Shahram Gholami | University of California, San Francisco (original) (raw)

Papers by Shahram Gholami

The Journal of Urology, Apr 1, 2003

Purpose: We provide a current review of Peyronie's disease. Materials and Methods: We reviewed th... more Purpose: We provide a current review of Peyronie's disease. Materials and Methods: We reviewed the world peer reviewed literature on the pathology, pathogenesis, diagnosis and treatment of Peyronie's disease. Results: The incidence of Peyronie's disease has continuously increased during the last 30 years. However, fewer patients need prosthesis surgery as the sole treatment option because of earlier diagnosis, improved medical therapy, refinement in surgical technique and better understanding of the basic sciences of the disease. Conclusions: Currently patients with Peyronie's disease have had improvements in prognosis and experienced an expansion of the available therapeutic options.

Urology, Nov 1, 2001

Objectives. To use a radially expanding system (Step) and a modified port location for intra-abdo... more Objectives. To use a radially expanding system (Step) and a modified port location for intra-abdominal access to decrease the access-related complications in renal and adrenal surgery. Access-related complications during laparoscopic renal surgery are frustrating and are more common in patients with previous abdominal surgery and associated adhesions. Methods. Laparoscopic upper tract procedures were performed in 62 patients using radially expanding trocars, and the results were reviewed with regard to access, port placement, and associated complications. For initial access, a Veress needle was placed subcostally in the midclavicular line. An expandable mesh sleeve trocar was used for trocar insertion after a pneumoperitoneum was established. A blunt-tipped fascial dilator was used to dilate to 10 or 12 mm. Additional ports were placed in an L shape (nephrectomy) or a subcostal configuration (adrenalectomy) under direct vision using the Step ports. Results. Of 62 patients, 24 had had prior abdominal surgery. Open insertion of the mesh sleeve was necessary in 20%, of whom 60% had had prior abdominal surgery. In 9% of cases, the liver was punctured with the initial pass of the Veress needle. Only minimal bleeding from the injury site was noticed. The liver punctures did not require cauterization and did not result in conversion to an open procedure. At a mean follow-up of 12 months, no access-related complications or port-site hernias were noted. Conclusions. Placement of the initial access subcostally at the level of the midclavicular line helps to prevent visceral injury, especially in patients with previous abdominal surgery. The use of the radially expanding access system with the modification of port location allows safe and rapid laparoscopic access for upper urinary tract surgery. This trocar system is an excellent alternative to the standard laparoscopic trocars.

European Urology Supplements, Mar 1, 2016

Four year results from the largest, prospective, randomized study of prostatic urethral lift (PUL)

PubMed, Feb 1, 2003

Purpose: We performed a nonrandomized retrospective comparison of 2 techniques for laparoscopic p... more Purpose: We performed a nonrandomized retrospective comparison of 2 techniques for laparoscopic partial nephrectomy, that is without and with clamping the renal vessels. Materials and methods: Between December 1997 and February 2002, 28 consecutive patients underwent transperitoneal laparoscopic partial nephrectomy for renal tumor. In group 1 (12 patients) partial nephrectomy was performed with ultrasonic shears and bipolar cautery without clamping the renal vessels, while in group 2 (16 patients) the renal pedicle was clamped before tumor excision. In group 2 patients intracorporeal kidney cooling was achieved by a ureteral catheter connected to 4C solution. Intracorporeal freehand suturing techniques were used to close the collecting system when opened and approximate the renal parenchyma. Results: All procedures were successfully completed laparoscopically. Mean renal ischemia time +/- SD was 27.3 +/- 7 minutes (range 15 to 47) in group 2 patients. Mean laparoscopic operating time was 179.1 +/- 86 minutes (range 90 to 390) in group 1 compared with 121.5 +/- 37 minutes (range 60 to 210) in group 2 (p = 0.004). Mean intraoperative blood loss was significantly higher in group 1 than in group 2 (708.3 +/- 569 versus 270.3 +/- 281 ml., p = 0.014). Three patients in group 1 and 2 in group 2 required blood transfusions. Immediately postoperatively mean creatinine was 1.26 +/- 0.36 and 1.45 +/- 0.61 mg./dl. in groups 1 and 2, respectively (p = 0.075). Surgical margins were negative in all specimens. Pathological examination revealed renal cell cancer in 18 cases (stages pT1 in 17 and pT3a in 1), oncocytoma in 4, angiomyolipoma in 5 and renal adenoma in 1. Conclusions: Laparoscopic partial nephrectomy represents a feasible option for patients with small renal masses. Clamping the renal vessels during tumor resection and suturing the kidney mimics the open technique and seems to be associated with less blood loss and shorter laparoscopic operative time.

The Journal of Urology, 2003

INTRODUCTION AND OBJECTIVE: The objectives of laparoscopic partial nephrectomy for renal cell car... more INTRODUCTION AND OBJECTIVE: The objectives of laparoscopic partial nephrectomy for renal cell carcinoma (RCC) should be similar to the open technique. Cold ischemia permits optimal tumor excision and reual reconstruction while preserving renal function. However, cold ischemia with laparoscopic partial nephrectomy remains unsolved. Our video presents a new technique obtaining cold ischemia during laparoscopy. METHODS: Cold ischemia is achieved by cold arterial renal perfusion. Prior to laparoscopy an angiocatheter is passed into the main renal artery through a femoral puncture. The renal artery is clamped by a tourniquet. The renal vein is secured with an umbilical tape, but not occluded. Perfusion is initiated with iced Ringer Lactate at 4 degrees celsius at a rate of 50 cc/min. Renal temperature is continously monitored with a thermoprobe residing in the parenchyma. When a parenchymal temperature of 25 degrees celsius is reached perfusion is reduced to maintain a steady state. Tumor excision is performed in a bloodless field with biopsy taken from the tumor bed. The collecting system is repaired, and renal reconstruction is performed using parenchymal sutures over a hemostatic bolster. All steps are done similar to the open partial nephrectomy. Between November 01 and September 02 nine patients (RCC: 8, pyelonephritic lower pole: 1) were operated using this technique. There were 6 men and 3 woman with a mean age of 52 years (29-67). Mean tumor size was 2.4 ern (2-3.5). RESULTS: Bloodless field was achieved in 8 cases and minor oozing from an accessory renal artery occured in one case. Total ischemia time was 27 to 71 minutes (mean 36 min). Renal hypothermia was maintained at 25 degrees celsius. Estimated blood loss was 30-650 cc (mean 135 cc); only one patient required transfusions. Adequate tumor excision with negative margins was acheived in all cases. One patient had a delayed bleeding which was managed by laparoscopic reexploration, No other postoperative complications were encountered. Postoperative renal function could be investigated in 4 patients with isotope nephrography and was essentially unchanged in all of them. CONCLUSIONS: Our initial experience of incorporating cold ischemia into laparoscopic partial nephrectomy shows the feasibility and safety of this technique. We believe this approach will allow duplication of the principles of the open procedure and makes laparoscopic partial nephrectomy for RCC and complex renal pathology safe and reliable. Source of Funding: None.

Journal of Clinical Periodontology, 2007

Background: Treatment with a natural bone mineral (NBM) and a guided tissue regeneration (GTR) ha... more Background: Treatment with a natural bone mineral (NBM) and a guided tissue regeneration (GTR) has been shown to promote periodontal regeneration. However, until now there are only very limited data on the long‐term clinical results following this regenerative technique.Aim: To present the 5‐year results of a prospective, randomized, controlled clinical study evaluating the treatment of deep intra‐bony defects either with open flap debridement (OFD) and a combination of an NBM and GTR (test) or OFD alone (control).Methods: Nineteen patients diagnosed with advanced chronic periodontitis, and each of whom displayed one intra‐bony defect, received randomly the test or the control treatment. Results were evaluated at baseline, at 1 and at 5 years following therapy.Results: No statistically significant differences in any of the investigated parameters were observed at baseline between the two groups. At 1 year after therapy, the test group showed a reduction in mean probing depth (PD) fr...

European Urology Supplements, Mar 1, 2017

Long term (5 year) results from the largest, prospective, randomized, controlled study of the min... more Long term (5 year) results from the largest, prospective, randomized, controlled study of the minimally invasive prostatic urethral lift (PUL)

Modern Pathology

There is a clinical need to identify novel biomarkers to improve diagnostic accuracy for the dete... more There is a clinical need to identify novel biomarkers to improve diagnostic accuracy for the detection of urothelial tumors. The current study aimed to evaluate keratin 17 (K17), an oncoprotein that drives cell cycle progression in cancers of multiple anatomic sites, as a diagnostic biomarker of urothelial neoplasia in bladder biopsies and in urine cytology specimens. We evaluated K17 expression by immunohistochemistry in formalin-fixed, paraffin embedded tissue specimens of non-papillary invasive urothelial carcinoma (UC) (classical histological cases), high grade papillary UC (PUC-LG), low grade papillary UC (PUC-HG), papillary urothelial neoplasia of low malignant potential (PUNLMP), and normal bladder mucosa. A threshold was established to dichotomize K17 status in tissue specimens as positive vs. negative, based on the proportion of cells that showed strong staining. In addition, K17 immunocytochemistry was performed on urine cytology slides, scoring positive test results based on the detection of K17 in any urothelial cells. Mann-Whitney and receiver operating characteristic analyses were used to compare K17 expression between histologic diagnostic categories. The median proportion of K17 positive tumor cells was 70% (range 20-90%) in PUNLMP, 30% (range 5-100%) in PUC-LG, 20% (range 1-100%), in PUC-HG, 35% (range 5-100%) in UC but staining was rarely detected (range 0-10%) in normal urothelial mucosa. Defining cases in which K17 was detected in ≥10% of cells were considered positive, the sensitivity of K17 in biopsies was 89% (95% CI: 80-96%) and the specificity was 88% (95% CI: 70-95%) to distinguish malignant lesions (PUC-LG, PUC-HG, and UC) from normal urothelial mucosa. Furthermore, K17 immunocytochemistry had a sensitivity of 100% and a specificity of 96% for urothelial carcinoma in 112 selected urine specimens. Thus, K17 is a sensitive and specific biomarker of urothelial neoplasia in tissue specimens and should be further explored as a novel biomarker for the cytologic diagnosis of urine specimens.

Urologic Clinics of North America, 2001

Peyronie's disease first was reported by Fallopius in 1561. It was popularized in 1743 by Francoi... more Peyronie's disease first was reported by Fallopius in 1561. It was popularized in 1743 by Francois Gigot de la Peyronie, surgeon to Kmg Louis XV of France, and has since born his name. Peyronie's disease (indurufo penis plusticu) is a condition characterized by the formation of fibrous plaques within the tunica albuginea. These plaques impede expansion of the tunica albuginea during erection, resulting in penile bending. In extreme cases, the plaques may induce a collarlike or an hourglasslike appearance in the erect penis. INCIDENCE Peyronie's disease has been reported to occur in association with Dupuytren's contractures, plantar fascia1 contractures, tympanosclerosis, trauma, urethral instrumentation, diabetes, gout, Paget's disease, and the use of

Pathophysiology and Treatment, 2007

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In this chapter, we will discuss the physiology and pathophysiology of erectile function and dysf... more In this chapter, we will discuss the physiology and pathophysiology of erectile function and dysfunction. We will review the current medical treatments of the disease and the surgical options for patients that fail medical management. Finally, we will mention some of the future treatment options becoming available in the near future.

The Journal of Urology, 2016

The Canadian journal of urology, 2015

To report the three year results of a multi-center, randomized, patient and outcome assessor blin... more To report the three year results of a multi-center, randomized, patient and outcome assessor blinded trial of the Prostatic Urethral Lift (PUL) in men with bothersome lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). At 19 centers in North America and Australia, 206 subjects = 50 years old with International Prostate Symptom Score (IPSS) ≥ 13, peak flow rate (Qmax) ≤ 12 mL/s, and prostate volume between 30 cc-80 cc were randomized 2:1 to the PUL procedure or sham control. PUL involved placing permanent UroLift implants into the lateral lobes of the prostate to enlarge the urethral lumen. After randomized comparison at 3 months, PUL patients were followed to 3 years. LUTS severity (IPSS), quality of life, Qmax, sexual function, and adverse events were assessed throughout follow up. The therapeutic effect of PUL regarding IPSS was 88% greater than sham at 3 months. Average improvements from baseline through 3 years were significant for total IPSS (41.1%), ...

The Journal of Urology, 2015

Urology Practice, 2015

ABSTRACT Introduction For a therapy to become an important part of a provider armamentarium it mu... more ABSTRACT Introduction For a therapy to become an important part of a provider armamentarium it must be safer or better than existing therapies and be durable. The prostatic urethral lift offers rapid improvement in lower urinary tract symptoms associated with benign prostatic hyperplasia with minimal side effects. We report 2-year results of a multicenter, randomized, blinded trial of the prostatic urethral lift. Methods A total of 206 men 50 years old or older with an AUA-SI of 13 or greater, a peak flow rate of 12 ml per second or less and a 30 to 80 cc prostate were randomized 2:1 between the prostatic urethral lift and sham treatment. The prostatic urethral lift is performed by placing permanent transprostatic implants to lift apart the prostate lobes and reduce urethral obstruction. Sham treatment entailed rigid cystoscopy, a blinding screen and sounds that mimicked those of the prostatic urethral lift procedure. Patients were assessed for lower urinary tract symptoms, peak flow rate, quality of life and sexual function. Results The prostatic urethral lift reduced the AUA-SI 88% more than sham treatment (−11.1 vs −5.9, p = 0.003). Patients with the prostatic urethral lift experienced an AUA-SI reduction from 22.1 at baseline to 18.0 (−17%), 11.1 (−50%), 11.4 (−48%) and 12.5 (−42%) at 2 weeks, 3 months, and 1 and 2 years, respectively (p <0.0001). The peak flow rate was increased 4.2 ml per second at 3 months and 2 years (p <0.0001). By 2 years only 7.5% of patients required additional intervention for lower urinary tract symptoms. Adverse events were typically mild and transient. Encrustation did not develop on implants properly placed in the prostate. There was no occurrence of de novo sustained ejaculatory or erectile dysfunction. Conclusions The prostatic urethral lift preserves sexual function and provides rapid improvement in symptoms, flow and quality of life that are sustained to 2 years.

The Journal of Urology, 2013

Purpose: We report the first multicenter randomized blinded trial of the prostatic urethral lift ... more Purpose: We report the first multicenter randomized blinded trial of the prostatic urethral lift for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Materials and Methods: Men at least 50 years old with AUASI (American Urological Association Symptom Index) 13 or greater, a maximum flow rate 12 ml per second or less and a prostate 30 to 80 cc were randomized 2:1 between prostatic urethral lift and sham. In the prostatic urethral lift group small permanent implants are placed within the prostate to retract encroaching lobes and open the prostatic urethra. Sham entailed rigid cystoscopy with sounds mimicking the prostatic urethral lift. The primary end point was comparison of AUASI reduction at 3 months. The prostatic urethral lift arm subjects were followed to 1 year and assessed for lower urinary tract symptoms, peak urinary flow rate, quality of life and sexual function. Results: A total of 206 men were randomized (prostatic urethral lift 140 vs sham 66). The prostatic urethral lift and sham AUASI was reduced by 11.1 AE 7.67 and 5.9 AE 7.66, respectively (p ¼ 0.003), thus meeting the primary end point. Prostatic urethral lift subjects experienced AUASI reduction from 22.1 baseline to 18.0, 11.0 and 11.1 at 2 weeks, 3 months and 12 months, respectively, p <0.001. Peak urinary flow rate increased 4.4 ml per second at 3 months and was sustained at 4.0 ml per second at 12 months, p <0.001.

The Journal of Urology, 2014

The Journal of Urology, 2002