Biomedical subjects
Publications and source records attributed to Lars M Ellison.
Objects placed in the bladder often become encrusted with stone. Using a technique combining endoscopic visualization and a small open cystotomy, a large encrusted foreign body was successfully and safely removed. The combination of endoscopy and cystotomy is rapid, safe, and potentially applicable for the removal of large vesical calculi.
AIMS: To assess the early results of mid-urethral slings placed via the transobturator approach (TVT-O) for stress urinary incontinence (SUI) in women with high (>60 cm H(2)O) and low ( 60 cm H(2)O) or low ( 60. CONCLUSIONS: With limited follow up, TVT-O appears to be a safe and effective surgical treatment for female SUI producing excellent results in patients with VLPP >60 cm/H(2)0. Patients with low VLPP may consider conventional, retropubic mid-urethral slings or other procedures as treatment for SUI.
PURPOSE: The incidence of renal cancer is increasing, while cases series suggest that tumor size is decreasing. This has important implications for treatment planning. We evaluated national trends in renal cancer size and observed survival in patients diagnosed in the 3 periods 1988 to 1992, 1993 to 1997 and 1998 to 2002. MATERIALS AND METHODS: From the Surveillance, Epidemiology, and End Results database we identified 29,053 patients diagnosed with primary renal cancer. Patients were stratified into size categories and 5-year time cohorts. Size distribution was compared across cohorts. Kaplan-Meier survival curves and Cox proportional hazards modeling were used to examine trends in overall and stage specific survival. RESULTS: From 1988 through 2002 renal tumor size decreased from 66.8 to 58.6 mm, while the age adjusted incidence of renal cancer increased from 8.6 to 11.2 cases per 100,000 individuals. Kaplan-Meier analysis showed steadily deteriorating survival with increased cancer size above 4 cm with a median survival of 105 months for 4 to 7 cm vs 46 months for more than 7 cm. Cox modeling demonstrated significantly improved survival in patients diagnosed in the latter cohorts. With adjustment for size the latter cohorts remained significantly improved compared to the earliest cohort, although the 1998 to 2002 cohort was no longer significantly different than the 1993 to 1997 cohort. CONCLUSIONS: Nationally renal tumor size at presentation has steadily and consistently decreased. Patients more recently diagnosed had improved survival, which could be attributable to decreased tumor size in the latter cohorts. Patients more recently diagnosed also demonstrated a relative survival advantage independent of size compared to the earliest patients studied.
We report a case of traumatic testicular injury resulting in significant loss of both tunica albuginea and seminiferous tubules. Secondary to the substantial tissue loss, our approach to surgical reconstruction required a certain degree of creativity. The injury was managed by creating a single midline testis with two distinct blood supplies. The use of this novel technique was necessary to achieve closure of the tunica albuginea. This case demonstrates the importance of the use of nontraditional reconstructive maneuvers to avoid orchiectomy, given the potential long-term health issues regarding infertility and androgen production.
BACKGROUND: Laparoscopic nephroureterectomy for upper-tract urothelial tumors is a minimally invasive approach that parallels the open technique in oncologic efficacy. Multiple approaches to manage the distal ureter have been described. We developed a new technique using the daVinci robot system to perform a transvesical excision of the distal ureter and bladder cuff. PATIENTS AND METHODS: Ten consecutive patients with upper-tract urothelial cancer underwent a laparoscopic nephroureterectomy. The daVinci robot was docked through the umbilical, ipsilateral lateral rectus, and an additional contralateral lateral rectus port. The bladder was clam-shelled in a coronal orientation at the dome and the distal ureterectomy performed. RESULTS: Our technique was successful in all ten patients. The mean operative time for the entire case was 4.4 hours. The average hospital stay was 3 days. CONCLUSIONS: Robot-assisted laparoscopic nephroureterectomy is a safe, minimally invasive approach to upper- tract urothelial cancer that reduces the technical challenge of excision of the distal ureter.
OBJECTIVE: The purpose of this report is to describe an alternative, using a transhepatic route, to CT guidance of radiofrequency ablation of renal masses. CONCLUSION: In four supine patients, radiofrequency ablation of a right renal mass was performed under sonographic guidance. The radiofrequency ablation needle was placed transhepatically into the mass. Color sonography was useful in guiding needle placement and avoiding intervening vessels in the liver and kidney. This technique may be used in selected patients as an alternative to CT guidance of radiofrequency ablation.
OBJECTIVES: To examine the racial differences in testicular cancer incidence, pathologic grade, stage, and survival with specific reference to Asian and white Americans and to evaluate the impact of disparities in stage at presentation, if present, on survival. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) database, we extracted all testicular cancer cases among white and Asian-American males for the years 1973 to 2000. Baseline demographic data included age at diagnosis, year of diagnosis, stage at diagnosis, and histologic features. Survival was examined using the Kaplan-Meier method and Cox proportional hazards modeling. RESULTS: The incidence of testicular cancer is lower among Asian Americans than among whites. However, Asian-American males presented with higher stage disease at diagnosis. Significant differences were noted in the histologic features between the two groups, with Asian Americans presenting with greater rates of seminoma. Asians also demonstrated survival differences, with poorer unadjusted survival compared with whites. However, when the variables of stage at diagnosis and histologic features were included in the analysis, the survival curves became similar. CONCLUSIONS: Asians appeared to present with higher stage disease than do whites. Observed differences in survival for the Asian group relative to whites appeared to be primarily a result of delayed presentation. Cultural perceptions of malignancy and the understanding of cancer screening may be important determinants of later presentation. Healthcare access and education issues, rather than inherent biologic differences, are more likely the primary underlying factors for the observed survival differences in Asian males.
OBJECTIVES: To compare the testicular cancer incidence, pathologic grade, stage, and survival between African Americans and whites. African Americans had a worse outcome relative to whites with regard to a number of different malignancies. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) database, we extracted all testicular cancer cases among white and African-American males for 1985 to 2000. Baseline demographic data included age at diagnosis, year of diagnosis, stage at diagnosis, and histologic type. Survival was examined using the Kaplan-Meier method and Cox proportional hazards modeling. RESULTS: The incidence of testicular cancer among African Americans was one fourth that observed among whites. However, African-Americans presented with a higher disease stage at diagnosis. African Americans also presented with significantly lower proportions of embryonal cell carcinoma. Overall survival among African-Americans was significantly worse at both 5 and 10 years. When overall survival was adjusted for stage at presentation and histologic type, the observed survival differences disappeared. CONCLUSIONS: African Americans appear to present with a higher disease stage than do whites. Observed differences in survival for the African-American group relative to whites appear to be primarily due to delayed presentation. Cultural perceptions of malignancy and understanding of cancer screening may be an important determinant of later presentation. Healthcare access and education issues, rather than inherent biologic differences, appear to be the primary underlying factor for the observed survival differences in African-American males.
BACKGROUND: Technologic advances in communications have facilitated the development and diffusion of telemedicine. Most applications have focused on remote outpatient management of medical conditions. We assessed the impact of introducing remote video conferencing during the immediate postoperative period (telerounds) on patient-reported satisfaction with their hospitalization. STUDY DESIGN: Between October 2002 and June 2003,85 patients undergoing elective laparoscopic or percutaneous urologic procedures were enrolled in a trial testing the impact of telerounds on patients' satisfaction with their hospitalization. Participants were entered into one of three postoperative care arms: standard once-daily attending bedside rounds; standard once-daily attending level bedside rounds plus one afternoon telerounding visit; or a substitution of one daily bedside round with a robotic telerounding visit. Participants completed a validated patient satisfaction survey 2 weeks after hospital discharge. RESULTS: Eighty-five individuals (100% response rate) completed the questionnaire. With responses dichotomized to "excellent" or "other," patients in the telerounding arm demonstrated statistically substantial improvements in ratings of examination thoroughness, quality of discussions about medical information, postoperative care coordination, and attending physician availability. Patients in the robotic telerounding arm indicated considerably higher satisfaction with regard to physician availability. After adjusting for age differences, ratings of each of the previously listed aspects of care remained notably improved in the telerounding arm. CONCLUSIONS: Telerounding either as an additional visit or as a substituted bedside visit is associated with increased patient satisfaction in postoperative care. This type of interaction appears to acceptably facilitate physician communication with hospitalized patients.
OBJECTIVES: To present our experience with 3 patients with small cell cancer (SCC) of the bladder who were treated with different modalities and review the literature for patients undergoing primary chemoradiotherapy. SCC of the bladder is a rare tumor, with patients commonly presenting with metastatic disease. Surgery, radiotherapy, and chemotherapy, either alone or as part of combined therapy, have been used. Because of the rarity of this disease, no prospective studies evaluating the most effective treatment have been done. METHODS: The medical records of 3 patients diagnosed with SCC of the bladder at our institution were reviewed. Additionally, we reviewed published reports to identify all cases of SCC of the bladder treated with primary chemoradiotherapy. RESULTS: Three patients with SCC of the bladder were identified at our institution. A total of 23 patients with SCC of the bladder who were treated with primary chemoradiotherapy were identified: 22 in published reports and 1 at our institution. Patients presented with muscle-invasive disease (17%), extravesical disease only (26%), and metastatic disease (52%). Multiagent chemotherapy was administered to most patients. The reported median radiation dose was 6000 cGy. A total of 16 patients (70%) were alive at a median follow-up of 34 months. The median survival of patients had not yet been reached in this study at the last follow-up. We did not find any reports of SCC recurrence in the bladder, and the bladder was preserved in most patients (87%). CONCLUSIONS: SCC of the bladder should be viewed as a systemic disease, because most patients present with metastatic disease. Primary chemoradiotherapy appears to be an effective treatment modality. Prospective studies are needed to evaluate the optimal treatment further.
PURPOSE: During radical perineal prostatectomy transection of the bladder neck and dissection of the seminal vesicles under direct vision can be difficult. We describe a technique of radical endoscopic assisted perineal prostatectomy that facilitates dissection of these structures. MATERIALS AND METHODS: Cadaveric dissections were performed in 4 individuals to develop and assess the technique. It was subsequently applied to a 64-year-old male with clinically localized prostate cancer (Gleason grade 3+3). Management of the bladder neck and seminal vesicles was performed with a bipolar transurethral resectoscope. The remainder of the procedure was performed via a traditional subsphincteric perineal approach with the patient in the standard dorsal lithotomy position. RESULTS: The bladder neck and seminal vesicles were successfully dissected in 55 minutes. Total operative time was 3 hours. Estimated blood loss was 500 cc. The patient was discharged home the morning of postoperative day 1 and the catheter was removed in the clinic on postoperative day 7. The final pathology report showed organ confined prostate cancer (Gleason 3+3). CONCLUSIONS: Radical endoscopic assisted perineal prostatectomy allows precise dissection of the bladder neck and seminal vesicles under direct vision. Accomplishing this dissection as the initial step of the procedure mobilizes the prostate, facilitating excision, and obviates the need for the extreme lithotomy position.