David Hrouda - Academia.edu (original) (raw)
Papers by David Hrouda
BMJ (Clinical research ed.), Jan 20, 1998
Objective: To present our initial peri-operative and pathological outcome data of 23 patients to ... more Objective: To present our initial peri-operative and pathological outcome data of 23 patients to establish the feasibility of robotic partial nephrectomy (RPN) in a UK cancer centre. Patient and methods: Clinical data from 23 patients who underwent RPN in a single institution between April 2008 and January 2010 were analysed. The RENAL Nephrometry Scoring System was applied to our series. Results: Mean patient age was 54.6 years with a mean tumour size of 2.53 cm. The median operative time was 198 min and warm ischaemia time (WIT) 30 min. There were two conversions and four patients required transfusion, with no other major complications. Histology confirmed renal cell carcinoma in 17 cases. All surgical margins were negative and to date there have been no local or distant recurrences. A mean RENAL score of 5.56 suggested that all the lesions had a low-moderate complexity and were therefore suitable for partial nephrectomy. Conclusion: RPN achieved acceptable WITs, blood loss and complication rates and oncological outcomes. We conclude that this technique is a feasible alternative to open surgery and conventional laparoscopic partial nephrectomy. The urological community need to establish the place for each technique although surgeon preference is likely to be a significant factor. Crown
Urological research, 2003
New vessel formation, a highly-regulated, active process commencing in the embryo and evident not... more New vessel formation, a highly-regulated, active process commencing in the embryo and evident notably during the pubertal growth spurt, is essential for normal prostate development. Reactivation of this process in response to physiological stimuli, particularly hypoxia in mature tissues, occurs with new vessels forming principally from stromal components. Although angiogenesis is complex, putatively involving a multitude of angiogenic factors and inhibitors, there is powerful evidence of the importance of the VEGF system in the development of both the normal prostate and prostate cancer. Recent advances include an understanding of how castration acts through the VEGF system to inhibit angiogenesis. Stromal-endothelial and epithelial-endothelial interactions are just beginning to be investigated. A better understanding of how physiological angiogenesis is controlled should help to provide further insights into the mechanism of disregulated angiogenesis in tumours. Ultimately, new ant...
European Urology Supplements
European Urology Supplements
Trends in Urology, Gynaecology & Sexual Health, 2007
Urology, 2006
Symptomatic presentation of partial duplication of the ureter in adults is rare. However, there a... more Symptomatic presentation of partial duplication of the ureter in adults is rare. However, there are reports of such conditions being treated with surgical correction with varying degrees of success. We present the case of a 23-year-old woman who underwent what is, to our knowledge, the first reported laparoscopic ureteropyelostomy for symptomatic "yo-yo" reflux.
Prostate Cancer and Prostatic Diseases, 2000
Advanced prostate cancer remains incurable with standard treatment options. Immunotherapy may be ... more Advanced prostate cancer remains incurable with standard treatment options. Immunotherapy may be a realistic alternative given the growing evidence that the immune response can affect the growth of other solid tumours and the regulation of both specific and shared prostate cancer antigens. Early studies suggest that both non-specific and specific vaccines can effect relevant animal models and clinical trials based on these observations are now in progress. A number of other approaches including gene therapy with HSVtk are already undergoing clinical studies (Herman et al. Hum Gene Ther 1999; 10: 1239-1249). Prostate Cancer and Prostatic Diseases (2000) 3, 303-307
Neuromuscular Disorders, 2010
Nature Clinical Practice Urology, 2007
Unrecognized or silent perioperative myocardial ischemia is common in patients who undergo high-r... more Unrecognized or silent perioperative myocardial ischemia is common in patients who undergo high-risk surgery, including cystectomy, and could predict cardiac morbidity and mortality in postoperative patients. This disorder is not merely a marker of extensive coronary disease but has a close association with perioperative myocardial infarction (PMI). In a review of published data, including meta-analyses, in the context of high-risk urological surgery, up to 50% of PMIs were found to go unrecognized if only clinical signs and symptoms are considered. Prevention and treatment of these previously unrecognized cardiac events might significantly reduce long-term morbidity and mortality. The emergence of reliable markers of PMI, such as increased levels of troponin I, could help in the detection of events that would have otherwise remained unnoticed. In this Review we examine the effect of these developments in the context of high-risk urological surgery. Changes to preoperative assessment, perioperative management, and prophylaxis of PMI are critically assessed. We performed a prospective audit using postoperative troponin I levels to assess the rate of silent perioperative myocardial ischemia and infarction. An increasingly proactive attitude towards perioperative monitoring for myocardial ischemia and infarction has evolved, and postoperative serial screening with troponin I might be beneficial in high-risk patients undergoing major urological surgery.
Journal of Medical Case Reports, 2008
Nerve sheath tumours of the kidney are particularly rare and, in the few reported cases, are all ... more Nerve sheath tumours of the kidney are particularly rare and, in the few reported cases, are all situated in the hilar region.
Journal of Endourology, 2007
We present the first report of a pseudoaneurysm of an accessory internal pudendal artery after tr... more We present the first report of a pseudoaneurysm of an accessory internal pudendal artery after transperitoneal robotic radical prostatectomy. The vesicourethral anastomosis was performed using two continuous 3-0 Monocryl sutures tied at the six o'clock position. As the anastomotic suture was placed at 11 o'clock, lateral to the dorsal venous complex, there was a small amount of pulsatile bleeding that ceased when the suture was completed and tied. The lesion presented as hematuria beginning on the fourth day. On the 14(th) day, the pseudoaneurysm was diagnosed by CT angiography and treated by embolization with eight 3-mm/30-mm micro coils after superselective catheterization. There were no complications or further hematuria.
The International Journal of Medical Robotics and Computer Assisted Surgery, 2006
We describe a teamwork approach to setting up the UK's first clinical pro... more We describe a teamwork approach to setting up the UK's first clinical programme for robotically assisted laparoscopic radical prostatectomy. On 22 November 2004 the Imperial Robotic Urological Surgery Group performed their first robotically assisted prostatectomy. Robotically assisted prostatectomy lends itself to division into eight definable stages. A team of four consultant urological surgeons utilized a structured rotating system, using these stages, for time at the console and tableside assisting. Fluidity of surgery was maintained by a surgeon acting as the tableside assistant for the stage prior to moving to the console. Data was collected prospectively for the first 50 cases and parameters associated with the learning curve compared to other reported series. Median operative time of 369.5 mins, median blood loss of 700 ml, with 12% of patients requiring a blood transfusion. Four patients required conversion to an open procedure; one resulting from equipment failure and three due to failure of progression. Four patients had an anastomotic leak with resulting ileus and two patients sustained rectal injuries, which were repaired intraoperatively using the robot. Median hospital stay was 4 days with a 22% positive surgical margin rate. Parameters indicative of the learning curve are comparable to existing published initial series of other robotic centres. The use of teamwork has enabled us to provide safe and time-efficient training for four surgeons simultaneously. The structured approach used in this setting demonstrates that urological surgeons of varying laparoscopic experience can acquire the skills necessary to competently perform laparoscopic radical prostatectomy.
Drugs & Aging, 2000
Prostate cancer continues to be a major cause of morbidity and mortality. Surgical and medical ma... more Prostate cancer continues to be a major cause of morbidity and mortality. Surgical and medical management of the disease has improved but there is little effect upon overall survival. Novel therapies such as immunotherapy offer the potential of treating the disease by stimulating the immune system to mount a response to the cancer systemically. This review highlights the pitfalls and progress in the understanding of the role of the immune system in malignancy and also explains the theory behind prostate cancer vaccine trials.
British Journal of Medical and Surgical Urology, 2011
Objective: To present our initial peri-operative and pathological outcome data of 23 patients to ... more Objective: To present our initial peri-operative and pathological outcome data of 23 patients to establish the feasibility of robotic partial nephrectomy (RPN) in a UK cancer centre. Patient and methods: Clinical data from 23 patients who underwent RPN in a single institution between April 2008 and January 2010 were analysed. The RENAL Nephrometry Scoring System was applied to our series. Results: Mean patient age was 54.6 years with a mean tumour size of 2.53 cm. The median operative time was 198 min and warm ischaemia time (WIT) 30 min. There were two conversions and four patients required transfusion, with no other major complications. Histology confirmed renal cell carcinoma in 17 cases. All surgical margins were negative and to date there have been no local or distant recurrences. A mean RENAL score of 5.56 suggested that all the lesions had a low-moderate complexity and were therefore suitable for partial nephrectomy. Conclusion: RPN achieved acceptable WITs, blood loss and complication rates and oncological outcomes. We conclude that this technique is a feasible alternative to open surgery and conventional laparoscopic partial nephrectomy. The urological community need to establish the place for each technique although surgeon preference is likely to be a significant factor. Crown
BJU International, 1998
Objective To evaluate the potential of heat-killed Results SRL172 was eCective as an adjuvant to ... more Objective To evaluate the potential of heat-killed Results SRL172 was eCective as an adjuvant to autologous whole tumour cell vaccination in the prevention Mycobacterium vaccae (SRL172) as a nonspecific immunostimulant and as an adjuvant to whole tumour cell of MAT-LyLu tumours and the survival benefit was equivalent to that provided when the adjuvant was vaccination in the rat model of prostate cancer. Materials and methods SRL172 was used as a vaccine live-attenuated BCG. SRL172 alone did not reduce tumour take or tumour growth in this model and in the prevention and treatment of subcutaneous tumours in rats. Prevention experiments were conduc-neither strategy was eCective in delaying the growth of established MAT-LyLu tumours. In the Lobund-ted using subcutaneous MAT-LyLu tumours in Copenhagen rats, comparing vaccination with Wistar rat vaccination with autologous whole tumour cells and SRL172 significantly delayed the growth of SRL172 alone, SRL172 plus autologous cells, and bacille Calmette-Guèrin (BCG) plus autologous cells established tumours. Conclusion Mycobacterium vaccae deserves further evalu-before tumour implantation. Treatment experiments were conducted using subcutaneous MAT-LyLu ation as an adjuvant to whole tumour cell vaccination in a phase I clinical trial in patients with prostate tumours in the Copenhagen rat and subcutaneous PAIII tumours in the Lobund-Wistar rat. Tumours cancer. Keywords Prostate cancer, immunotherapy, Myco-were induced by subcutaneous injection with tumour cells. Animals were then vaccinated with autologous bacterium vaccae, vaccine, rat model cells, autologous cells plus SRL172, or SRL172 alone. or by the co-injection of adjuvant [5]. In animal models
BMJ (Clinical research ed.), Jan 20, 1998
Objective: To present our initial peri-operative and pathological outcome data of 23 patients to ... more Objective: To present our initial peri-operative and pathological outcome data of 23 patients to establish the feasibility of robotic partial nephrectomy (RPN) in a UK cancer centre. Patient and methods: Clinical data from 23 patients who underwent RPN in a single institution between April 2008 and January 2010 were analysed. The RENAL Nephrometry Scoring System was applied to our series. Results: Mean patient age was 54.6 years with a mean tumour size of 2.53 cm. The median operative time was 198 min and warm ischaemia time (WIT) 30 min. There were two conversions and four patients required transfusion, with no other major complications. Histology confirmed renal cell carcinoma in 17 cases. All surgical margins were negative and to date there have been no local or distant recurrences. A mean RENAL score of 5.56 suggested that all the lesions had a low-moderate complexity and were therefore suitable for partial nephrectomy. Conclusion: RPN achieved acceptable WITs, blood loss and complication rates and oncological outcomes. We conclude that this technique is a feasible alternative to open surgery and conventional laparoscopic partial nephrectomy. The urological community need to establish the place for each technique although surgeon preference is likely to be a significant factor. Crown
Urological research, 2003
New vessel formation, a highly-regulated, active process commencing in the embryo and evident not... more New vessel formation, a highly-regulated, active process commencing in the embryo and evident notably during the pubertal growth spurt, is essential for normal prostate development. Reactivation of this process in response to physiological stimuli, particularly hypoxia in mature tissues, occurs with new vessels forming principally from stromal components. Although angiogenesis is complex, putatively involving a multitude of angiogenic factors and inhibitors, there is powerful evidence of the importance of the VEGF system in the development of both the normal prostate and prostate cancer. Recent advances include an understanding of how castration acts through the VEGF system to inhibit angiogenesis. Stromal-endothelial and epithelial-endothelial interactions are just beginning to be investigated. A better understanding of how physiological angiogenesis is controlled should help to provide further insights into the mechanism of disregulated angiogenesis in tumours. Ultimately, new ant...
European Urology Supplements
European Urology Supplements
Trends in Urology, Gynaecology & Sexual Health, 2007
Urology, 2006
Symptomatic presentation of partial duplication of the ureter in adults is rare. However, there a... more Symptomatic presentation of partial duplication of the ureter in adults is rare. However, there are reports of such conditions being treated with surgical correction with varying degrees of success. We present the case of a 23-year-old woman who underwent what is, to our knowledge, the first reported laparoscopic ureteropyelostomy for symptomatic "yo-yo" reflux.
Prostate Cancer and Prostatic Diseases, 2000
Advanced prostate cancer remains incurable with standard treatment options. Immunotherapy may be ... more Advanced prostate cancer remains incurable with standard treatment options. Immunotherapy may be a realistic alternative given the growing evidence that the immune response can affect the growth of other solid tumours and the regulation of both specific and shared prostate cancer antigens. Early studies suggest that both non-specific and specific vaccines can effect relevant animal models and clinical trials based on these observations are now in progress. A number of other approaches including gene therapy with HSVtk are already undergoing clinical studies (Herman et al. Hum Gene Ther 1999; 10: 1239-1249). Prostate Cancer and Prostatic Diseases (2000) 3, 303-307
Neuromuscular Disorders, 2010
Nature Clinical Practice Urology, 2007
Unrecognized or silent perioperative myocardial ischemia is common in patients who undergo high-r... more Unrecognized or silent perioperative myocardial ischemia is common in patients who undergo high-risk surgery, including cystectomy, and could predict cardiac morbidity and mortality in postoperative patients. This disorder is not merely a marker of extensive coronary disease but has a close association with perioperative myocardial infarction (PMI). In a review of published data, including meta-analyses, in the context of high-risk urological surgery, up to 50% of PMIs were found to go unrecognized if only clinical signs and symptoms are considered. Prevention and treatment of these previously unrecognized cardiac events might significantly reduce long-term morbidity and mortality. The emergence of reliable markers of PMI, such as increased levels of troponin I, could help in the detection of events that would have otherwise remained unnoticed. In this Review we examine the effect of these developments in the context of high-risk urological surgery. Changes to preoperative assessment, perioperative management, and prophylaxis of PMI are critically assessed. We performed a prospective audit using postoperative troponin I levels to assess the rate of silent perioperative myocardial ischemia and infarction. An increasingly proactive attitude towards perioperative monitoring for myocardial ischemia and infarction has evolved, and postoperative serial screening with troponin I might be beneficial in high-risk patients undergoing major urological surgery.
Journal of Medical Case Reports, 2008
Nerve sheath tumours of the kidney are particularly rare and, in the few reported cases, are all ... more Nerve sheath tumours of the kidney are particularly rare and, in the few reported cases, are all situated in the hilar region.
Journal of Endourology, 2007
We present the first report of a pseudoaneurysm of an accessory internal pudendal artery after tr... more We present the first report of a pseudoaneurysm of an accessory internal pudendal artery after transperitoneal robotic radical prostatectomy. The vesicourethral anastomosis was performed using two continuous 3-0 Monocryl sutures tied at the six o'clock position. As the anastomotic suture was placed at 11 o'clock, lateral to the dorsal venous complex, there was a small amount of pulsatile bleeding that ceased when the suture was completed and tied. The lesion presented as hematuria beginning on the fourth day. On the 14(th) day, the pseudoaneurysm was diagnosed by CT angiography and treated by embolization with eight 3-mm/30-mm micro coils after superselective catheterization. There were no complications or further hematuria.
The International Journal of Medical Robotics and Computer Assisted Surgery, 2006
We describe a teamwork approach to setting up the UK's first clinical pro... more We describe a teamwork approach to setting up the UK's first clinical programme for robotically assisted laparoscopic radical prostatectomy. On 22 November 2004 the Imperial Robotic Urological Surgery Group performed their first robotically assisted prostatectomy. Robotically assisted prostatectomy lends itself to division into eight definable stages. A team of four consultant urological surgeons utilized a structured rotating system, using these stages, for time at the console and tableside assisting. Fluidity of surgery was maintained by a surgeon acting as the tableside assistant for the stage prior to moving to the console. Data was collected prospectively for the first 50 cases and parameters associated with the learning curve compared to other reported series. Median operative time of 369.5 mins, median blood loss of 700 ml, with 12% of patients requiring a blood transfusion. Four patients required conversion to an open procedure; one resulting from equipment failure and three due to failure of progression. Four patients had an anastomotic leak with resulting ileus and two patients sustained rectal injuries, which were repaired intraoperatively using the robot. Median hospital stay was 4 days with a 22% positive surgical margin rate. Parameters indicative of the learning curve are comparable to existing published initial series of other robotic centres. The use of teamwork has enabled us to provide safe and time-efficient training for four surgeons simultaneously. The structured approach used in this setting demonstrates that urological surgeons of varying laparoscopic experience can acquire the skills necessary to competently perform laparoscopic radical prostatectomy.
Drugs & Aging, 2000
Prostate cancer continues to be a major cause of morbidity and mortality. Surgical and medical ma... more Prostate cancer continues to be a major cause of morbidity and mortality. Surgical and medical management of the disease has improved but there is little effect upon overall survival. Novel therapies such as immunotherapy offer the potential of treating the disease by stimulating the immune system to mount a response to the cancer systemically. This review highlights the pitfalls and progress in the understanding of the role of the immune system in malignancy and also explains the theory behind prostate cancer vaccine trials.
British Journal of Medical and Surgical Urology, 2011
Objective: To present our initial peri-operative and pathological outcome data of 23 patients to ... more Objective: To present our initial peri-operative and pathological outcome data of 23 patients to establish the feasibility of robotic partial nephrectomy (RPN) in a UK cancer centre. Patient and methods: Clinical data from 23 patients who underwent RPN in a single institution between April 2008 and January 2010 were analysed. The RENAL Nephrometry Scoring System was applied to our series. Results: Mean patient age was 54.6 years with a mean tumour size of 2.53 cm. The median operative time was 198 min and warm ischaemia time (WIT) 30 min. There were two conversions and four patients required transfusion, with no other major complications. Histology confirmed renal cell carcinoma in 17 cases. All surgical margins were negative and to date there have been no local or distant recurrences. A mean RENAL score of 5.56 suggested that all the lesions had a low-moderate complexity and were therefore suitable for partial nephrectomy. Conclusion: RPN achieved acceptable WITs, blood loss and complication rates and oncological outcomes. We conclude that this technique is a feasible alternative to open surgery and conventional laparoscopic partial nephrectomy. The urological community need to establish the place for each technique although surgeon preference is likely to be a significant factor. Crown
BJU International, 1998
Objective To evaluate the potential of heat-killed Results SRL172 was eCective as an adjuvant to ... more Objective To evaluate the potential of heat-killed Results SRL172 was eCective as an adjuvant to autologous whole tumour cell vaccination in the prevention Mycobacterium vaccae (SRL172) as a nonspecific immunostimulant and as an adjuvant to whole tumour cell of MAT-LyLu tumours and the survival benefit was equivalent to that provided when the adjuvant was vaccination in the rat model of prostate cancer. Materials and methods SRL172 was used as a vaccine live-attenuated BCG. SRL172 alone did not reduce tumour take or tumour growth in this model and in the prevention and treatment of subcutaneous tumours in rats. Prevention experiments were conduc-neither strategy was eCective in delaying the growth of established MAT-LyLu tumours. In the Lobund-ted using subcutaneous MAT-LyLu tumours in Copenhagen rats, comparing vaccination with Wistar rat vaccination with autologous whole tumour cells and SRL172 significantly delayed the growth of SRL172 alone, SRL172 plus autologous cells, and bacille Calmette-Guèrin (BCG) plus autologous cells established tumours. Conclusion Mycobacterium vaccae deserves further evalu-before tumour implantation. Treatment experiments were conducted using subcutaneous MAT-LyLu ation as an adjuvant to whole tumour cell vaccination in a phase I clinical trial in patients with prostate tumours in the Copenhagen rat and subcutaneous PAIII tumours in the Lobund-Wistar rat. Tumours cancer. Keywords Prostate cancer, immunotherapy, Myco-were induced by subcutaneous injection with tumour cells. Animals were then vaccinated with autologous bacterium vaccae, vaccine, rat model cells, autologous cells plus SRL172, or SRL172 alone. or by the co-injection of adjuvant [5]. In animal models