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Biomedical subjects

Kobi Stav

Publications and source records attributed to Kobi Stav.

12 recordsLinked to original sources
PubMed2006

Pelvis architecture and urinary incontinence in women.

OBJECTIVES: To examine anatomic features in the pelvic bones and muscles in women with urinary incontinence (UI). MATERIAL AND METHODS: Between October 2005 and January 2006, 212 consecutive women underwent pelvic computerized tomography in our center. Preceding the examination, all women completed a clinical and demographic questionnaire including detailed questions about UI. Several anatomic parameters using multiplanar reformation and three-dimensional techniques (volume rendering) were examined. We specifically evaluated different bony parameters, pelvic floor muscle angles, densities, and cross-sectional areas. Ninety-three women (46.5%) had UI; the remaining women served as the control group. A logistic regression model was used to evaluate risk factors for UI. RESULTS: The mean age was 55.5 yr (range: 19-90). Women who suffered from UI were older (60.97 vs. 50.77 yr, p<0.0001), had higher body mass index (27.65 vs. 25.49, p<0.01), had more previous hysterectomies (21.5% vs. 6.5%, p<0.005), underwent more pelvic irradiation (9.7% vs. 1.8%, p<0.05), and had more diabetes mellitus (31.2% vs. 13.1%, p<0.005). Patient's age and previous hysterectomy were found to be the major clinical risk factors for UI (OR: 1.029, p=0.002; OR: 2.94, p=0.024, respectively). Logistic regression analysis on all clinical and morphologic variables yielded the following risk factors: pelvic-inlet diameter (OR: 1.216, p<0.0001), pelvic-inlet anterior-posterior diameter (OR: 1.109, p=0.003), pelvic-outlet diameter (OR: 1.077, p=0.011) and transverse perineal muscle cross-section diameter (OR: 0.773, p<0.0001). CONCLUSIONS: Pelvic inlet and outlet dimensions are major risk factors for developing UI in women. These findings may lead to a better comprehension of the pathophysiology of UI in women.

Adult↗
PubMed2006

[Multivariate analysis on radical retropubic prostatectomy associated blood loss: importance of prostate size, pelvic lymph-node dissection and percentage of carcinoma].

BACKGROUND: Radical retropubic prostatectomy (RRP) has been associated with blood loss requiring blood transfusion. AIM: To define risk factors for blood transfusion. STUDY DESIGN AND METHODS: The charts of 303 patients who underwent RRP between the years 1992 and 2002 were prospectively reviewed. Blood loss, blood requirements and correlative clinical data were recorded and a multivariate analysis model was applied. RESULTS: Data was available in 293 cases (97%). A total of 122 patients were transfused (42%) with a median of 2 units of packed cells. Median estimated blood loss was 766 ml (range 150-2800). Blood loss declined progressively during the study period (1220 ml in 1992 to 826 ml in 2002). Multivariate analysis reveals that estimated blood loss and transfusion rate are related to performance of pelvic lymph node dissection, prostate size and percentage of cancer in the prostatectomy specimen. CONCLUSION: Our series indicates that blood preparation may be spared in patients who are not candidates for pelvic lymph node dissection with prostate smaller than 57 gr. and with less than 77% in the biopsy specimen (equivalent to < 66% of cancer in the prostatectomy specimen).

Blood Loss, Surgical↗
PubMed2006

[Percutaneous diagnostic biopsy of solid renal masses in adults].

Most solid renal masses are presumed to represent renal cell carcinoma. Percutaneous biopsies of renal cell carcinoma have been discouraged because traditionally it was believed that surgery provides tissue diagnosis, staging, and grading as well as definitive treatment. Percutaneous renal mass biopsy was shown to be inaccurate and finally, beside rare complications such as bleeding and pneumothorax, biopsy may facilitate tumor seeding along the needle tract. In recent years, due to an increased use of cross-sectional imaging, more renal masses are being detected. The size of renal masses in contemporary series is smaller than in historical cohorts. On the basis of our findings and according to reports by others, approximately 20% of small renal masses are benign. We reviewed the indications, techniques, success rates, accuracy and complications of percutaneous biopsy of solid renal masses in adults in order to debate whether it is currently indicated to reconsider the role of renal mass biopsy in the diagnostic flowchart of small renal masses workup. Such a modification, if proven to be justified, may spare a substantial number of patients the risk and morbidity of nephrectomy or partial nephrectomy.

Adult↗
PubMed2005

Retropubic radical prostatectomy: associated blood loss and transfusion requirements--a two-decade perspective review.

Bleeding during retropubic radical prostatectomy arises from venous structures in the majority of cases. Since its introduction two decades ago, the nerve-sparing procedure with surgical control of the dorsal venous complex has led to a reduction in blood loss and blood transfusion rate. The reducton in blood loss is a result of better understanding of the prostatic blood vessel anatomy, extensive surgical experience over time, and reduction in transfusion triggers with an acceptance of lower postoperative hemoglobin values. Increased blood loss during RRP is associated with poorer outcomes most probably due to surgical difficulties. But as for now, there are no decisive risk factors for clinically significant bleeding during RRP although newer technologies for hemostasis of the dorsal vein complex are being utilized.

Blood Transfusion↗
PubMed2005

[Long-term follow-up of radical retropubic prostatectomy for prostate cancer in 400 consecutive patients].

PURPOSE: To evaluate the long-term outcomes following radical retropubic prostatectomy for localized prostate cancer. STUDY DESIGN AND METHODS: The charts of 401 patients who underwent radical retropubic prostatectomy between 1992 and 2004 were reviewed. RESULTS: The average age was 63 years with a median PSA of 8.5 and median Gleason score of 5. Ninety one percent of the cases were diagnosed by a single prostate biopsy set (average 7 cores, range 3-16). Pelvic lymph node dissection was performed in 84 patients (21.7%). Nodal involvement was noted in 5 (6%). Capsular invasion was found in 91 patients (24%), positive surgical margin in 78 (20.1%) and seminal vesicle involvement in 37 (9.5%). The average admission stay was 5.2 days (3-22). Fever (11.4%), urine leakage (8%), wound infection (4%) and pulmonary embolism (1.5%) were the most common early complications. One year after the operation 72% of the patients were fully continent. Of the 172 patients who underwent nerve-sparing procedure, 80 patients (46.5%) regained their sexual potency one year after the operation and did not require pharmacological assistance. Median follow-up time was 84 months. The five and eight years overall survival rates were 85% and 73%, respectively. Ten years survival of 136 patients (35%) with clinical stage T1C was 95%. Biochemical failure was observed in 68 patients (18%). The average time to biochemical failure was 12.5 months (range 0-76. median 12). Forty five patients (12%) died, twenty one (5.4%) due to metastatic disease. Mortality correlated to pre-operative PSA, clinical stage and Gleason score. CONCLUSION: At one year follow up, most of the patients are continent and 46.5% have spontaneous erection following nerve-sparing procedure. The overall survival and the long-term outcomes of radical retropubic prostatectomy are equal to those reported in the current literature.

Follow-Up Studies↗
PubMed2005

[Endourological treatment of ureteropelvic obstruction using holmium YAG laser].

BACKGROUND: Ureteropelvic junction obstruction (UPJO) is defined as an impairment of urine outflow from the pelvis to the ureter. Several treatment approaches are in use. OBJECTIVES: To present the different endo-urological approaches--retrograde and antegrade techniques --for UPJO using the holmium: YAG laser. METHODS: We followed 67 patients who underwent endopyelotomy between 1994 - 1997 and compared the different approaches for the treatment of UPJO. RESULTS: A total of 67 patients were operated, 52 patients using retrograde approach and 15 using antegrade approach. In the retrograde approach success was achieved in 48 patients (93%) and in 14 patients (94%) in the antegrade approach. Complications rate was 10% and 40%, respectively. Hospital stay was 2.2 days in the retrograde approach and 4.6 in the antegrade approach. CONCLUSIONS: The success rate in the different endourologic approaches was high and no difference between the two approaches was identified. From our experience, lower complication rate and shorter hospital stay make the retrograde approach more advantageous.

Endoscopy↗
PubMed2005

[Tissue microarray--an infrastructure for prostate cancer outcome research].

UNLABELLED: In tissue microarray (TMA) approximately 500 clinical formalin fixed and paraffin embedded tissue cores are reorganized into a new recipient block. Each recipient block may be sectioned up to 200 times. MATERIAL AND METHODS: Radical prostatectomy specimens of 405 patients operated for prostate cancer (CaP) between 1992 and 2004 were considered. A large database was created incorporating clinical and pathological data. Median follow-up time was 84 months. A full pathological revision was performed. We allocated and marked sites of interest on patients' slides: CaP, normal prostate, capsular or seminal vesicles invasion and the appropriate controls. The corresponding paraffin blocks served as donor blocks for harvesting tissue cores sequentially incorporated into the TMA recipient block. RESULTS: The specimens of 264 patients out of 405 qualified for inclusion into the TMA (yield 65%). Two TMA copies were prepared containing 4 blocks each. Each copy includes approximately 2000 tissue cores. CONCLUSIONS: We have constructed a large scale TMA associated with a detailed clinical database. This TMA will serve for prostate cancer outcome studies by using immunohistochemical as well as other molecular staining. Our TMA is unique because it contains sites of interest for CaP local invasiveness and metastasis.

Biopsy↗
PubMed2004

Adverse effects of cystoscopy and its impact on patients' quality of life and sexual performance.

BACKGROUND: Cystoscopy, the principal means of diagnosis and surveillance of bladder tumors, is invasive and associated with unpleasant side effects. OBJECTIVES: To determine the early complications of rigid cystoscopy and the impact on patients' quality of life and sexual performance. METHODS: One hundred consecutive patients undergoing diagnostic rigid cystoscopy filled in questionnaires that included anxiety and pain levels (0-5 visual analogue scale), adverse events, Short-Form Health Survey, International Prostate Symptom Score, and functional sexual performance. Questionnaires were administered before, immediately after, and 1, 2 days, 2 and 4 weeks following cystoscopy. RESULTS: The pre-cystoscopy anxiety level was 2.01. The average pain during the examination was 1.41. SF-36 score was not affected by cystoscopy. The subjective impact on patients' quality of life was 0.51. The mean IPSS increased following cystoscopy (6.75 vs. 5.43, P = 0.001) and returned to baseline 2 weeks later. A decline in libido was reported by 55.6% (25/45) and 50% (3/6) of the sexually active men and women, respectively. Cystoscopy was associated with a decreased Erectile Dysfunction Intensity Score, from 15.6 to 9.26 during the first 2 weeks (P = 0.04). The overall complication rate was 15% and included urethrorrhagia and dysuria, None of the patients had fever or urinary retention and none was hospitalized. The complication rate was higher in patients with benign prostatic hyperplasia (24% vs. 9.7%, P = 0.001). CONCLUSIONS: Rigid cystoscopy is well tolerated by most patients and has only a minor impact on quality of life. However, cystoscopy transiently impairs sexual performance and libido. The early complications are mild and correlate with a diagnosis of BPH.

Aged↗
PubMed2003

Retrograde intrarenal lithotripsy outcome after failure of shock wave lithotripsy.

PURPOSE: We report our experience with retrograde intrarenal lithotripsy (RIRL) for renal stones not alleviated by shock wave lithotripsy (SWL). MATERIALS AND METHODS: A total of 28 females and 53 males with a mean age of 53 years (range 18 to 86) were studied. They had been treated with a mean of 3.2 previous SWLs. Mean stone size was 9.2 mm (range 4 to 22) and the mean number of stones per patient was 1.27 (range 1 to 5) for a total of 103 stones overall. In 70 patients there was 1 stone. Rigid and flexible ureteroscopes were used in 8 and 67 cases, respectively, while a combined approach was used in 6. A holmium:YAG laser was used for fragmentation in 52 patients. Success was defined as stone-free status or residual fragments less than 3 mm. RESULTS: The overall success rate was 67%. RIRL yielded a 46% stone-free rate. Of the 44 patients 17 (39%) had residual stones less than 3 mm, while 13 required ancillary procedures. There were no residual ureteral stones. Original stone size correlated inversely with the success rate. Most failures involved lower pole stones, in that laser fiber deflection prevented reaching them in 9 cases. The procedure was interrupted due to extravasation or bleeding in 5 patients and 6 had postoperative urinary tract infections (16% overall complication rate). CONCLUSIONS: RIRL effectively and safely alleviated upper tract stones unresponsive to earlier SWL. It can be considered salvage therapy in such cases. RIRL is well suited for treating stones less than 2 cm with better stone-free rates than SWL in the same circumstances. Residual stones were more likely in lower pole cases.

Adolescent↗
PubMed2003

[Acute epididymitis].

Epididymitis may be acute (symptoms last less than 6 weeks) or chronic (more than 3 months). Acute epididymitis is almost always unilateral. In sexually active men under 35 years of age, acute epididymitis is frequently caused by Chlamydia trachomatis and less frequently by Neisseria gonorrhoeae and is usually associated with overt or subclinical urethritis. Acute epididymitis in older men, children or following urinary tract instrumentation is commonly caused by gram-negative bacilli. The epididymis is sometimes the site of metastatic infection, such as tuberculosis. It is important to differentiate epididymitis from other causes for acute scrotum, such as testicular torsion and tumor. The cause of acute scrotum especially in children cannot always be identified. Therefore, Doppler ultrasonography and radionuclide scans are often used. In infants and young boys, genitourinary abnormalities are causative factors, and therefore should be excluded by imaging. Supportive measures and antimicrobial agents are the mainstay of therapy.

Acute Disease↗
PubMedDate not supplied

PSA elevation during prostate cryosurgery and subsequent decline.

PURPOSE: To determine the immediate effect of prostate cryosurgery on PSA and the subsequent decline. METHODS AND MATERIALS: PSA level was measured in 14 patients who underwent cryosurgery for prostate cancer. Blood samples were taken immediately before and after cryosurgery and 1, 2, 4, 6 weeks and 3 months postoperatively. A confidence interval for the elevation from baseline to maximal PSA was calculated. PSA decline was assessed in patients with a nadir PSA < or =0.5 ng/mL. Patients with a postoperative nadir PSA >0.5 ng/mL were considered to harbor viable cancer and were excluded from the decline analysis. The observed PSA levels during the postoperative period were compared with the expected levels that were calculated according to the maximal PSA level and a serum half-life of 2.5 days. Student t-test was used to compare expected and observed PSA levels. RESULTS: PSA increased from an average of 9.23 ng/mL preoperatively to a maximum average of 155 ng/mL (maximal PSA ranges: 18.9-490.5 ng/mL). The 95% CI for the increase in PSA from baseline level was 63.4 to 224.14. PSA nadir < or =0.5 ng/mL was achieved in 10 patients. The observed PSA decline course was slower than expected according to its half-life. Average observed and expected PSA levels at 2,4 and 6 weeks after cryosurgery were 10.4 versus 3.57 ng/mL (P = 0.005), 0.65 versus 0.07 (P = 0.007) and 0.09 versus 0.001 (P = 0.03), respectively. CONCLUSION: PSA levels increase steeply following cryosurgery, and decline slower than expected according to the serum half-life.

Adenocarcinoma↗