Nephrologist (kidney), Surgical Specialist, Urologists
24 years of experience

Accepting new patients
Cmh Urology Clinic
1155 W Parkview St
Ste 2C
Bolivar, MO 65613
417-326-2550
Locations and availability (3)

Education ?

Medical School Score
Saint Louis University (1986)
  • Currently 2 of 4 apples

Awards & Distinctions ?

Associations
American Urological Association
Member
American Urological Association (urologyhealth.org)
Member

Affiliations ?

Dr. Boullier is affiliated with 5 hospitals.

Hospital Affilations

Score

Rankings

  • Des Peres Hospital
    2345 Dougherty Ferry Rd, Saint Louis, MO 63122
    • Currently 4 of 4 crosses
    Top 25%
  • Saint Louis University Hospital
    3635 Vista Ave, Saint Louis, MO 63110
    • Currently 2 of 4 crosses
  • Citizens Memorial Hospital
    1500 N Oakland Ave, Bolivar, MO 65613
    • Currently 1 of 4 crosses
  • Citizens Merial Hospital
  • Usa Medical Center
  • Publications & Research

    Dr. Boullier has contributed to 26 publications.
    Title Male Sexual Dysfunction in Renal Transplant Recipients: Comparison to Men Awaiting Transplant.
    Date October 2003
    Journal Transplantation Proceedings
    Title Adult Testicular Torsion.
    Date April 2002
    Journal The Journal of Urology
    Excerpt

    Testicular torsion in adulthood is thought to be relatively unusual. We compared a series of men 21 years old or older with testicular torsion with a concurrent series of younger patients with torsion.

    Title Prediction of Spontaneous Ureteral Calculous Passage by an Artificial Neural Network.
    Date September 2000
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Although a consensus exists that small stones presenting in the distal ureter have a good probability of spontaneous passage, it is difficult to predict in individuals whether a particular ureteral stone would pass or require intervention. If an accurate judgment were made at presentation on the likelihood of stone passage, patients would receive immediate intervention for the stone or be notified of a more appropriate time at which to expect passage. We used an artificial neural network to evaluate data in patients with ureteral calculi to predict whether a stone would pass spontaneously or require intervention. MATERIALS AND METHODS: Data were collected from the records of 181 patients presenting with colic due to a ureteral calculus. Patient input factors included age, sex, race, marital status, insurance, stone side, level and size, hydronephrosis and obstruction grades, duration of symptoms before presentation, serum creatinine, history of stone passage or intervention and nausea, vomiting or fever. Outcomes evaluated were stone passage or intervention. Data were entered into a neural network created using commercially available computer software. RESULTS: A set of 125 patients from the database was used for training the network. The network correctly predicted outcome in 38 of the remaining 55 patients (76%) used for testing. In the 25 cases in which stones passed spontaneously sensitivity was 100%. Duration of symptoms before presentation was the most influential factor in network ability to predict accurately stone passage, followed by hydronephrosis grade. CONCLUSIONS: An artificial neural network may be used to predict accurately the probability of spontaneous ureteral stone passage. Using such a model at presentation may help to determine whether a patient should receive early intervention for a stone or expect a lengthy interval before stone passage.

    Title Scrotal Dog Bites.
    Date July 2000
    Journal The Journal of Urology
    Excerpt

    Dog bites to the scrotum are rare but they potentially result in morbidity if improperly managed.

    Title Traumatic Posterior Urethral Injury and Early Primary Endoscopic Realignment: Evaluation of Long-term Follow-up.
    Date July 1999
    Journal Urology
    Excerpt

    OBJECTIVES: The management of complete or partial posterior urethral disruption is controversial and much debate continues regarding immediate versus delayed definitive therapy. We further analyze our experience and long-term results using early endoscopic realignment. METHODS: Between April 1991 and June 1995, 8 men with posterior urethral avulsion, either complete or partial and secondary to blunt trauma and pelvic fractures, presented to our institution. A variety of endourologic techniques were employed to achieve urethral continuity while attempting to minimize stricture formation, incontinence, and impotence. RESULTS: After a mean of 50.4 months (range 35 to 85) of follow-up, 7 men (87.5%) are continent, with 2 of those requiring intermittent self-dilation ranging from once every 7 days to once a month. One patient required conversion to an open perineal urethroplasty. Of the 8 patients, 5 (62.5%) are potent, and 2 others achieve adequate erections for intercourse using intracorporeal injections. Four of the 8 have required subsequent internal urethrotomies with eventual voiding stabilization over the course of 1 2 months. Average time to realignment was 9.5 days (range 0 to 19). CONCLUSIONS: Primary endoscopic realignment offers an effective method for treating traumatic urethral injuries. Our long-term follow-up provides further support for use of this technique by demonstrating that urethral continuity can be established without increased incidence of impotence, stricture formation, or incontinence. By achieving early and minimally invasive realignment, we seem to lessen the severity of stricture disease that almost uniformly afflicts those patients who undergo delayed repair. If a minimally invasive technique should fail, it does not seem to delay nor does it preclude further management using open techniques.

    Title Surgical Correction of Stress Incontinence in Morbidly Obese Women.
    Date September 1998
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Obesity is a contributing factor to the development of stress urinary incontinence in women, in addition to surgical technical factors which may make some urologists reticent to offer operative therapy. We reviewed our series of morbidly obese women who underwent anti-incontinence surgery to determine if they were at higher risk for surgical failure. MATERIALS AND METHODS: The records of our operative series of female stress urinary incontinence were reviewed and 16 women were considered morbidly obese. Transvaginal bladder neck suspension was performed in 4 women and sling procedures in 12, depending on preoperative urodynamic findings. RESULTS: Bladder neck suspension procedures failed in 2 cases, and no sling procedures failed. There was no recurrent or new pelvic floor deficit. The operations were somewhat more difficult to perform due to the body habitus of these patients but there were no intraoperative complications and only 1 minor wound infection postoperatively. CONCLUSIONS: Morbidly obese women with stress urinary incontinence can undergo operations for this disorder with a good chance of success. We recommend complete evaluation including urodynamics to ensure proper classification of stress incontinence. Sling operations may be the procedure of choice for stress incontinence in morbidly obese women.

    Title Delayed Repair of Penile Fracture.
    Date August 1998
    Journal The Journal of Trauma
    Title Leak Point Pressures in Women with Urinary Stress Incontinence: Correlation with Patient History.
    Date March 1997
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We examined the relationship between historical factors in women with urinary stress incontinence and the Valsalva leak point pressure. MATERIALS AND METHODS: Valsalva leak point pressure measurements in 57 women with urinary stress incontinence were compared to findings in the history. RESULTS: Valsalva leak point pressure was low in 83% of women with severe leakage and previous surgery. Interestingly, 47% of patients without predisposing factors had low Valsalva leak point pressures. CONCLUSIONS: Women with severe leakage and previous bladder neck surgery are likely to have urethral dysfunction as demonstrated by Valsalva leak point pressure testing. A significant incidence of low Valsalva leak point pressures in patients without predisposing factors could account for many failures of routine suspension procedures.

    Title Laparoscopic Surgery for Bladder Carcinoma.
    Date August 1996
    Journal Seminars in Surgical Oncology
    Excerpt

    Recent utilization of laparoscopy in urology has led to the performance of several pelvic procedures. The successful performance of laparoscopic diverticulectomies and cystectomies for benign pathology has led to speculation about, and utilization of, the laparoscopic approach in the treatment of bladder cancer. Herein, we relay our experience with the laparoscopic approach for bladder surgery and discuss the pros and cons of its current status in the treatment of bladder cancer.

    Title Transurethral Collagen Injections in the Therapy of Post-radical Prostatectomy Stress Incontinence.
    Date March 1996
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We report on our initial results with glutaraldehyde cross-linked collagen used as an injectable bulking agent for the therapy of post-radical prostatectomy stress incontinence. MATERIALS AND METHODS: A total of 19 men underwent collagen injection for treatment of post-radical prostatectomy stress incontinence. RESULTS: Of the 19 patients treated 11 had either a good (4) or improved (7) result, for an overall satisfaction rate of 58% with a followup of 3 to 15 months (mean 10.4). Failure correlated with presence of bladder neck contracture or scarring and severity of incontinence. CONCLUSIONS: Injection of collagen for stress incontinence after radical prostatectomy has an acceptable short-term success rate, particularly in men with milder incontinence and lack of bladder neck scarring.

    Title Radical Perineal Prostatectomy Without Pelvic Lymphadenectomy: Selection Criteria and Early Results.
    Date February 1996
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We evaluated the surgical efficacy of radical perineal prostatectomy and determined preoperative parameters to identify patients at low risk for nodal metastasis. MATERIALS AND METHODS: Of 155 men evaluated for radical perineal prostatectomy, 74 were assigned to a low risk category (prostate specific antigen less than 10 ng./ml., Gleason score less than 7). Of the patients 40 underwent laparoscopic lymph node dissection and 34 did not. This group was compared to 81 patients who underwent surgical staging and did not fit the low risk criteria. RESULTS: None of 74 patients in the low risk group had nodal metastasis, while metastasis was present in 5 of 81 (6.1%) who did not meet such parameters. Organ-confined disease was present in 71.6% of men with low risk criteria, which was a significantly different rate than the 51.9% found in the other 81 men. CONCLUSIONS: Radical perineal prostatectomy confers adequate cancer control and can be performed without pelvic node dissection in select patients.

    Title Evaluation of Fluid Absorption During Laser Prostatectomy by Breath Ethanol Techniques.
    Date January 1996
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Laser prostatectomy has evolved as a less invasive method of relieving bladder outlet obstruction due to prostatic enlargement. The elimination of adenomatous tissue by laser induced coagulation necrosis theoretically avoids the sequelae of fluid absorption noted during traditional transurethral resection of the prostate. However, to our knowledge no accurate determination of fluid absorption during laser prostatectomy has been performed to date. MATERIALS AND METHODS: A technique previously described to determine the amount of irrigant absorbed during transurethral resection of the prostate measures breath ethanol levels using a standard alcohol breath analyzer during the procedure after a predetermined amount of ethanol is added to the irrigant fluid. This method was used in 4 men undergoing laser prostatectomy. RESULTS: All 4 subjects had ethanol levels of 0 throughout the operation, indicating that little or no irrigant fluid was absorbed. CONCLUSIONS: We demonstrated in a quantitative manner that fluid absorption during laser prostatectomy is almost nil and patients are, indeed, at no risk for the transurethral resection syndrome.

    Title Laser Prostatectomy: Initial Experience and Urodynamic Follow-up.
    Date April 1995
    Journal Urology
    Excerpt

    OBJECTIVES. An evolving technology for the treatment of bladder outlet obstruction due to benign prostatic hyperplasia (BPH) is the use of the side-firing neodymium: yttrium-aluminum-garnet (Nd:YAG) laser to achieve prostatic tissue ablation. The purpose of this study was to determine the short-term efficacy of this procedure in both an objective and subjective manner. METHODS. We examined this technique by carefully evaluating our first 25 men undergoing the procedure. Each patient was subjected to careful symptom score analysis using the American Urological Association symptom index and multichannel urodynamics, including pressure-flow studies both preoperatively and at 3 months postoperatively. RESULTS. At the 3-month follow-up, symptom scores improved from a preoperative mean of 11.4 to 7.2 and the mean maximum flow rate improved from 6.1 to 14.5 cc/s. These are both significant at P < 0.001. Statistically similar improvement was seen in detrusor pressure at opening and at maximum flow. Eighty percent of the men studied had at least a 50% reduction in symptom score and a 50% improvement in flow rate. CONCLUSIONS. We conclude that laser prostatectomy is a promising minimally invasive treatment for bladder outlet obstruction secondary to BPH and deserves further evaluation at longer terms of follow-up.

    Title Comparison Between Standard Flank Versus Laparoscopic Nephrectomy for Benign Renal Disease.
    Date March 1995
    Journal The Journal of Urology
    Excerpt

    To evaluate the role of laparoscopic nephrectomy in the management of benign renal diseases, 12 patients undergoing laparoscopic nephrectomy were compared to 13 undergoing a classical flank nephrectomy. Both groups were similar in regard to patient age and indications for surgery. The underlying pathological conditions included vesicoureteral reflux, tuberculosis, hydronephrosis, hypertension and failed pyeloplasty. Overall, operative time ranged from 105 to 360 minutes (mean 145) for the laparoscopic group and 60 to 240 minutes (mean 156.6) for the open surgery group. Hospital stay and interval to return to regular preoperative activities were 2 to 6 days (mean 3.5) and 10 to 21 days (mean 16) for patients undergoing laparoscopic nephrectomy, which was significantly shorter than for those undergoing a flank procedure, 3 to 16 days (mean 8) and 35 to 84 days (mean 32.3), respectively. Pain medication requirements were also markedly decreased after laparoscopic nephrectomy. Of the patients in the laparoscopic group 2 experienced complications with only 1 requiring conversion to open nephrectomy. The laparoscopic technique is an effective as the flank approach for benign renal conditions, while providing a more rapid recuperation and superior cosmetic result.

    Title Seminal Vesicle Volume As a Sonographic Predictor of Prostate Cancer Stage.
    Date August 1994
    Journal Urology
    Excerpt

    OBJECTIVES. Accurate clinical staging of prostate cancer continues to challenge the urologist, with understaging a common problem. Preoperative identification of men with capsular penetration or seminal vesicle invasion would allow deferment of radical surgery unlikely to cure the patient. We investigated the ability of seminal vesicle volume as determined by transrectal ultrasound (TRUS) to predict the stage of prostate carcinoma. METHODS. Forty-seven consecutive men undergoing radical prostatectomy had preoperative determination of the seminal vesicle volume by TRUS. The volume was determined for each individual seminal vesicle as well as the total seminal vesicle volume. Asymmetry was defined as one seminal vesicle having twice the volume of the other. RESULTS. Average total seminal vesicle volume was statistically greater for patients with Stage C disease as opposed to those with organ-confined tumors. Seminal vesicle asymmetry was also present statistically more often in Stage C patients than Stage B men. The combination of total seminal vesicle volume less than 15 cc and symmetrical seminal vesicles yielded a possibility of only 18% of extraprostatic extension of tumor. CONCLUSIONS. We believe that seminal vesicle volume as determined by TRUS can aid in the staging of adenocarcinoma of the prostate and should be considered along with other parameters, such as prostate-specific antigen, acid phosphatase, and Gleason score, when planning therapy for this disease.

    Title Simple Detubularization Technique for Construction of Continent Colonic Urinary Reservoirs.
    Date August 1994
    Journal Urology
    Excerpt

    OBJECTIVES. Despite the advantages offered by continent urinary diversion techniques, wide acceptance of the procedure has been hampered by the length of time required to detubularize and suture the reconfigured bowel. With the purpose of simplifying the procedure, a linear stapler loaded with absorbable staples was used to accomplish simultaneous detubularization and closure of the reservoirs. METHODS. Six patients, 4 men and 2 women received a stapled detubularized reservoir following radical cystectomy. The male patients all had construction of a neobladder, whereas in the females a catheterizable continent stoma was designed. RESULTS. Operative time was shortened by an average of 30 to 45 minutes without technical difficulties. No postoperative complications related to the staple line occurred and with a follow-up of 6 months good functional results have been achieved, with no patient experiencing diurnal incontinence. CONCLUSIONS. This simple mechanical detubularization technique offers results similar to the hand suture method while at the same time shortening and simplifying the procedure.

    Title The Value of Laparoscopic Lymphadenectomy in Conjunction with Radical Perineal or Retropubic Prostatectomy.
    Date June 1994
    Journal The Journal of Urology
    Excerpt

    A total of 76 men with clinically localized prostate cancer underwent surgical treatment at our institution during an 11-month period. Of the patients 26 underwent staging laparoscopic pelvic lymph node dissection followed by radical perineal prostatectomy (group 1), 24 underwent laparoscopic pelvic lymph node dissection and radical retropubic prostatectomy (group 2), and 26 underwent standard open lymphadenectomy and radical retropubic prostatectomy (group 3). Group 1 patients experienced statistically significantly less average blood loss (576 +/- 360 cc) than either group 2 (1,275 +/- 686.8) or 3 (1,100 +/- 459, p < 0.001). Hospital stay was also significantly less in group 1, with a mean of 4.6 +/- 1.9 days compared to 9.6 +/- 4.6 and 7.25 +/- 2.06 days for groups 2 and 3, respectively (p < 0.001). Our study supports the combination of laparoscopic pelvic lymph node dissection and radical perineal prostatectomy as a potentially less morbid approach to the surgical treatment of prostate cancer. However, no benefit was found for laparoscopic staging in patients before radical retropubic prostatectomy.

    Title Complications of Laparoscopic Urological Surgery: Experience at St. Louis University.
    Date March 1994
    Journal The Journal of Urology
    Excerpt

    A total of 221 patients underwent laparoscopic surgery at our institution. An outcome analysis with regard to type of procedure, success and complications was done. Overall, 216 of 221 procedures (97.7%) were performed as originally planned. One operation was converted to an open procedure. Complications producing morbidity occurred in 33 of 217 patients (15.2%). There was no associated mortality. Most complications occurred early in the participating surgeons experience. Of the complications 11 (5.0%) were considered major and included formation of symptomatic lymphoceles (4 patients), vascular injury (1), ureteral transection (1), bladder perforation (1), bowel obstruction (1), cecal perforation (1) and cerebrovascular accident (1). One patient had an idiopathic reaction to the inhalation anesthetic. Of the 11 major complications 9 occurred among 98 patients undergoing pelvic lymphadenectomy and 7 of these occurred among a subset of 15 patients undergoing an extended dissection. Adjuvant surgical intervention was necessary in 13 patients: celiotomy in 5, laparoscopic techniques in 4 and minor surgical procedures or percutaneous techniques in 4. Our experience suggests that urological laparoscopic surgery is safe and offers a shorter convalescence. However, the technique must be regarded as major surgery, associated with a steep learning curve.

    Title Endocavitary (laparoscopic) Bladder Surgery.
    Date February 1993
    Journal Seminars in Urology
    Title The Current Status of Endocavitary (laparoscopic) Pelvic Lymphadenectomy in the Staging of Prostate Cancer: Experience, Indications, and Future Directions.
    Date February 1993
    Journal Seminars in Urology
    Title Endocavitary (laparoscopic) Pelvic Lymphadenectomy with Specific Indications in Urologic Surgery.
    Date February 1993
    Journal Urology
    Excerpt

    Recent reports have established the feasibility and minimal morbidity of laparoscopic pelvic lymph node dissection in the staging of prostate and bladder cancer. In addition, a prospective study recently published established the completeness and efficacy of this form of endocavitary surgical lymphadenectomy with respect to the standard modified open procedure. The method's utility prior to definitive radiation therapy or radical perineal prostatectomy is obvious. However, clear indications of its utility in identifying men with positive nodes prior to radical retropubic prostatectomy are less clear. A description of the surgical technique as well as a review of the existing literature, and our present indications for its use are presented. In addition, possible future applications of endocavitary node dissection will be put in context.

    Title Endocavitary Bladder Surgery.
    Date February 1993
    Journal Urology
    Excerpt

    The advent of laparoscopy has expanded the horizon for endocavitarily approaching urologic disorders, otherwise managed by open surgical procedures. In this article we will review our experience with this new modality as applied to the urinary bladder, and put into perspective future applications.

    Title Staging Laparoscopic Pelvic Lymph Node Dissection. Experience and Indications.
    Date December 1992
    Journal Archives of Surgery (chicago, Ill. : 1960)
    Excerpt

    Laparoscopic pelvic lymph node dissection has proven to be a reliable, less-invasive method for staging prostate cancer. Presently, no clear indications for its performance prior to radical retropubic prostatectomy are available. With the purpose of identifying clinical parameters by which to better select patients who would benefit from laparoscopic pelvic lymph node dissection, we chose to perform the procedure only in patients considered at high risk for nodal metastasis: clinical stages B2 or C, poorly differentiated tumors, and/or a serum prostatic-specific antigen level of more than 20 ng/dL. We compared the results with those of patients not meeting such parameters. Of 80 men receiving treatment for clinically localized disease, 30 (38%) fulfilled one or more of the criteria. When considering the individual clinical parameters, clinical stage was predictive of nodal involvement in five (26%) of 19 patients, grade was predictive in three (37.5%) of eight patients, and prostatic-specific antigen level was predictive in six (40%) of 15 patients. Statistical analysis confirmed that the prostatic-specific antigen level was the single best predictor of nodal involvement. However, better predictive values were obtained when the different criteria were combined. Nodal involvement was predicted most consistently by a combination of clinical stage and prostatic-specific antigen level.

    Title Laparoscopic Cystectomy: Initial Report on a New Treatment for the Retained Bladder.
    Date October 1992
    Journal The Journal of Urology
    Excerpt

    The retained bladder of a 27-year-old paraplegic woman suffering from recurrent pyocystis was removed laparoscopically. Operative time was 130 minutes. Postoperative hospital stay was 5 days, which was significantly less than that in 5 similar patients undergoing open cystectomy for vesical empyema in whom the mean hospital stay was 20.6 days. We believe that laparoscopic cystectomy represents a plausible, minimally invasive alternative to standard cystectomy for the symptomatic bladder left behind after supravesical urinary diversion.

    Title Sclerotherapy with Tetracycline for Hydroceles in Renal Transplant Patients.
    Date October 1992
    Journal The Journal of Urology
    Excerpt

    A total of 17 patients with hydroceles following renal transplantation underwent sclerotherapy with tetracycline hydrochloride (10 ml. of a 5% solution of tetracycline in 1% lidocaine). A successful outcome was obtained in 15 patients (88%). Post-sclerotherapy hydrocelectomy was necessary in 2 patients (12%). No major complications (testicular loss, scrotal abscess or necrosis) occurred in any patient. Pain at injection was the only adverse effect. Tetracycline sclerotherapy for hydroceles appears to be an effective and safe procedure in the renal transplant population. We recommend this procedure as the initial treatment modality for hydroceles in patients with a renal allograft.

    Title Prostatic Titanium Urethral Stents. A New Treatment Option for Obstructive Uropathy: Early Clinical Results and Indications.
    Date January 1992
    Journal Asaio Transactions / American Society for Artificial Internal Organs
    Excerpt

    An expandable titanium stent was used as an alternative to standard treatment for urinary obstruction in 20 men. Six patients had recurrent urethral strictures. Fourteen patients had obstruction secondary to benign prostatic hyperplasia (BPH) and were considered high risk surgical candidates. Complete results with a mean follow-up of 12 months are available for 11 patients. Four of the six stricture patients are currently unobstructed. All seven of the available men with BPH are voiding well. No side effects have been related to the stents, and no encrustations or calculi have formed.

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