Jayant Uberoi - Academia.edu (original) (raw)
Papers by Jayant Uberoi
Http Dx Doi Org 10 1089 End 2006 0260, Apr 1, 2007
Laparoscopic partial nephrectomy (LPN) has emerged as a minimally invasive treatment for small re... more Laparoscopic partial nephrectomy (LPN) has emerged as a minimally invasive treatment for small renal masses. The most common complications include hemorrhage and urinary-fistula formulation. Renal-artery pseudoaneurysm has been described after open nephron-sparing surgery. We present two cases of renal-artery aneurysm following LPN. Two patients with incidentally discovered renal masses underwent LPN with excellent hemostasis and presented in a delayed fashion with gross hematuria and flank pain. Both patients were treated with angiographic coil embolization, resulting in resolution of the pseudoaneurysms on postprocedure imaging. Renal-artery pseudoaneurysm is a potentially life-threatening complication of LPN. Patients present in a delayed fashion with gross hematuria, flank pain, or both. The treatment of choice is angiography with selective coil embolization.
Current urology reports, 2009
The adrenal gland is a potential site of metastasis for various malignancies. Metastases to the a... more The adrenal gland is a potential site of metastasis for various malignancies. Metastases to the adrenal gland are the second most common type of adrenal mass lesion after adenomas. Differentiation of a metastatic lesion from a primary adrenal lesion can be challenging and requires the selective use of radiologic imaging, serologic testing, and adrenal biopsy. In patients who present with an isolated adrenal metastasis, adrenalectomy is often considered to aid in cancer control. Numerous studies have reported improved survival with resection of solitary adrenal metastases for various types of primary tumors. Traditionally, open adrenalectomy was the preferred option for these patients. More recently, laparoscopic adrenalectomy has offered a minimally invasive approach, with its resultant advantages of improved perioperative parameters. Proper patient selection for the laparoscopic versus open approach remains paramount in deciding the best treatment for the individual patient.
Journal of Robotic Surgery, 2010
Adrenal-sparing surgery has recently been reported in the literature on minimally-invasive surger... more Adrenal-sparing surgery has recently been reported in the literature on minimally-invasive surgery. Originally described as a conventional laparoscopic procedure, encouraging outcomes in terms of preservation of adrenal function have been reported. Since the introduction of robotic surgery, surgeons have utilized robotic assistance for adrenal surgery and have recently described adrenal-sparing surgery using this platform. Certain patients that present with adrenal
Journal of Endourology, 2007
Laparoscopic partial nephrectomy (LPN) has emerged as a minimally invasive treatment for small re... more Laparoscopic partial nephrectomy (LPN) has emerged as a minimally invasive treatment for small renal masses. The most common complications include hemorrhage and urinary-fistula formulation. Renal-artery pseudoaneurysm has been described after open nephron-sparing surgery. We present two cases of renal-artery aneurysm following LPN. Two patients with incidentally discovered renal masses underwent LPN with excellent hemostasis and presented in a delayed fashion with gross hematuria and flank pain. Both patients were treated with angiographic coil embolization, resulting in resolution of the pseudoaneurysms on postprocedure imaging. Renal-artery pseudoaneurysm is a potentially life-threatening complication of LPN. Patients present in a delayed fashion with gross hematuria, flank pain, or both. The treatment of choice is angiography with selective coil embolization.
Journal of Endourology, 2010
Background and Purpose: Percutaneous nephrostolithotomy (PCNL) is the current standard of care fo... more Background and Purpose: Percutaneous nephrostolithotomy (PCNL) is the current standard of care for management of large renal stones (>2 cm). Recent studies have evaluated flexible ureterorenoscopy (URS)=holmium laser lithotripsy as an alternative treatment for patients with contraindications to or preference against PCNL. Stones in an intermediate size range (2-3 cm) may be most amenable to URS=laser lithotripsy as definitive treatment in a single stage. We report a multi-institutional series of URS=laser lithotripsy for renal stone burdens that measure 2 to 3 cm. Patients and Methods: Patients who underwent URS=holmium laser lithotripsy for renal stones that measured 2 to 3 cm were identified retrospectively at three tertiary care centers. Demographic information, disease characteristics, and perioperative and postoperative data were gathered. Patients with renal stone burdens of 2 to 3 cm who were treated by URS=laser lithotripsy and had at least one postoperative visit and imaging study were included. Stone clearance was evaluated using 0-2 mm and < 4 mm residual stone burden on postoperative imaging. Results: One hundred and twenty patients underwent URS=holmium laser lithotripsy for renal stones of 2 to 3 cm. Mean stone burden was 2.4 cm, and mean body mass index was 29.3 kg=m 2 . Indications for URS=laser lithotripsy vs PCNL included patient preference (57), technical or anatomic factors (24), patient comorbidities (17), failed shockwave lithotripsy (9), patient body habitus (3), solitary kidney (3), chronic renal insufficiency (3), and strict anticoagulation (2). Thirty-one (26%) patients had stent placement preprocedure, and 94 (78%) patients underwent outpatient surgery. A ureteral access sheath was used in 67%. One hundred and one (84%) patients underwent single-stage procedures. There was one intraoperative complication (ureteral perforation), and there were eight minor postoperative complications (6.7%). The reoperation rate through the mean 18-month followup was 3=120 or 2.5%. Seventy-six (63%) patients had residual stone burden of 0 to 2 mm, and 100 (83%) patients had residual burden of <4 mm. Conclusions: We demonstrate that single-stage URS=holmium laser lithotripsy is effective for management of renal stones that measure 2 to 3 cm through intermediate follow-up. Staged procedures can be used selectively for technical reasons or disease factors. Although PCNL achieves superior stone clearance overall, URS=laser lithotripsy is a viable treatment option for selected patients.
Journal of Endourology, 2007
For midureteral and distal-ureteral tumors not amenable to endoscopic resection, distal ureterect... more For midureteral and distal-ureteral tumors not amenable to endoscopic resection, distal ureterectomy with ureteral reimplantation is a treatment option. When ureteral length is insufficient for direct reimplantation, additional length can be gained with either a psoas hitch or a Boari flap. We describe our technique for robot-assisted laparoscopic distal ureterectomy and ureteral reimplantation with psoas hitch.
Steroid injection for pain with Peyronie's Disease
The Journal of Urology, 2009
Purpose: Penile microarterial bypass surgery may be the only treatment capable of restoring norma... more Purpose: Penile microarterial bypass surgery may be the only treatment capable of restoring normal erectile function without the necessity of chronic use of vasoactive medications or placement of a penile prosthesis. Lack of standardization in patient selection, hemodynamic evaluation, surgical technique and limited long-term outcome data using validated instruments have resulted in this surgery being considered experimental. In this study we report long-term outcome data using validated questionnaires in young men (younger than 55 years) free of vascular risk factors who underwent microvascular arterial bypass surgery. Materials and Methods: This is a single institution retrospective institutional review board approved study of 71 men (mean age 30.5 Ϯ 9.2 years) who underwent microvascular arterial bypass surgery between 1996 and 2007 (mean followup 34.5 Ϯ 18 months). Results: Mean preoperative and postoperative penile rigidity measures with and without phosphodiesterase type 5 inhibitors were 41%, 77% and 71%, 90.8%, respectively. Mean total International Index of Erectile Function score, Erectile Function domain, and question 3 and 4 scores preoperatively and postoperatively were 35.5 Ϯ 14.8, 13.7 Ϯ 6.7, 2.2 Ϯ 1.4 and 2.1 Ϯ 1.3, and 56.2 Ϯ 16.6, 23.8 Ϯ 6.6, 4.1 Ϯ 1.4 and 3.9 Ϯ 1.5, respectively. Preoperative and postoperative Center for Epidemiologic Studies Depression Scale scores were 42.0 Ϯ 10.0 and 33.7 Ϯ 6.1. Treatment satisfaction according to the Erectile Dysfunction Inventory of Treatment Satisfaction was high. All differences were statistically significant. Short-term complications included emesis (2 of 71), dysuria (5 of 71) and wound infection (2 of 71). Long-term complications were loss of penile length (20 of 71) and decreased penile sensation (18 of 71). There were no cases of prolonged penile pain or glans hyperemia. Conclusions: In patients with no vascular risk factors and pure cavernous arterial insufficiency, microvascular arterial bypass surgery provides long-term improvements in erectile function, depression and overall satisfaction.
The Journal of Urology, 2010
The Journal of Sexual Medicine, 2005
To investigate the differential impact of straddles (A(ns) and B(ns)) and noseless two-cheek seat... more To investigate the differential impact of straddles (A(ns) and B(ns)) and noseless two-cheek seats (A(ntcs) and B(ntcs)) on penile hemodynamics and perineal compressive forces in subjects who cycle in a stationary bicycle. Subjects underwent cavernosal artery peak systolic velocity (CAPSV) measurements after intracavernosal injection of vasoactive agents while supine, sitting upright on an examination table, straddling a saddle, sitting on a seat, and again supine. Mean perineal compression pressures recorded while straddling the saddles were compared with those while sitting upright. No differences were found in right and left CAPSV values while supine, sitting upright on an examination table, sitting on a seat, and supine again. Right/left CAPSV (cm/second) values straddling A(ns) and saddle B(ns) (0.7 +/- 2.9/1.5 +/- 6.2 and 0/0, respectively) were significantly lower than values obtained while sitting on A(ntcs) and B(ntcs) (25.6 +/- 13.4/23.8 +/- 12.0 and 17.3 +/- 6.4/18.3 +/- 6.5, respectively) (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Mean perineal compression pressures (mm Hg) on A(ns) and saddle B(ns) (315.2 +/- 39 and 387.9 +/- 64.3, respectively) were significantly higher than values obtained while sitting upright on an examination table (47.6 +/- 5.2 and 46.0 +/- 8.1, respectively) (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). We have identified an objective test to assess if an individual bicycle rider, sitting on a certain shape of bicycle saddle or seat generates sufficient compressive forces at the perineal-saddle interface to obstruct cavernosal arterial inflow. This study also demonstrated that straddling bicycle saddles with nose extensions is associated with perineum-saddle interface compressive pressures that exceed systolic perfusion pressures, significantly diminishing penile hemodynamics.
Journal of Andrology, 2010
International Journal of Urology, 2010
The Journal of Urology, 2010
Http Dx Doi Org 10 1089 End 2006 0260, Apr 1, 2007
Laparoscopic partial nephrectomy (LPN) has emerged as a minimally invasive treatment for small re... more Laparoscopic partial nephrectomy (LPN) has emerged as a minimally invasive treatment for small renal masses. The most common complications include hemorrhage and urinary-fistula formulation. Renal-artery pseudoaneurysm has been described after open nephron-sparing surgery. We present two cases of renal-artery aneurysm following LPN. Two patients with incidentally discovered renal masses underwent LPN with excellent hemostasis and presented in a delayed fashion with gross hematuria and flank pain. Both patients were treated with angiographic coil embolization, resulting in resolution of the pseudoaneurysms on postprocedure imaging. Renal-artery pseudoaneurysm is a potentially life-threatening complication of LPN. Patients present in a delayed fashion with gross hematuria, flank pain, or both. The treatment of choice is angiography with selective coil embolization.
Current urology reports, 2009
The adrenal gland is a potential site of metastasis for various malignancies. Metastases to the a... more The adrenal gland is a potential site of metastasis for various malignancies. Metastases to the adrenal gland are the second most common type of adrenal mass lesion after adenomas. Differentiation of a metastatic lesion from a primary adrenal lesion can be challenging and requires the selective use of radiologic imaging, serologic testing, and adrenal biopsy. In patients who present with an isolated adrenal metastasis, adrenalectomy is often considered to aid in cancer control. Numerous studies have reported improved survival with resection of solitary adrenal metastases for various types of primary tumors. Traditionally, open adrenalectomy was the preferred option for these patients. More recently, laparoscopic adrenalectomy has offered a minimally invasive approach, with its resultant advantages of improved perioperative parameters. Proper patient selection for the laparoscopic versus open approach remains paramount in deciding the best treatment for the individual patient.
Journal of Robotic Surgery, 2010
Adrenal-sparing surgery has recently been reported in the literature on minimally-invasive surger... more Adrenal-sparing surgery has recently been reported in the literature on minimally-invasive surgery. Originally described as a conventional laparoscopic procedure, encouraging outcomes in terms of preservation of adrenal function have been reported. Since the introduction of robotic surgery, surgeons have utilized robotic assistance for adrenal surgery and have recently described adrenal-sparing surgery using this platform. Certain patients that present with adrenal
Journal of Endourology, 2007
Laparoscopic partial nephrectomy (LPN) has emerged as a minimally invasive treatment for small re... more Laparoscopic partial nephrectomy (LPN) has emerged as a minimally invasive treatment for small renal masses. The most common complications include hemorrhage and urinary-fistula formulation. Renal-artery pseudoaneurysm has been described after open nephron-sparing surgery. We present two cases of renal-artery aneurysm following LPN. Two patients with incidentally discovered renal masses underwent LPN with excellent hemostasis and presented in a delayed fashion with gross hematuria and flank pain. Both patients were treated with angiographic coil embolization, resulting in resolution of the pseudoaneurysms on postprocedure imaging. Renal-artery pseudoaneurysm is a potentially life-threatening complication of LPN. Patients present in a delayed fashion with gross hematuria, flank pain, or both. The treatment of choice is angiography with selective coil embolization.
Journal of Endourology, 2010
Background and Purpose: Percutaneous nephrostolithotomy (PCNL) is the current standard of care fo... more Background and Purpose: Percutaneous nephrostolithotomy (PCNL) is the current standard of care for management of large renal stones (>2 cm). Recent studies have evaluated flexible ureterorenoscopy (URS)=holmium laser lithotripsy as an alternative treatment for patients with contraindications to or preference against PCNL. Stones in an intermediate size range (2-3 cm) may be most amenable to URS=laser lithotripsy as definitive treatment in a single stage. We report a multi-institutional series of URS=laser lithotripsy for renal stone burdens that measure 2 to 3 cm. Patients and Methods: Patients who underwent URS=holmium laser lithotripsy for renal stones that measured 2 to 3 cm were identified retrospectively at three tertiary care centers. Demographic information, disease characteristics, and perioperative and postoperative data were gathered. Patients with renal stone burdens of 2 to 3 cm who were treated by URS=laser lithotripsy and had at least one postoperative visit and imaging study were included. Stone clearance was evaluated using 0-2 mm and < 4 mm residual stone burden on postoperative imaging. Results: One hundred and twenty patients underwent URS=holmium laser lithotripsy for renal stones of 2 to 3 cm. Mean stone burden was 2.4 cm, and mean body mass index was 29.3 kg=m 2 . Indications for URS=laser lithotripsy vs PCNL included patient preference (57), technical or anatomic factors (24), patient comorbidities (17), failed shockwave lithotripsy (9), patient body habitus (3), solitary kidney (3), chronic renal insufficiency (3), and strict anticoagulation (2). Thirty-one (26%) patients had stent placement preprocedure, and 94 (78%) patients underwent outpatient surgery. A ureteral access sheath was used in 67%. One hundred and one (84%) patients underwent single-stage procedures. There was one intraoperative complication (ureteral perforation), and there were eight minor postoperative complications (6.7%). The reoperation rate through the mean 18-month followup was 3=120 or 2.5%. Seventy-six (63%) patients had residual stone burden of 0 to 2 mm, and 100 (83%) patients had residual burden of <4 mm. Conclusions: We demonstrate that single-stage URS=holmium laser lithotripsy is effective for management of renal stones that measure 2 to 3 cm through intermediate follow-up. Staged procedures can be used selectively for technical reasons or disease factors. Although PCNL achieves superior stone clearance overall, URS=laser lithotripsy is a viable treatment option for selected patients.
Journal of Endourology, 2007
For midureteral and distal-ureteral tumors not amenable to endoscopic resection, distal ureterect... more For midureteral and distal-ureteral tumors not amenable to endoscopic resection, distal ureterectomy with ureteral reimplantation is a treatment option. When ureteral length is insufficient for direct reimplantation, additional length can be gained with either a psoas hitch or a Boari flap. We describe our technique for robot-assisted laparoscopic distal ureterectomy and ureteral reimplantation with psoas hitch.
Steroid injection for pain with Peyronie's Disease
The Journal of Urology, 2009
Purpose: Penile microarterial bypass surgery may be the only treatment capable of restoring norma... more Purpose: Penile microarterial bypass surgery may be the only treatment capable of restoring normal erectile function without the necessity of chronic use of vasoactive medications or placement of a penile prosthesis. Lack of standardization in patient selection, hemodynamic evaluation, surgical technique and limited long-term outcome data using validated instruments have resulted in this surgery being considered experimental. In this study we report long-term outcome data using validated questionnaires in young men (younger than 55 years) free of vascular risk factors who underwent microvascular arterial bypass surgery. Materials and Methods: This is a single institution retrospective institutional review board approved study of 71 men (mean age 30.5 Ϯ 9.2 years) who underwent microvascular arterial bypass surgery between 1996 and 2007 (mean followup 34.5 Ϯ 18 months). Results: Mean preoperative and postoperative penile rigidity measures with and without phosphodiesterase type 5 inhibitors were 41%, 77% and 71%, 90.8%, respectively. Mean total International Index of Erectile Function score, Erectile Function domain, and question 3 and 4 scores preoperatively and postoperatively were 35.5 Ϯ 14.8, 13.7 Ϯ 6.7, 2.2 Ϯ 1.4 and 2.1 Ϯ 1.3, and 56.2 Ϯ 16.6, 23.8 Ϯ 6.6, 4.1 Ϯ 1.4 and 3.9 Ϯ 1.5, respectively. Preoperative and postoperative Center for Epidemiologic Studies Depression Scale scores were 42.0 Ϯ 10.0 and 33.7 Ϯ 6.1. Treatment satisfaction according to the Erectile Dysfunction Inventory of Treatment Satisfaction was high. All differences were statistically significant. Short-term complications included emesis (2 of 71), dysuria (5 of 71) and wound infection (2 of 71). Long-term complications were loss of penile length (20 of 71) and decreased penile sensation (18 of 71). There were no cases of prolonged penile pain or glans hyperemia. Conclusions: In patients with no vascular risk factors and pure cavernous arterial insufficiency, microvascular arterial bypass surgery provides long-term improvements in erectile function, depression and overall satisfaction.
The Journal of Urology, 2010
The Journal of Sexual Medicine, 2005
To investigate the differential impact of straddles (A(ns) and B(ns)) and noseless two-cheek seat... more To investigate the differential impact of straddles (A(ns) and B(ns)) and noseless two-cheek seats (A(ntcs) and B(ntcs)) on penile hemodynamics and perineal compressive forces in subjects who cycle in a stationary bicycle. Subjects underwent cavernosal artery peak systolic velocity (CAPSV) measurements after intracavernosal injection of vasoactive agents while supine, sitting upright on an examination table, straddling a saddle, sitting on a seat, and again supine. Mean perineal compression pressures recorded while straddling the saddles were compared with those while sitting upright. No differences were found in right and left CAPSV values while supine, sitting upright on an examination table, sitting on a seat, and supine again. Right/left CAPSV (cm/second) values straddling A(ns) and saddle B(ns) (0.7 +/- 2.9/1.5 +/- 6.2 and 0/0, respectively) were significantly lower than values obtained while sitting on A(ntcs) and B(ntcs) (25.6 +/- 13.4/23.8 +/- 12.0 and 17.3 +/- 6.4/18.3 +/- 6.5, respectively) (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Mean perineal compression pressures (mm Hg) on A(ns) and saddle B(ns) (315.2 +/- 39 and 387.9 +/- 64.3, respectively) were significantly higher than values obtained while sitting upright on an examination table (47.6 +/- 5.2 and 46.0 +/- 8.1, respectively) (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). We have identified an objective test to assess if an individual bicycle rider, sitting on a certain shape of bicycle saddle or seat generates sufficient compressive forces at the perineal-saddle interface to obstruct cavernosal arterial inflow. This study also demonstrated that straddling bicycle saddles with nose extensions is associated with perineum-saddle interface compressive pressures that exceed systolic perfusion pressures, significantly diminishing penile hemodynamics.
Journal of Andrology, 2010
International Journal of Urology, 2010
The Journal of Urology, 2010