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Surgical Specialist, Urologist

Awards & Distinctions ?

Associations
American Urological Association

Publications & Research

Dr. Simhan has contributed to 10 publications.
Title Clinical Stage T1 Micropapillary Urothelial Carcinoma Presenting with Metastasis to the Pancreas.
Date May 2012
Journal Urology
Excerpt

Micropapillary carcinoma of the bladder is an extremely aggressive variant of urothelial carcinoma. Radical cystectomy is the standard treatment for all patients, including those with nonmuscle-invasive disease. We present a patient diagnosed with clinical Stage T1 micropapillary carcinoma of the bladder who was found to have a 2-cm metastasis to the head of the pancreas. To our knowledge, this case represents the first report of a solitary metastatic urothelial carcinoma to the pancreas.

Title Delayed Proximal Ureteric Stricture Formation After Complex Partial Nephrectomy.
Date March 2012
Journal Bju International
Excerpt

•  To report and review our incidence of delayed ureteric stricture (US) after complex nephron-sparing surgery (NSS).

Title Intensely Positron Emission Tomography-avid Benign Adrenal Adenoma.
Date February 2012
Journal Urology
Excerpt

Both positron emission tomography/computed tomography (CT) and adrenal washout studies are highly accurate in differentiating benign from malignant adrenal lesions. Very few data exist to help guide management when the positron emission tomography and CT adrenal findings contradict each other with regard to the malignant potential. We present a patient with a remote history of breast cancer and a new solitary left adrenal mass. A CT washout study suggested a lipid-poor adenoma; however, positron emission tomography/CT demonstrated intense fluorodeoxyglucose uptake, suggesting malignancy. The pathologic evaluation after laparoscopic adrenalectomy revealed a benign adrenal adenoma.

Title Anatomic Features of Enhancing Renal Masses Predict Malignant and High-grade Pathology: a Preoperative Nomogram Using the Renal Nephrometry Score.
Date October 2011
Journal European Urology
Excerpt

Counseling patients with enhancing renal mass currently occurs in the context of significant uncertainty regarding tumor pathology.

Title Prostate-specific Antigen Changes and Prostate Cancer in Hypogonadal Men Treated with Testosterone Replacement Therapy.
Date May 2009
Journal Bju International
Excerpt

To retrospectively review hypogonadal men receiving testosterone replacement therapy (TRT), and evaluate the changes in prostate-specific antigen (PSA) levels over an extended period, and thus evaluate the occurrence of prostate cancer, as a primary concern in treating late-onset hypogonadism (LOH) is the potential increased risk of prostate cancer; we also recorded the cardiovascular effects of TRT.

Title Racial Differences in Hypogonadal Improvement and Prostate-specific Antigen Levels in Hypogonadal Men Treated with Testosterone Replacement Therapy.
Date
Journal International Braz J Urol : Official Journal of the Brazilian Society of Urology
Excerpt

To observe hypogonadal men undergoing testosterone replacement therapy (TRT) and assess racial differences in hypogonadal improvement and prostate-specific antigen (PSA) levels.

Title Co-administration of Piperine and Docetaxel Results in Improved Anti-tumor Efficacy Via Inhibition of Cyp3a4 Activity.
Date
Journal The Prostate
Excerpt

Docetaxel is the mainline treatment approved by the FDA for castration-resistant prostate cancer (CRPC) yet its administration only increases median survival by 2-4 months. Docetaxel is metabolized in the liver by hepatic CYP3A4 activity. Piperine, a major plant alkaloid/amide, has been shown to inhibit the CYP3A4 enzymatic activity in a cell-free system. Thus, we investigated whether the co-administration of piperine and docetaxel could increase docetaxel's pharmacokinetic activity in vitro and in vivo.

Title Adrenocortical Carcinoma Masquerading As a Benign Adenoma on Computed Tomography Washout Study.
Date
Journal Urology
Excerpt

An incidental adrenal mass is a common finding on cross-sectional imaging, with most of these lesions being benign adenomas. Indications for adrenalectomy turn on the likelihood that a mass is malignant or whether it exhibits metabolic activity. Modern imaging is considered highly accurate in differentiating adrenal adenomas from other adrenal pathology. We present a case of a 5-cm adrenal lesion with computed tomography washout characteristics consistent with a benign adenoma, which proved upon resection to be an adrenocortical carcinoma.

Title Use of Radical Cystectomy As Initial Therapy for the Treatment of High-grade T1 Urothelial Carcinoma of the Bladder: A Seer Database Analysis.
Date
Journal Urologic Oncology
Excerpt

OBJECTIVES: High-grade T1 (HGT1) bladder cancer represents a heterogeneous disease with an aggressive phenotype. Despite prior reports demonstrating improved cancer-specific mortality (CSM) in patients who receive an early/immediate radical cystectomy (RC), the role of early surgery remains ill-defined. We analyzed the Surveillance Epidemiology and End Results (SEER) database to ascertain the use of RC as an initial therapy for clinical HGT1 bladder cancer. MATERIALS AND METHODS: Using the SEER database from 2004 through 2007, we identified and stratified patients with clinical HGT1 bladder cancer who underwent RC as initial therapy within 1 year of diagnosis. We used χ(2) tests and t-tests to compare characteristics of surgical vs. nonsurgical patients. Cumulative incidence functions and Gray's test for inferences were employed to assess cause-specific mortality outcomes. RESULTS: From 2004 to 2007, 8,467 patients were diagnosed with clinical HGT1 bladder cancer, and 397 (4.7%) patients underwent RC. Patients who underwent RC for clinical HGT1 disease were significantly younger (P < 0.0001) and married (P < 0.0001). Surgical patients also had a significantly improved overall (P = 0.004) and other cause of death (P = 0.0053) survival probabilities yet CSM at 1, 2, and 3 years was not statistically different between the surgical and nonsurgical groups (P = 0.134). CONCLUSIONS: In contrast to the clinically early stage renal and prostate cancers, HGT1 bladder cancer exhibits a higher degree of early progression and potential lethality. Despite routine use of extirpative surgery for T1 lesions of the kidney and prostate, our analysis of the SEER database reveals that definitive surgical therapy is uncommonly employed for HGT1 bladder cancer.

Title Gunshot Wounds to the Scrotum: a Large Single-institutional 20-year Experience.
Date
Journal Bju International
Excerpt

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Penetrating trauma to the scrotum often requires operative intervention, with testicular salvage only possible when enough testicular tissue can be re-approximated in the traumatic setting. The present report represents the largest series of gunshot wound trauma to the scrotum in the literature. Further, it validates recommendations of the European Association of Urology guidelines on urological trauma that advocate operative intervention due to minimal rates of patient morbidity and the inherent limitations of scrotal ultrasonography in discerning testicular compromise.

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