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Biomedical subjects

Badrinath R Konety

Publications and source records attributed to Badrinath R Konety.

At least 37 records · Page 2Linked to original sources
PubMed2005

Two-surgeon versus single-surgeon radical cystectomy and urinary diversion: impact on patient outcomes and costs.

OBJECTIVES: To examine the difference in charges and outcomes between patients who underwent radical cystectomy and urinary diversion by a team of two surgeons versus a single surgeon. METHODS: A total of 63 patients with bladder cancer who underwent the procedures were retrospectively analyzed. Two surgeons sequentially performed the cystectomy and ileal conduit (IC, n = 17) or neobladder (NBL, n = 18) or a single surgeon performed both the cystectomy and IC (n = 21) or NBL (n = 7). Procedure-related charges, hospital charges, operating room time, length of stay, and complications were compared between the two groups. RESULTS: For the IC patients, the two-surgeon team had 60% greater mean surgeon charges (P <0.0001), 23% lower mean anesthesia charges (P <0.0001), 121 minutes shorter operating room time (P = 0.001), and 30% lower operating room charges (P = 0.001). For the NBL patients, the two-surgeon team had 32% greater surgeon charges (P <0.0001), 22% lower anesthesia charges (P = 0.003), 149 minutes shorter operating room time (P <0.0001), and 41% less operating room charges (P <0.0001). No differences were found in total hospital charges. The NBL patients who underwent surgery by two surgeons had a longer length of stay (P = 0.008). No differences were found in complications between the groups. CONCLUSIONS: For IC patients, our data showed no differences in the average overall charges, whether a two-surgeon team or a single surgeon performed the procedure. Additional reductions in hospital charges could offset the greater physician charges in the NBL patients and allow full realization of the benefit from the shorter operative time with the two-surgeon team.

Aged↗
PubMed2005

Impact of lymphadenectomy and nodal burden in renal cell carcinoma: retrospective analysis of the National Surveillance, Epidemiology, and End Results database.

OBJECTIVES: To analyze the additional impact of retroperitoneal lymphadenectomy on overall and cancer-specific survival (CSS) in patients with primary renal cell carcinoma (RCC) undergoing radical nephrectomy. The benefit of regional lymphadenectomy in patients with primary RCC remains controversial. METHODS: Of 33,016 patients diagnosed with primary RCC between 1983 and 1998, a subset of 4453 underwent radical nephrectomy with or without regional lymphadenectomy. The extent of lymphadenectomy was assessed using the number of nodes examined, and the tumor burden was assessed using the number of positive nodes and the ratio of the number of positive nodes to the total number of nodes examined. Associations between CSS and the number of nodes examined, number of positive nodes, and ratio of the number of positive nodes to the total number of nodes examined were assessed. RESULTS: An inverse correlation was found between the likelihood of CSS and the number of nodes examined, particularly for those with regional disease even after controlling for other factors. A correlation was noted between the number of nodes examined and the number of positive nodes. Significant differences in CSS were observed in node-negative patients with regional disease compared with node-positive patients. An increasing nodal burden was associated with worse CSS. CONCLUSIONS: More extensive lymphadenectomy does not appear to increase further the probability of CSS in patients undergoing radical nephrectomy for RCC. An increased number of positive nodes, as well as an increasing nodal burden, although associated with a lower likelihood of survival, were not independent predictors of RCC-specific mortality.

Adult↗
PubMed2005

Use of bipolar power source for transurethral resection of bladder tumor in patient with implanted pacemaker.

Patients with implanted electrical devices such as cardiac pacemakers and cochlear implants typically must have the device inactivated before surgical procedures in which the use of electrocautery is possible. In situations in which the patient cannot tolerate inactivation of the device even for a short while, the use of a bipolar energy source may allow performance of the procedure without inactivating the device. We report the case of a patient who underwent transurethral resection of a bladder tumor using a bipolar energy source uneventfully despite the presence of an implanted cardioverter defibrillator that was not deactivated before resection.

Electrosurgery↗
PubMed2005

Impact of hospital and surgeon volume on in-hospital mortality from radical cystectomy: data from the health care utilization project.

PURPOSE: We determined the influence of hospital and surgeon volume on various outcome parameters after radical cystectomy for bladder cancer. MATERIALS AND METHODS: All inpatient discharges after radical cystectomy for bladder cancer (1988 to 1999) from the Health Care Utilization Project-Nationwide Inpatient Sample were included in the analysis. Hospital and individual surgeon volume of discharges per year were separated into terciles. Outcome measures were in-hospital mortality, length of stay (LOS), and inflation adjusted charge per admission. Mortality was compared among hospital volume levels using the Mantel-Haenszel chi-square test while the LOS and charges were compared using ANOVA. Multivariate linear and logistic regression analyses were used to adjust for confounding factors. All the analyses were also performed in 3 different age strata (younger than 50 years, 50 to 69 years and 70 years or more). RESULTS: There were 13,964 patients who underwent radical cystectomy. Overall in-hospital mortality was 408 of 13,964 (2.9%), average LOS was 14 days (+/- SD 10.28) and average charges were 47,146 dollars (+/- SD 45,263 dollars). In-hospital mortality was significantly associated with higher volume particularly for patients older than 50 years. Surgeon volume did not influence in-hospital mortality except for patients in the 50 to 69-year-old age group. Results of multivariate regression analysis demonstrated hospital volume was a significant predictor of in-hospital mortality but this effect was lost when controlling for surgeon volume. LOS was significantly higher for low volume surgeons. High volume hospitals had lower average total charges compared with the low and moderate volume hospitals. CONCLUSIONS: Hospital and surgeon volume have a significant impact on in-hospital mortality and LOS after radical cystectomy. Radical cystectomy performed at a higher volume center may result in lower charges and shorter hospital stay while decreasing the likelihood of in-hospital mortality.

Aged↗
PubMed2005

Impact of malpractice caps on use and outcomes of radical cystectomy for bladder cancer: data from the surveillance, epidemiology, and end results program.

PURPOSE: The impact of malpractice awards on insurance premiums and health care delivery generates much concern. To our knowledge no data exist regarding the impact of caps, or upper limits, on awards for noneconomic damages (also termed pain and suffering) on health care delivery patterns or outcomes. We investigated the effect of caps on the use of and outcomes following aggressive surgical treatment (radical cystectomy) in patients with bladder cancer. MATERIALS AND METHODS: We performed a retrospective cohort study of patients with bladder cancer who underwent radical cystectomy, identified from the Surveillance, Epidemiology, and End Results (SEER) Program database. Cystectomy rates and post-cystectomy disease specific survival were compared between SEER regions with and without a cap, while controlling for other variables. RESULTS: A significantly greater proportion of patients with stages III and IV bladder cancer underwent cystectomy in SEER regions with a cap. Cap status was a significant predictor of survival from bladder cancer. CONCLUSIONS: Radical cystectomy for bladder cancer is performed more often even for advanced bladder cancer in geographic regions with a cap with a positive impact on survival. The institution of caps may have beneficial effects on patterns of health care beyond that of merely decreasing insurance premium costs.

Adult↗
PubMed2005

The impact of provider volume on outcomes from urological cancer therapy.

PURPOSE: Growing evidence suggests an association between higher hospital and surgeon volumes, and better outcomes after high risk surgical procedures. We reviewed the literature on volume and outcomes, specifically in urological cancer therapy. MATERIALS AND METHODS: We searched the literature from 1966 to 2004 using MEDLINE with the keywords outcomes, urology, neoplasms, volume, hospital volume, surgeon volume, prostatectomy, cystectomy, nephrectomy, prostate cancer, bladder cancer, kidney cancer and testis cancer. Relevant articles were reviewed and results were compared for each urological cancer. RESULTS: Several studies demonstrated that higher hospital volume is associated with better outcomes for all urological cancer surgeries. We found that long-term morbidity associated with radical prostatectomy is significantly associated with individual surgeon volume. There were variations in outcome even among high volume surgeons, suggesting that surgical technique can independently impact outcome. Hospitals with a high volume of cystectomies and nephrectomies had decreased overall mortality rates compared with low volume hospitals. Patients undergoing retroperitoneal lymph node dissection for metastatic germ cell tumor had statistically significantly improved survival when treated at larger oncology centers. CONCLUSIONS: Evidence that high volume hospitals have better outcomes is increasing for urological cancer surgeries. Whether volume affects quality or better clinicians and services attract more patients can be debated. Centralizing health care will have major health policy implications, ie high volume hospitals may be overwhelmed and low volume hospitals may be at a disadvantage. An alternative would be to attempt to improve outcomes at low volume hospitals by identifying drivers of high quality care at high volume hospitals and transferring some of these characteristics.

Clinical Competence↗
PubMed2005

Comparison of the incidence of latent prostate cancer detected at autopsy before and after the prostate specific antigen era.

PURPOSE: Most data regarding the prevalence of latent prostate cancer found only at autopsy are from old reports. To determine if significant differences exist in the prevalence of latent prostate cancer between periods before and after the advent of screening for prostate cancer, we compared 2 groups of men undergoing autopsy during the 2 periods. MATERIALS AND METHODS: Our institutional autopsy record database was searched to identify all men found to have prostate cancer before or after death between 1955 and 1960 (total 3,307 men and 1,578 men older than 40 years), and between 1991 and 2001 (total 2,938 men, 1,380 men older than 40 years). We calculated the age based incidence of latent prostate cancer detected only at autopsy in an at risk population of men (older than 40 years). We also compared Gleason grade distribution and proportion of stage cT3 or greater cancers between the 2 periods. RESULTS: Between 1955 and 1960 the prevalence of latent prostate cancer detected only at autopsy in men older than 40 years was 4.8% compared to 1.2% (p < 0.0001) between 1991 and 2001. A significant decrease in the prevalence of latent, autopsy detected cancers was observed in men 70 to 89 years old at death. Autopsy detected cancers were found to be grossly invading adjacent structures (stage cT3 or greater) in 17 of 76 (22%) cancers discovered between 1955 and 1960, while none of the latent prostate cancers found in the 1991 to 2001 period were found to extend grossly beyond the prostate. CONCLUSIONS: Autopsy rates are decreasing at our institution. With the more widespread use of screening, the prevalence of latent prostate cancer has decreased 3-fold. The decrease in the prevalence of latent prostate cancer is especially dramatic in men older than 70 years. Further study will determine the significance of many of the tumors currently detected clinically, which may have been latent and found at autopsy if not for screening.

Adult↗
PubMed2005

The prevalence of renal cell carcinoma diagnosed at autopsy.

OBJECTIVE: To compare the rate of renal cell carcinoma (RCC) detected only at autopsy, from two periods, to determine if the apparent recent increase in RCC in the USA is a true increase or mainly a result of improved imaging techniques, as a true increase in the clinical incidence of RCC should not affect the number of previously undiscovered RCC found only at autopsy. PATIENTS AND METHODS: We identified all individuals who underwent autopsy in two periods, 1955-60 (3307) and 1991-2001 (2938), and who were identified with renal tumour either before or after death. Information was obtained on age, sex, histological type and size of tumour, and whether the tumour was identified before or only after death. All cases of RCC detected at autopsy were reviewed for this analysis by one pathologist (L.D.). RESULTS: Between 1955-60 and 1991-2001 there was a 55% reduction in the mean annual number of autopsies. The proportion of malignant renal masses (RCC) did not change significantly (35.4% to 32.8%). The rate of previously unsuspected RCC detected only at autopsy did not change significantly (0.91 vs 0.72 per 100 autopsies). CONCLUSION: The number of renal masses, both benign and malignant, discovered only at autopsy is declining, possibly because of better detection before death. However, the rate of occult kidney cancer per 100 autopsies did not change significantly between the two periods, suggesting a true increase in the frequency of clinically detected kidney cancer.

Aged↗
PubMed2004

Squamous cell carcinoma of the penis: evaluation of data from the surveillance, epidemiology, and end results program.

BACKGROUND: Penile carcinoma is uncommon. Therefore, obtaining meaningful epidemiologic data requires analysis of large, multisource databases. The authors examined the association between different demographic variables and the prevalence, presentation, and survival of patients with penile squamous cell carcinoma in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. METHODS: The SEER database represents 12% of the U.S. population. The database included 1605 patients with a diagnosis of penile squamous cell carcinoma between 1973 and 1998. The variables analyzed were age, race, marital status, stage at presentation, type of surgery, performance of lymphadenectomy, and disease-specific survival. RESULTS: Of 1605 patients, 37% presented with carcinoma in situ (CIS), 39% with localized disease, 13% with regional disease, 2.3% with distant disease, and 7.9% of the patients were unstaged. The percentage of patients presenting with CIS and localized disease increased and decreased yearly, respectively. African Americans represented 9.9% of the population and tended to present at a younger age and with a higher stage of disease, and their cancer-specific survival was shorter in all stages. However, these associations were statistically significant only for men with regional disease. Marital status was documented for 1394 patients (87%). The majority (84%) had a history of marriage and presented at an earlier stage of disease and had higher disease-specific survival in the localized (P = 0.0002) and regional stages (P = 0.0010) of disease. CONCLUSIONS: The diagnosis of penile carcinoma significantly reduced survival. African-American men presented with a higher stage of disease and statistically significant decreased survival, whereas previously or currently married men presented at an earlier stage of disease and sought more aggressive treatment.

Adult↗
PubMed2004

Functional characterization of the bladder cancer marker, BLCA-4.

INTRODUCTION: Bladder cancer is a common disease of the genitourinary tract for which the development of a noninvasive detection technique would have a significant impact on disease management. One of our previously identified bladder cancer-specific proteins, BLCA-4, appears to be associated with a "field effect" of the disease, and in clinical trials is able to separate individuals with bladder cancer from those without the disease with high sensitivity and specificity. The potential clinical utility of this marker has led to the analysis of its function in bladder cancer pathobiology. EXPERIMENTAL DESIGN: To additionally analyze the specificity of this marker, the expression in the urine of a variety of benign urologic conditions was analyzed. After cloning the gene encoding BLCA-4, functional aspects of the protein were analyzed by overexpressing it in cell systems, as well as its interaction with other transcription factors and in gel mobility shift assays. Finally, to determine the timing of expression in relation to the observance of bladder cancer, an animal model of the disease was examined. RESULTS: Expression of BLCA-4, the cDNA of which reveals that it is a novel member of the ETS transcription factor family, is not found in benign urologic conditions. Overexpression leads to increased growth rates of cells, and the protein interacts with other transcription factors. In vivo studies reveal that BLCA-4 expression occurs significantly before the observance of grossly visible tumors in an animal model of the disease. CONCLUSIONS: BLCA-4 is a bladder cancer marker that is highly specific and occurs early in the development of the disease. It appears to be a transcription factor that may play a role in the regulation of the gene expression in bladder cancer. BLCA-4 is a marker with significant clinical utility that may have an active role in the disease.

Amino Acid Sequence↗
PubMed2004

Prostate cancer screening parameters in a high-risk African-Caribbean population.

OBJECTIVES: To estimate the prostate cancer screening parameters in a population-based study of African-Caribbean men from the Island of Tobago. METHODS: A total of 2582 men aged 40 to 79 years (50% of all Tobago men in this age group) were screened using both serum prostate-specific antigen (PSA) and digital rectal examination (DRE). Men with an elevated PSA level (4 ng/mL or greater) or abnormal DRE findings were referred for ultrasound-guided sextant biopsy. RESULTS: The screening results for one or both tests were abnormal in 32% of men. The prevalence of prostate cancer was 10.7 of 100 screened men. The positive predictive value for PSA was 56% compared with 39% for DRE. The positive predictive value for PSA ranged from 6% for those aged 40 to 49 years to 59% for those aged 70 to 79 years. The sensitivity was 71% and the specificity 86% for DRE. The sensitivity for PSA was 80%. The sensitivity was low among men aged 40 to 49 years (20%) and 50 to 59 years (66%). The specificity for PSA declined across age groups from 98% for those aged 40 to 49 years to 70% for those 70 to 79 years. CONCLUSIONS: The screening parameters in this African-Caribbean population were similar to the sparse data available from other populations of African descent. The screening was highly efficacious, with a positive predictive value of 56% for an elevated PSA level and 40% for an elevated PSA level and/or abnormal DRE findings.

Adult↗
PubMed2004

Testicular recurrence from "primary" retroperitoneal germ cell tumor.

Extragonadal germ cell tumors are a rare clinical entity. We present the case of an extragonadal germ cell tumor followed by testicular recurrence more than 4 years later. This presents an interesting dilemma as to whether this was recurrence of the original tumor or a new, primary tumor. The patient's outcome and surveillance protocol for these tumors are presented.

Adult↗
PubMed2004

Fluorescence cystoscopy and bladder surveillance.

PURPOSE OF REVIEW: Update on new developments in the field of fluorescence cystoscopy. RECENT FINDINGS: New agents are being studied to improve the accuracy of fluorescence cystoscopy. Hexyl-5-aminolevulinic acid is an ester form of 5-aminolevulinic acid with improved uptake by tumor cells. It has been shown to have higher specificity than 5-aminolevulinic acid and can possibly play a complementary role to standard cystoscopy. Hypericin is a promising new agent that has excellent sensitivity and specificity. The use of confocal microscopy to examine fluorescent tissue may help improve the accuracy. SUMMARY: The addition of newer agents to the armamentarium of fluorescence cystoscopy has great potential with promising results in improving the diagnostic accuracy of bladder cancer and in particular carcinoma in situ. These agents need to be studied in large randomized trials to prove that using these agents can facilitate early diagnosis and improved prognosis in patients with bladder cancer.

Cystoscopy↗
PubMed2004

Feasibility of radical prostatectomy after neoadjuvant chemohormonal therapy for patients with high risk or locally advanced prostate cancer: results of a phase I/II study.

PURPOSE: We determined the feasibility of radical prostatectomy after neoadjuvant chemohormonal therapy in locally advanced (stage T3 or greater) and/or high risk tumors (Gleason 8 to 10 and/or serum prostate specific antigen (PSA) greater than 20 ng/ml). MATERIALS AND METHODS: Enrollment criteria included clinical stage T1 to 2 with any Gleason grade and PSA greater than 20 ng/ml, clinical stage T3 to 4 with any serum PSA or Gleason grade, or any clinical stage with biopsy Gleason grade of 8 to 10 and any serum PSA. All patients received neoadjuvant hormonal therapy during chemotherapy (4 cycles of paclitaxel and carboplatin and estramustine) followed by radical prostatectomy. Nerve sparing was decided on an individual basis and a nerve graft was offered to those who underwent unilateral or bilateral nerve resection. Perioperative morbidity, mortality and delayed complications were assessed. RESULTS: A total of 36 patients were enrolled. After chemohormonal therapy clinical stage was less in 39% of patients and greater in 36%. Bilateral nerve sparing was performed in 3 patients and the remaining 33 underwent either unilateral or bilateral neurovascular bundle resection with nerve grafts performed in 17 (52%). Deep vein thrombosis (22%) was the most frequent complication of chemotherapy. Minor postoperative complications occurred in 6 patients. At a median followup of 29 months (range 5 to 51) after radical prostatectomy 32 (89%) were continent and 5 (15%) preoperatively potent men remained potent. The positive surgical margin rate was 22%. Of all subjects 45% remain free from biochemical recurrence. CONCLUSIONS: Neoadjuvant chemohormonal therapy followed by radical prostatectomy can be performed with low morbidity. Positive surgical margin rates are low. This approach yielded good local control of disease, however impact on tumor recurrence and survival is not known.

Adult↗
PubMed2004

Association between volume and charges for most frequently performed ambulatory and nonambulatory surgery for bladder cancer. Is more cheaper?

PURPOSE: We investigated the relationship between provider volume and charges for transurethral bladder tumor resection (TURBT) and radical cystectomy in patients with bladder cancer. MATERIALS AND METHODS: The National Inpatient Sample (1988 to 1999) of the Health Care Utilization Project, and State Ambulatory Surgery Databases for Wisconsin and Florida (2000 data set) were used for analysis. All patients with bladder cancer who had undergone radical cystectomy or TURBT as the principal procedure were identified. Hospitals and surgeons were categorized into terciles of volume based on the average number performed per year. The average hospital charge per discharge/procedure corrected to 2000 levels was calculated. One-way ANOVA with the Bonferroni correction was used to compare charges between different volume levels. RESULTS: A total of 13,498 patients who underwent radical cystectomy and 5,954 who underwent TURBT were included in the analysis. Charges for radical cystectomy were 5,648 USD lower at high volume hospitals than at low volume hospitals (p <0.001). High volume surgeons were 2,976 USD less expensive than low volume surgeons (p =0.054). For TURBT total hospital charges at high volume hospitals were 1,013 USD more than at low volume hospitals (p <0.0001), while average total hospital charges for procedures performed by high volume surgeons were 919 USD less compared to low volume surgeons (p <0.0001). CONCLUSIONS: High risk inpatient procedures for bladder cancer such as cystectomy, which are more influenced by systems of care, are less expensive to perform at high volume centers. Lower risk ambulatory procedures for bladder cancer, such as TURBT, which are not influenced by systems of care, may be more cost efficiently performed by high volume surgeons at low volume centers.

Ambulatory Surgical Procedures↗
PubMed2004

Health related quality of life assessments for patients with bladder cancer.

PURPOSE: We review the current data regarding the impact of various therapeutic alternatives for bladder cancer on health related (HR) quality of life (QOL). MATERIALS AND METHODS: A MEDLINE search of the English literature from 1966 to November 2003 using the search terms "cystectomy," "intravesical therapy" or "bladder cancer" and quality of life yielded 33 articles. Studies of metastatic disease were excluded. The method of evaluation of quality of life in each article was assessed, particularly the instruments used and the population studied. RESULTS: The majority of these reports (20 of 33) compared the impact of different types of urinary diversion on quality of life. The reports provided conflicting data, with several studies showing no significant difference in overall QOL. Some studies revealed a greater improvement in HRQOL with time following continent diversion. Only 2 reports discussed evaluation of HRQOL during intravesical therapy. Either an established standardized QOL instrument or an internally validated instrument was used in all but 8 of the studies. No reports compared the HRQOL effects of bladder sparing treatments to radical cystectomy. CONCLUSIONS: There is no single measure of HRQOL predominantly used in patients with bladder cancer. There is a lack of data comparing HRQOL outcomes in patients receiving bladder sparing therapies versus cystectomy. Development of a universally applicable validated instrument would allow a more effective comparison of HRQOL outcomes in these patients as well as in those with superficial and muscle invasive bladder cancer.

Humans↗