Gopal Badlani - Academia.edu (original) (raw)

Papers by Gopal Badlani

The Journal of Urology, 2007

The Journal of Urology, Sep 1, 1993

During the last 8 years we performed 212 endopyelotomies with an overall success rate of 86%. To ... more During the last 8 years we performed 212 endopyelotomies with an overall success rate of 86%. To determine if the failed endopyelotomies resulted in a more difficult subsequent open corrective procedure, we compared the procedures and outcomes of 15 failed endopyelotomies with 16 control patients undergoing pyeloplasty who had not undergone a previous endopyelotomy. The variables of duration of the surgical procedure, average estimated blood loss, average number of transfusions and average length of hospitalization were analyzed for both groups. No statistically significant differences were detected for any of these variables. We conclude that despite a previously failed endopyelotomy, a subsequent open operation on the ureteropelvic junction, although slightly more difficult, was not associated with an increased morbidity rate nor less successful than de novo pyeloplasty. Therefore, we continue to advocate endopyelotomy as the procedure of choice for obstruction of the ureteropelvic junction.

PubMed, Apr 1, 2020

Introduction: To report 2-year safety and effectiveness of the Aquablation procedure for the trea... more Introduction: To report 2-year safety and effectiveness of the Aquablation procedure for the treatment of men with symptomatic benign prostatic hyperplasia (BPH) and large-volume 80-150 cc prostates. Materials and methods: Between September-December 2017, 101 men with moderate-to-severe BPH symptoms and prostate volumes of 80-150 cc underwent an ultrasound-guided robotically executed Aquablation procedure in a prospective multicenter international clinical trial (WATER II). Baseline, procedural and follow up parameters were recorded at baseline and scheduled postoperative visits. Herein we report 2-year safety and efficacy for this cohort. Results: Mean prostate volume was 107 cc (range 80-150 cc). Mean IPSS improved from 23.2 at baseline to 5.8 at 2 years (17-point improvement, p < .0001). Mean IPSS quality of life improved from 4.6 at baseline to 1.1 at 2 years (p < .0001). Maximum urinary flow increased from 8.7 to 18.2 cc/sec. Two subjects underwent a repeat procedure for BPH symptoms over the 2-year follow up period. By 2 years or study exit, all but 2 of 74 subjects stopped taking alpha blockers. Similarly, all but 4 of 32 subjects stopped taking 5α-reductase inhibitors. Conclusions: Two-year prospective multicenter follow up demonstrated that the Aquablation procedure is safe and effective in the treatment of men with LUTS due to BPH and prostates 80-150 cc with durable treatment efficacy, acceptable safety profile and a low retreatment rate. ClinicalTrials.gov number, NCT03123250.

The Journal of Urology, 1986

We incised ureteropelvic junction obstruction in 31 patients with a cold knife direct-vision uret... more We incised ureteropelvic junction obstruction in 31 patients with a cold knife direct-vision urethrotome inserted through a percutaneous nephrostomy tract. In 12 patients renal calculi were removed endourologically during the same session. There were no immediate complications and nephrostograms showed adequate drainage in all cases. Of these patients 8 had previously undergone open pyeloplasty without success. The longest followup is almost 2 years. There have been 4 failures and, thus, the success rate is 87.1 per cent.

Urologic Clinics of North America, Aug 1, 1988

There can be no single ideal stent, as each individual need requires a different type of stent. F... more There can be no single ideal stent, as each individual need requires a different type of stent. For endopyelotomy, at the present time, we think we have a stent that meets most of the criteria we set. From past experience, we are sure there will be further modifications and improvements in our quest for the ideal stent for this indication.

The Journal of Urology, Apr 1, 2006

Clinics in Geriatric Medicine, Feb 1, 1990

Benign prostatic hyperplasia is a significant cause of morbidity in the elderly male population. ... more Benign prostatic hyperplasia is a significant cause of morbidity in the elderly male population. The standard therapy for symptomatic prostatic obstruction has been prostatectomy by transurethral resection (TURP) or, less frequently, by open surgery. Innovative alternative treatments of benign prostatic hyperplasia, both surgical and nonsurgical, will be discussed. Additionally, an appraisal of TURP will be made.

Neurourology and Urodynamics, 2004

The objective of this study was to demonstrate that weakened pelvic £oor support of the lower gen... more The objective of this study was to demonstrate that weakened pelvic £oor support of the lower genitourinary tract in women with stress urinary incontinence (SUI) is due, in part, to decreased collagen synthesis and secretion and/or an altered ratio of collagen III/I synthesis by the ¢broblasts of the endopelvic fascia and skin compared to that of women without evidence of pelvic £oor weakening. Methods: Endopelvic fascia and skin biopsies were obtained from women with SUI (n ¼ 14) and women without evidence of SUI or genital prolapse (n ¼ 12). Fibroblast cultures established from the biopsies were incubated with 3 H-proline in medium containing ascorbic acid for 3 hr. Conditioned medium was collected and cells were harvested. The radiolabeled collagens were precipitated and digested with collagenase. The collagen synthesized (as a percent of total protein) was determined. Collagen a1(III) was separated from collagen a1(I) and a2(I) by interrupted SDS-PAGE and the amount of 3 H-proline in each band was determined. Results: Collagen synthesis, expressed as percent of total protein synthesis, was not signi¢cantly di¡erent between ¢broblasts obtained from women with or without SUI. The mean of collagen III/I synthesized in ¢broblasts was not signi¢cantly di¡erent between ¢broblasts obtained from women with or without SUI. Conclusions: These data suggest that the lower collagen content in the endopelvic fascia and skin of women with SUI is not due to reduced collagen synthesis or selective reduction in synthesis of either collagen I or collagen III, compared to women without pelvic £oor weakening.

The Journal of Urology, Mar 1, 1993

Between 1983 and 1991 we performed 212 endopyelotomies on 110 cases of primary and 102 of seconda... more Between 1983 and 1991 we performed 212 endopyelotomies on 110 cases of primary and 102 of secondary obstruction of the ureteropelvic junction. Of the 189 patients in the series 89% have been followed for a minimum of 6 months postoperatively, 63% for more than 3 years (3 to 8-year followup). Our overall success rate has been 86% with little difference being detected between the success that we have obtained with primary and secondary obstructions (85% versus 86%). Other variables, such as patient age, sex or side of obstruction, have little bearing on the outcome of the procedure. Endopyelotomy is passing the test of time as a safe and reliable means to correct ureteropelvic junction obstruction. Endopyelotomy should be the first choice for the correction of ureteropelvic junction obstruction in most patients.

The Journal of Urology, 2006

Archivos españoles de urología, 1990

Ultrasound is ideally suited for imaging of renal calculi for extracorporeal shock wave lithotrip... more Ultrasound is ideally suited for imaging of renal calculi for extracorporeal shock wave lithotripsy. Ultrasound can localize radiolucent stones, monitor fragmentation in real time, and differentiate the stone from a stent. Its use significantly reduces the radiation exposure to patient and operator, which is particularly desirable in the pediatric patient. Furthermore, sonography-guided lithotripsy can reveal any incidental finding in the affected kidney that may require further evaluation and familiarizes the operator with this increasingly useful imaging method. The ultrasound-guided Sonolith 3000 with its enlarged ellipsoid aperture has a decreased energy focus size and voltage, permitting fragmentation with reduced anesthesia requirements. The initial extracorporeal shockwave lithotripsy (ESWL) machine, the Dornier H3, uses fluoroscopy for stone localization and treatment monitoring. Although this imaging method has the benefit of being familiar to urologists, it has some drawba...

Wiley-Blackwell eBooks, Feb 1, 2012

European Urology, Jun 1, 2021

To report 12-month safety and effectiveness outcomes of the Aquablation procedure for the treatme... more To report 12-month safety and effectiveness outcomes of the Aquablation procedure for the treatment of men with symptomatic benign prostatic hyperplasia (BPH) and large-volume prostates. METHODS One hundred and one men with moderate-to-severe BPH symptoms and prostate volumes of 80-150 cc underwent a robotic-assisted Aquablation procedure in a prospective multicenter international clinical trial. Functional and safety outcomes were assessed at 12 months postoperatively. RESULTS Mean prostate volume was 107 cc (range 80-150). Mean operative time was 37 minutes and mean Aquablation resection time was 8 minutes. The average length of hospital stay following the procedure was 1.6 days. Mean International Prostate Symptom Score improved from 23.2 at baseline to 6.2 at 12 months (P <.0001). Mean International Prostate Symptom Score quality of life improved from 4.6 at baseline to 1.3 at 12-month follow-up (P <.0001). Significant improvements were seen in Qmax (12-month improvement of 12.5 cc/sec) and postvoid residual (drop of 171 cc in those with postvoid residual >100 at baseline). Antegrade ejaculation was maintained in 81% of sexually active men. No patient underwent a repeat procedure for BPH symptoms. There was a 2% de novo incontinence rate at 12 months, and 10 patients did require a transfusion postoperatively while 5 required take back fulgurations. At 12 months, prostate-specific antigen reduced from 7.1 § 5.9 ng/mL at baseline to 4.4 § 4.3 ng/mL. CONCLUSION The Aquablation procedure is demonstrated to be safe and effective in treating men with large prostates (80-150 cc) after 1 year of follow-up, with an acceptable complication rate and without a significant increase in procedure or resection time compared to smaller sized glands. Clinical-Trials.gov number, NCT03123250. UROLOGY 129: 1−7, 2019.

Urology, Jul 1, 2019

Urology, Jul 1, 2022

OBJECTIVE To compare the outcomes of Aquablation for small-to-moderate (30-80cc) prostates with t... more OBJECTIVE To compare the outcomes of Aquablation for small-to-moderate (30-80cc) prostates with the outcomes for large (80-150 cc) prostates at 3-yr follow up. METHODS WATER is a prospective, double-blind, multicenter, international clinical trial comparing the safety and efficacy of Aquablation and TURP in the treatment of LUTS/BPH in men 45-80 yr with a prostate of 30cc-80cc. WATER II is a prospective, multicenter, single-arm international clinical trial of Aquablation in men with a prostate of 80cc-150cc. We compare 36-mo outcomes amongst 116 WATER and 101 WATER II study subjects undergoing Aquablation. RESULTS International Prostate Symptom Score (IPSS) scores improved from 22.9 and 23.2 at baseline in WATER and WATER II, respectively, to 8.0 and 6.5 at 36-mo, with 36-mo reductions of 14.4 and 16.3 points, respectively (p=0.247). At baseline, urinary flow rate (Qmax) was 9.4 and 8.7 cc/sec in WATER and WATER II, improving to 20.6 and 18.5 cc/sec, respectively (p=0.552) at 36-mo. Improvements in both IPSS and Qmax were immediate and sustained throughout follow-up. At 3yr, 98% and 94% of treated patients were BPH medication-free in WATER and WATER II, respectively (p=0.038). At 3yr, 96% and 97% of treated patients were free from surgical retreatment in WATER and WATER II, respectively (p=0.613). CONCLUSIONS Three-year follow-up demonstrates that Aquablation therapy leads to sustained outcomes, few irreversible complications, and low retreatment rates for the treatment of LUTS/BPH independently of prostate volume.

The Journal of Urology, Jul 1, 2023