Doreen Chung | Columbia University (original) (raw)
Papers by Doreen Chung
Current Bladder Dysfunction Reports, 2021
The purpose of this review is to summarize the literature on safety and efficacy of minimally inv... more The purpose of this review is to summarize the literature on safety and efficacy of minimally invasive thulium laser procedures for benign prostatic hypertrophy (BPH). Recent studies have confirmed long-term safety and efficacy of thulium laser prostatectomy. There has been recent literature published from around the world confirming safety and efficacy in treatment of large prostates, obese patients, and in patients taking oral anticoagulation. Newer thulium laser systems use a wavelength of 1.9μm instead of 2 μm. Thus far, no clinical differences have been seen in outcomes of thulium laser procedures done with this wavelength. The high-power thulium laser was first introduced in 2005 for treatment of BPH [1]. Thulium vapoenucleation (ThuVEP), thulium laser resection of the prostate-tangerine technique (TmLRP), thulium laser enucleation (ThuLEP), and thulium vaporization (ThuVP) are techniques for thulium laser prostatectomy that have been described. Studies using the 70W to 200W thulium laser systems demonstrated good efficacy of these procedures with low morbidity and few complications in prostates of small to medium sizes [2]. Comparative studies have been published comparing thulium laser prostatectomy to monopolar transurethral resection of prostate (TURP), bipolar TURP, and holmium laser enucleation of prostate (HoLEP) [1]. In general, thulium laser prostatectomy appears to have longer operative times, shorter catheterization times, shorter hospital stay, and lower transfusion rates compared to standard and bipolar TURP. Outcomes of HoLEP and thulium enucleation techniques appear to be similar. Overall, thulium laser prostatectomy appears to be very safe and effective with low morbidity [3].
Journal of Urology, 2021
Test-phase success did not differ based on PD disease severity or UDS parameters. In patients wit... more Test-phase success did not differ based on PD disease severity or UDS parameters. In patients with OAB/UUI who progressed to permanent implant, 83% (24/28) experienced subjective improvement in their urgency and there was a statistically significant improvement in their urinary symptoms from baseline (Figure I). Most (68%) patients were able to discontinue OAB medications post-implant, and 62.5% did not require further treatment. Overall lead revision rate was 14% (4/28) and 3 devices required removal. CONCLUSIONS: SNM is an efficacious treatment option for PD patients with a high percentage of patients having improvement in their urinary symptoms. No UDS parameters were found to predict which patients would progress to permanent implantation.
Journal of Urology, 2021
of micturitions in patients with OAB wet and dry, suggesting that vibegron works similarly for th... more of micturitions in patients with OAB wet and dry, suggesting that vibegron works similarly for these endpoints in OAB wet and in OAB dry.
Journal of Urology, 2020
1.14) for women and 1.06 (95% CI: 0.98, 1.14) for men. Results were similar in persons 65 years. ... more 1.14) for women and 1.06 (95% CI: 0.98, 1.14) for men. Results were similar in persons 65 years. IRs for bladder and prostate cancers were higher in both mirabegron and AM cohorts in the first 6 months after treatment initiation, suggesting protopathic bias. CONCLUSIONS: This large multi-country real-world study, with up to 6 years of follow up, found no evidence of an association between mirabegron use and risk of the studied cancers, compared to AMs, in either men or women.
University of Toronto Medical Journal, 2005
... At that time, Mrs. W. reported that the pain in her abdomen had "exploded" ... more ... At that time, Mrs. W. reported that the pain in her abdomen had "exploded" and had remained constant ever since. She described the pain as dull and poorly localized, but most intense in the periumbilical region. ... Devon McDonald, B.Sc. (0T7) Kevin Schwartz, B.Sc. ...
The Journal of Urology, 2017
Lower urinary tract symptoms, while common, are under reported in patients with multiple sclerosi... more Lower urinary tract symptoms, while common, are under reported in patients with multiple sclerosis. It is unclear what the impact of lower urinary tract symptoms due to MS is on the overall quality of life. We aim to define the incidence of lower urinary tract symptoms in patients with MS and their effect on neurologic quality of life. METHODS: We identified patients presenting to neurology clinic for routine follow up for multiple sclerosis. Each patient responded to validated questionnaires regarding urinary quality of life (MSQLI) and overall neurologic quality of life (NeuroQOL). Medical records were reviewed to assess for the presence of lower urinary tract symptoms. Overall neurologic quality of life was measured in the presence and absence of lower urinary tract symptoms and p-values were calculated using student 0 s t-test. Urinary quality of life score was correlated to overall neurologic quality of life score by calculating the Spearman 0 s rank correlation coefficient. RESULTS: 91 patients were included in the study. All 91 patients completed the validated questionnaires. 85 patients (93%) described the presence of at least one lower urinary tract symptom. The most common urinary tract symptoms were urgency (84%), frequency (69%), incontinence (54%), and retention (38%). 72 patients reported urologic symptoms negatively impacted urinary quality of life. Presence of lower urinary tract symptoms negatively impacted overall neurologic quality of life (Figure 1). Urinary quality of life was predictive of the overall neurologic quality of life (-0.24, p¼0.02). CONCLUSIONS: Lower urinary tract symptoms are very common in patients with multiple sclerosis. These symptoms greatly impact and importantly predict the overall neurologic quality of life in patients with multiple sclerosis.
Current Urology Reports, 2017
Purpose of review Pelvic organ prolapse (POP) is a significant problem with many options for surg... more Purpose of review Pelvic organ prolapse (POP) is a significant problem with many options for surgical correction. Following prolapse surgery, de novo lower urinary tract symptoms (LUTS) are not uncommon. We review the current literature on de novo lower urinary tract symptoms following POP repair and discuss the role of urodynamics in the evaluation of the prolapse patient. Recent findings Patients with occult stress urinary incontinence (SUI) appear to be at higher risk of developing de novo SUI after POP repair. Prolapse reduction in patients undergoing urodynamic evaluation is important. Different types of POP repair influence rates of de novo SUI. Also, prophylactic antiincontinence procedures at time of POP repair appear to lower the incidence of de novo SUI, but at the cost of increased risk of complications and morbidity. Pre-existing overactive bladder (OAB) symptoms may either improve or persist, and de novo OAB can develop. The specific role of urodynamic study testing for POP is still being determined. Summary Increasingly, women are seeking surgical treatment for POP. Aside from complications related to surgery in general, proper patient counseling is important regarding the risk of development of de novo voiding problems following surgery. Despite a growing body of literature looking at de novo voiding symptoms after prolapse repair, more studies are still needed.
The Journal of urology, Jan 7, 2017
The use of mesh in vaginal cystocele repair has declined. We analyzed the American College of Sur... more The use of mesh in vaginal cystocele repair has declined. We analyzed the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database to compare outcomes of repairs with and without mesh. Current Procedural Terminology was used to identify patients undergoing cystocele repair with and without mesh from 2006-2013. Patient characteristics and complications were analyzed. 6,849 patients were identified. 5,667 (82.5%) underwent native tissue repair and 1,182 (17.5%) underwent repair with mesh. Patients receiving mesh were older (64±11 vs 60±12 years p<0.001), with more comorbidities (56 vs 47% p<0.001). Operative time (mesh vs non-mesh), (97 ± 67 vs 95 ± 53 min p=0.2) and length of stay (1.3 ± 2.4 vs 1.4± 1.3 days p=.2) were similar in both groups. Urinary tract infection was the most common complication in cases without and with mesh (3.8% vs 3.5%). Mesh procedure rates of mortality (0 vs 0.3% p=0.04), and overall surgical complications (1.8 vs 3.9...
The Journal of Urology, 2016
INTRODUCTION AND OBJECTIVES: It is hypothesized that patient position, supine or recline, and bla... more INTRODUCTION AND OBJECTIVES: It is hypothesized that patient position, supine or recline, and bladder filling status, empty or full, could change the Q-tip test result. This study evaluated the effect of the patient position and bladder filling status on the Q-tip angle for urethral hypermobility (UH). METHODS: There was a measurement of the Q-tip angle in the supine position and at a 45 angle in a reclining position during bladder emptying; and then the measurements were repeated while filling the bladder. We defined urethral hypermobility as the urethral angle straining or coughing minus that at rest ! 30. RESULTS: All 63 female patients (mean age: 61.6 years, range: 36-81) who complained of urinary incontinence were assessed using the Q-tip angle test. The pelvic organ prolapse quantification stages of all patients were stage 1. The mean Q-tip angle with an empty bladder was 14.1 AE 9.1 in the supine position and 16.4 AE 11.1 in the reclining position (p ¼ 0.001). Then mean Q-tip angle during the filling bladder state was 15.4 AE 9.7 in the supine position and 15.9 AE 11.0 in the reclining position (p ¼ 0.771). The UH rate during the bladder emptying state was 11.1% (7/63) in the supine position and 19.1% (12/63) in the reclining position. The UH rate during the bladder filling state was 15.0% (9/60) in the supine position and 15.3% (9/59) in the 45 reclining position. The odds ratio (OR) was 7.03 in the reclining position for a positive Q-tip angle. The positive rate was higher in the 45 reclining position during bladder emptying than that in the other position during bladder filling. CONCLUSIONS: The outcome of the Q-tip angle and the rate of UH changed in relation to patient position. The reclining position during bladder emptying increased the Q-tip angle, thereby resulting in a positive UH.
Principles of Gender-Specific Medicine, 2010
The field of gender-specific medicine examines how normal human biology and physiology differ bet... more The field of gender-specific medicine examines how normal human biology and physiology differ between men and women and how the diagnosis and treatment of disease differs as a function of gender. This revealing research covers various conditions that predominantly occur in men as well conditions that predominantly occur in women. Among the areas of greatest difference are cardiovascular disease, mood disorders, the immune system, lung cancer as a consequence of smoking, osteoporosis, diabetes, obesity, and infectious diseases. The Second Edition of Principles of Gender-Specific Medicine focuses on the essentials of gender-specific medicine and the current study of sex and gender differences in human physiology and pathophysiology. New section editors, new chapter authors, and new chapters have been added to reflect the most up-to-date clinical research and practice. * Offers insight into how the gender-specific risks of one organ system's disease affects the health of other organ systems * Outlines the sex-specific differences of normal anatomy and physiology * Illustrates the gender-specific features and quantifies "gender" and "sex" as risk factors across all major diseases * Qualifies and analyzes the results of new drug therapies designed with gender-specific differences in mind: ex, hormone therapy in men and women for the prevention and treatment of cardiovascular disease * All chapters progress translationally from the basic science to the clinical applications of gender-specific therapies, drugs, or treatments * Sections on drug metabolism, aging, and meta-analysis of data incorporated into all disease-specific chapters
Treatment of Benign Prostatic Hyperplasia: Modern Alternative to Transurethral Resection of the Prostate, 2014
The thulium laser has several properties that confer some theoretical advantages over other laser... more The thulium laser has several properties that confer some theoretical advantages over other lasers used for the treatment of BPH such as a relatively small zone of thermal damage. In ex vivo animal studies comparing the KTP and thulium lasers, similar hemostatic properties were observed with a shallower coagulation zone (Wendt-Nordahl et al. J Endourol. 2008;22:1041). Two main techniques for laser resection and vapoenucleation have been described: ThuVEP and TmLRP (Xia et al. Eur Urol. 2008;53:383, Bach et al. World J Urol. 2007;25:257). Studies using the 70–120-W thulium laser systems demonstrate good efficacy of these procedures with low morbidity and few complications in mostly small- and medium-sized prostates (Gross et al. Eur Urol. 2012;63:859). Safety and efficacy has also been demonstrated in patients taking oral anticoagulation (Macchione et al. Int Urol Nephrol. 2013;45:1545–51). Comparative studies have been published comparing thulium laser prostatectomy to monopolar TURP, bipolar TURP, and HoLEP. Compared to all these techniques, thulium laser prostatectomy had a longer operative time and demonstrated superior blood loss compared to TURP techniques. Short- and intermediate-term improvements in IPSS, QoL, Qmax, and PVR were similar across techniques. Overall thulium laser resection and vapoenucleation, and enucleation techniques appear safe and effective with low morbidity. Further comparative and long-term studies are needed for this promising technology, particularly in larger prostates.
Journal of Urology, 2021
Reduction in diastolic blood pressure was associated with improvement in nocturia severity after ... more Reduction in diastolic blood pressure was associated with improvement in nocturia severity after adjustment for relevant covariates. This link between cardiovascular health and nocturia carries potential important public health implications. Prospective longitudinal research to further elucidate this relationship is warranted.
Urology, 2017
• Most commonly performed for invasive bladder cancer-Complex procedure with high morbidity (3%) ... more • Most commonly performed for invasive bladder cancer-Complex procedure with high morbidity (3%) and mortality (25-45%)
Canadian Urological Association Journal, 2010
Xanthogranulomatous inflammation is a benign condition characterized by the presence of multinucl... more Xanthogranulomatous inflammation is a benign condition characterized by the presence of multinucleated giant cells, chronic inflammatory cells and lipid-laden macrophages, known as xanthoma cells. Only 22 cases of xanthogranulomatous cystitis (XGC) have been reported in the Japanese and English literature. In this report, we describe the twenty-third case of XGC and the third case associated with inflammatory bowel disease (IBD). A 50-year-old woman with quiescent Crohn's disease was incidentally found to have a bladder mass on ultrasound. The lesion was resected through a transurethral approach. Pathology demonstrated XGC. At 3 months post-resection, there was no evidence of recurrence adjacent to the previous resection scar.
Canadian Urological Association Journal
Introduction: We aimed to assess safety and efficacy of incobotulinumtoxinA for the treatment of ... more Introduction: We aimed to assess safety and efficacy of incobotulinumtoxinA for the treatment of neurogenic detrusor overactivity (DO). Methods: We identified patients with neurogenic DO confirmed on urodynamics (UDS) and reported urgency incontinence (UI) in those who received intravesical incobotulinumtoxin A injection for neurogenic bladder between November 2013 and May 2017. Parameters studied were daytime frequency, daily incontinence episodes, daily pad use, clean intermittent catheterization (CIC) volumes, symptom scores (UDI6, IIQ7, PGII), and complications. Results: We examined 17 male patients who met inclusion criteria and underwent incobotulinumtoxinA injection. Mean age was 61.2±15.4 years. Fourteen patients (82%) were taking oral antimuscarinics prior to the incobotulinumtoxin A injection. There were improvements in the following parameters: average daily pads (4.5 to 3.3, p=0.465), daily urinary frequency (9.4 to 4.6, p=0.048), daily incontinent episodes (2.5 to 0.4, ...
International Urogynecology Journal
Urology, Jan 6, 2018
To examine the effects of trainee involvement on fundamental urology procedures. Current Procedur... more To examine the effects of trainee involvement on fundamental urology procedures. Current Procedural Terminology codes were used to identify patients within the National Surgical Quality Improvement Program database who underwent a selection of fundamental general urology procedures (2005-2013). Operative time and perioperative complications (30-day) were compared between cases with and without trainee involvement. 29,488 patients had general urology procedures with information regarding trainee involvement, 13,251 (44.9%) with trainee involvement and 16,237 (55.1%) without. Overall patients who underwent procedures with trainee involvement were younger and had fewer comorbidities (table 1). Trainee involvement showed significant increase in operative time in all procedures included in the study (table 2.) On multivariate analysis trainee involvement increased the risk of complications (OR 1.61, 95% CI 1.45-1.78, p<0.001). Other factors that increased the risk of complications wer...
Current Bladder Dysfunction Reports, 2021
The purpose of this review is to summarize the literature on safety and efficacy of minimally inv... more The purpose of this review is to summarize the literature on safety and efficacy of minimally invasive thulium laser procedures for benign prostatic hypertrophy (BPH). Recent studies have confirmed long-term safety and efficacy of thulium laser prostatectomy. There has been recent literature published from around the world confirming safety and efficacy in treatment of large prostates, obese patients, and in patients taking oral anticoagulation. Newer thulium laser systems use a wavelength of 1.9μm instead of 2 μm. Thus far, no clinical differences have been seen in outcomes of thulium laser procedures done with this wavelength. The high-power thulium laser was first introduced in 2005 for treatment of BPH [1]. Thulium vapoenucleation (ThuVEP), thulium laser resection of the prostate-tangerine technique (TmLRP), thulium laser enucleation (ThuLEP), and thulium vaporization (ThuVP) are techniques for thulium laser prostatectomy that have been described. Studies using the 70W to 200W thulium laser systems demonstrated good efficacy of these procedures with low morbidity and few complications in prostates of small to medium sizes [2]. Comparative studies have been published comparing thulium laser prostatectomy to monopolar transurethral resection of prostate (TURP), bipolar TURP, and holmium laser enucleation of prostate (HoLEP) [1]. In general, thulium laser prostatectomy appears to have longer operative times, shorter catheterization times, shorter hospital stay, and lower transfusion rates compared to standard and bipolar TURP. Outcomes of HoLEP and thulium enucleation techniques appear to be similar. Overall, thulium laser prostatectomy appears to be very safe and effective with low morbidity [3].
Journal of Urology, 2021
Test-phase success did not differ based on PD disease severity or UDS parameters. In patients wit... more Test-phase success did not differ based on PD disease severity or UDS parameters. In patients with OAB/UUI who progressed to permanent implant, 83% (24/28) experienced subjective improvement in their urgency and there was a statistically significant improvement in their urinary symptoms from baseline (Figure I). Most (68%) patients were able to discontinue OAB medications post-implant, and 62.5% did not require further treatment. Overall lead revision rate was 14% (4/28) and 3 devices required removal. CONCLUSIONS: SNM is an efficacious treatment option for PD patients with a high percentage of patients having improvement in their urinary symptoms. No UDS parameters were found to predict which patients would progress to permanent implantation.
Journal of Urology, 2021
of micturitions in patients with OAB wet and dry, suggesting that vibegron works similarly for th... more of micturitions in patients with OAB wet and dry, suggesting that vibegron works similarly for these endpoints in OAB wet and in OAB dry.
Journal of Urology, 2020
1.14) for women and 1.06 (95% CI: 0.98, 1.14) for men. Results were similar in persons 65 years. ... more 1.14) for women and 1.06 (95% CI: 0.98, 1.14) for men. Results were similar in persons 65 years. IRs for bladder and prostate cancers were higher in both mirabegron and AM cohorts in the first 6 months after treatment initiation, suggesting protopathic bias. CONCLUSIONS: This large multi-country real-world study, with up to 6 years of follow up, found no evidence of an association between mirabegron use and risk of the studied cancers, compared to AMs, in either men or women.
University of Toronto Medical Journal, 2005
... At that time, Mrs. W. reported that the pain in her abdomen had "exploded" ... more ... At that time, Mrs. W. reported that the pain in her abdomen had "exploded" and had remained constant ever since. She described the pain as dull and poorly localized, but most intense in the periumbilical region. ... Devon McDonald, B.Sc. (0T7) Kevin Schwartz, B.Sc. ...
The Journal of Urology, 2017
Lower urinary tract symptoms, while common, are under reported in patients with multiple sclerosi... more Lower urinary tract symptoms, while common, are under reported in patients with multiple sclerosis. It is unclear what the impact of lower urinary tract symptoms due to MS is on the overall quality of life. We aim to define the incidence of lower urinary tract symptoms in patients with MS and their effect on neurologic quality of life. METHODS: We identified patients presenting to neurology clinic for routine follow up for multiple sclerosis. Each patient responded to validated questionnaires regarding urinary quality of life (MSQLI) and overall neurologic quality of life (NeuroQOL). Medical records were reviewed to assess for the presence of lower urinary tract symptoms. Overall neurologic quality of life was measured in the presence and absence of lower urinary tract symptoms and p-values were calculated using student 0 s t-test. Urinary quality of life score was correlated to overall neurologic quality of life score by calculating the Spearman 0 s rank correlation coefficient. RESULTS: 91 patients were included in the study. All 91 patients completed the validated questionnaires. 85 patients (93%) described the presence of at least one lower urinary tract symptom. The most common urinary tract symptoms were urgency (84%), frequency (69%), incontinence (54%), and retention (38%). 72 patients reported urologic symptoms negatively impacted urinary quality of life. Presence of lower urinary tract symptoms negatively impacted overall neurologic quality of life (Figure 1). Urinary quality of life was predictive of the overall neurologic quality of life (-0.24, p¼0.02). CONCLUSIONS: Lower urinary tract symptoms are very common in patients with multiple sclerosis. These symptoms greatly impact and importantly predict the overall neurologic quality of life in patients with multiple sclerosis.
Current Urology Reports, 2017
Purpose of review Pelvic organ prolapse (POP) is a significant problem with many options for surg... more Purpose of review Pelvic organ prolapse (POP) is a significant problem with many options for surgical correction. Following prolapse surgery, de novo lower urinary tract symptoms (LUTS) are not uncommon. We review the current literature on de novo lower urinary tract symptoms following POP repair and discuss the role of urodynamics in the evaluation of the prolapse patient. Recent findings Patients with occult stress urinary incontinence (SUI) appear to be at higher risk of developing de novo SUI after POP repair. Prolapse reduction in patients undergoing urodynamic evaluation is important. Different types of POP repair influence rates of de novo SUI. Also, prophylactic antiincontinence procedures at time of POP repair appear to lower the incidence of de novo SUI, but at the cost of increased risk of complications and morbidity. Pre-existing overactive bladder (OAB) symptoms may either improve or persist, and de novo OAB can develop. The specific role of urodynamic study testing for POP is still being determined. Summary Increasingly, women are seeking surgical treatment for POP. Aside from complications related to surgery in general, proper patient counseling is important regarding the risk of development of de novo voiding problems following surgery. Despite a growing body of literature looking at de novo voiding symptoms after prolapse repair, more studies are still needed.
The Journal of urology, Jan 7, 2017
The use of mesh in vaginal cystocele repair has declined. We analyzed the American College of Sur... more The use of mesh in vaginal cystocele repair has declined. We analyzed the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database to compare outcomes of repairs with and without mesh. Current Procedural Terminology was used to identify patients undergoing cystocele repair with and without mesh from 2006-2013. Patient characteristics and complications were analyzed. 6,849 patients were identified. 5,667 (82.5%) underwent native tissue repair and 1,182 (17.5%) underwent repair with mesh. Patients receiving mesh were older (64±11 vs 60±12 years p<0.001), with more comorbidities (56 vs 47% p<0.001). Operative time (mesh vs non-mesh), (97 ± 67 vs 95 ± 53 min p=0.2) and length of stay (1.3 ± 2.4 vs 1.4± 1.3 days p=.2) were similar in both groups. Urinary tract infection was the most common complication in cases without and with mesh (3.8% vs 3.5%). Mesh procedure rates of mortality (0 vs 0.3% p=0.04), and overall surgical complications (1.8 vs 3.9...
The Journal of Urology, 2016
INTRODUCTION AND OBJECTIVES: It is hypothesized that patient position, supine or recline, and bla... more INTRODUCTION AND OBJECTIVES: It is hypothesized that patient position, supine or recline, and bladder filling status, empty or full, could change the Q-tip test result. This study evaluated the effect of the patient position and bladder filling status on the Q-tip angle for urethral hypermobility (UH). METHODS: There was a measurement of the Q-tip angle in the supine position and at a 45 angle in a reclining position during bladder emptying; and then the measurements were repeated while filling the bladder. We defined urethral hypermobility as the urethral angle straining or coughing minus that at rest ! 30. RESULTS: All 63 female patients (mean age: 61.6 years, range: 36-81) who complained of urinary incontinence were assessed using the Q-tip angle test. The pelvic organ prolapse quantification stages of all patients were stage 1. The mean Q-tip angle with an empty bladder was 14.1 AE 9.1 in the supine position and 16.4 AE 11.1 in the reclining position (p ¼ 0.001). Then mean Q-tip angle during the filling bladder state was 15.4 AE 9.7 in the supine position and 15.9 AE 11.0 in the reclining position (p ¼ 0.771). The UH rate during the bladder emptying state was 11.1% (7/63) in the supine position and 19.1% (12/63) in the reclining position. The UH rate during the bladder filling state was 15.0% (9/60) in the supine position and 15.3% (9/59) in the 45 reclining position. The odds ratio (OR) was 7.03 in the reclining position for a positive Q-tip angle. The positive rate was higher in the 45 reclining position during bladder emptying than that in the other position during bladder filling. CONCLUSIONS: The outcome of the Q-tip angle and the rate of UH changed in relation to patient position. The reclining position during bladder emptying increased the Q-tip angle, thereby resulting in a positive UH.
Principles of Gender-Specific Medicine, 2010
The field of gender-specific medicine examines how normal human biology and physiology differ bet... more The field of gender-specific medicine examines how normal human biology and physiology differ between men and women and how the diagnosis and treatment of disease differs as a function of gender. This revealing research covers various conditions that predominantly occur in men as well conditions that predominantly occur in women. Among the areas of greatest difference are cardiovascular disease, mood disorders, the immune system, lung cancer as a consequence of smoking, osteoporosis, diabetes, obesity, and infectious diseases. The Second Edition of Principles of Gender-Specific Medicine focuses on the essentials of gender-specific medicine and the current study of sex and gender differences in human physiology and pathophysiology. New section editors, new chapter authors, and new chapters have been added to reflect the most up-to-date clinical research and practice. * Offers insight into how the gender-specific risks of one organ system's disease affects the health of other organ systems * Outlines the sex-specific differences of normal anatomy and physiology * Illustrates the gender-specific features and quantifies "gender" and "sex" as risk factors across all major diseases * Qualifies and analyzes the results of new drug therapies designed with gender-specific differences in mind: ex, hormone therapy in men and women for the prevention and treatment of cardiovascular disease * All chapters progress translationally from the basic science to the clinical applications of gender-specific therapies, drugs, or treatments * Sections on drug metabolism, aging, and meta-analysis of data incorporated into all disease-specific chapters
Treatment of Benign Prostatic Hyperplasia: Modern Alternative to Transurethral Resection of the Prostate, 2014
The thulium laser has several properties that confer some theoretical advantages over other laser... more The thulium laser has several properties that confer some theoretical advantages over other lasers used for the treatment of BPH such as a relatively small zone of thermal damage. In ex vivo animal studies comparing the KTP and thulium lasers, similar hemostatic properties were observed with a shallower coagulation zone (Wendt-Nordahl et al. J Endourol. 2008;22:1041). Two main techniques for laser resection and vapoenucleation have been described: ThuVEP and TmLRP (Xia et al. Eur Urol. 2008;53:383, Bach et al. World J Urol. 2007;25:257). Studies using the 70–120-W thulium laser systems demonstrate good efficacy of these procedures with low morbidity and few complications in mostly small- and medium-sized prostates (Gross et al. Eur Urol. 2012;63:859). Safety and efficacy has also been demonstrated in patients taking oral anticoagulation (Macchione et al. Int Urol Nephrol. 2013;45:1545–51). Comparative studies have been published comparing thulium laser prostatectomy to monopolar TURP, bipolar TURP, and HoLEP. Compared to all these techniques, thulium laser prostatectomy had a longer operative time and demonstrated superior blood loss compared to TURP techniques. Short- and intermediate-term improvements in IPSS, QoL, Qmax, and PVR were similar across techniques. Overall thulium laser resection and vapoenucleation, and enucleation techniques appear safe and effective with low morbidity. Further comparative and long-term studies are needed for this promising technology, particularly in larger prostates.
Journal of Urology, 2021
Reduction in diastolic blood pressure was associated with improvement in nocturia severity after ... more Reduction in diastolic blood pressure was associated with improvement in nocturia severity after adjustment for relevant covariates. This link between cardiovascular health and nocturia carries potential important public health implications. Prospective longitudinal research to further elucidate this relationship is warranted.
Urology, 2017
• Most commonly performed for invasive bladder cancer-Complex procedure with high morbidity (3%) ... more • Most commonly performed for invasive bladder cancer-Complex procedure with high morbidity (3%) and mortality (25-45%)
Canadian Urological Association Journal, 2010
Xanthogranulomatous inflammation is a benign condition characterized by the presence of multinucl... more Xanthogranulomatous inflammation is a benign condition characterized by the presence of multinucleated giant cells, chronic inflammatory cells and lipid-laden macrophages, known as xanthoma cells. Only 22 cases of xanthogranulomatous cystitis (XGC) have been reported in the Japanese and English literature. In this report, we describe the twenty-third case of XGC and the third case associated with inflammatory bowel disease (IBD). A 50-year-old woman with quiescent Crohn's disease was incidentally found to have a bladder mass on ultrasound. The lesion was resected through a transurethral approach. Pathology demonstrated XGC. At 3 months post-resection, there was no evidence of recurrence adjacent to the previous resection scar.
Canadian Urological Association Journal
Introduction: We aimed to assess safety and efficacy of incobotulinumtoxinA for the treatment of ... more Introduction: We aimed to assess safety and efficacy of incobotulinumtoxinA for the treatment of neurogenic detrusor overactivity (DO). Methods: We identified patients with neurogenic DO confirmed on urodynamics (UDS) and reported urgency incontinence (UI) in those who received intravesical incobotulinumtoxin A injection for neurogenic bladder between November 2013 and May 2017. Parameters studied were daytime frequency, daily incontinence episodes, daily pad use, clean intermittent catheterization (CIC) volumes, symptom scores (UDI6, IIQ7, PGII), and complications. Results: We examined 17 male patients who met inclusion criteria and underwent incobotulinumtoxinA injection. Mean age was 61.2±15.4 years. Fourteen patients (82%) were taking oral antimuscarinics prior to the incobotulinumtoxin A injection. There were improvements in the following parameters: average daily pads (4.5 to 3.3, p=0.465), daily urinary frequency (9.4 to 4.6, p=0.048), daily incontinent episodes (2.5 to 0.4, ...
International Urogynecology Journal
Urology, Jan 6, 2018
To examine the effects of trainee involvement on fundamental urology procedures. Current Procedur... more To examine the effects of trainee involvement on fundamental urology procedures. Current Procedural Terminology codes were used to identify patients within the National Surgical Quality Improvement Program database who underwent a selection of fundamental general urology procedures (2005-2013). Operative time and perioperative complications (30-day) were compared between cases with and without trainee involvement. 29,488 patients had general urology procedures with information regarding trainee involvement, 13,251 (44.9%) with trainee involvement and 16,237 (55.1%) without. Overall patients who underwent procedures with trainee involvement were younger and had fewer comorbidities (table 1). Trainee involvement showed significant increase in operative time in all procedures included in the study (table 2.) On multivariate analysis trainee involvement increased the risk of complications (OR 1.61, 95% CI 1.45-1.78, p<0.001). Other factors that increased the risk of complications wer...