Muta Issa - Academia.edu (original) (raw)

Papers by Muta Issa

Urology, Apr 30, 1997

Impacted ureteral stones pose a challenge during retrograde ureteral stenting. Multiple attempts ... more Impacted ureteral stones pose a challenge during retrograde ureteral stenting. Multiple attempts to bypass the obstruction with conventional guide wires often fail and may result in perforation of the ureter. We describe a new, simple approach to overcome this common problem by utilizing a retrograde glidewire loop technique. The technique described allows safe and successful bypassing and stenting of ureteral obstruction.

Urology, Oct 31, 1999

Objectives. To investigate and compare the effectiveness of three analgesic protocols for pain ma... more Objectives. To investigate and compare the effectiveness of three analgesic protocols for pain management during extracorporeal shock wave lithotripsy (ESWL) in a prospective, randomized clinical trial. Methods. Seventy-four patients were randomized into three groups before ESWL; group A (n ϭ 23) received 10 mg morphine sulfate (MS), group B (n ϭ 25) 60 mg ketorolac tromethamine (KT), and group C (n ϭ 26) topical 2.5% lidocaine/prilocaine gel (Emla). Each method of pain management during ESWL was assessed using a standard 10-point linear pain scale and by the requirement for supplemental analgesia during treatment. Supplemental analgesia was administered intravenously using a patient-controlled analgesic pump. The results were compared between the three groups, as were such parameters as body habitus, stone burden, stone location, number of shock waves, and the presence of ureteral stents. Results. Pain severity averaged 4.6 points on the pain scale for the three groups combined. Pain tended to be more severe in group C (5.4) than in group A (4.3) or group B (4.1); however, the differences were not statistically significant (P Ͼ0.05). The amount of supplemental analgesia was similar in all three groups. Stone burden, stone location, and number of shock waves did not influence the severity of pain or analgesic requirement during ESWL. The analgesic requirement was significantly less in patients with ureteral stents (n ϭ 32) than in patients without (n ϭ 42), averaging 10 mg versus 24 mg MS, respectively (P ϭ 0.01). KT was not associated with adverse events such as bleeding. MS was more likely to cause oversedation and nausea or vomiting, necessitating naloxone and antiemetic therapy, respectively. Conclusions. The use of KT was safe and effective for premedication before ESWL; patients receiving KT before ESWL reported lower pain scores and required less supplemental analgesia requirement than those who received MS or Emla; however, the differences were not statistically significant. Patients receiving Emla recorded the highest pain scores. Patients with ureteral stents had lower pain scores and required less supplemental analgesia. UROLOGY 54: 625-628, 1999.

American Journal of Roentgenology, Nov 23, 2012

The 24-hour creatinine clearance is the standard clinical technique for measuring kidney function... more The 24-hour creatinine clearance is the standard clinical technique for measuring kidney function; however, this measurement is cumbersome and inconvenient for patients. We hypothesized that a camera-based technetium-99m mercaptoacetyltriglycine (MAG3) clearance obtained simultaneously with a standard MAG3 scan would correlate well with the 24-hour creatinine clearance and could serve as a simple marker of kidney function. Data were obtained from a retrospective analysis of 28 patients with varying degrees of kidney dysfunction and 85 subjects evaluated for kidney donation. The MAG3 clearance was calculated using a camera-based technique without blood or urine sampling. The creatinine clearance was measured using the plasma creatinine and a 24-hour urine collection. The MAG3 and creatinine clearances were corrected for body surface area, and clearance values in healthy subjects and patients were compared using the paired Student's t test. The linear association between the MAG3 and creatinine clearances was expressed by Pearson's correlation coefficient. The mean MAG3 clearance in the potential kidney donors was 321 +/- 95 mL/min/1.73 m2 (95% CI, 171-546 mL/min/1.73 m2), significantly higher than the mean creatinine clearance of 152 +/- 51 mL/min/1.73 m2 (79-278 mL/min/1.73 m2, p < 0.001). The mean MAG3 clearance in patients was 153 +/- 70 mL/min/1.73 m2 (32-316 mL/min/1.73 m2) and was also significantly higher than the mean creatinine clearance of 74 +/- 36 mL/min/1.73 m2 (21-138 mL/min/1.73 m2, p < 0.001). The ratio of the mean creatinine clearance to the mean MAG3 clearance was essentially the same for volunteers and patients, 0.47 and 0.48, respectively. The…

Canadian Urological Association Journal Journal De L Association Des Urologues Du Canada, Dec 1, 2008

Bladder involvement occurs in 1%-4% of cases of inguinal hernias. Among obese men aged 50 to 70, ... more Bladder involvement occurs in 1%-4% of cases of inguinal hernias. Among obese men aged 50 to 70, the incidence may reach 10%. 1,2 The diagnosis of bladder involvement is often difficult to delineate at the time of presentation and may only become apparent at the time of herniorrhaphy. Surgical management pertaining to the approach, repair and potential need for bladder resection may challenge the surgeon. We report a series of 4 cases of large inguinoscrotal bladder hernias and provide a literature review. Our goal is to highlight the clinical presentation and the decisive issues surrounding the diagnosis and management of this condition.

The American journal of managed care, 2006

A lack of focus on certain men's health problems has led to significant morbidity and mortali... more A lack of focus on certain men's health problems has led to significant morbidity and mortality in aging men. Managed care must begin to focus on the conditions that are most prevalent in this fast-growing population in an effort to improve the quality of care. To assist in achieving this goal, a naturalistic retrospective study assessing the prevalence of the 10 leading disorders in men older than the age of 50 was conducted, with an additional focus on men eligible for Medicare. Claims data were obtained from the Integrated Health Care Information Solutions National Managed Care Benchmark database (Waltham, Mass), that includes data from 30 health plans covering more than 25 million lives, and from the Centers for Medicare & Medicaid Services, representing men from a 5% random sample of Medicare-eligible patients. Men older than 50 years of age were included in the study. The prevalence of all diseases was determined in the 2003 calendar year for each population. Prevalence wa...

Urologia internationalis, 1994

We report a 30-year-old female with vesicouterine fistula (Youssef's syndrome). Surgical ther... more We report a 30-year-old female with vesicouterine fistula (Youssef's syndrome). Surgical therapy included transabdominal repair of bladder and uterus with interposition of greater omentum. Uterine function was preserved with subsequent successful pregnancy and delivery of a healthy baby boy by elective Cesarean section at 36 weeks' gestation. The details of the case are discussed and the literature is reviewed regarding fertility and pregnancy after surgical repair.

Urologia internationalis, 1992

In order to evaluate the effectiveness of microwave coagulation therapy on urinary bladder carcin... more In order to evaluate the effectiveness of microwave coagulation therapy on urinary bladder carcinoma, we conducted a series of experiments using carcinoma VX-2 cells designed for the application on animal hosts. Three days after implantation of VX-2 cells into the bladder of the rabbits, microwave coagulation therapy was performed. The antitumor effect, i.e. the survival rate, the histological study and the immunological response of the microwave therapy was examined in comparison with the control group (no treatment), the partially cystectomized group and the sham-operated group (no tumor cell implantation). The results were obtained as follows. (1) The survival rate in the microwave group was greater than that in the control group. (2) The stimulation index value (SI), which represents humoral immunity, decreased postoperatively in all groups. In the microwave group, SI increased gradually beginning 21 days after the transient decrease. (3) Histological findings revealed severe de...

The American journal of managed care, 2007

The purpose of this study was to examine the rates of acute urinary retention (AUR) and surgery a... more The purpose of this study was to examine the rates of acute urinary retention (AUR) and surgery after initiating 5-alpha reductase inhibitor (5ARI) therapy and to compare the 2 currently available 5ARIs, dutasteride and finasteride, in a real-world, managed care setting. This study constitutes the first direct comparison of therapeutic outcome between a mono 5ARI (finasteride) and a dual 5ARI (dutasteride). This is a retrospective descriptive and comparative analysis of the rates of AUR and prostate surgery in patients with benign prostatic hyperplasia (BPH) treated with 5ARI therapy, either dutasteride or finasteride. Data were obtained from the PharMetrics Integrated Medical and Pharmaceutical Database (PIMPD) (Watertown, Mass) during a 6-year period. The PIMPD is a large national healthcare database that represents a total of 85 managed health plans and covers more than 45 million patients. The data analysis included all patients aged 50 years or older diagnosed with BPH who were...

A Textbook of Perioperative Medicine, 2006

The Scientific World JOURNAL, 2009

Utilization of nuclear bone scans for staging newly diagnosed prostate cancer has decreased drama... more Utilization of nuclear bone scans for staging newly diagnosed prostate cancer has decreased dramatically due to PSA-driven stage migration. The current criteria for performing bone scans are based on limited historical data. This study evaluates serum PSA and Gleason grade in predicting positive scans in a contemporary large series of newly diagnosed prostate cancer patients. Eight hundred consecutive cases of newly diagnosed prostate cancer over a 64-month period underwent a staging nuclear scan. All subjects had histologically confirmed cancer. The relationship between PSA, Gleason grade, and bone scan was examined by calculating series of crude, stratified, and adjusted odds ratios with corresponding 95% confidence intervals. Four percent (32/800) of all bone scans were positive. This proportion was significantly lower in patients with Gleason score ≤7 (1.9%) vs. Gleason score ≥8 (18.8%, p < 0.001). Among patients with Gleason score ≤7, the rate of positive bones scans was 70-fold higher when the PSA was >30 ng/ml compared to ≤30 ng/ml (p < 0.001). For Gleason score ≥8, the rate was significantly higher (27.9 vs. 0%) when PSA was >10 ng/ml compared to ≤10 ng/ml (p = 0.002). The combination of Gleason score and PSA enhances predictability of bone scans in newly diagnosed prostate cancer patients. The PSA threshold for ordering bone scans should be adjusted according to Gleason score. For patients with Gleason scores ≤7, we recommend a bone scan if the PSA is >30 ng/ml. However, for patients with a high Gleason score (8-10), we recommend a bone scan if the PSA is >10 ng/ml.

Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2008

Bladder involvement occurs in 1%-4% of cases of inguinal hernias. Among obese men aged 50 to 70, ... more Bladder involvement occurs in 1%-4% of cases of inguinal hernias. Among obese men aged 50 to 70, the incidence may reach 10%.1,2 The diagnosis of bladder involvement is often difficult to delineate at the time of presentation and may only become apparent at the time of herniorrhaphy. Surgical management pertaining to the approach, repair and potential need for bladder resection may challenge the surgeon. We report a series of 4 cases of large inguinoscrotal bladder hernias and provide a literature review. Our goal is to highlight the clinical presentation and the decisive issues surrounding the diagnosis and management of this condition.

The 24-hour creatinine clearance is the standard clinical technique to measure renal function; ho... more The 24-hour creatinine clearance is the standard clinical technique to measure renal function; however, this measurement is cumbersome and inconvenient for patients. We hypothesized that a camera-based Tc-99m mercaptoacetyltriglycine (MAG3) clearance obtained simultaneously with a standard MAG3 scan would correlate well with the 24-hour creatinine clearance and could serve as a simple marker of renal function.

Urology, 1998

A new technique of cystoscopic insertion of laser fiber into the prostate is described for inters... more A new technique of cystoscopic insertion of laser fiber into the prostate is described for interstitial laser thermal therapy in the treatment of benign prostatic hyperplasia. The technique uses the inherent physical properties of the fused silica laser fiber with the assistance of a standard cystoscope to insert the laser fiber into the inner region of the prostate gland. Laser thermal therapy is subsequently maintained within the inner prostate at a distance from the prostatic urothelium. The technique described is simple, safe, and minimizes the potential for thermal injury to the prostatic urothelium. UROLOGY 51: 105-110, 1998.

Urology, 1994

A case of transitional cell carcinoma of the bladder metastasizing to the spermatic cord is repor... more A case of transitional cell carcinoma of the bladder metastasizing to the spermatic cord is reported. This represents the only clinically recognized site of tumor recurrence in a man treated with radical cystoprostatectomy followed by four cycles of adjuvant cis-platinum/methotrexate/vinblastine (CMV) chemotherapy for Stage D1 disease (local pelvic lymph node involvement). The existing literature concerning metastatic tumors of the spermatic cord is reviewed.

Urology, 2010

To address the fact that a decrease in the relative renal uptake of 99mTc-mercaptoacetyltriglycin... more To address the fact that a decrease in the relative renal uptake of 99mTc-mercaptoacetyltriglycine (MAG3) on serial MAG3 scans may indicate a loss of function and require a change in management by providing guidance as to what constitutes a meaningful change in serial relative function measurements as well determining the normal variation of other common MAG3 renogram parameters.

Urology, 2007

To determine the value and limitations of technetium-99m mercaptoacetyltriglycine (MAG3) clearanc... more To determine the value and limitations of technetium-99m mercaptoacetyltriglycine (MAG3) clearance measurements obtained using a gamma camera (camera-based MAG3 clearance), a prospective study was conducted to evaluate the reproducibility of camera-based MAG3 clearance compared with that of conventional creatinine clearance.

The Journal of Urology, 2006

We evaluated the documentation of informed consent for 2 common prostate operations using current... more We evaluated the documentation of informed consent for 2 common prostate operations using current, conventional, paper based consent forms. Based on the results of the review the conventional paper based consent system was replaced with a new, standardized electronic consent system. Materials and Methods: We retrospectively reviewed the consent forms obtained for transurethral resection of the prostate and radical prostatectomy procedures during the 6-year period 1995 to 2000 at Atlanta Veterans Affairs Medical Center. Analysis focused on the basic elements of informed consent, including a description of the proposed treatment, and the purpose, benefits, risks and alternatives. Based on these findings we standardized the procedure specific information contained in consent forms and stored it electronically in a central network accessible to all urology providers throughout the medical center. Results: Of the 222 total procedures 204 consent forms were available for review. Senior residents, junior residents and physician assistants obtained consent for 42.2%, 30.9% and 25.5% of procedures, respectively. Information on the purpose and benefits of treatment was missing in 4.4% of cases and deficient in 22.6%. General or procedure specific risks were documented inconsistently in 0% to 96% of cases. Alternative treatment options were missing in 49% of the consent forms and they were significantly deficient in the remaining 51%. Prognosis and surgical risks were documented variably for each procedure. For example, in the radical prostatectomy group 79 patients (88.8%) had appropriate documentation regarding the potential for significant blood loss and yet only 23 (25.8%) had documented consent for blood transfusion. Following the implementation of a new standardized electronic consent program 96.1% of the patients surveyed preferred the new system. Conclusions: Conventional nonstandardized consent forms have significant deficiencies and errors. The new system of electronic informed consent is standardized, legible and understandable, and it assists providers in fully informing patients about the treatment, risks, benefits and alternative therapies, thereby supporting ethical and legal standards, and improving the quality of care. In our opinion standardized electronic informed consent should be the new standard of care.

The Journal of Urology, 2001

Journal of the American College of Surgeons, 2013

Urology, Apr 30, 1997

Impacted ureteral stones pose a challenge during retrograde ureteral stenting. Multiple attempts ... more Impacted ureteral stones pose a challenge during retrograde ureteral stenting. Multiple attempts to bypass the obstruction with conventional guide wires often fail and may result in perforation of the ureter. We describe a new, simple approach to overcome this common problem by utilizing a retrograde glidewire loop technique. The technique described allows safe and successful bypassing and stenting of ureteral obstruction.

Urology, Oct 31, 1999

Objectives. To investigate and compare the effectiveness of three analgesic protocols for pain ma... more Objectives. To investigate and compare the effectiveness of three analgesic protocols for pain management during extracorporeal shock wave lithotripsy (ESWL) in a prospective, randomized clinical trial. Methods. Seventy-four patients were randomized into three groups before ESWL; group A (n ϭ 23) received 10 mg morphine sulfate (MS), group B (n ϭ 25) 60 mg ketorolac tromethamine (KT), and group C (n ϭ 26) topical 2.5% lidocaine/prilocaine gel (Emla). Each method of pain management during ESWL was assessed using a standard 10-point linear pain scale and by the requirement for supplemental analgesia during treatment. Supplemental analgesia was administered intravenously using a patient-controlled analgesic pump. The results were compared between the three groups, as were such parameters as body habitus, stone burden, stone location, number of shock waves, and the presence of ureteral stents. Results. Pain severity averaged 4.6 points on the pain scale for the three groups combined. Pain tended to be more severe in group C (5.4) than in group A (4.3) or group B (4.1); however, the differences were not statistically significant (P Ͼ0.05). The amount of supplemental analgesia was similar in all three groups. Stone burden, stone location, and number of shock waves did not influence the severity of pain or analgesic requirement during ESWL. The analgesic requirement was significantly less in patients with ureteral stents (n ϭ 32) than in patients without (n ϭ 42), averaging 10 mg versus 24 mg MS, respectively (P ϭ 0.01). KT was not associated with adverse events such as bleeding. MS was more likely to cause oversedation and nausea or vomiting, necessitating naloxone and antiemetic therapy, respectively. Conclusions. The use of KT was safe and effective for premedication before ESWL; patients receiving KT before ESWL reported lower pain scores and required less supplemental analgesia requirement than those who received MS or Emla; however, the differences were not statistically significant. Patients receiving Emla recorded the highest pain scores. Patients with ureteral stents had lower pain scores and required less supplemental analgesia. UROLOGY 54: 625-628, 1999.

American Journal of Roentgenology, Nov 23, 2012

The 24-hour creatinine clearance is the standard clinical technique for measuring kidney function... more The 24-hour creatinine clearance is the standard clinical technique for measuring kidney function; however, this measurement is cumbersome and inconvenient for patients. We hypothesized that a camera-based technetium-99m mercaptoacetyltriglycine (MAG3) clearance obtained simultaneously with a standard MAG3 scan would correlate well with the 24-hour creatinine clearance and could serve as a simple marker of kidney function. Data were obtained from a retrospective analysis of 28 patients with varying degrees of kidney dysfunction and 85 subjects evaluated for kidney donation. The MAG3 clearance was calculated using a camera-based technique without blood or urine sampling. The creatinine clearance was measured using the plasma creatinine and a 24-hour urine collection. The MAG3 and creatinine clearances were corrected for body surface area, and clearance values in healthy subjects and patients were compared using the paired Student&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;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;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;#39;s t test. The linear association between the MAG3 and creatinine clearances was expressed by Pearson&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;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;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;#39;s correlation coefficient. The mean MAG3 clearance in the potential kidney donors was 321 +/- 95 mL/min/1.73 m2 (95% CI, 171-546 mL/min/1.73 m2), significantly higher than the mean creatinine clearance of 152 +/- 51 mL/min/1.73 m2 (79-278 mL/min/1.73 m2, 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;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;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). The mean MAG3 clearance in patients was 153 +/- 70 mL/min/1.73 m2 (32-316 mL/min/1.73 m2) and was also significantly higher than the mean creatinine clearance of 74 +/- 36 mL/min/1.73 m2 (21-138 mL/min/1.73 m2, 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;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;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). The ratio of the mean creatinine clearance to the mean MAG3 clearance was essentially the same for volunteers and patients, 0.47 and 0.48, respectively. The…

Canadian Urological Association Journal Journal De L Association Des Urologues Du Canada, Dec 1, 2008

Bladder involvement occurs in 1%-4% of cases of inguinal hernias. Among obese men aged 50 to 70, ... more Bladder involvement occurs in 1%-4% of cases of inguinal hernias. Among obese men aged 50 to 70, the incidence may reach 10%. 1,2 The diagnosis of bladder involvement is often difficult to delineate at the time of presentation and may only become apparent at the time of herniorrhaphy. Surgical management pertaining to the approach, repair and potential need for bladder resection may challenge the surgeon. We report a series of 4 cases of large inguinoscrotal bladder hernias and provide a literature review. Our goal is to highlight the clinical presentation and the decisive issues surrounding the diagnosis and management of this condition.

The American journal of managed care, 2006

A lack of focus on certain men's health problems has led to significant morbidity and mortali... more A lack of focus on certain men's health problems has led to significant morbidity and mortality in aging men. Managed care must begin to focus on the conditions that are most prevalent in this fast-growing population in an effort to improve the quality of care. To assist in achieving this goal, a naturalistic retrospective study assessing the prevalence of the 10 leading disorders in men older than the age of 50 was conducted, with an additional focus on men eligible for Medicare. Claims data were obtained from the Integrated Health Care Information Solutions National Managed Care Benchmark database (Waltham, Mass), that includes data from 30 health plans covering more than 25 million lives, and from the Centers for Medicare & Medicaid Services, representing men from a 5% random sample of Medicare-eligible patients. Men older than 50 years of age were included in the study. The prevalence of all diseases was determined in the 2003 calendar year for each population. Prevalence wa...

Urologia internationalis, 1994

We report a 30-year-old female with vesicouterine fistula (Youssef's syndrome). Surgical ther... more We report a 30-year-old female with vesicouterine fistula (Youssef's syndrome). Surgical therapy included transabdominal repair of bladder and uterus with interposition of greater omentum. Uterine function was preserved with subsequent successful pregnancy and delivery of a healthy baby boy by elective Cesarean section at 36 weeks' gestation. The details of the case are discussed and the literature is reviewed regarding fertility and pregnancy after surgical repair.

Urologia internationalis, 1992

In order to evaluate the effectiveness of microwave coagulation therapy on urinary bladder carcin... more In order to evaluate the effectiveness of microwave coagulation therapy on urinary bladder carcinoma, we conducted a series of experiments using carcinoma VX-2 cells designed for the application on animal hosts. Three days after implantation of VX-2 cells into the bladder of the rabbits, microwave coagulation therapy was performed. The antitumor effect, i.e. the survival rate, the histological study and the immunological response of the microwave therapy was examined in comparison with the control group (no treatment), the partially cystectomized group and the sham-operated group (no tumor cell implantation). The results were obtained as follows. (1) The survival rate in the microwave group was greater than that in the control group. (2) The stimulation index value (SI), which represents humoral immunity, decreased postoperatively in all groups. In the microwave group, SI increased gradually beginning 21 days after the transient decrease. (3) Histological findings revealed severe de...

The American journal of managed care, 2007

The purpose of this study was to examine the rates of acute urinary retention (AUR) and surgery a... more The purpose of this study was to examine the rates of acute urinary retention (AUR) and surgery after initiating 5-alpha reductase inhibitor (5ARI) therapy and to compare the 2 currently available 5ARIs, dutasteride and finasteride, in a real-world, managed care setting. This study constitutes the first direct comparison of therapeutic outcome between a mono 5ARI (finasteride) and a dual 5ARI (dutasteride). This is a retrospective descriptive and comparative analysis of the rates of AUR and prostate surgery in patients with benign prostatic hyperplasia (BPH) treated with 5ARI therapy, either dutasteride or finasteride. Data were obtained from the PharMetrics Integrated Medical and Pharmaceutical Database (PIMPD) (Watertown, Mass) during a 6-year period. The PIMPD is a large national healthcare database that represents a total of 85 managed health plans and covers more than 45 million patients. The data analysis included all patients aged 50 years or older diagnosed with BPH who were...

A Textbook of Perioperative Medicine, 2006

The Scientific World JOURNAL, 2009

Utilization of nuclear bone scans for staging newly diagnosed prostate cancer has decreased drama... more Utilization of nuclear bone scans for staging newly diagnosed prostate cancer has decreased dramatically due to PSA-driven stage migration. The current criteria for performing bone scans are based on limited historical data. This study evaluates serum PSA and Gleason grade in predicting positive scans in a contemporary large series of newly diagnosed prostate cancer patients. Eight hundred consecutive cases of newly diagnosed prostate cancer over a 64-month period underwent a staging nuclear scan. All subjects had histologically confirmed cancer. The relationship between PSA, Gleason grade, and bone scan was examined by calculating series of crude, stratified, and adjusted odds ratios with corresponding 95% confidence intervals. Four percent (32/800) of all bone scans were positive. This proportion was significantly lower in patients with Gleason score ≤7 (1.9%) vs. Gleason score ≥8 (18.8%, p < 0.001). Among patients with Gleason score ≤7, the rate of positive bones scans was 70-fold higher when the PSA was >30 ng/ml compared to ≤30 ng/ml (p < 0.001). For Gleason score ≥8, the rate was significantly higher (27.9 vs. 0%) when PSA was >10 ng/ml compared to ≤10 ng/ml (p = 0.002). The combination of Gleason score and PSA enhances predictability of bone scans in newly diagnosed prostate cancer patients. The PSA threshold for ordering bone scans should be adjusted according to Gleason score. For patients with Gleason scores ≤7, we recommend a bone scan if the PSA is >30 ng/ml. However, for patients with a high Gleason score (8-10), we recommend a bone scan if the PSA is >10 ng/ml.

Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2008

Bladder involvement occurs in 1%-4% of cases of inguinal hernias. Among obese men aged 50 to 70, ... more Bladder involvement occurs in 1%-4% of cases of inguinal hernias. Among obese men aged 50 to 70, the incidence may reach 10%.1,2 The diagnosis of bladder involvement is often difficult to delineate at the time of presentation and may only become apparent at the time of herniorrhaphy. Surgical management pertaining to the approach, repair and potential need for bladder resection may challenge the surgeon. We report a series of 4 cases of large inguinoscrotal bladder hernias and provide a literature review. Our goal is to highlight the clinical presentation and the decisive issues surrounding the diagnosis and management of this condition.

The 24-hour creatinine clearance is the standard clinical technique to measure renal function; ho... more The 24-hour creatinine clearance is the standard clinical technique to measure renal function; however, this measurement is cumbersome and inconvenient for patients. We hypothesized that a camera-based Tc-99m mercaptoacetyltriglycine (MAG3) clearance obtained simultaneously with a standard MAG3 scan would correlate well with the 24-hour creatinine clearance and could serve as a simple marker of renal function.

Urology, 1998

A new technique of cystoscopic insertion of laser fiber into the prostate is described for inters... more A new technique of cystoscopic insertion of laser fiber into the prostate is described for interstitial laser thermal therapy in the treatment of benign prostatic hyperplasia. The technique uses the inherent physical properties of the fused silica laser fiber with the assistance of a standard cystoscope to insert the laser fiber into the inner region of the prostate gland. Laser thermal therapy is subsequently maintained within the inner prostate at a distance from the prostatic urothelium. The technique described is simple, safe, and minimizes the potential for thermal injury to the prostatic urothelium. UROLOGY 51: 105-110, 1998.

Urology, 1994

A case of transitional cell carcinoma of the bladder metastasizing to the spermatic cord is repor... more A case of transitional cell carcinoma of the bladder metastasizing to the spermatic cord is reported. This represents the only clinically recognized site of tumor recurrence in a man treated with radical cystoprostatectomy followed by four cycles of adjuvant cis-platinum/methotrexate/vinblastine (CMV) chemotherapy for Stage D1 disease (local pelvic lymph node involvement). The existing literature concerning metastatic tumors of the spermatic cord is reviewed.

Urology, 2010

To address the fact that a decrease in the relative renal uptake of 99mTc-mercaptoacetyltriglycin... more To address the fact that a decrease in the relative renal uptake of 99mTc-mercaptoacetyltriglycine (MAG3) on serial MAG3 scans may indicate a loss of function and require a change in management by providing guidance as to what constitutes a meaningful change in serial relative function measurements as well determining the normal variation of other common MAG3 renogram parameters.

Urology, 2007

To determine the value and limitations of technetium-99m mercaptoacetyltriglycine (MAG3) clearanc... more To determine the value and limitations of technetium-99m mercaptoacetyltriglycine (MAG3) clearance measurements obtained using a gamma camera (camera-based MAG3 clearance), a prospective study was conducted to evaluate the reproducibility of camera-based MAG3 clearance compared with that of conventional creatinine clearance.

The Journal of Urology, 2006

We evaluated the documentation of informed consent for 2 common prostate operations using current... more We evaluated the documentation of informed consent for 2 common prostate operations using current, conventional, paper based consent forms. Based on the results of the review the conventional paper based consent system was replaced with a new, standardized electronic consent system. Materials and Methods: We retrospectively reviewed the consent forms obtained for transurethral resection of the prostate and radical prostatectomy procedures during the 6-year period 1995 to 2000 at Atlanta Veterans Affairs Medical Center. Analysis focused on the basic elements of informed consent, including a description of the proposed treatment, and the purpose, benefits, risks and alternatives. Based on these findings we standardized the procedure specific information contained in consent forms and stored it electronically in a central network accessible to all urology providers throughout the medical center. Results: Of the 222 total procedures 204 consent forms were available for review. Senior residents, junior residents and physician assistants obtained consent for 42.2%, 30.9% and 25.5% of procedures, respectively. Information on the purpose and benefits of treatment was missing in 4.4% of cases and deficient in 22.6%. General or procedure specific risks were documented inconsistently in 0% to 96% of cases. Alternative treatment options were missing in 49% of the consent forms and they were significantly deficient in the remaining 51%. Prognosis and surgical risks were documented variably for each procedure. For example, in the radical prostatectomy group 79 patients (88.8%) had appropriate documentation regarding the potential for significant blood loss and yet only 23 (25.8%) had documented consent for blood transfusion. Following the implementation of a new standardized electronic consent program 96.1% of the patients surveyed preferred the new system. Conclusions: Conventional nonstandardized consent forms have significant deficiencies and errors. The new system of electronic informed consent is standardized, legible and understandable, and it assists providers in fully informing patients about the treatment, risks, benefits and alternative therapies, thereby supporting ethical and legal standards, and improving the quality of care. In our opinion standardized electronic informed consent should be the new standard of care.

The Journal of Urology, 2001

Journal of the American College of Surgeons, 2013