in an identical manner from applicants to our institution for the 2021 Urology Residency Match.Of the 418 survey recipients, 155 (37%) responded to our survey. A majority of applicants (83%) thought that preference signaling should remain in future years, and 66% of applicants matched to a program to which they had signaled or where they completed a subinternship. Geographic location of programs was ranked to have the highest impact on choice of programs for preference signaling. Fifty-two percent of 2022 applicants thought that interviews should remain virtual compared with 39% of 2021 applicants (P = .03). Twenty-one percent of 2022 applicants agreed that pre/post-interview socials were well-replicated virtually compared with 10% of 2021 applicants (P = .04).A majority of urology applicants were satisfied with the preference signaling program, suggesting that preference signaling should remain in future matches. A majority of urology applicants now favor the virtual interview platform. While it is gaining greater acceptance among applicants, the virtual platform generally still carries deficiencies. Further research of the urology match process is necessary for continued optimization of the program for all stakeholders.
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- 2023
3. The Virtual Urology Residency Match Process: Moving Beyond the Pandemic
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Vishnu Ganesan, Roger K. Khouri, Amy Kuprasertkul, Kelly M. Caldwell, Alexander P. Kenigsberg, Gianpaolo Carpinito, Steven J. Hudak, and Gary E. Lemack
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Resident selection ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Process (engineering) ,Urology ,COVID-19 ,Internship and Residency ,Online Systems ,United States ,Ranking (information retrieval) ,Surveys and Questionnaires ,Job Application ,Pandemic ,Medicine ,Virtual platform ,business ,Multiple choice - Abstract
OBJECTIVES: To define applicant response to the 2021 Urology Residency Match Process in the COVID-19 Pandemic and to extrapolate lessons to optimize the urology resident selection process after the pandemic. METHODS: We emailed an anonymous, de-identified 22-question, multiple choice survey to all applicants to our institution for the 2021 Urology Residency Match, including a summary of the study with a survey link (RedCap). RESULTS: Of the 398 survey recipients, 144 responded (36%). Even if the match process were not limited by COVID-19, 39% of applicants thought interviews should remain in virtual format, 23% said "no," and 30% said "not sure." Nearly all applicants (97%) thought all interview offers should be released on the same day. Regarding the early match, 84% thought this should remain. When asked what factors had the most impact on rank lists, faculty and resident interviews were overwhelmingly favored. Open houses and resident "happy hours" were less important. Most applicants agreed that the faculty and resident interviews and informational talks were adequately replicated on the virtual platform. A majority of applicants (65%) spent under $2000 for the application cycle. CONCLUSION: The COVID-19 pandemic dramatically changed the urology match process. The faculty and resident interviews remained the most important factors in program ranking, and most applicants agreed those were adequately replicated in the virtual format. A plurality of applicants felt that the interview process should remain virtual in a post-COVID-19 environment. The virtual application cycle reduced the cost of applying to residency.
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- 2021
4. Artificial intelligence in stone disease
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Margaret S. Pearle and Vishnu Ganesan
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Elementary cognitive task ,Ureteral Calculi ,business.industry ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,MEDLINE ,Nephrolithotomy, Percutaneous ,Machine Learning ,External validity ,03 medical and health sciences ,0302 clinical medicine ,Artificial Intelligence ,Lithotripsy ,030220 oncology & carcinogenesis ,medicine ,Humans ,Generalizability theory ,In patient ,Artificial intelligence ,Percutaneous nephrolithotomy ,business ,Algorithms ,Stone disease ,Watchful waiting - Abstract
Purpose of review Artificial intelligence (AI) is the ability of a machine, or computer, to simulate intelligent behavior. In medicine, the use of large datasets enables a computer to learn how to perform cognitive tasks, thereby facilitating medical decision-making. This review aims to describe advancements in AI in stone disease to improve diagnostic accuracy in determining stone composition, to predict outcomes of surgical procedures or watchful waiting and ultimately to optimize treatment choices for patients. Recent findings AI algorithms show high accuracy in different realms including stone detection and in the prediction of surgical outcomes. There are machine learning algorithms for outcomes after percutaneous nephrolithotomy, extracorporeal shockwave lithotripsy, and for ureteral stone passage. Some of these algorithms show better predictive capabilities compared to existing scoring systems and nomograms. Summary The use of AI can facilitate the development of diagnostic and treatment algorithms in patients with stone disease. Although the generalizability and external validity of these algorithms remain uncertain, the development of highly accurate AI-based tools may enable the urologist to provide more customized patient care and superior outcomes.
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- 2021
5. 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
6. Assessing the relationship between statin use and oncologic outcomes among men electing active surveillance for localized prostate cancer
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Michael Gong, Ryan K. Berglund, Daniel Greene, Nima Almassi, Eric A. Klein, Andrew J. Stephenson, Yaw A. Nyame, Lamont Wilkins, Charles Dai, and Vishnu Ganesan
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Cancer Research ,medicine.medical_specialty ,Univariate analysis ,Statin ,business.industry ,Prostatectomy ,medicine.drug_class ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Retrospective cohort study ,Disease ,medicine.disease ,Radiation therapy ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,Internal medicine ,Cohort ,medicine ,business - Abstract
BACKGROUND This study aims to assess the effect of statin therapy on outcomes among men managed with active surveillance. METHODS This is a retrospective cohort study evaluating 635 men managed with active surveillance from 2005 to 2015 at a large, academic medical center. The primary endpoints of analyses are disease reclassification (i.e., change in volume or grade of cancer on subsequent biopsies after diagnosis), progression to definitive therapy with curative intent (i.e., surgery or radiotherapy), and surveillance failure-defined as the development of either biochemical failure after definitive therapy, metastases, or prostate cancer-specific mortality-among statin and non-statin users. Secondary analyses were performed to assess the effect of statin use on outcomes among men who progressed to definitive treatment. RESULTS Three hundred fifty-six (56.1%) patients in the cohort were on statin therapy at the initiation of surveillance. The median age was 66.7 and 63.3 years among statin and non-statin users, respectively. On univariate analysis, there were no differences in the rates of disease reclassification, progression to definitive treatment, and surveillance failure between the statin and non-statin users in the cohort (all p > 0.05). There was no difference in the rate of biochemical failure among men who progressed to definitive therapy when stratified by statin use (p = 0.89). Pathologic data were available for 105 men who progressed to radical prostatectomy while on surveillance at our institution. Duration of statin use (months) was inversely correlated with adverse pathology for radical prostatectomy on both univariate (OR: 0.99; 95% CI 0.98, 0.99; p = 0.03) and multivariate analysis (OR: 0.98; 95% CI 0.97, 0.99; p = 0.02). CONCLUSION Statin use was not associated with any clinical benefit with regard to disease reclassification, progression to definitive treatment, or surveillance failure among men selecting active surveillance at our institution. There was a 2% decrease in the odds of adverse pathology for each month of statin use among the men who progressed to radical prostatectomy while on active surveillance, but it is unclear at this time if this association has any durable impact on surveillance outcomes among men with favorable risk prostate cancer.
- Published
- 2019
7. Supracostal Upper Pole Endoscopic-Guided Prone Tubeless 'Maxi-Percutaneous Nephrolithotomy': A Contemporary Evaluation of Complications
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Manoj Monga, Rajat Jain, Joshua Altschuler, and Vishnu Ganesan
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medicine.medical_specialty ,business.industry ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Patient positioning ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,Complication ,Percutaneous nephrolithotomy ,business - Abstract
Objective: To develop a contemporary complication profile for supracostal upper pole endoscopic-guided prone tubeless “maxi-PCNL” to evaluate the need for change. Materials/Methods: We ide...
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- 2019
8. Retained Ureteral Stents at a Tertiary Referral Stone Center—Who is at Risk?
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Manoj Monga, Vishnu Ganesan, Sri Sivalingam, Mohamed Omar, Rajat Jain, Mark Noble, and Hemant Chaparala
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medicine.medical_specialty ,medicine.diagnostic_test ,Referral ,business.industry ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Electronic medical record ,Insurance type ,Ureteral stents ,Lithotripsy ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Cohort ,medicine ,Medical history ,Ureteroscopy ,business - Abstract
Introduction: Encrustation of retained ureteral stents can lead to significant morbidity. We examined the treatment of patients with retained stents.Methods: Patients with retained stents were identified from a prospectively collected stone registry at a high volume center. The electronic medical record was queried using a relational database management program to parse operative notes for the terms “retained” and “encrusted.” The generated list was manually validated, and data were collected and analyzed retrospectively. We collected demographics, medical history, insurance type, and surgical and postoperative data. Preoperative degree of encrustation was graded using the forgotten, encrusted, calcified system. A cohort of patients undergoing ureteroscopy for urolithiasis was identified as a control group.Results: Overall 66 patients with retained, encrusted stents and 4,962 controls were identified. The indication for stent insertion was most commonly obstructing stone (53%), after ureteroscopy ...
- Published
- 2018
9. Twitter and Instagram Use in the Urology Residency Application Process
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Vishnu Ganesan, Roger K. Khouri, Alexander P. Kenigsberg, Gianpaolo Carpinito, Kelly M. Caldwell, Amy Kuprasertkul, Steven J. Hudak, and Gary E. Lemack
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Male ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Urology ,Internship and Residency ,Social life ,Job Application ,medicine ,Humans ,Social media ,Female ,business ,Social Media ,Multiple choice - Abstract
Objectives : To define urology applicant attitudes and usage trends of social media (SM) during the 2021 urology match cycle. Methods : We emailed an anonymous, de-identified 22-question, multiple choice survey to all applicants to our institution for the 2021 Urology Residency Match. We asked participants about use of SM and which aspects they found useful in the application process. Univariate descriptive analyses were conducted based on survey responses. Chi-square analyses were performed to define significant differences in use of social media and resultant match outcomes. Results : Of the 528 students who registered for the 2021 AUA Match, 398 received our survey (75%), and 144 responded (27% of applicants nationwide). Of survey participants, 49% made a new account on Twitter while 30% had a preexisting account. Most participants (71%) had a preexisting Instagram account, while only 3% made a new account. Most participants agreed Twitter was used as a source to gather information about programs (84%) and learn about events (89%). Participants found SM most helpful for announcing event dates (71%) and highlighting resident social life (59%). Applicants did not match more highly on their rank lists if they used Twitter (p=0.427) or Instagram (p=0.166) and were not more likely to get more interviews if they used Twitter (p=0.246) or Instagram (p=0.114) Conclusions : Applicants found Twitter to be an important source of information through the virtual interview process. Despite the use of SM by most applicants, published content did not impact rank list decisions nor did SM engagement predict match outcomes.
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- 2021
10. Single-port robotic-assisted simple prostatectomy is associated with decreased post-operative narcotic use in a propensity score matched analysis
- Author
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Vishnu, Ganesan, Ryan L, Steinberg, Alaina, Garbens, Hersh, Trivedi, Igor, Sorokin, Claus A, Roehrborn, Brett A, Johnson, and Jeffrey C, Gahan
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Male ,Narcotics ,Prostatectomy ,Treatment Outcome ,Robotic Surgical Procedures ,Humans ,Propensity Score - 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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- 2020
11. Urology Residency Applications in the COVID-19 Era
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Roger K. Khouri, Vishnu Ganesan, Gary E. Lemack, Amy Kuprasertkul, Alexander P. Kenigsberg, and Daniel Wong
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Adult ,Male ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Best practice ,Urology ,Pneumonia, Viral ,030232 urology & nephrology ,Article ,Interviews as Topic ,Betacoronavirus ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Humans ,Medicine ,School Admission Criteria ,Pandemics ,Career Choice ,Descriptive statistics ,SARS-CoV-2 ,business.industry ,Communication ,COVID-19 ,Internship and Residency ,030220 oncology & carcinogenesis ,Female ,Professional association ,Coronavirus Infections ,business ,Career choice - Abstract
Objective To evaluate urology applicants’ opinions about the interview process during the COVID-19 pandemic. Material and Methods An anonymous survey was emailed to applicants to our institution from the 2019 and 2020 urology matches prior to issuance of professional organization guidelines. The survey inquired about attitudes toward the residency interview process in the era of COVID-19 and which interview elements could be replicated virtually. Descriptive statistics were utilized. Results Eighty percent of urology applicants from the 2019 and 2020 matches received our survey. One hundred fifty-six people (24% of recipients) responded. Thirty-four percent preferred virtual interviews, while 41% in-person interviews at each program, and 25% regional/centralized interviews. Sixty-four percent said that interactions with residents (pre/postinterview social and informal time) were the most important interview day component and 81% said it could not be replicated virtually. Conversely, 81% believed faculty interviews could be replicated virtually. Eighty-seven percent believed that city visits could not be accomplished virtually. A plurality felt that away rotations and second-looks should be allowed (both 45%). Comment Applicants feel that faculty interviews can be replicated virtually, while resident interactions cannot. Steps such as a low-stakes second looks after programs submit rank lists (potentially extending this window) and small virtual encounters with residents could ease applicant concerns. Conclusion Applicants have concerns about changes to the match processes. Programs can adopt virtual best practices to address these issues.
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- 2020
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12. The effect of partial nephrectomy on blood pressure in patients with solitary kidney
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Georges-Pascal Haber, Nikhil Gupta, Tian min Gao, Joseph Zabell, Steven C. Campbell, and Vishnu Ganesan
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Nephrology ,Adult ,Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Diastole ,Blood Pressure ,Nephrectomy ,Cohort Studies ,03 medical and health sciences ,Solitary Kidney ,Young Adult ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Antihypertensive Agents ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Retrospective cohort study ,Perioperative ,Middle Aged ,medicine.disease ,Kidney Neoplasms ,Blood pressure ,030220 oncology & carcinogenesis ,Cohort ,Hypertension ,Female ,business ,Kidney cancer - Abstract
To determine the effect of partial nephrectomy (PN) in the solitary kidney on systolic and diastolic blood pressures (SBP and DBP, respectively), and use of antihypertensive medications. We performed a retrospective cohort study of solitary kidney patients who underwent PN for kidney cancer from 1999–2015. Primary outcomes evaluated were blood pressure (BP) and antihypertensive medication changes from baseline up to 5 years postoperatively. Using a multivariable mixed-effects model to account for repeated measurements, we evaluated the effect of PN on the outcome measurements while controlling for baseline patient, pathologic, and perioperative characteristics. 292 patients who underwent PN on solitary kidneys met inclusion criteria (median [range] age, 63 [24–84] years; 179 men [61%]). SBP decreased immediately postoperatively (− 1.7 mmHg [− 2.6, − 0.7], p
- Published
- 2020
13. MP36-09 SLING POSITION ON 3D-TRANSLABIAL ULTRASOUND CORRELATES WITH VOIDING SYMPTOMS IN WOMEN UNDERGOING MIDURETHRAL SLING REMOVAL
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Jorge L. Fuentes, Monica Morgan, Gaurav Khatri, Philippe E. Zimmern, Vishnu Ganesan, and Melissa Foreman
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medicine.medical_specialty ,Sling removal ,Sling (implant) ,genetic structures ,business.industry ,Urology ,Ultrasound ,Medicine ,Translabial ultrasound ,business ,Surgery - Abstract
INTRODUCTION AND OBJECTIVE:3D-Translabial Ultrasound (3DUS) has proven to be an effective modality for identifying the morphology and course of a mid-urethral sling (MUS) prior to sling removal. Th...
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- 2020
14. 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
15. Intermediate-Term Outcomes for Men with Very Low/Low and Intermediate/High Risk Prostate Cancer Managed by Active Surveillance
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Daniel Greene, Vishnu Ganesan, Eric A. Klein, Khaled Fareed, Nima Almassi, Daniel Hettel, Chad A. Reichard, Samuel Haywood, Yaw A. Nyame, Michael Gong, Ahmed Elshafei, J. Stephen Jones, Alice Crane, Robert J. Stein, Ryan K. Berglund, Joseph Zabell, Andrew J. Stephenson, Charles Dai, Hans Arora, and Anna Zampini
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Intermediate term ,medicine.medical_specialty ,business.industry ,Urology ,030232 urology & nephrology ,Cancer ,medicine.disease ,Surgery ,Metastasis ,03 medical and health sciences ,Prostate cancer ,Prostate-specific antigen ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Epidemiology ,Cohort ,medicine ,business ,Survival analysis - Abstract
Purpose: We compare intermediate term clinical outcomes among men with favorable risk and intermediate/high risk prostate cancer managed by active surveillance.Materials and Methods: A total of 635 men with localized prostate cancer have been on active surveillance since 2002 at a high volume academic hospital in the United States. Median followup is 50.5 months (IQR 31.1–80.3). Time to event analysis was performed for our clinical end points.Results: Of the cohort 117 men (18.4%) had intermediate/high risk disease. Overall 5 and 10-year all cause survival was 98% and 94%, respectively. Cumulative metastasis-free survival at 5 and 10 years was 99% and 98%, respectively. To date no cancer specific deaths had been observed. Overall freedom from intervention was 61% and 49% at 5 and 10 years, respectively. Overall cumulative freedom from failure of active surveillance, defined as metastasis or biochemical failure after local therapy with curative intent, was 97% and 91% at 5 and 10 years, respectively. Of th...
- Published
- 2017
16. C-Reactive Protein and Erythrocyte Sedimentation Rate Predict Systemic Inflammatory Response Syndrome After Percutaneous Nephrolithotomy
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Manoj Monga, Juan Jimenez, Robert D. Brown, Vishnu Ganesan, and Shubha De
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Adult ,Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Blood Sedimentation ,Nephrolithotomy, Percutaneous ,Sensitivity and Specificity ,Gastroenterology ,Kidney Calculi ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Percutaneous nephrolithotomy ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,biology ,business.industry ,C-reactive protein ,Length of Stay ,Middle Aged ,medicine.disease ,Systemic Inflammatory Response Syndrome ,Systemic inflammatory response syndrome ,C-Reactive Protein ,Logistic Models ,ROC Curve ,030220 oncology & carcinogenesis ,Erythrocyte sedimentation rate ,Anesthesia ,biology.protein ,Female ,business - Abstract
The aim of the study was to test the hypothesis that high levels of preoperative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are associated with an increased risk of systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL).This is a retrospective study of patients who underwent PCNL at our institution between October 2012 and October 2013 when ESR and CRP levels were part of our standard preoperative order set. The primary endpoint was development of SIRS. Receiver operating characteristic curves were used to evaluate the discriminative ability of the test.Among the 107 PCNLs performed during the study period, 35 (33%) patients had evidence of SIRS during the postoperative stay. Patients who experienced SIRS had a longer operative time (99 min vs. 85 min, p = 0.016), were more likely to have been transferred to the intensive care unit (ICU) (15% vs. 0%, p = 0.002), and experienced a longer length of stay (2 days vs. 1 day, p 0.001). On multivariable analysis controlling for operative time and positive urine culture, ESR (odds ratio [OR] 1.32, 95% confidence interval [CI]: 1.01-1.72, p = 0.04) and CRP (OR 1.59; 95% CI: 1.07-2.37, p = 0.02) were associated with development of SIRS. Among patients without a positive urine culture, an ESR6.5 mm/hr (AUC 0.62; 95% CI: 0.52-0.78) had sensitivity, specificity, and negative predictive value (NPV) of 70.4%, 61.5%, and 80.0%, respectively, for development of SIRS. Among all patients, a CRP0.65 mg/dL (AUC 0.63; 95% CI: 0.51-0.74) had sensitivity, specificity, and NPV of 51.4%, 69.4%, and 74.6%.A preoperative blood test for ESR and CRP was predictive for the development of SIRS after PCNL. This knowledge could be used to risk stratify patients and guide duration of antibiotic prophylaxis before PCNL, particularly among those without a positive urine culture.
- Published
- 2017
17. Urolithiasis and Frequent CT Scans: Does Chronic Pain Play a Role?
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Manoj Monga, Arash Akhavein, Sarah Tarplin, Sri Sivalingam, and Vishnu Ganesan
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Adult ,Male ,Background information ,medicine.medical_specialty ,Urology ,030232 urology & nephrology ,Computed tomography ,Tertiary care ,Insurance Coverage ,03 medical and health sciences ,0302 clinical medicine ,Urolithiasis ,Odds Ratio ,medicine ,Humans ,In patient ,Retrospective Studies ,Retrospective review ,medicine.diagnostic_test ,Medicaid ,business.industry ,Chronic pain ,030208 emergency & critical care medicine ,Health Care Costs ,Emergency department ,Middle Aged ,medicine.disease ,United States ,Logistic Models ,Pain Clinics ,Multivariate Analysis ,Female ,Radiology ,Chronic Pain ,Emergency Service, Hospital ,Tomography, X-Ray Computed ,business - Abstract
Urolithiasis is among the top 10 causes of Emergency Department (ED) visits in the United States. Approximately 50% of these patients undergo abdominopelvic CT scan, many more than once. We hypothesized that chronic pain conditions may contribute to frequent CT scans in patients who are evaluated in ED for urolithiasis.A retrospective review of patients presenting to our tertiary care and the associated satellite EDs for urolithiasis, during the period 12/2012-05/2013, was performed. Patients with multiple ED visits and two or more abdominopelvic CT scans in any 6-month period were labeled as the frequent CT group. Control group consisted of similar patients who had no more than one CT scan in any 6-month period. Background information, number of CT scans for urolithiasis and other reasons, and the presence of chronic pain (established pain clinic visits, chronic pain medication, known chronic pain syndromes) were captured from charts. Wilcoxon rank-sum test and Fisher's exact test were used to compare variables. Multivariable logistic regression was performed to identify predictors associated with frequent CT scans.We identified 185 patients with frequent CTs and 139 patients in the control arm. Frequent CT scans were independently associated with chronic pain (odds ratio [OR]: 2.67, confidence interval [95% CI]: 1.55, 4.50), age (OR: 0.73, 95% CI: 0.60, 0.89), history of prior urolithiasis (OR: 2.15, 95% CI: 1.11, 4.15), and Medicaid insurance status (OR: 3.94, 95% CI: 1.66, 9.35).Chronic pain is a significant contributing factor to frequent CT scans among patients presenting to ED with urolithiasis, leading to increased radiation exposure and healthcare costs.
- Published
- 2016
18. Clinical Predictors of 30-Day Emergency Department Revisits for Patients with Ureteral Stones
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Sri Sivalingam, Manoj Monga, Bryan Hinck, Christopher J. Loftus, Daniel Greene, Yaw A. Nyame, and Vishnu Ganesan
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Ureteral Calculi ,Nausea ,Urology ,030232 urology & nephrology ,Patient characteristics ,Patient Readmission ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Ureter ,Initial visit ,medicine ,Humans ,030212 general & internal medicine ,Hydronephrosis ,Retrospective Studies ,business.industry ,General surgery ,Retrospective cohort study ,Emergency department ,Middle Aged ,Prognosis ,medicine.disease ,humanities ,medicine.anatomical_structure ,Female ,Medical emergency ,medicine.symptom ,Emergency Service, Hospital ,Tomography, X-Ray Computed ,business ,Cohort study - Abstract
Patients with ureteral stones frequently present to the emergency department for an initial evaluation with pain and/or nausea. However, a subset of these patients subsequently return to the emergency department for additional visits. We sought to identify clinical predictors of emergency department revisits.We reviewed emergency department visits at our institution with an ICD-9 diagnosis of urolithiasis and an associated computerized tomography scan between 2010 and 2013. Computerized tomography studies were independently reviewed to confirm stone size and location, and degree of hydronephrosis. The primary outcome was a second emergency department visit within 30 days of the initial visit for reasons related to the stone. Patient characteristics and stone parameters at presentation were recorded. Univariable and multivariable analyses were done to identify factors associated with emergency department revisits.We reviewed the records of 1,510 patients 18 years old or older who presented to the emergency department with a diagnosis of ureteral stones confirmed by computerized tomography. Of the patients 164 (11%) revisited the emergency department within 30 days. On multivariable analysis the presence of a proximal ureteral stone, age less than 30 years and the need for intravenous narcotics in the emergency department remained independently associated with an emergency department revisit.Younger patients, those with proximal stones and those requiring intravenous narcotics for pain control are more likely to return to the emergency department. Consideration should be given for early followup or intervention for these patients to prevent costly emergency department returns.
- Published
- 2016
19. Single-port robotic-assisted laparoscopic sacrocolpopexy with magnetic retraction: first experience using the SP da Vinci platform
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Maude Carmel, Vishnu Ganesan, Dayron Rodriguez, Ramy Goueli, and Deborah Hess
- Subjects
medicine.medical_specialty ,Robotic assisted ,Operative Time ,030232 urology & nephrology ,Blood Loss, Surgical ,Health Informatics ,Pelvic Organ Prolapse ,03 medical and health sciences ,Magnetics ,0302 clinical medicine ,Port (medical) ,Gynecologic Surgical Procedures ,Blood loss ,Robotic Surgical Procedures ,medicine ,Humans ,Laparoscopic sacrocolpopexy ,Aged ,Pelvic organ ,business.industry ,Middle Aged ,Right upper quadrant ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Laparoscopy ,business - Abstract
The purpose of this study was to describe technical considerations and first outcomes from a single-port robotic-assisted sacrocolpopexy (RSC) using the da Vinci SP platform (Intuitive Surgical, Sunnyvale, CA) and the Levita™ Magnetic Surgical System (San Mateo, CA, USA), a novel magnetic retraction system. Three females with pelvic organ prolapse elected to undergo RSC using the da Vinci SP platform. The supraumbilical incision length was 25 mm through which SP trocar was placed. A 12-mm assistant port was placed in the right upper quadrant. The external magnet was attached to the left side of the bed and used for bowel and bladder retraction. We then proceeded by duplicating the steps of our approach for a RSC performed using a multi-port robotic platform with necessary modifications given the SP approach. Intra-operative outcomes and peri-operative outcomes were collected and reported. The patients were women of 64, 66 and 73 years of age with BMI of 22, 25, and 34, respectively, and POP-Q stage III and IV prolapse. The RSC was performed between 198 and 247 min, estimated blood loss was 10–50 cc, and there were no complications. All patients were discharged home on post-operative day 1. All patients were doing well 1 month out with resolution of bulge symptoms. To our knowledge, this represents the first case series of robotic, magnetic-assisted sacrocolpopexies using the da Vinci SP platform and the Levita™ Magnetic Surgical System. It appears to be a safe and feasible approach, but long-term comparative studies will be necessary to assess functional outcomes.
- Published
- 2019
20. Assessing the relationship between statin use and oncologic outcomes among men electing active surveillance for localized prostate cancer
- Author
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Yaw A, Nyame, Lamont, Wilkins, Daniel J, Greene, Vishnu, Ganesan, Charles, Dai, Nima, Almassi, Andrew J, Stephenson, Michael, Gong, Ryan, Berglund, and Eric A, Klein
- Subjects
Male ,Prostatectomy ,Biopsy ,Brachytherapy ,Prostate ,Prostatic Neoplasms ,Kaplan-Meier Estimate ,Middle Aged ,Prostate-Specific Antigen ,Risk Assessment ,Disease-Free Survival ,Disease Progression ,Humans ,Kallikreins ,Treatment Failure ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Neoplasm Grading ,Watchful Waiting ,Aged ,Follow-Up Studies ,Retrospective Studies - Abstract
This study aims to assess the effect of statin therapy on outcomes among men managed with active surveillance.This is a retrospective cohort study evaluating 635 men managed with active surveillance from 2005 to 2015 at a large, academic medical center. The primary endpoints of analyses are disease reclassification (i.e., change in volume or grade of cancer on subsequent biopsies after diagnosis), progression to definitive therapy with curative intent (i.e., surgery or radiotherapy), and surveillance failure-defined as the development of either biochemical failure after definitive therapy, metastases, or prostate cancer-specific mortality-among statin and non-statin users. Secondary analyses were performed to assess the effect of statin use on outcomes among men who progressed to definitive treatment.Three hundred fifty-six (56.1%) patients in the cohort were on statin therapy at the initiation of surveillance. The median age was 66.7 and 63.3 years among statin and non-statin users, respectively. On univariate analysis, there were no differences in the rates of disease reclassification, progression to definitive treatment, and surveillance failure between the statin and non-statin users in the cohort (all p 0.05). There was no difference in the rate of biochemical failure among men who progressed to definitive therapy when stratified by statin use (p = 0.89). Pathologic data were available for 105 men who progressed to radical prostatectomy while on surveillance at our institution. Duration of statin use (months) was inversely correlated with adverse pathology for radical prostatectomy on both univariate (OR: 0.99; 95% CI 0.98, 0.99; p = 0.03) and multivariate analysis (OR: 0.98; 95% CI 0.97, 0.99; p = 0.02).Statin use was not associated with any clinical benefit with regard to disease reclassification, progression to definitive treatment, or surveillance failure among men selecting active surveillance at our institution. There was a 2% decrease in the odds of adverse pathology for each month of statin use among the men who progressed to radical prostatectomy while on active surveillance, but it is unclear at this time if this association has any durable impact on surveillance outcomes among men with favorable risk prostate cancer.
- Published
- 2019
21. Plasmacytoid Urothelial Carcinoma of the Bladder Presenting as a Rectal Mass
- Author
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Bradley C. Gill, David A. Goldfarb, and Vishnu Ganesan
- Subjects
Male ,Carcinoma, Transitional Cell ,Pathology ,medicine.medical_specialty ,CARCINOMA TRANSITIONAL CELL ,Rectal Neoplasms ,business.industry ,Urology ,030232 urology & nephrology ,03 medical and health sciences ,RECTAL MASS ,0302 clinical medicine ,Urinary Bladder Neoplasms ,Neoplasm Invasiveness ,030220 oncology & carcinogenesis ,medicine ,Humans ,business ,Aged ,Urothelial carcinoma - Published
- 2016
22. 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
23. Older Age at Diagnosis and Initial Disease Volume Predict Grade Reclassification Risk on Confirmatory Biopsy in Patients Considered for Active Surveillance
- Author
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Vishnu Ganesan, Cristina Magi-Galluzzi, Michael Gong, Nima Almassi, Daniel Greene, Daniel Hettel, Andrew J. Stephenson, Yaw A. Nyame, J. Stephen Jones, Eric A. Klein, Ryan K. Berglund, and Charles Dai
- Subjects
Male ,medicine.medical_specialty ,Urology ,Biopsy ,030232 urology & nephrology ,Recursive partitioning ,Logistic regression ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,Medicine ,Humans ,Stage (cooking) ,Watchful Waiting ,medicine.diagnostic_test ,business.industry ,Age Factors ,Prostatic Neoplasms ,Odds ratio ,Confidence interval ,Tumor Burden ,030220 oncology & carcinogenesis ,Predictive value of tests ,Cohort ,Neoplasm Grading ,business - Abstract
OBJECTIVE To identify which active surveillance candidates benefit most from confirmatory biopsies to exclude grade underclassification. MATERIALS AND METHODS This observational study includes 556 men diagnosed between 2002 and 2015 with Gleason 3 + 3 (GG1) disease on initial diagnostic biopsy, of whom 406 received a confirmatory biopsy within 12 months for active surveillance. Multivariable logistic regression analysis was performed to determine clinicopathologic features associated with Gleason 7 or higher (GG2+) on a confirmatory biopsy. Regression tree analysis was employed to stratify patients into select risk groups. RESULTS Eighty-five of 406 patients (20.9%) with initially GG1 disease were reclassified to GG2+ on a confirmatory biopsy. On multivariable analysis, increasing age (per year odds ratio 1.07; 95% confidence interval 1.02-1.12; P
- Published
- 2018
24. Reducing Costs for Robotic Radical Prostatectomy: Three-instrument Technique
- Author
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Daniel Ramirez, Ryan J. Nelson, Vishnu Ganesan, and Georges-Pascal Haber
- Subjects
medicine.medical_specialty ,business.industry ,Prostatectomy ,Urology ,medicine.medical_treatment ,Forceps ,030232 urology & nephrology ,Robotic Surgical Procedures ,Positive patient ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Laparoscopic Prostatectomy ,Medicine ,Initial capital ,Robotic surgery ,Operations management ,Instrumentation (computer programming) ,business - Abstract
Objective To describe our technique for performing robotic-assisted laparoscopic prostatectomy (RALP) and pelvic lymph node dissection using only 3 robotic instruments to reduce disposable costs associated with the robotic surgical platform. Methods The financial impact of robotic surgery is real. Whereas the initial capital investment of the robotic platform (including the cost of the device itself and the maintenance contract) is largely fixed, the cost of disposable instrumentation can vary depending on utilization. Herein we describe our technique for 3-instrument robotic radical prostatectomy that may decrease costs by limiting the use of disposable instruments. Results Exclusion of the high-cost energy instruments may reduce operative costs by up to 40%. In addition, using 1 robotic needle driver vs 2 may decrease overall costs by another 12%. At our institution, we have adopted these techniques in cost-efficiency and have gone further by only using 3 instruments during robotic radical prostatectomy. The only 3 instruments necessary to perform a successful RALP are a robotic needle driver, Prograsp forceps, and monopolar scissors. Conclusion To improve the value of care while utilizing robotic technology, we must be cognizant of keeping operative costs to a minimum while maintaining positive patient outcomes. We demonstrate here a method to decrease disposable operating room costs while preserving the ability to successfully perform a RALP.
- Published
- 2016
25. Accurately Diagnosing Uric Acid Stones from Conventional Computerized Tomography Imaging: Development and Preliminary Assessment of a Pixel Mapping Software
- Author
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Manoj Monga, Vishnu Ganesan, Giovanni Scala Marchini, Nicholas Shkumat, and Shubha De
- Subjects
Adult ,Pixel mapping ,Urology ,030232 urology & nephrology ,Calcium oxalate ,Uric acid stones ,Models, Biological ,Sensitivity and Specificity ,030218 nuclear medicine & medical imaging ,Diagnosis, Differential ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Software ,Hounsfield scale ,Medical imaging ,Medicine ,Humans ,Aged ,Retrospective Studies ,Calcium Oxalate ,business.industry ,Middle Aged ,Uric Acid ,chemistry ,Uric acid ,Urinary Calculi ,Tomography ,Nuclear medicine ,business ,Tomography, X-Ray Computed ,Algorithms - Abstract
Preoperative determination of uric acid stones from computerized tomography imaging would be of tremendous clinical use. We sought to design a software algorithm that could apply data from noncontrast computerized tomography to predict the presence of uric acid stones.Patients with pure uric acid and calcium oxalate stones were identified from our stone registry. Only stones greater than 4 mm which were clearly traceable from initial computerized tomography to final composition were included in analysis. A semiautomated computer algorithm was used to process image data. Average and maximum HU, eccentricity (deviation from a circle) and kurtosis (peakedness vs flatness) were automatically generated. These parameters were examined in several mathematical models to predict the presence of uric acid stones.A total of 100 patients, of whom 52 had calcium oxalate and 48 had uric acid stones, were included in the final analysis. Uric acid stones were significantly larger (12.2 vs 9.0 mm, p = 0.03) but calcium oxalate stones had higher mean attenuation (457 vs 315 HU, p = 0.001) and maximum attenuation (918 vs 553 HU, p0.001). Kurtosis was significantly higher in each axis for calcium oxalate stones (each p0.001). A composite algorithm using attenuation distribution pattern, average attenuation and stone size had overall 89% sensitivity, 91% specificity, 91% positive predictive value and 89% negative predictive value to predict uric acid stones.A combination of stone size, attenuation intensity and attenuation pattern from conventional computerized tomography can distinguish uric acid stones from calcium oxalate stones with high sensitivity and specificity.
- Published
- 2017
26. Impact of 5α-Reductase Inhibitors on Disease Reclassification among Men on Active Surveillance for Localized Prostate Cancer with Favorable Features
- Author
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Daniel Greene, Yaw A. Nyame, Nima Almassi, Daniel Hettel, Eric A. Klein, Cristina Magi-Galluzzi, Anna Zampini, Michael Gong, Andrew J. Stephenson, Hans Arora, J. Stephen Jones, Alice Crane, Robert J. Stein, Khaled Fareed, Vishnu Ganesan, Ahmed Elshafei, Chad A. Reichard, Joseph Zabell, Charles Dai, Jianbo Li, and Samuel Haywood
- Subjects
Adult ,Male ,medicine.medical_specialty ,Urology ,030232 urology & nephrology ,Antineoplastic Agents ,Disease ,Drug Administration Schedule ,03 medical and health sciences ,chemistry.chemical_compound ,Prostate cancer ,0302 clinical medicine ,5-alpha Reductase Inhibitors ,Internal medicine ,Biopsy ,medicine ,Clinical endpoint ,Humans ,Watchful Waiting ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Gynecology ,medicine.diagnostic_test ,business.industry ,Cancer ,Prostatic Neoplasms ,Middle Aged ,medicine.disease ,Dutasteride ,Survival Analysis ,Treatment Outcome ,chemistry ,030220 oncology & carcinogenesis ,Cohort ,Finasteride ,Neoplasm Grading ,business ,Follow-Up Studies - Abstract
We determined the effect of 5α-reductase inhibitors on disease reclassification in men with prostate cancer optimally selected for active surveillance.In this retrospective review we identified 635 patients on active surveillance between 2002 and 2015. Patients with favorable cancer features on repeat biopsy, defined as absent Gleason upgrading, were included in the cohort. Patients were stratified by those who did or did not receive finasteride or dutasteride within 1 year of diagnosis. The primary end point was grade reclassification, defined as any increase in Gleason score or predominant Gleason pattern on subsequent biopsy. This was assessed by multivariable Cox proportional hazards regression analysis.At diagnosis 371 patients met study inclusion criteria, of whom 70 (19%) were started on 5α-reductase inhibitors within 12 months. Median time on active surveillance was 53 vs 35 months in men on vs not on 5α-reductase inhibitors (p 0.01). Men on 5α-reductase inhibitors received them for a median of 23 months (IQR 6-37). On actuarial analysis there was no significant difference in grade reclassification for 5α-reductase inhibitor use in patients overall or in the very low/low risk subset. The overall percent of patients who experienced grade reclassification was similar at 13% vs 14% (p = 0.75). After adjusting for baseline clinicopathological features 5α-reductase inhibitors were not significantly associated with grade reclassification (HR 0.80, 95% CI 0.31-1.80, p = 0.62). Furthermore, no difference in adverse features on radical prostatectomy specimens was observed in treated patients (p = 0.36).Among our cohort of men on active surveillance 5α-reductase inhibitor use was not associated with a significant difference in grade reclassification with time.
- Published
- 2017
27. Prognostic Significance of a Negative Confirmatory Biopsy on Reclassification Among Men on Active Surveillance
- Author
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Hans Arora, Andrew J. Stephenson, Nima Almassi, J. Stephen Jones, Daniel Hettel, Alice Crane, Robert J. Stein, Khaled Fareed, Michael Gong, Yaw A. Nyame, Anna Zampini, Charles Dai, Vishnu Ganesan, Ryan K. Berglund, Joseph Zabell, Daniel Greene, Samuel Haywood, Ahmed Elshafei, Eric A. Klein, and Chad A. Reichard
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Urology ,Biopsy ,030232 urology & nephrology ,Kaplan-Meier Estimate ,Risk Assessment ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Aged ,Ohio ,Retrospective Studies ,Gynecology ,medicine.diagnostic_test ,business.industry ,Proportional hazards model ,Incidence (epidemiology) ,Incidence ,Hazard ratio ,Prostate ,Prostatic Neoplasms ,Retrospective cohort study ,Middle Aged ,Prostate-Specific Antigen ,medicine.disease ,Prognosis ,Confidence interval ,Survival Rate ,030220 oncology & carcinogenesis ,Disease Progression ,Neoplasm Grading ,business ,Primary Gleason Pattern ,Follow-Up Studies - Abstract
Objective To examine the association between absence of disease on confirmatory biopsy and risk of pathologic reclassification in men on active surveillance (AS). Materials and Methods Men with grade groups 1 and 2 disease on AS between 2002 and 2015 were identified who received a confirmatory biopsy within 1 year of diagnosis and ≥3 biopsies overall. The primary outcomes were pathologic reclassification by grade (any increase in primary Gleason pattern or Gleason score) or volume (>33% of sampled cores involved or increase in the number of cores with >50% involvement). The effect of a negative confirmatory biopsy survival was evaluated using Kaplan-Meier analysis and a Cox proportional hazards modeling. Results Out of 635 men, 224 met inclusion criteria (median follow-up: 55.8 months). A total of 111 men (49.6%) had a negative confirmatory biopsy. Decreased grade reclassification (69.7% vs 83.9%; P = .01) and volume reclassification (66.3% vs 87.4%; P = .004) was seen at 5 years for men with a negative confirmatory biopsy compared with those with a positive biopsy. On adjusted analysis, a negative confirmatory biopsy was associated with a decreased risk of grade reclassification (hazard ratio, 0.51; 95% confidence interval, 0.28-0.94; P = .03) and volume reclassification (hazard ratio, 0.32; 95% confidence interval, 0.17-0.61; P = .0006) at a median of 4.7 years. Conclusion Absence of cancer on the confirmatory biopsy is associated with a significant decrease in rate of grade and volume reclassification among men on AS. This information may be used to better counsel men on AS.
- Published
- 2017
28. MP75-17 C-REACTIVE PROTEIN AND ERYTHROCYTE SEDIMENTATION RATE PREDICTS SIRS AFTER PERCUTANEOUS NEPHROLITHOTOMY
- Author
-
Manoj Monga, Shubha De, Juan A. Jiménez, Robert S. Brown, and Vishnu Ganesan
- Subjects
medicine.medical_specialty ,biology ,medicine.diagnostic_test ,business.industry ,Urology ,Erythrocyte sedimentation rate ,medicine.medical_treatment ,C-reactive protein ,biology.protein ,medicine ,Percutaneous nephrolithotomy ,business - Published
- 2017
29. PD55-12 OLDER AGE AT DIAGNOSIS AND DISEASE VOLUME PREDICT UPGRADING ON CONFIRMATORY BIOPSY IN PROSTATE CANCER PATIENTS BEING CONSIDERED FOR ACTIVE SURVEILLANCE
- Author
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Alice Crane, Anna Zampini, Robert Stein, Chad A. Reichard, Daniel Greene, Joseph Zabell, Yaw A. Nyame, Khaled Fareed, Vishnu Ganesan, Eric A. Klein, Charles Dai, Hans Arora, Andrew J. Stephenson, Nima Almassi, J. Stephen Jones, Michael Gong, Ahmed Elshafei, Samuel Haywood, and Daniel Hettel
- Subjects
Gynecology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Urology ,Age at diagnosis ,Disease ,medicine.disease ,Prostate cancer ,Biopsy ,medicine ,Radiology ,business ,Volume (compression) - Published
- 2017
30. Multiple sclerosis and nephrolithiasis: a matched-case comparative study
- Author
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Rajat Jain, Shubha De, Manoj Monga, Vishnu Ganesan, and Wen Min Chen
- Subjects
Male ,medicine.medical_specialty ,Multiple Sclerosis ,Urology ,medicine.medical_treatment ,Urinary system ,Population ,030232 urology & nephrology ,Urine ,03 medical and health sciences ,chemistry.chemical_compound ,Kidney Calculi ,0302 clinical medicine ,Risk Factors ,Medicine ,Humans ,Hypercalciuria ,Percutaneous nephrolithotomy ,education ,Retrospective Studies ,education.field_of_study ,business.industry ,Middle Aged ,Hyperuricosuria ,medicine.disease ,Surgery ,chemistry ,Kidney stone disease ,Case-Control Studies ,Uric acid ,Female ,business ,030217 neurology & neurosurgery - Abstract
Objective To compare stone composition and serum/urine biochemistries in stone formers with multiple sclerosis (MS) against stone formers without MS and to examine the association between mobility, methods of bladder emptying, and stone formation. Materials and Methods In this retrospective case-control study, we identified patients diagnosed with multiple sclerosis and kidney stone disease who were seen at our institution between 2001 and 2016. For the first part of the study, up to 2 controls (stone formers without a history of MS) were identified for each case and matched on age, body mass index (BMI), and sex. For the second part of this study, matched controls (MS patients without a history of stones) were identified in a 1:1 ratio in a similar fashion. Results of 24-hour urine biochemistry studies, stone compositions, serum labs, medications, history of stone surgeries, mobility, and method of bladder emptying were collected. Results A total of 587 patients were identified who had both multiple sclerosis and a history of stone disease. Of these, 118 patients had a stone composition available. When compared to matched controls, patients with MS were significantly more likely to have calcium phosphate stones (42% vs 15%, p < 0.001) and struvite stones (8% vs 3%, p = 0.03) and less likely to have calcium oxalate monohydrate stones (39% vs. 64%, p < 0.001). Among those patients with a composition available, those with MS were more likely to have undergone a PCNL (25% vs 12%, p = 0.005) or a cystolithopaxy (16% vs. 3%, p < 0.001) compared to their matched controls. 61 patients had a complete 24-hour urinary stone panel. There were no significant differences in urinary pH, volume, creatinine, calcium, citrate, oxalate, sodium, and uric acid as well as rates of hypocitraturia, hyperoxaluria, hypercalciuria, and hyperuricosuria among patients with MS. Use of intermittent straight catheterization (OR, 3.50 [95% CI, 1.89-6.47]; P = < 0.001) or an indwelling catheter (OR, 9.78 [95% CI, 4.81-19.88]; P =
- Published
- 2017
31. Accuracy of ultrasonography for renal stone detection and size determination: is it good enough for management decisions?
- Author
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Shubha De, Manoj Monga, Vishnu Ganesan, Fabio Cesar Miranda Torricelli, and Daniel Greene
- Subjects
medicine.medical_specialty ,Urology ,Clinical Decision-Making ,030232 urology & nephrology ,Patient characteristics ,Computed tomography ,Asymptomatic ,Sensitivity and Specificity ,03 medical and health sciences ,Kidney Calculi ,0302 clinical medicine ,Ureter ,medicine ,Humans ,Size determination ,Retrospective Studies ,Ultrasonography ,Renal stone ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Radiology ,medicine.symptom ,business ,Tomography, X-Ray Computed - Abstract
Objectives To determine the sensitivity and specificity of ultrasonography (US) for detecting renal calculi and to assess the accuracy of US for determining the size of calculi and how this can affect counselling decisions. Materials and Methods We retrospectively identified all patients at our institution with a diagnosis of nephrolithiasis who underwent US followed by non-contrast computed tomography (CT) within 60 days. Data on patient characteristics, stone size (maximum axial diameter) and stone location were collected. The sensitivity, specificity and size accuracy of US was determined using CT as the standard. Results A total of 552 US and CT examinations met the inclusion criteria. Overall, the sensitivity and specificity of US was 54 and 91%, respectively. There was a significant association between sensitivity of US and stone size (P < 0.001), but not with stone location (P = 0.58). US significantly overestimated the size of stones in the 0–10 mm range (P < 0.001). Assuming patients with stones 0–4 mm in size will be selected for observation and those with stones ≥5 mm could be counselled on the alternative of intervention, we found that in 14% (54/384) of cases where CT would suggest observation, US would lead to a recommendation for intervention. By contrast, when CT results would suggest intervention as management, US would suggest observation in 39% (65/168) of cases. An average of 22% (119/552) of patients could be inappropriately counselled. Stones classified as 5–10 mm according to US had the highest probability (43% [41/96]) of having their management recommendation changed when CT was performed. The use of plain abdominal film of kidney, ureter and bladder and US increases sensitivity (78%), but 37% (13/35) of patients may still be counselled inappropriately to undergo observation. Conclusions Using US to guide clinical decision-making for residual or asymptomatic calculi is limited by low sensitivity and inability to size the stone accurately. As a result, one in five patients may be inappropriately counselled when using US alone.
- Published
- 2016
32. PD47-11 PREDICTORS OF EMERGENCY DEPARTMENT REVISITS FOR URETERAL STONES
- Author
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Daniel Greene, Yaw A. Nyame, Manoj Monga, Sri Sivalingam, Vishnu Ganesan, Christopher J. Loftus, and Bryan Hinck
- Subjects
business.industry ,Urology ,medicine ,Medical emergency ,Emergency department ,medicine.disease ,business - Published
- 2016
33. PD03-11 PATHOLOGIC OUTCOMES AMONG MEN WITH EARLY VERSUS DELAYED PROGRESSION TO RADICAL PROSTATECTOMY AFTER INITIAL ACTIVE SURVEILLANCE
- Author
-
Vishnu Ganesan, Yaw A. Nyame, Daniel Greene, Anna Zampini, Joseph Zabell, Robert Stein, Eric A. Klein, Nima Almassi, Khaled Fareed, Charles Dai, Daniel Hettel, Ahmed Elshafei, Michael Gong, J. Stephen Jones, Andrew J. Stephenson, Samuel Haywood, Hans Arora, Alice Crane, and Chad A. Reichard
- Subjects
Biochemical recurrence ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Prostatectomy ,Urology ,medicine.medical_treatment ,Disease ,Log-rank test ,symbols.namesake ,Biopsy ,Chi-square test ,symbols ,Medicine ,Stage (cooking) ,business ,Fisher's exact test - Abstract
primary treatment for PCa between September 2001 and December 2013 at a high volume US tertiary referral center was used. Patients satisfying Epstein’s criteria pre-operatively for AS based on a standard biopsy strategy (Biopsy Gleason 6 or less, clinical stage T1b or T1c, pre-operative PSA 10ng/ml or less, tumor volume in any core less than 50% and only 1 or 2 positive cores) were identified. Race, Post-surgical disease stage, Gleason score, lymph node status, tumor volume assessment and biochemical recurrence free survival (BRFS) were assessed. Statistical differences in post-operative disease status were assessed with Chi square or Fisher Exact test (categorical variables) and t-distribution for Pearson correlation coefficient. RESULTS: 6,372 men underwent RARP, of whom 1,358 (21.3%) satisfied Epstein’s criteria for AS. 22% Caucasians and only 14% African-Americans met AS criteria. No racial differences in post-surgical disease status or outcome were noted. 209 of patient’s satisfying Epstein’s criteria (15.3%) had pathological stage T3 or T4 disease and 2 patients had positive lymph nodes. 550 patients (41%) were upgraded on final pathology with 68 (5%) having Gleason 4+3 disease and 11 (1%) having Gleason 8 or more disease. Tumor volume in the biopsy specimen significantly correlated with final pathology volume (p
- Published
- 2016
34. MP15-10 THE PROGNOSTIC SIGNIFICANCE OF A NEGATIVE CONFIRMATORY PROSTATE BIOPSY ON PROGRESSION FOR PATIENTS ON ACTIVE SURVEILLANCE
- Author
-
Daniel Greene, Eric A. Klein, Vishnu Ganesan, J. Stephen Jones, Anna Zampini, Sam Haywood, Nima Almassi, Daniel Hettel, Alice Crane, Khaled Fareed, Robert Stein, Chad A. Reichard, Hans Arora, Joseph Zabell, Andrew J. Stephenson, Yaw A. Nyame, Michael Gong, Ahmed Elshafei, and Charles Dai
- Subjects
Oncology ,medicine.medical_specialty ,Prostate biopsy ,medicine.diagnostic_test ,business.industry ,Urology ,Internal medicine ,medicine ,business - Published
- 2016
35. MP15-15 A RETROSPECTIVE REVIEW OF A LARGE ACTIVE SURVEILLANCE COHORT IN PATIENTS WITH PROSTATE CANCER AT THE CLEVELAND CLINIC
- Author
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Nima Almassi, Anna Zampini, Khaled Fareed, Robert Stein, Alice Crane, Yaw A. Nyame, Hans Arora, Daniel Hettel, Chad A. Reichard, Ahmed Elshafei, Andrew J. Stephenson, Michael Gong, Charles Dai, Samuel Haywood, Joseph Zabell, J. Stephen Jones, Daniel Greene, Vishnu Ganesan, and Eric A. Klein
- Subjects
Biochemical recurrence ,Gynecology ,Retrospective review ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Prostatectomy ,Urology ,medicine.medical_treatment ,Gleason grading ,urologic and male genital diseases ,medicine.disease ,Prostate cancer ,Biopsy ,Cohort ,Medicine ,In patient ,business - Abstract
Gleason score undergrading. We compared biochemical recurrence rates (BCR) after radical prostatectomy between patients with active surveillance (AS) suitable prostate cancer versus wider defined low risk prostate cancer and the effect of Gleason score upgrading after surgery. METHODS: Two prostatectomy cohorts were combined. Lowrisk PC was defined as T1-2, Gleason 6 prostate cancer and AS-suitable prostate cancer was defined using the ‘PRIAS-criteria’ as T1-2, PSA 1⁄4
- Published
- 2016
36. PD08-03 5-ALPHA-REDUCTASE INHIBITORS IN MEN ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER
- Author
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Vishnu Ganesan, Alice Crane, Chad A. Reichard, Michael Gong, Charles Dai, Samuel Haywood, Yaw A. Nyame, Andrew J. Stephenson, Hans Arora, Khaled Fareed, Ahmed Elshafei, Daniel Hettel, Nima Almassi, Joseph Zabell, Daniel Greene, Eric A. Klein, Robert Stein, J. Stephen Jones, and Anna Zampini
- Subjects
5 Alpha-Reductase Inhibitor ,Prostate cancer ,business.industry ,Urology ,Cancer research ,Medicine ,business ,medicine.disease - Published
- 2016
37. Robotic-assisted Laparoscopic Bilateral Nerve Sparing and Apex Preserving Cystoprostatectomy in Young Men With Bladder Cancer
- Author
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Daniel Ramirez, Homayoun Zargar, Georges-Pascal Haber, Yaw A. Nyame, Paurush Babbar, Vishnu Ganesan, and Arnauld Villers
- Subjects
Adult ,Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Urinary Diversion ,Ileal conduit urinary diversion ,Cystectomy ,Cystoprostatectomy ,03 medical and health sciences ,0302 clinical medicine ,Robotic Surgical Procedures ,Ileum ,medicine ,Carcinoma ,Humans ,Laparoscopy ,Prostatectomy ,Carcinoma, Transitional Cell ,Bladder cancer ,medicine.diagnostic_test ,Urinary continence ,business.industry ,Urinary diversion ,Prostate ,medicine.disease ,Surgery ,Urinary Bladder Neoplasms ,030220 oncology & carcinogenesis ,business ,Organ Sparing Treatments - Abstract
To describe our technique and outcomes of robotic-assisted nerve-sparing cystoprostatectomy with prostatic apex preservation and orthotopic ileal conduit urinary diversion in young men undergoing robotic-assisted radical cystectomy (RARC) for the management of urothelial carcinoma.Young men (40 years old) with the diagnosis of urothelial carcinoma undergoing RARC with orthotopic neobaldder formation were eligible for our technique of nerve-sparing cystoprostatectomy with prostatic apex preservation at the time of orthotopic ileal conduit urinary diversion. During the apical prostatic dissection step of the RARC, the plane of dissection is directed under the dorsal vein complex and through anterior prostatic fibromuscular stroma. This plane is further carried through the prostatic urethra, transecting the most caudal aspect of prostatic peripheral zone posteriorly, to create a long urethra and a posterior urethral plate formed by peripheral zone of the prostate, which serves as a robust, long stump for the subsequent vesicourethral anastomosis.From January 2013 to January 2014, 3 men were treated with RARC and intracorporeal neobladder urinary diversion based on the described technique. There were no intraoperative complications. Two patients experienced grade II complications postoperatively. Pathologic assessment demonstrated negative surgical margins in all 3 cases. With mean follow-up time of 28.2 months, 2 out of 3 patients are free from disease recurrence. All patients report daytime urinary continence with no pad usage and potency without the need for phosphodiesterase-5 inhibitors.RARC with bilateral nerve and apical preservation can be performed safely in appropriately selected young patients with excellent functional and acceptable short-term oncologic results.
- Published
- 2016
38. Management of Challenging Urethro-ileal Anastomosis During Robotic Assisted Radical Cystectomy with Intracorporeal Neobladder Formation
- Author
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Nima Almassi, Georges-Pascal Haber, Homayoun Zargar, Vishnu Ganesan, and Amr Fergany
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Urology ,medicine.medical_treatment ,Operative Time ,Urinary Bladder ,030232 urology & nephrology ,Anastomosis ,Urinary Diversion ,Cystectomy ,Surgically-Created Structures ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Robotic Surgical Procedures ,Urethra ,Ileum ,Risk Factors ,Medicine ,Humans ,Aged ,Ohio ,Retrospective Studies ,business.industry ,Medical record ,Urinary diversion ,Anastomosis, Surgical ,Sigmoid colon ,Retrospective cohort study ,Length of Stay ,Middle Aged ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,business - Abstract
Background Robotic assisted radical cystectomy (RARC) is increasingly being adopted, but intracorporeal neobladder formation remains a challenging procedure limited to selected centers. Common challenges with intracorporeal neobladder formation relate to fashioning a tension-free urethro-ileal anastomosis. In this paper, we describe a series of maneuvers to overcome these challenges that we believe will be of great utility to surgeons performing intracorporeal neobladder. Objective To describe maneuvers to overcome challenges during intracorporeal urethro-ileal anastomosis formation and to report postoperative outcomes for patients in whom these maneuvers were used. Design, setting, and participants A retrospective review of medical records of patients who underwent RARC with intracorporeal neobladder performed by one surgeon (G.-P.H.) at our tertiary center from January 2012 to February 2015 in which at least one additional maneuver was required beyond preservation of urethral length, removal of the sigmoid colon from the pelvis, and careful ileal loop selection. The primary end point was 90-d complications. Follow-up ranged from 6 to 36 mo, and 16 patients had at least 1-yr follow-up. Surgical procedure RARC with intracorporeal neobladder formation. Outcome measurements and statistical analyses Clinical and operative data collected from a prospectively maintained, institutional review board–approved database. Maneuvers used during intracorporeal urethro-ileal anastomosis were recorded. Descriptive statistics were used to evaluate postoperative outcomes. Results and limitations Nineteen patients met the inclusion criteria. Mean operative time was 486min (standard deviation: 112min) with median hospitalization of 7 d (interquartile range: 7–9 d). Seven patients (36.8%) experienced a complication, with one (5.3%) major complication thought to be unrelated to surgery. No open conversions were required. There was no 90-d mortality. Conclusions Our stepwise approach can help overcome challenges of urethro-ileal anastomosis during intracorporeal neobladder formation. Patient summary When performing intracorporeal neobladder formation, challenges are often encountered in fashioning the urethro-ileal anastomosis. We describe a series of maneuvers that, when used in a stepwise manner, help overcome these challenges.
- Published
- 2015
39. Stone formation and management after bariatric surgery
- Author
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Sarah Tarplin, Manoj Monga, and Vishnu Ganesan
- Subjects
Male ,medicine.medical_specialty ,Urology ,Urinary system ,Population ,Calcium oxalate ,Bariatric Surgery ,Global Health ,Oxalate ,chemistry.chemical_compound ,Insulin resistance ,Postoperative Complications ,Urolithiasis ,Risk Factors ,medicine ,Prevalence ,Humans ,education ,education.field_of_study ,business.industry ,medicine.disease ,Hyperuricosuria ,Fat malabsorption ,Surgery ,Obesity, Morbid ,chemistry ,Female ,business ,Hypocitraturia - Abstract
Obesity is a significant health concern and is associated with an increased risk of nephrolithiasis, particularly in women. The underlying pathophysiology of stone formation in obese patients is thought to be related to insulin resistance, dietary factors, and a lithogenic urinary profile. Uric acid stones and calcium oxalate stones are common in these patients. Use of surgical procedures for obesity (bariatric surgery) has risen over the past two decades. Although such procedures effectively manage obesity-dependent comorbidities, several large, controlled studies have revealed that modern bariatric surgeries increase the risk of nephrolithiasis by approximately twofold. In patients who have undergone bariatric surgery, fat malabsorption leads to hyperabsorption of oxalate, which is exacerbated by an increased permeability of the gut to oxalate. Patients who have undergone bariatric surgery show characteristic 24 h urine parameters including low urine volume, low urinary pH, hypocitraturia, hyperoxaluria and hyperuricosuria. Prevention of stones with dietary limitation of oxalate and sodium and a high intake of fluids is critical, and calcium supplementation with calcium citrate is typically required. Potassium citrate is valuable for treating the common metabolic derangements as it raises urinary pH, enhances the activity of stone inhibitors, reduces the supersaturation of calcium oxalate, and corrects hypokalaemia. Both pyridoxine and probiotics have been shown in small studies to reduce hyperoxaluria, but further study is necessary to clarify their effects on stone morbidity in the bariatric surgery population.
- Published
- 2015
40. V8-02 MANAGEMENT OF CHALLENGING URETHRO-ILEAL ANASTOMOSIS DURING ROBOTIC INTRACORPOREAL NEOBLADDER FORMATION
- Author
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Georges-Pascal Haber, Homayoun Zargar, Nima Almassi, Amr Fergany, and Vishnu Ganesan
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,medicine ,Anastomosis ,business ,Surgery - Published
- 2015
41. Implementation and Validation of Bioplausible Visual Servoing Control
- Author
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William D. Nothwang, Joe Conroy, Richard Murray, Vishnu Ganesan, Shuo Han, Alec Koppel, and Alma Wickenden
- Subjects
business.industry ,Settling time ,Computer science ,ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION ,Optical flow ,Stability (learning theory) ,Context (language use) ,Robotics ,Visual servoing ,Noise ,Control theory ,Artificial intelligence ,business ,Simulation - Abstract
In this report, we compare the performance of the Lucas-Kanade algorithm with feature tracking with the bioplausible optical flow algorithm to achieve pose stabilization in the context of one-dimensional (1-D) attitude stabilization. These results have been benchmarked against an ideal controller in both simulation and robotic experimentation. Within both environments, the accuracy, stability, and settling time were evaluated as a function of contrast and system noise. Both algorithms achieved reasonable performance when compared to the ideal controller, but in most cases the Lucas-Kanade algorithm outperformed the bioplausible algorithm. Within the evaluated serial implementation, the Lucas-Kanade algorithm was also faster. It is anticipated that both performance and processing speed will improve for the bioplausible algorithm when it is implemented in a parallel instantiation.
- Published
- 2013
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