Publications by authors named "Igor Sorokin"

39 Publications

Neutron Source Based on Vacuum Insulated Tandem Accelerator and Lithium Target.

Biology (Basel) 2021 Apr 21;10(5). Epub 2021 Apr 21.

Faculty of Physics, Novosibirsk State University, 2 Pirogov Str., 630090 Novosibirsk, Russia.

A compact accelerator-based neutron source has been proposed and created at the Budker Institute of Nuclear Physics in Novosibirsk, Russia. An original design tandem accelerator is used to provide a proton beam. The proton beam energy can be varied within a range of 0.6-2.3 MeV, keeping a high-energy stability of 0.1%. The beam current can also be varied in a wide range (from 0.3 mA to 10 mA) with high current stability (0.4%). In the device, neutron flux is generated as a result of the Li(p,n)Be threshold reaction. A beam-shaping assembly is applied to convert this flux into a beam of epithermal neutrons with characteristics suitable for BNCT. A lot of scientific research has been carried out at the facility, including the study of blistering and its effect on the neutron yield. The BNCT technique is being tested in in vitro and in vivo studies, and the methods of dosimetry are being developed. It is planned to certify the neutron source next year and conduct clinical trials on it. The neutron source served as a prototype for a facility created for a clinic in Xiamen (China).
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http://dx.doi.org/10.3390/biology10050350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143170PMC
April 2021

Single-port robotic-assisted simple prostatectomy is associated with decreased post-operative narcotic use in a propensity score matched analysis.

J Robot Surg 2021 Apr 10. Epub 2021 Apr 10.

Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA.

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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http://dx.doi.org/10.1007/s11701-021-01236-1DOI Listing
April 2021

Irreversible Electroporation for Renal Ablation Does Not Cause Significant Injury to Adjacent Ureter or Bowel in a Porcine Model.

J Endourol 2021 06 17;35(6):873-877. Epub 2020 Dec 17.

Department of Urology and UT Southwestern Medical Center, Dallas, Texas, USA.

To evaluate the safety of irreversible electroporation (IRE) for renal ablation adjacent to the ureter or bowel. Six adult pigs each underwent bilateral IRE of the kidney. To simulate adjacence, the left proximal ureter and duodenum were secured onto the left and right kidney capsule, respectively. Two IRE probes were placed into the renal parenchyma and configured to bridge the ureter and bowel. Therapeutic IRE was delivered at 2000 V/cm for 70 pulses in both forward and reverse polarity. The animal was survived and euthanized at 1, 3, or 14 days. Histopathology was obtained for all potentially injured bowel and ureteral segments. Retrograde pyelogram (RPG) was performed on each left-sided ureter. Histologic analysis of the ureter identified reactive changes at the level of the periureteral adipose tissue, which progressed from acute inflammation on day 1 to focal fibrosis by day 14. Urothelial mucosa and surrounding smooth muscle layers were unaffected at all time points. RPGs did not show any abnormalities in all specimens. Histologic analysis of the bowel demonstrated acute inflammation in the serosa and subserosal tissue on day 1. Three days after IRE, inflammation and crypt abscesses were focally present in the deep aspects of the bowel mucosa. Inflammation in the mucosal layer resolved 14 days after IRE. In a porcine model of renal IRE, no significant injury was apparent after intentional ablation adjacent to the ureter and bowel. IRE may be a safe alternative to thermal ablation for tumors near the ureter or bowel.
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http://dx.doi.org/10.1089/end.2020.0856DOI Listing
June 2021

Expression of Small Noncoding RNAs in Urinary Exosomes Classifies Prostate Cancer into Indolent and Aggressive Disease.

J Urol 2020 09 19;204(3):466-475. Epub 2020 Mar 19.

miR Scientific LLC, Rensselaer, New York.

Purpose: This is the first report of the development and performance of a platform that interrogates small noncoding RNAs (sncRNA) isolated from urinary exosomes. The Sentinel™ PCa Test classifies patients with prostate cancer from subjects with no evidence of prostate cancer, the miR Sentinel CS Test stratifies patients with prostate cancer between those with low risk prostate cancer (Grade Group 1) from those with intermediate and high risk disease (Grade Group 2-5), and the miR Sentinel HG Test stratifies patients with prostate cancer between those with low and favorable intermediate risk prostate cancer (Grade Group 1 or 2) and those with high risk (Grade Group 3-5) disease.

Materials And Methods: sncRNAs were extracted from urinary exosomes of 235 participants and interrogated on miR 4.0 microarrays. Using proprietary selection and classification algorithms, informative sncRNAs were selected to customize an interrogation OpenArray™ platform that forms the basis of the tests. The tests were validated using a case-control sample of 1,436 subjects.

Results: The performance of the miR Sentinel PCa Test demonstrated a sensitivity of 94% and specificity of 92%. The Sentinel CS Test demonstrated a sensitivity of 93% and specificity of 90% for prediction of the presence of Grade Group 2 or greater cancer, and the Sentinel HG Test demonstrated a sensitivity of 94% and specificity of 96% for the prediction of the presence of Grade Group 3 or greater cancer.

Conclusions: The Sentinel PCa, CS and HG Tests demonstrated high levels of sensitivity and specificity, highlighting the utility of interrogation of urinary exosomal sncRNAs for noninvasively diagnosing and classifying prostate cancer with high precision.
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http://dx.doi.org/10.1097/JU.0000000000001020DOI Listing
September 2020

Ten-Year Outcomes of Renal Tumor Radio Frequency Ablation.

J Urol 2019 02;201(2):251-258

Department of Urology, University of Texas Southwestern, Dallas, Texas.

Purpose: We reviewed long-term oncologic outcomes in patients with renal tumors treated with radio frequency ablation more than 10 years ago.

Materials And Methods: We retrospectively reviewed the records of patients with renal tumors who underwent radio frequency ablation from November 2000 to August 2007. Demographic, clinical and radiological data were assessed to determine evidence of disease recurrence. Patients with familial renal cell carcinoma syndromes were excluded from study. We calculated disease-free, metastasis-free, cancer specific and overall survival with the Kaplan-Meier method. Subgroup analysis of patients who had at least 10 years followup was performed to determine actual 10-year survival. Analysis was also performed based on tumor size.

Results: A total of 112 tumors in 106 patients were treated with radio frequency ablation. Median followup was 79 months (IQR 28.9-121.1) and mean ± SD tumor size was 2.5 ± 0.8 cm. Initial technical success was achieved in 97% of cases. There were 10 recurrences. Kaplan-Meier 6-year disease-free and cancer specific survival rates were 89% and 96%, respectively. Disease-free survival decreased to 68% for tumors greater than 3 cm. In the subgroup with at least 10-year followup the actual disease-free, cancer specific and overall survival rates were 82%, 94% and 49%, respectively. No patient experienced recurrence after 5 years.

Conclusions: Radio frequency ablation is a safe and effective treatment option for small renal masses less than 3 cm in diameter. We report good oncologic outcomes with actual 10-year survival data. No recurrence developed after 5 years. Tumors greater than 3 cm have significantly poorer outcomes.
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http://dx.doi.org/10.1016/j.juro.2018.08.045DOI Listing
February 2019

Medical therapy for nephrolithiasis: State of the art.

Asian J Urol 2018 Oct 3;5(4):243-255. Epub 2018 Sep 3.

Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.

The prevalence of nephrolithiasis is increasing worldwide. Understanding and implementing medical therapies for kidney stone prevention are critical to prevent recurrences and decrease the economic burden of this condition. Dietary and pharmacologic therapies require understanding on the part of the patient and the prescribing practitioner in order to promote compliance. Insights into occupational exposures and antibiotic use may help uncover individual risk factors. Follow-up is essential to assess response to treatment and to modify treatment plans to maximize therapeutic benefit.
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http://dx.doi.org/10.1016/j.ajur.2018.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197179PMC
October 2018

Development and Evaluation of a Novel Endoscopic Sack to Facilitate Tissue Prostate Adenoma Morcellation.

J Endourol 2018 12;32(12):1136-1141

1 Department of Urology, University of Texas Southwestern , Dallas, Texas.

Introduction: Morcellation of the adenoma after laser enucleation of the prostate (LEP) is both time-consuming and prone to complications. We have designed a novel polyethylene sack (ProSac) to improve the morcellation process following LEP. Both silicone and cadaver models were utilized to evaluate the safety and efficacy of ProSac.

Methods: The inanimate model used tissue-mimicking silicone to accurately approximate bladder volume and compliance. The second model was developed using a fresh cadaver. Heat-fixed chicken breast was used to mimic enucleated prostatic adenoma. Morcellation of the simulated adenoma tissue was tested in both models with and without the ProSac. Morcellated tissue was removed from the filter, desiccated, and weighed after each run to establish morcellation efficiency. Visual inspection was used to evaluate for mucosal injury or bladder perforation. A hydromanometer was placed in the cadaveric bladder to measure bladder pressure.

Results: The device was able to capture up to 30 g of tissue with good closure while maintaining good distention and visualization during morcellation. In the silicone model, morcellation efficiency with the device was 4.6 g/minute, while efficiency without the device was 2.6 g/minute (p = 0.03). In the cadaveric model, mean entrapment time was 22 ± 11 seconds. Morcellation efficiency with the device was 2.1 g/minute when excluding entrapment time and 1.9 g/minute including entrapment time. Without the ProSac, morcellation efficiency was 1.2 g/minute (p = 0.05). In both models, multiple mucosal injuries occurred without the device, while none occurred with the device. Bladder pressure was similar between study arms.

Conclusions: The ProSac is a novel device that can provide additional safety during adenoma morcellation. It may also achieve clinically and statistically significant improvement in morcellation efficiency without increasing bladder pressure.
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http://dx.doi.org/10.1089/end.2018.0618DOI Listing
December 2018

Surgical Outcomes of Three vs Four Arm Robotic Partial Nephrectomy: Is the Fourth Arm Necessary?

Urology 2019 01 21;123:140-145. Epub 2018 Sep 21.

Department of Urology, University of Texas Southwestern, Dallas, TX. Electronic address:

Objective: To compare the cost, efficacy, and safety of 3-arm versus 4-arm technique in robotic partial nephrectomy (RPN). Surgeons may either elect to utilize three vs four robotic instruments depending on preference. The purpose of this study is to compare the outcomes between the two techniques.

Methods: RPNs from June 2016 to August 2017 were retrospectively reviewed. Tumor features, surgical parameters, and operative outcomes were evaluated. The number of arms used was determined. Statistical analysis was performed with the Student's t test, chi-squared, and Mann-Whitney test.

Results: A total of 61 consecutive 3-arm RPNs and 59 consecutive 4-arm RPNs were evaluated. Mean tumor diameter and median nephrometry score were 3.4 cm (± 1.1 SD) and 7 (6-8 IQR) for the 3-arm group and 3.3 cm (±1.2 SD) and 6 (5-8 IQR) for the 4-arm group, respectively (size: p = 0.7, nephrometry: p = 0.07). Hospital length of stay, operative time, estimated blood loss, complication rate, blood transfusion rate, and readmission rate all demonstrated no statistically significant difference between 3-arm and 4-arm groups (p >0.05). Mean ischemia time was shorter by 5.1 minutes in the 4-arm group (p = 0.02). Rate of margin positivity was higher in the 4-arm group (0% vs 10%, p = 0.03).

Conclusion: RPN can be safely and effectively completed with 3-robotic arms. While there was increased ischemia time, the difference was small and likely not of clinical significance. The routine addition of the fourth robotic arm in RPN is not necessary.
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http://dx.doi.org/10.1016/j.urology.2018.06.068DOI Listing
January 2019

Determining the Learning Curve for Robot-Assisted Simple Prostatectomy in Surgeons Familiar with Robotic Surgery.

J Endourol 2018 09;32(9):865-870

Department of Urology, University of Texas Southwestern , Dallas, Texas.

Purpose: Robot-assisted simple prostatectomy (RASP) has excellent outcomes when treating large volume prostates and incorporates the already familiar skills to most robotic surgeons. Our objective was to determine the learning curve for RASP.

Materials And Methods: A retrospective review of RASP on 120 consecutive cases performed by two experienced robotic surgeons from 2014 to 2017 was conducted. We defined "learning curve" as the point at which operative parameters transition from logarithmic to linear improvement. Scatter plots of operative outcomes were constructed and logarithmic and linear best-fit line were estimated to determine the point of transition from logarithmic to linear improvement.

Results: Surgeon 1 operated on 76 cases and surgeon 2 on 44 cases. The median age of the 120 patients who underwent RASP was 70.0 years (interquartile range [IQR] 65.0-74.0 years) and median prostate mass was 121.5 g (IQR = 102.0-149.3). Overall, high-grade complication rate was 7.5%; median hematocrit change was 5.4% (IQR = 3.2-7.7) and tissue yield was 61.2 g (IQR = 49.7-76.9). Tissue yield demonstrated logarithmic improvement over the first 12 cases and then transitioned to a linear patter for one surgeon. Operative time in the last 10 cases was statistically different from the first 10 cases (p < 0.01). Drop in hematocrit (ΔHct) for surgeon 2 demonstrated logarithmic improvement for the first 10 cases and then transitioned to a linear pattern.

Conclusion: The learning curve for RASP varied depending on the variable examined. Blood loss (ΔHct) and tissue yield showed the greatest improvement over time, but neither showed significant improvement beyond 12 cases. We estimated the learning curve for RASP to be ∼10 to 12 cases for experienced robotic surgeons.
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http://dx.doi.org/10.1089/end.2018.0377DOI Listing
September 2018

Comparison of Robot-Assisted Versus Open Simple Prostatectomy for Benign Prostatic Hyperplasia.

Curr Urol Rep 2018 Jul 12;19(9):71. Epub 2018 Jul 12.

Department of Urology, University of Massachusetts, 119 Belmont St, Worcester, MA, 01605, USA.

Purpose Of Review: Recent advancements in minimally invasive approaches for prostate surgery have provided numerous options for surgical management of benign prostatic hyperplasia (BPH). In the setting of a large prostate, an open simple prostatectomy was previously considered the gold standard surgical treatment. However, the recently updated American Urological Association (AUA) guidelines on surgical management of BPH now consider both open and minimally invasive approaches to simple prostatectomy viable alternatives for treating large glands, depending on expertise with the techniques. The purpose of our review is to discuss the minimally invasive robot-assisted approach and compare it to the classic open approach to simple prostatectomy.

Recent Findings: Despite longer operative times, the robotic approach is associated with shorter hospital stay and lower morbidity profile. The morbidity of an open approach remains significant. Blood transfusions are 3-4 times as likely compared to a robotic approach and major complications are twice as likely. Consistent with previous literature, our review shows functional outcome improvements like flow rate and symptom score to be comparable between the robotic and open approach. The amount of adenoma resected and PSA decline is also similar among robotic and open cases. Robot-assisted simple prostatectomy is a safe and effective procedure for BPH secondary to a large prostate gland. Appropriately, it is no longer deemed "investigational" by the latest AUA guidelines on BPH and recommended as an alternative to the open approach.
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http://dx.doi.org/10.1007/s11934-018-0820-1DOI Listing
July 2018

Re: Robot-assisted laparoscopic radical prostatectomy: assistant's seniority has no influence on perioperative course.

J Robot Surg 2018 09;12(3):389-390

Department of Urology, UC Davis Medical Center, Sacramento, CA, USA.

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http://dx.doi.org/10.1007/s11701-018-0836-zDOI Listing
September 2018

Robotic Laparoendoscopic Single Site: Pyeloplasty and Nephrectomy Chapter.

J Endourol 2018 05;32(S1):S88-S92

Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.

Robotic laparoendoscopic single site (RLESS) for upper tract procedures is safe and feasible in the correctly selected patient. An ideal candidate is young, has a low body mass index, and is undergoing surgery for benign indications. For RLESS procedures, we utilize a GelPOINT access platform for "single-port" placement and ports are configured in a diamond shape. Five millimeter EndoWrist robotic instruments are placed under direct vision. Range of motion is increased by utilizing the chopstick technique. The surgeon must always be aware of the orientation of each instrument to prevent counter-springing associated with their crossing at the level of the abdominal wall. The robotic camera lens and instruments must be moved synchronously, given their coaxial orientation relative to each other. In this chapter, we describe our technique for two of the most common RLESS upper tract procedures: pyeloplasty and nephrectomy.
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http://dx.doi.org/10.1089/end.2017.0724DOI Listing
May 2018

Phenazopyridine: A Preoperative Way to Identify Ureteral Orifices.

Urology 2018 May 1;115:36-38. Epub 2018 Mar 1.

Division of Urology, Albany Medical College, Albany, NY; Stratton VA Medical Center, Albany, NY.

Objective: To identify difficult to see ureteral orifices (UOs), urologists need a method to stain the urine. Phenazopyridine, a urinary analgesic which discolors the urine orange, can be administered orally preoperatively. We evaluated the usefulness of phenazopyridine in identifying the UOs and optimal timing of administration.

Methods: Adult patients undergoing endoscopic procedures at the Stratton VA were prospectively enrolled. Preoperative metabolic panels were reviewed. Exclusion criteria were renal insufficiency (creatinine clearance <50 mL/min), severe hepatitis or severe liver disease, glucose-6-phosphate dehydrogenase deficiency, previous hypersensitivity to phenazopyridine, or pregnancy. In phase 1, patients undergoing office flexible cystoscopy were administered 200 mg phenazopyridine the morning of the procedure. Because of the robust orange color of the urine, phase 2 was implemented. In phase 2, patients undergoing rigid cystoscopy in the operating room took 200 mg phenazopyridine at 7 PM the night before surgery. Upon entry into the bladder, UOs were identified and urine color was graded (0 = no dye, 1 = weak, 2 = moderate, and 3 = strong). Patients were assessed postoperatively for side effects.

Results: Five patients were included in phase 1. The mean time from medication to cystoscopy was 153 minutes (range 17-304 minutes). One-third of patients had excretion of grade 3 orange urine that obscured inspection of the bladder mucosa. The study design was adjusted and we transitioned to phase 2. Twenty-three patients were enrolled in phase 2. The mean time from phenazopyridine dose to cystoscopy was 14 hours (range 13-17 hours). Seventy-three percent of patients had grade 2 efflux from the UOs.

Conclusion: Phenazopyridine can successfully identify UOs and can be administered as early as the evening before the procedure.
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http://dx.doi.org/10.1016/j.urology.2018.02.023DOI Listing
May 2018

Re: Time to consider integration of a formal robotic-assisted surgical training program.

J Robot Surg 2018 06;12(2):199-200

Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.

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http://dx.doi.org/10.1007/s11701-018-0794-5DOI Listing
June 2018

Effect of Differing Parameters on Irreversible Electroporation in a Porcine Model.

J Endourol 2018 04 30;32(4):338-343. Epub 2018 Jan 30.

1 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.

Introduction And Objective: Irreversible electroporation (IRE) is a new ablative technology to treat small renal masses. We evaluated differed ablation settings on lesion size and temperature changes in a porcine model.

Materials And Methods: After Institutional Animal Care and Use Committee approval, 36 laparoscopy-guided and 16 open ablations were performed on 13 domestic female pigs. Ablation parameters studied were voltage (1000 V/cm, 1500 V/cm, or 2000 V/cm), probe exposure (1.0 or 1.5 cm), and lesion size over time (survival) (0-, 7-, or 14 day). Temperature changes were monitored during open ablations with differed settings. Gross lesion size was measured, and histologic analysis with hematoxylin and eosin and nicotinamide adenine dinucleotide staining was performed.

Results: The 1000 V/cm ablations had no gross or histologic lesions. A factorial analysis of variance demonstrated that day (p = 0.56), exposure (p = 0.33), and voltage (p = 0.06) did not demonstrate statistical significance for affecting lesion size. For 1.0 cm probe exposure, 2000 V/cm did more closely approximate expected lesion size (p = 0.02) compared with 1500 V/cm. While significance was not seen for 1.5 cm probe exposure, 2000 V/cm often exceeded expected lesion volume. Only 1 of 4 temperature sensors, located adjacent to one of the IRE probes, noted a significant increase with increased voltage. However, all maximum temperatures remained less than 70°C.

Conclusions: Variation in lesion volume was seen with different ablation settings in this porcine model. Maximal energy and probe exposure settings should be utilized to ensure full coverage of target volume/mass, potentially without concern for thermal injury to renal collecting system or nearby structures.
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http://dx.doi.org/10.1089/end.2017.0495DOI Listing
April 2018

Re: Should every medical student have exposure to robotic surgery?

J Robot Surg 2018 03;12(1):1-2

Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.

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http://dx.doi.org/10.1007/s11701-017-0764-3DOI Listing
March 2018

Robot-assisted laparoscopic extravascular stent for nutcracker syndrome.

J Robot Surg 2018 Sep 31;12(3):561-565. Epub 2017 Aug 31.

Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.

Minimally invasive treatment options are a safe and feasible alternative for treatment of nutcracker syndrome. Endovascular stenting has shown promising long-term resolution of symptoms but can be complicated by stent migration or thrombosis. Laparoscopic extravascular stent placement has shown promising results with the potential to avoid these complications. We report the first case of extravascular stent placement using the robotic approach for the treatment of nutcracker syndrome.
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http://dx.doi.org/10.1007/s11701-017-0744-7DOI Listing
September 2018

Robot-Assisted Versus Open Simple Prostatectomy for Benign Prostatic Hyperplasia in Large Glands: A Propensity Score-Matched Comparison of Perioperative and Short-Term Outcomes.

J Endourol 2017 11 26;31(11):1164-1169. Epub 2017 Sep 26.

Department of Urology, UT Southwestern Medical Center , Dallas, Texas.

Objective: To report the largest comparative analysis of robotic vs open simple prostatectomy (OSP) for large-volume prostate glands.

Materials And Methods: We retrospectively reviewed 103 patients that underwent open and 64 patients that underwent robotic simple prostatectomy from 2012 to 2016 at a single institution. A propensity score-matched analysis was performed with five covariates, including age, body mass index, race, Charlson comorbidity index, and prostate volume. Perioperative, postoperative, and functional outcomes were compared between groups.

Results: After propensity score matching there were 59 patients in each group available for comparison. There was no statistically significant difference between groups for all preoperative demographic variables. Robotic compared with OSP demonstrated a significant shorter average length of stay (LOS) (1.5 vs 2.6 days, p < 0.001), but longer mean operative time (161 vs 93 minutes, p < 0.001). The robotic approach was also associated with a lower estimated blood loss (339 vs 587 mL, p < 0.001) and lower percentage hematocrit drop (12.3% vs 19.5%, p = 0.001). Two patients required blood transfusions in the robot group compared with four in the open group, but this was not significant (p = 0.271). Improvements in maximal flow rate, International Prostate Symptom Score, quality of life, postvoid residual, and postoperative prostate-specific antigen levels were similar before and after surgery for both groups, but there was no difference between groups. There was no difference in complications between groups.

Conclusion: Robotic simple prostatectomy is a safe and effective treatment for the surgical management of benign prostatic hyperplasia. It provides similar function outcomes to the open approach; however, offers the advantage of reduced LOS and reduced blood loss.
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http://dx.doi.org/10.1089/end.2017.0489DOI Listing
November 2017

The Decline of Laparoendoscopic Single-Site Surgery: A Survey of the Endourological Society to Identify Shortcomings and Guidance for Future Directions.

J Endourol 2017 10 28;31(10):1049-1055. Epub 2017 Aug 28.

5 Department of Urology, East Surrey Hospital , Redhill, United Kingdom .

Introduction: To analyze the most recent temporal trends in the adoption of urologic laparoendoscopic single-site (LESS), to identify the perceived limitations associated with its decline, and to determine factors that might revive the role of LESS in the field of minimally invasive urologic surgery.

Materials And Methods: A 15 question survey was created and sent to members of the Endourological Society in September 2016. Only members who performed LESS procedures in practice were asked to respond.

Results: In total, 106 urologists responded to the survey. Most of the respondents were from the United States (35%) and worked in an academic hospital (84.9%). Standard LESS was the most popular approach (78.1%), while 14.3% used robotics, and 7.6% used both. 2009 marked the most popular year to perform the initial (27.6%) and the majority (20%) of LESS procedures. The most common LESS procedure was a radical/simple nephrectomy (51%) followed by pyeloplasty (17.3%). In the past 12 months, 60% of respondents had performed no LESS procedures. Compared to conventional laparoscopy, respondents only believed cosmesis to be better, however, this enthusiasm waned over time. Worsening shifts in enthusiasm for LESS also occurred with patient desire, marketability, cost, safety, and robotic adaptability. The highest rated factor to help LESS regain popularity was a new robotic platform.

Conclusion: The decline of LESS is apparent, with few urologists continuing to perform procedures attributed to multiple factors. The availability of a purpose-built robotic platform and better instrumentation might translate into a renewed future interest of LESS.
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http://dx.doi.org/10.1089/end.2017.0280DOI Listing
October 2017

Introducing the Twitter Impact Factor: An Objective Measure of Urology's Academic Impact on Twitter.

Eur Urol Focus 2016 Oct 2;2(4):412-417. Epub 2016 Apr 2.

Urological Institute of Northeastern New York; Albany Medical College, Albany, NY, USA. Electronic address:

Background: Social media use in academia and urology is rising. Specifically, individual journals now have Twitter accounts (Twitter Inc, San Francisco, CA, USA) and regularly tweet academic content.

Objective: To present and evaluate the Twitter impact factor (TIF), a novel means of measuring a journal's academic influence in the realm of social media.

Design, Setting, And Participants: Journal Citation Reports (JCR; Thomson Reuters, New York, NY, USA) for 2014 was queried for urologic academic journals. English-language journals with active Twitter accounts since 2013 were included. The total number of followers, tweets, and retweets over a 2-yr period were collected.

Outcome Measures And Statistical Analysis: Each journal's TIF was calculated based on the number of retweets per original relevant tweet. Comparisons between the TIF and the journal impact factor (JIF) as well as the Klout score were made using the Pearson correlation.

Results And Limitations: Of 33 journals listed in the JCR for 2014, 7 (21%) had a Twitter presence as of 2013. The number of JCR-listed journals with a Twitter handle increased by 29% in 2014. There was an increase in the mean number of relevant tweets per journal during the study period and a 130% increase in the number of retweets over 1 yr. European Urology (1.80) and BJU International (1.46) had the highest TIFs. The journals with the highest number of Twitter followers were European Urology (5807) and the Journal of Urology (4402). The journals with the highest numbers of relevant tweets were European Urology (1159) and BJU International (1090). There was a positive but statistically insignificant association between the TIF and the JIF (r=0.64, p=0.12). There was a strongly positive linear correlation between the TIF and the Klout score (r=0.84, p=0.0086).

Conclusions: With the increasing use of social media by individuals and academic journals, the TIF can be a useful tool to measure the academic reach and impact of a journal on Twitter.

Patient Summary: Social media is an increasing part of the way in which practitioners and academicians communicate. The TIF can be used to analyze the impact of journal Twitter feeds and their social media content.
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http://dx.doi.org/10.1016/j.euf.2016.03.006DOI Listing
October 2016

Three-Dimensional Printing of Surgical Clips: An In Vitro Pilot Study and Trial of Efficacy.

J Endourol 2017 09 11;31(9):930-933. Epub 2017 Aug 11.

1 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.

Introduction And Objective: Three-dimensional (3D) printing applications have increased over the past decade. Our objective was to test rapid prototyping of a 3D printed surgical clip for intraoperative use.

Materials And Methods: Our prototype was modeled after the 10 mm Weck Hem-o-lok polymer clip (Teleflex, Inc., Wayne, PA). A 3D computer-aided design model of the Hem-o-lok clip was reverse engineered using commercial microscopy and printing was done using an Objet Connex500 multijetting system (Stratasys, Eden Prairie, MN). The initial polymer was Objet VeroWhitePlus RGD835; the addition of Objet TangoBlackPlus FLX980 during the design process improved hinge flexibility. The 3D printed clips were then pressure tested on rubber Penrose tubing and compared in vitro versus commercial Hem-o-lok clips.

Results: Initial 3D printed clips were not functional as they split at the hinge upon closure of the clip jaws. Design changes were made to add Objet TangoBlackPlus FLX980 at the hinge to improve flexibility. Additional modifications were made to allow for clips to be compatible with the Hem-o-lok endoscopic clip applier. A total of 50 clips were tested. Fracture rate for the printed clips using a clip applier was 54% (n = 27), whereas none of the commercial Hem-o-lok clips broke upon closure. Of the 23 printed clips that closed, mean leak was at 20.7 κPa (range 4.8-42.7). In contrast, none of the commercial clips leaked, and fill continued until Penrose rupture at mean 46.2 κPa (44.8-47.6).

Conclusions: This pilot study demonstrates feasibility of 3D printing functional surgical clips. However, the performance of our first generation clips is poor compared with commercial grade product. Refinement in printers and materials available may allow for customization of such printed surgical instruments that could be economically competitive to purchasing and stocking product.
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http://dx.doi.org/10.1089/end.2017.0221DOI Listing
September 2017

Pain After Percutaneous Irreversible Electroporation of Renal Tumors Is Not Dependent on Tumor Location.

J Endourol 2017 08 5;31(8):751-755. Epub 2017 Jul 5.

1 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.

Introduction: Irreversible electroporation (IRE) is a non-thermal minimally invasive technique that is used to treat small renal masses (SRMs). Prior work has demonstrated greater narcotic requirements after radiofrequency ablation (RFA) for tumors that are closer to body-wall musculature. We hypothesized that pain after IRE is not dependent on tumor location due to the athermal mechanistic action.

Materials And Methods: A retrospective review of 50 consecutive percutaneous IRE and RFA cases was performed from 2013 to 2014. Eight patients were excluded from analysis due to incomplete anesthesia record and/or multiple ablations per session, leaving 21 patients in each group. Data collected included patient age, sex, body mass index, nephrometry score, shortest distance to the closest body-wall muscle, perioperative narcotic use, and patient-reported pain score. Pearson correlation test and multivariable linear regression were used to identify predictors of postoperative pain, with significance set at p = 0.05.

Results: There was no difference in the mean distance from tumor edge to the nearest body-wall muscle between IRE and RFA (2.6 cm vs 2.4 cm, p = 0.729, respectively). Total mean perioperative narcotic usage was 20.4 mg after IRE and 26.7 mg after RFA (p = 0.096). Mean postoperative pain score (scale 0-10) was slightly higher after RFA (4.3) compared with IRE (2.4), but this was not statistically significant (p = 0.088). Pearson correlation test identified tumor proximity to be significiantly associated with both pain score (p = 0.011) and postoperative narcotic use (p = 0.049) after RFA but not after IRE. On multivariable analysis, only tumor proximity to the body wall was significantly correlated to pain score (-1.4, p = 0.041) after RFA but was not found to be a factor for pain after IRE.

Conclusions: Patients whose tumors lie close to their body-wall musculature do not have greater narcotic requirements or higher pain scores in the perioperative period after IRE. Percutaneous IRE may be preferred over RFA for SRMs that are close to the body wall to minimize pain.
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http://dx.doi.org/10.1089/end.2017.0201DOI Listing
August 2017

Periarterial papaverine to treat renal artery vasospasm during robot-assisted laparoscopic partial nephrectomy.

J Robot Surg 2018 Mar 28;12(1):189-191. Epub 2017 Apr 28.

Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.

Renal artery vasospasm can be a troublesome complication during robot-assisted laparoscopic partial nephrectomy. Urologists performing this procedure, especially if utilizing selective arterial vascular microdissection, should be aware of using papaverine for both prevention and treatment of renal artery vasospasm. We present a 33-year-old male who developed severe renal artery vasospasm just with hilar dissection causing the kidney to become ischemic. Papaverine was topically applied on the renal arteries resulting in vasodilation and reperfusion of the kidney. Our objective of this report is to raise awareness of this complication as well as to review the literature on periarterial papaverine use and the dosing for topical applications.
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http://dx.doi.org/10.1007/s11701-017-0710-4DOI Listing
March 2018

Axial Abdominal Imaging after Partial Nephrectomy for T1 Renal Cell Carcinoma Surveillance.

J Urol 2017 11 23;198(5):1021-1026. Epub 2017 Apr 23.

Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address:

Purpose: The overall recurrence rate of T1 renal cell carcinoma is low. We evaluated abdominal imaging after partial nephrectomy based on current guidelines for T1 renal cell carcinoma surveillance.

Materials And Methods: We retrospectively reviewed the records of patients with T1 renal cell carcinoma who underwent partial nephrectomy between 2006 and 2012 followed by abdominal imaging at our institution. Primary and secondary outcomes were the incidence and timing, respectively, of imaging diagnosed abdominal recurrences. A literature review was performed to summarize prior reports of recurrence incidence and timing after partial nephrectomy for T1 disease.

Results: A total of 160 patients with stage T1a and 37 with T1b underwent partial nephrectomy. Seven patients had an abdominal recurrence, including 3 with local and distant recurrences, and 4 with a metachronous contralateral kidney recurrence. The incidence of abdominal recurrence detected by imaging was higher in the T1b than in the T1a group (10.8% vs 1.9%, p = 0.024). Although it was not significant, median time to recurrence was earlier in T1b vs T1a cases (13 vs 37 months, p = 0.480). In each group recurrences developed after 3 years of suggested guideline surveillance. In the literature combined with the current study the time to median recurrence for T1b vs T1a was 24 vs 29 months (p = 0.226).

Conclusions: Recurrences detected by abdominal imaging developed earlier and more frequently in T1b than in T1a cases. Future recommendations for surveillance strategies after partial nephrectomy should distinguish T1a from T1b with less intense frequency of imaging for T1a. A longer period of surveillance should be considered since recurrences can develop beyond 3 years.
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http://dx.doi.org/10.1016/j.juro.2017.04.080DOI Listing
November 2017

National Utilization of Partial Nephrectomy Pre- and Post- AUA Guidelines: Is This as Good as It Gets?

Clin Genitourin Cancer 2017 10 23;15(5):591-597.e1. Epub 2017 Mar 23.

Albany Medical College, Albany Stratton VA, Albany, NY. Electronic address:

Background: The purpose of the study was to compare utilization and predictors of partial nephrectomy (PN) in the pre- and post-guideline eras.

Materials And Methods: American Board of Urology certification/recertification operative logs were reviewed from 2003 to 2014. Nephrectomy cases were extracted using Current Procedural Terminology codes. The cases were then stratified according to pre-guidelines (2003-October 2009) and post-guidelines (November 2009-2014). Multivariable logistic regression was used to evaluate patient, surgeon, and practice characteristics as predictors of PN. A general linear model with regression analysis was used to evaluate the change in PN over time relative to the incidence of renal cell carcinoma (RCC).

Results: We identified 20,402 and 20,729 nephrectomies in the pre- and post-guidelines eras, respectively. In multivariable analysis, the post-guidelines group was more likely to undergo PN (odds ratio, 1.87; P < .001). The pre- as well as post-guidelines groups had a higher likelihood of undergoing PN with an open approach, higher-volume surgeons, and younger patient age (P < .05). Surgeon subspecialty and US region were no longer significant factors after guidelines publication. Number of PN normalized to the incidence of RCC continued to increase over time (0.14%/y; R = 0.77; P < .001).

Conclusion: Partial nephrectomy in the post-guidelines era is no longer confined to urological subspecialists or certain densely populated US regions. Although rates of PN continue to increase relative to the recently decreasing overall incidence of RCC, the slope has leveled off somewhat. This is likely related to clinical intricacies of the best treatment modality and technologic advances rather than changes related to guidelines publication.
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http://dx.doi.org/10.1016/j.clgc.2017.03.006DOI Listing
October 2017

How I do it: percutaneous radiofrequency ablation (RFA).

Can J Urol 2017 Feb;24(1):8679-8683

Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA.

Percutaneous radiofrequency ablation has seen increased utilization secondary to the rising incidence of renal cell carcinoma. This has been shown to be an effective and durable treatment especially in the elderly comorbid patient. In this article, we describe our technique and factors related to successful outcomes.
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February 2017

Irreversible electroporation of small renal masses: suboptimal oncologic efficacy in an early series.

World J Urol 2017 Oct 2;35(10):1549-1555. Epub 2017 Mar 2.

Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.

Purpose: To report on the first short-term oncologic outcomes of percutaneous irreversible electroporation for small renal masses.

Methods: Patients with cT1a renal masses treated with irreversible electroporation from April 2013 through December 2016 were reviewed. Small, low complexity tumors were generally selected for irreversible electroporation using the NanoKnife System (Angiodynamics, Latham, NY, USA). Surveillance imaging was performed post-operatively, and survival analysis was completed using the Kaplan-Meier method.

Results: A total of 42 tumors in 41 patients underwent irreversible electroporation. Mean tumor size was 2.0 cm with a median R.E.N.A.L nephrometry score of 5. Twenty-nine patients (71%) were discharged the same day of the procedure and no major (Clavien grade II or higher) intraoperative or post-operative complications occurred. Initial treatment success rate was 93%; our three failures (7%) underwent salvage radiofrequency ablation. With a mean follow-up of 22 months, 2-year local recurrence-free survival was 83% for patients with biopsy confirmed renal cell carcinoma, 87% with biopsy confirmed or a history of renal cell carcinoma, and 92% for the intent-to-treat cohort.

Conclusions: Although with low morbidity, in comparison to extirpation and conventional thermal ablation technologies, irreversible electroporation has suboptimal short-term local disease control results in this series of small, low complexity tumors. Larger series and longer follow-up will determine the durability of this modality.
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http://dx.doi.org/10.1007/s00345-017-2025-5DOI Listing
October 2017

Epidemiology of stone disease across the world.

World J Urol 2017 Sep 17;35(9):1301-1320. Epub 2017 Feb 17.

Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.

Nephrolithiasis is a highly prevalent disease worldwide with rates ranging from 7 to 13% in North America, 5-9% in Europe, and 1-5% in Asia. Due to high rates of new and recurrent stones, management of stones is expensive and the disease has a high level of acute and chronic morbidity. The goal of this study is to review the epidemiology of stone disease in order to improve patient care. A review of the literature was conducted through a search on Pubmed, Medline, and Google Scholar. This review was presented and peer-reviewed at the 3rd International Consultation on Stone Disease during the 2014 Société Internationale d'Urologie Congress in Glasgow. It represents an update of the 2008 consensus document based on expert opinion of the most relevant studies. There has been a rising incidence in stone disease throughout the world with a narrowing of the gender gap. Increased stone prevalence has been attributed to population growth and increases in obesity and diabetes. General dietary recommendations of increased fluid, decreased salt, and moderate intake of protein have not changed. However, specific recommended values have either changed or are more frequently reported. Geography and environment influenced the likelihood of stone disease and more information is needed regarding stone disease in a large portion of the world including Asia and Africa. Randomized controlled studies are lacking but are necessary to improve recommendations regarding diet and fluid intake. Understanding the impact of associated conditions that are rapidly increasing will improve the prevention of stone disease.
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http://dx.doi.org/10.1007/s00345-017-2008-6DOI Listing
September 2017

A query on da Vinci robot console preferences: insights for the novice surgeon.

J Robot Surg 2017 Jun 15;11(2):231-233. Epub 2016 Nov 15.

Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.

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http://dx.doi.org/10.1007/s11701-016-0654-0DOI Listing
June 2017
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