Publications by authors named "Jonathan Rubenstein"

48 Publications

Cryoneurotomy to Reduce Spasticity and Improve Range of Motion in Spastic Flexed Elbow: A Visual Vignette.

Am J Phys Med Rehabil 2021 May;100(5):e65

From the Faculty of Medicine, University of British Columbia, Victoria, British Columbia, Canada (JR, AWH, DV, PW); Department of Anesthesiology, University of British Columbia, Victoria, British Columbia, Canada (DV); and Division of Physical Medicine and Rehabilitation, University of British Columbia, Victoria, British Columbia, Canada (PW).

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http://dx.doi.org/10.1097/PHM.0000000000001624DOI Listing
May 2021

Update of the Standard Operating Procedure on the Use of Multiparametric Magnetic Resonance Imaging for the Diagnosis, Staging and Management of Prostate Cancer.

J Urol 2020 Apr 23;203(4):706-712. Epub 2019 Oct 23.

National Cancer Institute, National Institutes of Health, Bethesda, Maryland.

Purpose: We update the prior standard operating procedure for magnetic resonance imaging of the prostate, and summarize the available data about the technique and clinical use for the diagnosis and management of prostate cancer. This update includes practical recommendations on the use of magnetic resonance imaging for screening, diagnosis, staging, treatment and surveillance of prostate cancer.

Materials And Methods: A panel of clinicians from the American Urological Association and Society of Abdominal Radiology with expertise in the diagnosis and management of prostate cancer evaluated the current published literature on the use and technique of magnetic resonance imaging for this disease. When adequate studies were available for analysis, recommendations were made on the basis of data and when adequate studies were not available, recommendations were made on the basis of expert consensus.

Results: Prostate magnetic resonance imaging should be performed according to technical specifications and standards, and interpreted according to standard reporting. Data support its use in men with a previous negative biopsy and ongoing concerns about increased risk of prostate cancer. Sufficient data now exist to support the recommendation of magnetic resonance imaging before prostate biopsy in all men who have no history of biopsy. Currently, the evidence is insufficient to recommend magnetic resonance imaging for screening, staging or surveillance of prostate cancer.

Conclusions: Use of prostate magnetic resonance imaging in the risk stratification, diagnosis and treatment pathway of men with prostate cancer is expanding. When quality prostate imaging is obtained, current evidence now supports its use in men at risk of harboring prostate cancer and who have not undergone a previous biopsy, as well as in men with an increasing prostate specific antigen following an initial negative standard prostate biopsy procedure.
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http://dx.doi.org/10.1097/JU.0000000000000617DOI Listing
April 2020

A Multicenter Study Evaluating the Risk Factors and Outcomes of Repeat Descemet Stripping Endothelial Keratoplasty.

Cornea 2019 Feb;38(2):177-182

Department of Ophthalmology, Loyola University Medical Center, Maywood, IL.

Purpose: Descemet stripping endothelial keratoplasty (DSEK), currently the most common procedure for managing corneal endothelial dysfunction, may be repeated following DSEK failure from a variety of causes. This multicenter study reports the risk factors and outcomes of repeat DSEK.

Methods: This was an institutional review board-approved multicenter retrospective chart review of patients who underwent repeat DSEK. Twelve surgeons from 5 Midwest academic centers and 3 private practice groups participated. The Eversight Eye Bank provided clinical indication and donor graft data. We also assessed the role of the learning curve by comparing cohorts from the first and second 5-year periods.

Results: A total of 121 eyes from 121 patients who underwent repeat DSEK were identified. The average age of the patients was 70 ± 12 years. The most common indication for repeat DSEK was late endothelial graft failure without rejection (58%, N = 63). Average preoperative and 12-month postoperative repeat DSEK corrected distance visual acuities were 20/694 and 20/89, respectively. Visual acuity outcomes, endothelial cell density, and cell loss did not significantly vary between the 2 cohorts. Initial graft rebubble rates for the first and second cohorts were 51% and 25%. The presence of glaucoma, prior glaucoma surgery, or a history of penetrating (full thickness) keratoplasty did not significantly affect visual outcomes. The median, mean, and range of intraocular pressures before repeat DSEK were 15.0, 15.7, and 6 to 37 mm Hg, respectively. Patients with higher intraocular pressures before repeat DSEK had improved postoperative corrected distance visual acuities.

Conclusions: Repeating DSEK improves vision following failed or decompensated DSEK surgery. Higher preoperative repeat DSEK IOPs were associated with improved visual outcomes, and initial graft rebubble rates, which decreased over time, were likely due to surgeon experience.
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http://dx.doi.org/10.1097/ICO.0000000000001817DOI Listing
February 2019

ICD-10 Changes for October 1, 2018.

Rev Urol 2018 ;20(3):133-136

Chesapeake Urology Associates Baltimore, MD.

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http://dx.doi.org/10.3909/riu0817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241898PMC
January 2018

ICD-10-CM changes for October 1, 2017.

Rev Urol 2017 ;19(2):129-130

Chesapeake Urology AssociatesBaltimore, MD.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610365PMC
http://dx.doi.org/10.3909/riu0766DOI Listing
January 2017

AUA Policy Statement on the Use of Multiparametric Magnetic Resonance Imaging in the Diagnosis, Staging and Management of Prostate Cancer.

J Urol 2017 10 5;198(4):832-838. Epub 2017 May 5.

The University of Chicago Medical Center, Chicago, Illinois.

Purpose: We summarize the available data about the clinical and economic effectiveness of magnetic resonance imaging in the diagnosis and management of prostate cancer, and provide practical recommendations for its use in the screening, diagnosis, staging and surveillance of prostate cancer.

Materials And Methods: A panel of clinicians with expertise in the diagnosis and management of prostate cancer evaluated the current published literature on the use and effectiveness of magnetic resonance imaging for this disease. When adequate studies were available for analysis, recommendations were made on the basis of data and when adequate studies were not available, recommendations were made on the basis of expert consensus.

Results: At this time the data support the use of magnetic resonance imaging in patients with a previous negative biopsy and ongoing concerns about increased risk of prostate cancer. The data regarding its usefulness for initial biopsy suggest a possible role for magnetic resonance imaging in some circumstances. There is currently insufficient evidence to recommend magnetic resonance imaging for screening, staging or surveillance of prostate cancer.

Conclusions: Although it adds cost to the management of prostate cancer, magnetic resonance imaging offers superior anatomic detail, and the ability to evaluate cellular density based on water diffusion and blood flow based on contrast enhancement. Imaging targeted biopsy may increase the diagnosis of clinically significant cancers by identifying specific lesions not visible on conventional ultrasound. The clinical indications for the use of magnetic resonance imaging in the management of prostate cancer are rapidly evolving.
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http://dx.doi.org/10.1016/j.juro.2017.04.101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905434PMC
October 2017

Laparoscopic Cystectomy Coding.

Rev Urol 2016 ;18(3):157-158

Chesapeake Urology Associates Baltimore, MD.

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http://dx.doi.org/10.3909/riu0728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102933PMC
January 2016

ICD-10 Changes for October 1, 2016 of Interest to Urologists.

Rev Urol 2016 ;18(2):110-3

Chesapeake Urology Associates Baltimore.

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http://dx.doi.org/10.3909/riu0718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010632PMC
September 2016

Percutaneous Procedure CPT Code Update.

Rev Urol 2016 ;18(1):38-43

Chesapeake Urology Associates, Baltimore, MD.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859928PMC
May 2016

Pediatric interventional radiology clinic - how are we doing?

Pediatr Radiol 2016 Jul 6;46(8):1165-72. Epub 2016 Apr 6.

Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children & University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.

Background: Development of a pediatric interventional radiology clinic is a necessary component of providing a pediatric interventional radiology service. Patient satisfaction is important when providing efficient, high-quality care.

Objective: To analyze the care provided by a pediatric interventional radiology clinic from the perspective of efficiency and parent satisfaction, so as to identify areas for improvement.

Materials And Methods: The prospective study was both quantitative and qualitative. The quantitative component measured clinic efficiency (waiting times, duration of clinic visit, nurse/physician time allocation and assessments performed; n = 91). The qualitative component assessed parental satisfaction with their experience with the pediatric interventional radiology clinic, using a questionnaire (5-point Likert scale) and optional free text section for feedback (n = 80). Questions explored the family's perception of relevance of information provided, consent process and overall satisfaction with their pediatric interventional radiology clinic experience.

Results: Families waited a mean of 11 and 10 min to meet the physician and nurse, respectively. Nurses and physicians spent a mean of 28 and 21 min with the families, respectively. The average duration of the pediatric interventional radiology clinic consultation was 56 min. Of 80 survey participants, 83% were satisfied with their experience and 94% said they believed providing consent before the day of the procedure was helpful. Only 5% of respondents were not satisfied with the time-efficiency of the interventional radiology clinic.

Conclusion: Results show the majority of patients/parents are very satisfied with the pediatric interventional radiology clinic visit. The efficiency of the pediatric interventional radiology clinic is satisfactory; however, adherence to stricter scheduling can be improved.
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http://dx.doi.org/10.1007/s00247-016-3593-zDOI Listing
July 2016

How best to use modifier 59.

Rev Urol 2015 ;17(1):33-4

Chesapeake Urology Associates, Baltimore, MD.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4444773PMC
June 2015

Clostridium perfringens endophthalmitis after penetrating keratoplasty with contaminated corneal allografts: a case series.

Cornea 2015 Jan;34(1):23-7

*Department of Ophthalmology and Visual Sciences, University of Illinois Eye and Ear Infirmary, Chicago, IL; †Department of Ophthalmology, Rush University Medical Center, Chicago, IL; ‡Chicago Eye Institute, Chicago, IL; and §Midwest Eye-Banks, Ann Arbor, MI.

Purpose: To report the postoperative clinical course of 3 patients who underwent corneal transplantation with corneal allografts contaminated with Clostridium perfringens and to evaluate the risk factors for anaerobic contamination in 2 donors.

Methods: Patient records and adverse reaction reports from a single eye bank related to cases of posttransplant C. perfringens endophthalmitis were reviewed. Records regarding the mated corneas, donor autopsy reports, and other pertinent data were also reviewed.

Results: Three adverse reactions associated with transplantation of corneal allografts contaminated with C. perfringens were reported. Two cases were from mated corneas. Both patients developed fulminant endophthalmitis after undergoing uncomplicated penetrating keratoplasty and required subsequent enucleation. Another isolated case (with no adverse reaction in the mate cornea) developed hypopyon postoperatively that resolved with intravitreal and topical antibiotics. Possible risk factors for anaerobic tissue contamination in the donors included illicit drug use in the first donor and exposure to sewage at the time of death in the second donor.

Conclusions: Clostridial endophthalmitis is an aggressive rapidly progressive infection with potentially poor visual outcomes that can be transmitted from infected corneal allografts. Further investigation is needed to clarify the role of anaerobic donor rim cultures and the donor risk factors associated with recovering corneal allograft tissue contaminated with C. perfringens.
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http://dx.doi.org/10.1097/ICO.0000000000000303DOI Listing
January 2015

Shared medical appointments in urology.

Rev Urol 2014 ;16(3):136-8

Chesapeake Urology Associates, Baltimore, MD.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4191635PMC
October 2014

ICD-10: are you ready?

Curr Urol Rep 2014 Nov;15(11):449

Chesapeake Urology Associates, PA, 8322 Bellona Ave #202, Baltimore, MD, 21204, USA,

With the signing of H.R. 4302 ( https://beta.congress.gov/bill/113th-congress/house-bill/4302 ), the implementation date for using ICD-0-CM codes for coding and billing medical encounters in the United States is now scheduled for October 1, 2015. This conversion from using ICD-9-CM codes will be a tremendous change in the way providers and practices deliver health care and could be financially devastating to those who are not properly prepared. Proper preparations will require educating virtually everyone involved in almost every aspect of patient care with a sufficient understanding of ICD-10 language, coding structure, and rules. Vital to this conversion is accurate documentation in the medical records by providers, knowledge of insurance coverage (local and national) rules, and acceptance of those codes by electronic health record systems, clearinghouses, and payors. Early preparation, appropriate education, and proper testing will minimize the financial impact.
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http://dx.doi.org/10.1007/s11934-014-0449-7DOI Listing
November 2014

How to Code for Magnetic Resonance Imaging-informed Prostate Biopsies.

Rev Urol 2014 ;16(2):88-9

Chesapeake Urology Associates, Baltimore, MD.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080854PMC
July 2014

Transitioning to ICD-10: Steps for Urologists and Urology Groups.

Rev Urol 2014 ;16(1):44-6

Chesapeake Urology Associates, Baltimore, MD.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004283PMC
May 2014

Ocular adnexal MALTomas: case series of patients treated with primary radiation.

Clin Adv Hematol Oncol 2013 Apr;11(4):209-14

Rush University Medical Center, Department of Radiation Oncology, Chicago, IL 60612, USA.

Background: Ocular adnexal mucosal-associated lymphoid tissue lymphomas (MALTomas) are rare, and there are no phase III trials to guide treatment. Primary radiation therapy has been the typical management. This retrospective series reports the experience of a single institution and adds to the current literature.

Methods: Our electronic medical record system and available paper charts were used to identify patients with MALTomas of the lacrimal gland or sac, conjunctiva, and orbital structures, including extraocular muscles. In order to determine pathology, staging, treatment information, local and distant control, salvage treatments, and late toxicity, records were reviewed.

Results: Sixteen patients with ocular adnexal MALTomas had local radiation between 1992 and 2011 for primary or recurrent disease. Fifty percent of patients had lymphoma in the conjunctiva, 25% had lymphoma in the lacrimal sac/gland, and 25% of patients had lymphoma in the posterior orbit. Stage IAE disease occurred in 75% of patients, 6% had stage IIAE disease, and 19% of patients had a positive bone marrow biopsy. One patient received chemotherapy as part of initial therapy. The median radiation dose was 30 Gy (25.5-36 Gy) delivered with electrons (31%) or photons (69%). After a mean follow-up of 62.8 months, 2 patients had residual/progressive disease, 2 had contralateral recurrence, and 1 patient had a distant failure, for local control of 87.5% and overall disease control of 68.75%. Recurrence/progression occurred at a median of 35.45 months. Two patients with residual/progressive disease and 1 patient with a contralateral recurrence were followed, successfully salvaged, and have no evidence of disease. Fourteen patients are still alive, and there were no disease-related/toxicity deaths. Seven patients developed cataracts in the treated eye, 2 patients had radiation retinopathy, 2 had permanent dry eye syndrome, and 1 patient had severe keratopathy requiring enucleation. Six patients (3.75%) had worsening visual acuity of unclear etiology.

Conclusions: Primary radiation therapy for ocular adnexal MALTomas with a median dose of 30 Gy led to excellent local control. Patients who did recur were successfully salvaged. Radiation was generally well tolerated, with expected cataractogenesis, given the dose required to achieve local control (with only 1 patient developing severe keratopathy after receiving the highest dose in this series).
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April 2013

Approaches to corneal astigmatism in cataract surgery.

Curr Opin Ophthalmol 2013 Jan;24(1):30-4

Rush University Medical Center, Chicago, Illinois 60612, USA.

Purpose Of Review: To outline current options for managing astigmatism during cataract surgery and update readers on new techniques for improving the final refractive outcome in these patients.

Recent Findings: Recent studies continue to show the effectiveness of peripheral corneal relaxing incisions (PCRIs) for correcting astigmatism in combination with monofocal, multifocal, and toric intraocular lens (IOL) implants. The options in toric IOLs are expanding. Intraoperative aberrometry is a new tool that can improve the accuracy of PCRIs and toric IOLs.

Summary: PCRIs and toric IOLs are currently the two main options for astigmatism management during cataract surgery. Refractive outcomes are improved by new techniques, which refine the effectiveness and accuracy of these two options.
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http://dx.doi.org/10.1097/ICU.0b013e32835ac853DOI Listing
January 2013

Management of astigmatism: LRIs.

Int Ophthalmol Clin 2012 ;52(2):31-40

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http://dx.doi.org/10.1097/IIO.0b013e31824b8786DOI Listing
July 2012

Retrospective review of graft dislocation rate associated with descemet stripping automated endothelial keratoplasty after primary failed penetrating keratoplasty.

Cornea 2011 Apr;30(4):414-8

Department of Ophthalmology, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.

Purpose: To report the rate of graft dislocation in patients who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) after a previous penetrating keratoplasty (PKP).

Methods: Institutional review board-approved, multicenter, retrospective chart review. Inclusion criteria included: prior failed PKP and subsequent DSAEK. The primary outcomes measured in this study were the presence of a graft dislocation, rate of rebubble, and graft attachment. Additional variables included: presence of a prior glaucoma drainage device, graft-to-host size disparity, number of sutures remaining in PKP, and stripping of the Descemet membrane at the time of DSAEK surgery.

Results: Ninety patients (97 eyes) were included in the study. In 31% (30 of 97), the endothelial graft dislocated after surgery. All 30 cases required a rebubble except 1, which reattached spontaneously. Ninety-eight percent (95 of 97) of all grafts remained attached for the duration of the follow-up period. Only 2 eyes (2.2%) required repeat graft. Endothelial grafts dislocated in 67% of patients with glaucoma draining devices. The dislocation rate for grafts larger than the host was 12 of 49 (24%), equal to the host was 3 of 17 (18%), and smaller than the host was 8 of 19 (42%). Dislocations occurred in 5 of 21 (24%) of grafts with sutures remaining and 22 of 76 (29%) of those with all sutures out. Five of 12 (42%) cases of grafts performed without stripping the Descemet had dislocations.

Conclusions: The graft dislocation rate in DSAEK procedures after PKP is comparable to that after primary DSAEK cases. Donor grafts that are smaller than the host PKP and the presence of prior glaucoma drainage devices are risk factors for higher rates of graft dislocation.
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http://dx.doi.org/10.1097/ICO.0b013e3181f7f163DOI Listing
April 2011

External refinement of the donor lenticule position during descemet's stripping and automated endothelial keratoplasty.

Ophthalmic Surg Lasers Imaging 2008 Nov-Dec;39(6):522-3

Eye Institute, Froedtert and Medical College of Wisconsin, Milwaukee, WI 53226, USA.

The authors describe a technique to facilitate the centration of the donor lenticule during Descemet's stripping and automated endothelial keratoplasty. The donor corneal lenticule is unfolded and grossly centered in the anterior chamber using a barbed 30-gauge needle on a 3-cc air syringe or a reverse Sinsky hook. Fine adjustments to center the lenticule can be achieved by applying external pressure to the cornea with a laser in-situ keratomileusis flap roller. This simple technique provides a mechanism for simultaneously removing interface fluid and allows the surgeon to center the donor corneal lenticule without further risk of direct mechanical trauma to the donor endothelium.
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http://dx.doi.org/10.3928/15428877-20081101-06DOI Listing
January 2009

Effect of body position on renal parenchyma perfusion as measured by nuclear scintigraphy.

Urology 2007 Aug;70(2):227-9

Department of Urology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9665, USA.

Objectives: To compare differential renal perfusion in various body positions in healthy volunteers, to help postulate factors responsible for recurrent unilateral stone formation.

Methods: Ten volunteers with normal renal function and no history of urinary disease were evaluated with diuretic renography using mercaptoacetyl-triglycine. Scintigraphy was performed 1 week apart in each of three typical sleep positions (supine, left lateral decubitus, right lateral decubitus), and renal perfusion was measured.

Results: Symmetric renal perfusion was noted in all volunteers in the supine position. Subjects positioned in the left lateral decubitus position had a mean renal perfusion of 61.3% in the dependent (left) kidney, compared with 38.7% in the nondependent (right) kidney (P <0.05). In the right lateral decubitus position, the mean renal perfusion in the right kidney was 63.3%, whereas that in the left kidney measured 36.7% (P <0.05). Renal perfusion in the dependent kidney was increased when compared with the same kidney in the supine position in both the left and right kidneys.

Conclusions: Body position had a significant effect on renal perfusion as measured by nuclear renal scintigraphy. If altered renal blood flow contributes to urinary calculogenesis, these data suggest that the urinary and vascular milieu in the decubitus position may contribute to risk factors for stone formation.
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http://dx.doi.org/10.1016/j.urology.2007.03.057DOI Listing
August 2007

Juxtaglomerular apparatus tumor: a rare, surgically correctable cause of hypertension.

Rev Urol 2002 ;4(4):192-5

Although uncommon, presentation of juxtaglomerular cell tumor is distinct and should allow a correct preoperative diagnosis in most patients. Typical clinical presentations include headaches, polyuria, or isolated, asymptomatic, severe hypertension. The diagnosis of a juxtaglomerular apparatus (JGA) tumor typically results from identification of plasma renin levels two- to sevenfold greater than the normal value. Although JGA tumors are considered benign, with no reports of metastases or recurrence, they are potentially lethal if left untreated. Surgical excision is curative.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1475994PMC
July 2011

The effect of kidney morcellation on operative time, incision complications, and postoperative analgesia after laparoscopic nephrectomy.

Int Braz J Urol 2006 May-Jun;32(3):273-9; discussion 279-80

Department of Urology, University of California San Francisco, San Francisco, California 94143, USA.

Introduction: Compare the outcomes between kidney morcellation and two types of open specimen extraction incisions, several covariates need to be taken into consideration that have not yet been studied.

Materials And Methods: We retrospectively reviewed 153 consecutive patients who underwent laparoscopic nephrectomy at our institution, 107 who underwent specimen morcellation and 46 with intact specimen removal, either those with connected port sites with a muscle-cutting incision and those with a remote, muscle-splitting incision. Operative time, postoperative analgesia requirements, and incisional complications were evaluated using univariate and multivariate analysis, comparing variables such as patient age, gender, body mass index (BMI), laterality, benign versus cancerous renal conditions, estimated blood loss, specimen weight, overall complications, and length of stay.

Results: There was no significant difference for operative time between the 2 treatment groups (p = 0.65). Incision related complications occurred in 2 patients (4.4%) from the intact specimen group but none in the morcellation group (p = 0.03). Overall narcotic requirement was lower in patients with morcellated (41 mg) compared to intact specimen retrieval (66 mg) on univariate (p = 0.03) and multivariate analysis (p = 0.049). Upon further stratification, however, there was no significant difference in mean narcotic requirement between the morcellation and muscle-splitting incision subgroup (p = 0.14).

Conclusion: Morcellation does not extend operative time, and is associated with significantly less postoperative pain compared to intact specimen retrieval overall, although this is not statistically significant if a remote, muscle-splitting incision is made. Morcellation markedly reduces the risk of incisional-related complications.
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http://dx.doi.org/10.1590/s1677-55382006000300003DOI Listing
February 2007

Novel everting urologic access sheath: potential advantages of decreased cellular advancement.

J Endourol 2006 Feb;20(2):153-6

Department of Urology, University of California San Francisco, San Francisco, California 94143, USA.

Background And Purpose: Axial forces are imposed on the urothelium during advancement of instruments across the urinary tract, potentially transferring cellular debris, bacteria, or urothelial carcinoma from one anatomic location to another. A prototype access sheath (Cystoglide; Percutaneous Systems, Mountain View, CA) was created that everts and radially dilates but does not provide axial forces during deployment that can be used in a variety of anatomic systems. We created a urinary-tract model to evaluate the in-vitro advancement of cells to compare this technology with using instruments alone.

Materials And Methods: Blocks of sterile agar were created with 17F tracts of three lengths (2.7, 5.5, and 11 cm) with 5 mL of Luria-Bertani broth/ampicillin solution in a well at the end. The tips of a Cystoglide sheath and a traditional urologic instrument of the same diameter were dipped into a suspension of ampicillin-resistant Escherichia coli and advanced through the tracts. After a 10-second exposure, 4 mL of broth was collected and cultured. Bacterial growth was compared by measuring the optical density (OD) of the broth at multiple time points.

Results: The mean overall OD of the broth was significantly lower (P < 0.001) in the novel-sheath cultures than with a traditional instrument for all advancements at all tract lengths.

Conclusion: The Cystoglide sheath significantly reduces the advancement of cells within an artificial urinary tract compared with a non-everting instrument. Clinical studies are needed to assess the utility of this technology in vivo.
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http://dx.doi.org/10.1089/end.2006.20.153DOI Listing
February 2006

Novel everting urologic access sheath: decreased axial forces during insertion.

J Endourol 2005 Dec;19(10):1216-20

Department of Urology, University of California, San Francisco, San Francisco, California 94143-1611, USA.

Background: Advancement of urologic instruments through the genitourinary tract is associated with significant axial forces that likely contribute to patient discomfort, even after injection of a local anesthetic, and may lead to mucosal trauma, postprocedural dysuria and hematuria, and increased susceptibility to infection and strictures. Placing an everting urethral sheath prior to instrumentation may decrease these problems.

Materials And Methods: Two 7-cm-long, 5-mm diameter urethral luminal models were created, one with and one without an artificial stricture. We measured the forces generated during advancement of a novel everting access sheath (Cystoglide; Percutaneous Systems, Mountain View, CA) through the models in comparison with a representative cystoscope and a urologic dilator simulating a traditional access sheath.

Results: The mean force generated during advancement of the everting sheath was significantly less than that of both the representative cystoscope (P<0.01) and the traditional access sheath (P<0.01). This held true for the urethral models both with and without an artificial stricture (P<0.01) and with and without lubrication (P<0.01).

Conclusions: This novel introduction sheath markedly decreased the axial forces applied to an artificial urethral luminal wall. It is possible that the clinical use of this technology will decrease the discomfort and potential complications associated with lower urinary-tract endoscopy.
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http://dx.doi.org/10.1089/end.2005.19.1216DOI Listing
December 2005

Laparoscopic appreciation of the adrenal artery: fact or fiction?

J Endourol 2005 Sep;19(7):793-6

Department of Urology, University of California-San Francisco, CA 94143, USA.

Background: It is well accepted that identification and control of the adrenal vein is a critical step in laparoscopic adrenalectomy. The surgical and anatomic literature propagates the notion of a dominant or multiple dominant adrenal arteries that should likewise be controlled during surgical extirpation.

Materials And Methods: We assessed the frequency of adrenal-artery identification and the need for formal ligation in an extensive series of laparoscopic adrenalectomies.

Results: In our experience, even using a magnified laparoscopic view, we found it possible to identify and necessary to formally ligate an adrenal artery in only 3 of 265 cases (1.1%). Further, in this series, only the inferior adrenal artery was ever seen definitively to require formal clip ligation, while a discrete middle or superior adrenal artery was almost never seen, and the vasculature in these areas could be controlled with electrocautery or ultrasonic energy alone during routine dissection.

Conclusions: The need to search for and ligate the arterial supply during laparoscopic adrenalectomy is not as clinically significant as once thought, and formal control appears unnecessary unless the vessels are serendipitously encountered during the routine dissection.
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http://dx.doi.org/10.1089/end.2005.19.793DOI Listing
September 2005

Failed percutaneous balloon dilation for renal access: incidence and risk factors.

Urology 2005 Jul;66(1):29-32

Department of Urology, University of California, School of Medicine, San Francisco, California 94143, USA.

Objectives: To present our experience using balloon dilation and discuss secondary techniques to establish a percutaneous tract when balloon dilation fails. Balloon dilation is a safe and effective method to achieve percutaneous renal access, but it is not uniformly successful. Also, the failure rate and risk factors have not been well documented.

Methods: We retrospectively reviewed our last 99 consecutive percutaneous renal procedures using a balloon system as our initial dilation modality. In all cases, the urologist achieved needle access. We determined the balloon failure rate, relationship to prior renal surgery and other patient-related factors, and success rate using secondary techniques of tract dilation.

Results: The balloon did not adequately dilate a tract in 17 (17% failure rate) of 99 cases. The risk factors for failure included a history of prior ipsilateral renal surgery (25% failure rate versus 8% without surgery) and subcostal compared with supracostal puncture (18% versus 9% failure rate). The failure rate was not increased when stratified by laterality, stone composition, stone size and location, or history of ipsilateral renal infection. Amplatz dilators were used in 16 refractory cases and were successful in 15. Metal Alken dilators were successfully used in 2 patients.

Conclusions: The balloon dilation system is commonly used as the primary modality to establish percutaneous renal access. Although safe and effective (83%), the success rate drops dramatically in patients with prior ipsilateral renal surgery. Knowledge and skill with alternative dilation systems, such as Amplatz or metal Alken dilators, are necessary to successfully gain entry into all renal collecting systems.
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http://dx.doi.org/10.1016/j.urology.2005.02.018DOI Listing
July 2005