Jaya Telang - Academia.edu (original) (raw)
Papers by Jaya Telang
BMC Urology
Background Unplanned hospitalization following ureteroscopy (URS) for urinary stone disease is as... more Background Unplanned hospitalization following ureteroscopy (URS) for urinary stone disease is associated with patient morbidity and increased healthcare costs. To this effect, AUA guidelines recommend at least a urinalysis in patients prior to URS. We examined risk factors for infection-related hospitalization following URS for urinary stones in a surgical collaborative. Methods Reducing Operative Complications from Kidney Stones (ROCKS) is a quality improvement (QI) initiative from the Michigan Urological Surgery Improvement Collaborative (MUSIC) consisting of academic and community practices in the State of Michigan. Trained abstractors prospectively record standardized data elements from the health record in a web-based registry including patient characteristics, surgical details and complications. Using the ROCKS registry, we identified all patients undergoing primary URS for urinary stones between June 2016 and October 2017, and determined the proportion hospitalized within 30...
Journal of Endourology
Introduction: Ureteral access sheaths (UASs) are frequently used during ureteroscopy (URS), but t... more Introduction: Ureteral access sheaths (UASs) are frequently used during ureteroscopy (URS), but their use is not without potential risk. We investigated patterns of UAS use and associated outcomes across practices in Michigan within a quality improvement collaborative. Methods: The Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) initiative maintains a web-based, prospective clinical registry of patients undergoing URS for urinary stone disease (USD). We analyzed all patients undergoing primary URS for renal and ureteral stones from June 2016 to July 2018 in the ROCKS registry. We determined rates of UAS usage across practices and associated outcomes, including 30-day emergency department (ED) visits and hospitalization, as well as stone-free rates. Using multivariate logistical regression, we determined the predictors of UAS use as well as outcomes, including stone-free rates, ED visits, and hospitalizations, associated with UAS use. Results: Of the 5316 URS procedures identified, UASs were used in 1969 (37.7%) cases. Stones were significantly larger and more likely to be located in the kidney in cases with UAS use. UAS use during URS varied greatly across practices (1.9%-96%, p < 0.05). After adjusting for clinical and surgical risk factors, UAS use significantly increased the odds of postoperative ED visits (odds ratio [OR] = 1.50, 95% confidence interval [CI] 1.17-1.93, p < 0.05) and hospitalization (OR = 1.77, 95% CI 1.22-2.56, p < 0.05) as well as decreased the odds of being stone free (OR = 0.75, 95% CI 0.57-0.99, p < 0.05). Conclusions: In the current study, UAS use during URS for USD was not associated with an increased likelihood of being stone free; moreover, it increased the odds of a postoperative ED visit and or hospitalization. Our findings demonstrate that UAS use is not without risk and should be employed judiciously.
Journal of Urology
INTRODUCTION AND OBJECTIVES: Conservative management is recommended as the preferred management o... more INTRODUCTION AND OBJECTIVES: Conservative management is recommended as the preferred management option for most low-risk prostate cancer, with certain specific exceptions. Although many studies have documented significant heterogeneity in the utilization of conservative management among men with low-risk disease, less is known about the underlying reasons for this variation and whether the variation is due to differences in case mix with respect to the specific factors mentioned in the guidelines: age <55 years, African American race, and high-volume Gleason 6 disease. Our objective was to explore what proportion of the heterogeneity in the utilization of conservative management for low-risk prostate cancer could be explained by guideline-concordant factors.
Journal of Urology
period. Gender, diabetes, urinary tract abnormalities did not correlate with UTIs. Age as a conti... more period. Gender, diabetes, urinary tract abnormalities did not correlate with UTIs. Age as a continuous variable (p[0.008) and asymptomatic bacteriuria before the stent removal (p<0.001) correlate with the frequency of UTI.
Journal of Urology
On unadjusted logistic regression, men were more likely to earn >$350K (OR[2.01, p[0.02). However... more On unadjusted logistic regression, men were more likely to earn >$350K (OR[2.01, p[0.02). However, on multivariable regression gender was no longer significant (OR[1.59 p[0.11) after adjusting for covariates. Factors associated with higher odds of earning >$350K include: more clinical hours, fewer non-clinical hours, shorter mean office visits, more office visits, more inpatient surgical procedures, private practice setting, subspecialty training, practicing in the Northeast and non-white race . Sex, urban practice setting, age, and Hispanic ethnicity were not associated with salary in the adjusted model.
Journal of Urology
INTRODUCTION AND OBJECTIVES: Extracorporeal shockwave lithotripsy (ESWL) and flexible ureteroreno... more INTRODUCTION AND OBJECTIVES: Extracorporeal shockwave lithotripsy (ESWL) and flexible ureterorenoscopy (URS) are firstline treatment options for uncomplicated nephroureterolithiasis. It is well established that stone-free rates are higher for those undergoing URS. Given the variable definitions for "stone-free", however, an analysis of retreatment rates in clinical practice is necessary to truly evaluate the effectiveness of the two modalities. Furthermore, an accurate understanding of the treatment costs is paramount in today's cost-conscious healthcare environment.
The Journal of Urology
00 treatment 00 sessions, five sessions for each setting, were performed at different frequency s... more 00 treatment 00 sessions, five sessions for each setting, were performed at different frequency settings: 60Hz, 120Hz and a variable frequency of 60-120Hz. For the 60-120Hz setting, we delivered first 1000 shocks at 60Hz and the next 2000 shocks at 120Hz. For the ureteral model 90Hz was also studied as prior clinical randomized studies had shown conflicting results between 60Hz and 90Hz in ureter. Total weight and total number of significant fragments (TWSF and TNSF, respectively), defined as any fragments greater than 3 mm in size, were measured to assess the effectiveness of stone fragmentation in each setting. Spearman correlations were then used to test for a linear trend with each setting. A multilevel model was also used to compare the differences in fragmentation with each setting.
The Journal of Urology
regression models with SAS v9.4 software. Significance was set as twotailed p-values <0.05.
The Journal of Urology
INTRODUCTION AND OBJECTIVES: Identifying robotic skill proficiency and exposing areas for refinem... more INTRODUCTION AND OBJECTIVES: Identifying robotic skill proficiency and exposing areas for refinement may improve patient outcomes and safety. Previously, we demonstrated a strong correlation with crowdsourced (i.e. lay-person) and peer surgeon video ratings of skill for surgeons performing robot-assisted radical prostatectomy (RARP). However, these evaluations can consume considerable resources. In this project, we evaluated whether the time taken to complete a step for RARP could be used to determine technical skill proficiency.
The Journal of Urology
we prospectively enrolled 111 patients with intermediate or high risk PCa who were scheduled for ... more we prospectively enrolled 111 patients with intermediate or high risk PCa who were scheduled for RP. Patients with previous neoadjuvant hormonal therapy or primary radiation therapy were not included. A template ePLND was performed including obturatoric fossa, internal, external and common iliac vessels. LNs 3mm were bisected and examined by standard histopathology as well as qPCR for expression of Kallikrein 3 (KLK3). A threshold for unspecific baseline expression of KLK3 was determined in a control group (143 LNs of 25 male patients with histopathologic exclusion of PCa). Biochemical recurrence was defined by a postoperative prostatespecific antigen (PSA) increase > 0.2 ng/ml. RESULTS: In 111 patients (29% intermediate and 71% high risk), 3173 LNs (median 27 LNs per patient) were dissected, of which 2411 LNs with a diameter 3mm were examined by both methods. Histopathology detected 68 LN metastases in 28 (25%) patients. Molecular LN analysis confirmed LN metastases in all 28 histopathologic positive patients. In addition, molecular LN analysis detected 224 LN metastases and identified 32 (29%) patients harbouring LN metastases despite negative histopathology.At a median follow-up of 48 months 52/ 111 (47%) patients developed biochemical recurrence. Median biochemical recurrence-free survival (bRFS) was 9 months [95%CI 0.0-20.1] in patients with histopathologic and molecular LN metastases (n¼28, pN1/molN1), 24 months [95%CI 1.7-46.3] in patients with only molecular LN metastases (n¼32, pN0/molN1) and was not reached in patients without LN metastases (n¼51, pN0/molN0) (log-rank test p<0.001). In a multivariable Cox regression analysis, pN0/molN1-status (HR4.1 [95%CI 1.9-8.7]) and pN1/molN1-status (HR5.9 [95%CI2.6-13.8]) independently predicted biochemical recurrence. Molecular (molN1 vs. molN0) LN status predicted the risk of biochemical recurrence better than histopathologic LN status (pN1 vs. pN0)(p<0.001).
BJU international, Oct 29, 2017
Active surveillance (AS) is an increasingly prevalent treatment choice for low grade prostate can... more Active surveillance (AS) is an increasingly prevalent treatment choice for low grade prostate cancer. Eligibility criteria for AS are varied and it is unclear if family history of prostate cancer should be used as an exclusion criterion when considering men for AS. To determine whether family history plays a significant role in the progression of prostate cancer for men undergoing active surveillance, PubMed searches of 'family history and prostate cancer', 'family history and prostate cancer progression' and 'factors of prostate cancer progression' were used to identify research publications about the relationship between family history and prostate cancer progression. These searches generated 536 papers that were screened and reviewed. Six publications were ultimately included in this analysis. Review of the six publications suggests that family history does not increase the risk of prostate cancer progression, whilst a subgroup analysis in one study found ...
Journal of Urology
period. Gender, diabetes, urinary tract abnormalities did not correlate with UTIs. Age as a conti... more period. Gender, diabetes, urinary tract abnormalities did not correlate with UTIs. Age as a continuous variable (p[0.008) and asymptomatic bacteriuria before the stent removal (p<0.001) correlate with the frequency of UTI.
BMC Urology
Background Unplanned hospitalization following ureteroscopy (URS) for urinary stone disease is as... more Background Unplanned hospitalization following ureteroscopy (URS) for urinary stone disease is associated with patient morbidity and increased healthcare costs. To this effect, AUA guidelines recommend at least a urinalysis in patients prior to URS. We examined risk factors for infection-related hospitalization following URS for urinary stones in a surgical collaborative. Methods Reducing Operative Complications from Kidney Stones (ROCKS) is a quality improvement (QI) initiative from the Michigan Urological Surgery Improvement Collaborative (MUSIC) consisting of academic and community practices in the State of Michigan. Trained abstractors prospectively record standardized data elements from the health record in a web-based registry including patient characteristics, surgical details and complications. Using the ROCKS registry, we identified all patients undergoing primary URS for urinary stones between June 2016 and October 2017, and determined the proportion hospitalized within 30...
Journal of Endourology
Introduction: Ureteral access sheaths (UASs) are frequently used during ureteroscopy (URS), but t... more Introduction: Ureteral access sheaths (UASs) are frequently used during ureteroscopy (URS), but their use is not without potential risk. We investigated patterns of UAS use and associated outcomes across practices in Michigan within a quality improvement collaborative. Methods: The Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) initiative maintains a web-based, prospective clinical registry of patients undergoing URS for urinary stone disease (USD). We analyzed all patients undergoing primary URS for renal and ureteral stones from June 2016 to July 2018 in the ROCKS registry. We determined rates of UAS usage across practices and associated outcomes, including 30-day emergency department (ED) visits and hospitalization, as well as stone-free rates. Using multivariate logistical regression, we determined the predictors of UAS use as well as outcomes, including stone-free rates, ED visits, and hospitalizations, associated with UAS use. Results: Of the 5316 URS procedures identified, UASs were used in 1969 (37.7%) cases. Stones were significantly larger and more likely to be located in the kidney in cases with UAS use. UAS use during URS varied greatly across practices (1.9%-96%, p < 0.05). After adjusting for clinical and surgical risk factors, UAS use significantly increased the odds of postoperative ED visits (odds ratio [OR] = 1.50, 95% confidence interval [CI] 1.17-1.93, p < 0.05) and hospitalization (OR = 1.77, 95% CI 1.22-2.56, p < 0.05) as well as decreased the odds of being stone free (OR = 0.75, 95% CI 0.57-0.99, p < 0.05). Conclusions: In the current study, UAS use during URS for USD was not associated with an increased likelihood of being stone free; moreover, it increased the odds of a postoperative ED visit and or hospitalization. Our findings demonstrate that UAS use is not without risk and should be employed judiciously.
Journal of Urology
INTRODUCTION AND OBJECTIVES: Conservative management is recommended as the preferred management o... more INTRODUCTION AND OBJECTIVES: Conservative management is recommended as the preferred management option for most low-risk prostate cancer, with certain specific exceptions. Although many studies have documented significant heterogeneity in the utilization of conservative management among men with low-risk disease, less is known about the underlying reasons for this variation and whether the variation is due to differences in case mix with respect to the specific factors mentioned in the guidelines: age <55 years, African American race, and high-volume Gleason 6 disease. Our objective was to explore what proportion of the heterogeneity in the utilization of conservative management for low-risk prostate cancer could be explained by guideline-concordant factors.
Journal of Urology
period. Gender, diabetes, urinary tract abnormalities did not correlate with UTIs. Age as a conti... more period. Gender, diabetes, urinary tract abnormalities did not correlate with UTIs. Age as a continuous variable (p[0.008) and asymptomatic bacteriuria before the stent removal (p<0.001) correlate with the frequency of UTI.
Journal of Urology
On unadjusted logistic regression, men were more likely to earn >$350K (OR[2.01, p[0.02). However... more On unadjusted logistic regression, men were more likely to earn >$350K (OR[2.01, p[0.02). However, on multivariable regression gender was no longer significant (OR[1.59 p[0.11) after adjusting for covariates. Factors associated with higher odds of earning >$350K include: more clinical hours, fewer non-clinical hours, shorter mean office visits, more office visits, more inpatient surgical procedures, private practice setting, subspecialty training, practicing in the Northeast and non-white race . Sex, urban practice setting, age, and Hispanic ethnicity were not associated with salary in the adjusted model.
Journal of Urology
INTRODUCTION AND OBJECTIVES: Extracorporeal shockwave lithotripsy (ESWL) and flexible ureteroreno... more INTRODUCTION AND OBJECTIVES: Extracorporeal shockwave lithotripsy (ESWL) and flexible ureterorenoscopy (URS) are firstline treatment options for uncomplicated nephroureterolithiasis. It is well established that stone-free rates are higher for those undergoing URS. Given the variable definitions for "stone-free", however, an analysis of retreatment rates in clinical practice is necessary to truly evaluate the effectiveness of the two modalities. Furthermore, an accurate understanding of the treatment costs is paramount in today's cost-conscious healthcare environment.
The Journal of Urology
00 treatment 00 sessions, five sessions for each setting, were performed at different frequency s... more 00 treatment 00 sessions, five sessions for each setting, were performed at different frequency settings: 60Hz, 120Hz and a variable frequency of 60-120Hz. For the 60-120Hz setting, we delivered first 1000 shocks at 60Hz and the next 2000 shocks at 120Hz. For the ureteral model 90Hz was also studied as prior clinical randomized studies had shown conflicting results between 60Hz and 90Hz in ureter. Total weight and total number of significant fragments (TWSF and TNSF, respectively), defined as any fragments greater than 3 mm in size, were measured to assess the effectiveness of stone fragmentation in each setting. Spearman correlations were then used to test for a linear trend with each setting. A multilevel model was also used to compare the differences in fragmentation with each setting.
The Journal of Urology
regression models with SAS v9.4 software. Significance was set as twotailed p-values <0.05.
The Journal of Urology
INTRODUCTION AND OBJECTIVES: Identifying robotic skill proficiency and exposing areas for refinem... more INTRODUCTION AND OBJECTIVES: Identifying robotic skill proficiency and exposing areas for refinement may improve patient outcomes and safety. Previously, we demonstrated a strong correlation with crowdsourced (i.e. lay-person) and peer surgeon video ratings of skill for surgeons performing robot-assisted radical prostatectomy (RARP). However, these evaluations can consume considerable resources. In this project, we evaluated whether the time taken to complete a step for RARP could be used to determine technical skill proficiency.
The Journal of Urology
we prospectively enrolled 111 patients with intermediate or high risk PCa who were scheduled for ... more we prospectively enrolled 111 patients with intermediate or high risk PCa who were scheduled for RP. Patients with previous neoadjuvant hormonal therapy or primary radiation therapy were not included. A template ePLND was performed including obturatoric fossa, internal, external and common iliac vessels. LNs 3mm were bisected and examined by standard histopathology as well as qPCR for expression of Kallikrein 3 (KLK3). A threshold for unspecific baseline expression of KLK3 was determined in a control group (143 LNs of 25 male patients with histopathologic exclusion of PCa). Biochemical recurrence was defined by a postoperative prostatespecific antigen (PSA) increase > 0.2 ng/ml. RESULTS: In 111 patients (29% intermediate and 71% high risk), 3173 LNs (median 27 LNs per patient) were dissected, of which 2411 LNs with a diameter 3mm were examined by both methods. Histopathology detected 68 LN metastases in 28 (25%) patients. Molecular LN analysis confirmed LN metastases in all 28 histopathologic positive patients. In addition, molecular LN analysis detected 224 LN metastases and identified 32 (29%) patients harbouring LN metastases despite negative histopathology.At a median follow-up of 48 months 52/ 111 (47%) patients developed biochemical recurrence. Median biochemical recurrence-free survival (bRFS) was 9 months [95%CI 0.0-20.1] in patients with histopathologic and molecular LN metastases (n¼28, pN1/molN1), 24 months [95%CI 1.7-46.3] in patients with only molecular LN metastases (n¼32, pN0/molN1) and was not reached in patients without LN metastases (n¼51, pN0/molN0) (log-rank test p<0.001). In a multivariable Cox regression analysis, pN0/molN1-status (HR4.1 [95%CI 1.9-8.7]) and pN1/molN1-status (HR5.9 [95%CI2.6-13.8]) independently predicted biochemical recurrence. Molecular (molN1 vs. molN0) LN status predicted the risk of biochemical recurrence better than histopathologic LN status (pN1 vs. pN0)(p<0.001).
BJU international, Oct 29, 2017
Active surveillance (AS) is an increasingly prevalent treatment choice for low grade prostate can... more Active surveillance (AS) is an increasingly prevalent treatment choice for low grade prostate cancer. Eligibility criteria for AS are varied and it is unclear if family history of prostate cancer should be used as an exclusion criterion when considering men for AS. To determine whether family history plays a significant role in the progression of prostate cancer for men undergoing active surveillance, PubMed searches of 'family history and prostate cancer', 'family history and prostate cancer progression' and 'factors of prostate cancer progression' were used to identify research publications about the relationship between family history and prostate cancer progression. These searches generated 536 papers that were screened and reviewed. Six publications were ultimately included in this analysis. Review of the six publications suggests that family history does not increase the risk of prostate cancer progression, whilst a subgroup analysis in one study found ...
Journal of Urology
period. Gender, diabetes, urinary tract abnormalities did not correlate with UTIs. Age as a conti... more period. Gender, diabetes, urinary tract abnormalities did not correlate with UTIs. Age as a continuous variable (p[0.008) and asymptomatic bacteriuria before the stent removal (p<0.001) correlate with the frequency of UTI.