Urologists
12 years of experience

275 Collier Road, Suite 400
Atlanta, GA 30309
404-605-4848
Locations and availability (1)

Education ?

Medical School Score
A.T. Still University - Kirksville (1997)
  • Currently 1 of 4 apples

Awards & Distinctions ?

Awards  
Patients' Choice 5th Anniversary Award (2012)
Patients' Choice Award (2008 - 2012)
Compassionate Doctor Recognition (2010 - 2012)

Affiliations ?

Dr. Shah is affiliated with 10 hospitals.

Hospital Affilations

Score

Rankings

  • Wellstar Cobb Hospital
    3950 Austell Rd, Austell, GA 30106
    • Currently 4 of 4 crosses
    Top 25%
  • Northside Forsyth Hospital
    1200 Northside Forsyth Dr, Cumming, GA 30041
    • Currently 4 of 4 crosses
    Top 25%
  • Northside Hospital
    Urology
    1000 Johnson Ferry Rd, Atlanta, GA 30342
    • Currently 4 of 4 crosses
    Top 25%
  • Piedmont Hospital
    1968 Peachtree Rd NW, Atlanta, GA 30309
    • Currently 3 of 4 crosses
    Top 50%
  • Henry Medical Center Inc
    Urology
    1133 Eagles Landing Pkwy, Stockbridge, GA 30281
    • Currently 2 of 4 crosses
  • Saint Joseph'S Hospital Of Atlanta
    Urology
    5665 Peachtree Dunwoody Rd, Atlanta, GA 30342
    • Currently 1 of 4 crosses
  • Cobb Hospital
  • Northside Hospital Atlanta, Northside Hospital Forsyth
  • ST Josephs Hospital
  • Piedmont Newnan Hospital
    60 Hospital Rd, Newnan, GA 30263
  • Publications & Research

    Dr. Shah has contributed to 20 publications.
    Title Sorafenib Therapy for Hepatocellular Carcinoma Prior to Liver Transplant is Associated with Increased Complications After Transplant.
    Date January 2012
    Journal Transplant International : Official Journal of the European Society for Organ Transplantation
    Excerpt

    This study compared post-transplant outcomes of patients with hepatocellular carcinoma (HCC) who took sorafenib prior to orthotopic liver transplantation (OLT) with those patients who were not treated with sorafenib. Thirty-three patients with HCC who were listed for liver transplantation were studied: 10 patients were treated with sorafenib prior to transplantation in an attempt to prevent progression of HCC while awaiting transplant. The remaining 23 patients were considered controls. The mean duration of sorafenib use was 19.2 (SD 25.2) weeks. Overall death rates were similar between the sorafenib group and control group (20% vs. 8.7%, respectively, P = 0.56). However, the patients in the sorafenib group had a higher incidence of acute cellular rejection following transplantation (67% vs. 22%, OR = 7.2, 95% CI 1.3-39.6, P = 0.04). The sorafenib group also had a higher rate of early biliary complications (67% vs. 17%, OR = 9.5, 1.6-55.0, P = 0.01). The use of sorafenib was found to be an independent predictor of post-transplant biliary complications (OR 12.6, 1.4-116.2, P = 0.03). Sorafenib administration prior to OLT appears to be associated with an increase in biliary complications and possibly in acute rejection following liver transplantation. Caution should be taken in this setting until larger studies are completed.

    Title Reactivation of Hepatitis B with Reappearance of Hepatitis B Surface Antigen After Chemotherapy and Immunosuppression.
    Date December 2009
    Journal Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
    Excerpt

    HBV infection may reactivate in the setting of immunosuppression, although the frequency and consequences of HBV reactivation are not well known. We report 6 patients who experienced loss of serologic markers of hepatitis B immunity and reappearance of HBsAg in the serum as a result of a variety of acquired immune deficiencies.

    Title The Role of Anti-fibrinolytics, Rfviia and Other Pro-coagulants: Prophylactic Versus Rescue?
    Date April 2009
    Journal Clinics in Liver Disease
    Excerpt

    Patients who have liver disease experience an increased risk for bleeding and resulting complications. Diseases affecting the liver can cause a deficiency of pro-coagulant factors or induce a state of increased clot breakdown. Although traditional tests of coagulation, such as prothrombin time or international normalized ratio (INR), may not accurately measure bleeding risk, many studies have assessed measures used to correct an increased INR and minimize adverse outcomes. This article discusses the use of activated factor VIIa and anti-fibrinolytic agents to treat coagulopathy in the setting of liver disease and the potential advantages and disadvantages of these alternatives, and the limitations of the current literature. This article also compares the limitations, risks, and potential benefits of prophylactic therapy to prevent bleeding before invasive procedures with rescue therapy for spontaneous and postprocedure bleeding, and describes the relative advantages and disadvantages of these two approaches.

    Title Methasteron-associated Cholestatic Liver Injury: Clinicopathologic Findings in 5 Cases.
    Date February 2008
    Journal Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
    Excerpt

    BACKGROUND & AIMS: Methasteron is a nutritional supplement used to increase weight or accelerate the build-up of muscle mass. The aim of this study was to describe 5 cases of hepatotoxicity in patients using methasteron seen at tertiary-care medical centers. METHODS: A case report design was used. RESULTS: Five previously healthy patients who used methasteron developed jaundice 2 weeks after discontinuation; they presented to a tertiary-care medical center 2 weeks later. Within another 2 to 3 weeks, bilirubin levels peaked. About 12 weeks after initial presentation, all cases resolved with no identifiable residual hepatic dysfunction. CONCLUSIONS: Methasteron use can result in severe hepatotoxicity. Liver failure can worsen after initial presentation, especially within 2 weeks. With close observation and supportive care, acute hepatic injury should resolve.

    Title N-acetylcysteine for Acetaminophen Overdose: when Enough is Enough.
    Date October 2007
    Journal Hepatology (baltimore, Md.)
    Title Robotic Radical Prostatectomy with the "veil of Aphrodite" Technique: Histologic Evidence of Enhanced Nerve Sparing.
    Date November 2006
    Journal European Urology
    Excerpt

    OBJECTIVE: We have recently described a modification (Veil of Aphrodite) designed to preserve the lateral prostatic fascia (LPF) during robotic prostatectomy. Here, we histologically compare the Veil of Aphrodite technique (VT) and standard nerve-sparing technique (ST). METHODS: Thirty-six consecutive prostatectomies performed by a single surgeon were processed by the whole-mount method. The right and left anterolateral (AL) zones of each prostate were independently evaluated for LPF, plane of excision, capsular incision/margin status, margin clearance, and quantitative analysis of periprostatic nerve bundles using S100 immunostain. RESULTS: There were 42 AL zones with ST and 30 with VT. In all 42 ST zones, the plane of excision was outside the prostate and a rim of LPF was present. The mean margin clearance was 1.4 mm (0.6-2.8 mm) and the mean nerve bundle count was 10 (3-19). Capsular incision and margin status were negative in all 42. For VT, 24 of 30 zones lacked LPF and the plane of excision ran just by the prostatic edge. The mean margin clearance was 0.3 mm (0-1.7 mm) and the mean nerve bundle count was two (0-11). Two VT AL zones revealed capsular incision; the margin was negative for tumour in all 30. Differences in the margin clearances and nerve bundle counts between ST and VT were statistically significant (p < 0.0001). CONCLUSIONS: The LPF contains nerve bundles that run along the surface of the AL zones. The VT is a safe procedure that effectively preserves the LPF and appears to provide enhanced nerve sparing as compared to the ST.

    Title Learning Curve Using Robotic Surgery.
    Date July 2006
    Journal Current Urology Reports
    Excerpt

    The da Vinci (Intuitive Surgical, Inc., Sunnyvale, CA) surgical system is being used by an increasing number of surgeons across several surgical specialties. The robotic interface is different not only to open surgery, but also to laparoscopy because it involves remote surgical control, stereoscopic vision, and lack of haptic feedback. As the transition is made from traditional open to robotic surgery, factors such as learning of robotic skills, assessment of proficiency in robotics, and structured training for urologists in practice and residents assumes importance. Understanding how the robotic surgical technique is learned and how such learning can be best assessed will enable us to define protocols for training and set standards for proficiency. Learning curve and surgical dexterity are two parameters that are used to compare surgical learning and training. This article presents the current gold standard for assessing skill training and compares surgical skill acquisition and proficiency using conventional laparoscopy and robotic interfaces.

    Title Robot-assisted Radical Cystectomy and Urinary Diversion.
    Date May 2005
    Journal Current Urology Reports
    Excerpt

    Radical cystectomy remains the standard for muscle-invasive, organ-confined urothelial carcinoma of the bladder. With the emergence of minimally invasive approaches for the treatment of urologic cancers, technologic advances using laparoscopy have led to the development of robotic assistance to increase the feasibility of performing this formidable operation. In this article, we describe the procedure of robotic-assisted laparoscopic radical cystectomy with urinary diversion and review the pertinent literature.

    Title Baseline Hemodynamic and Echocardiographic Indices in Anesthetized Calves.
    Date December 2004
    Journal Asaio Journal (american Society for Artificial Internal Organs : 1992)
    Excerpt

    The experimental calf model is used to assess mechanical circulatory support devices and prosthetic heart valves. Baseline indices of cardiac function have been established for the normal awake calf but not for the anesthetized calf. Therefore, we gathered hemodynamic and echocardiographic data from 16 healthy anesthetized calves (mean age, 189.0 +/- 87.0 days; mean body weight, 106.9 +/- 32.3 kg) by cardiac catheterization and noninvasive echocardiography, respectively. Baseline hemodynamic data included heart rate (65 +/- 12 beats per minute), mean aortic pressure (113.5 +/- 17.4 mm Hg), left ventricular end-diastolic pressure (16.3 +/- 38.9 mm Hg), and mean pulmonary artery pressure (21.7 +/- 8.3 mm Hg). Baseline two-dimensional echocardiographic data included left ventricular systolic dimension (3.5 +/- 0.7 cm), left ventricular diastolic dimension (5.6 +/- 0.8 cm), end-systolic intraventricular septal thickness (1.7 +/- 0.2 cm), end-diastolic intraventricular septal thickness (1.2 +/- 0.2 cm), ejection fraction (63 +/- 10%), and fractional shortening (37 +/- 10%). Doppler echocardiography revealed a maximum aortic valve velocity of 0.9 +/- 0.5 m/s and a cardiac index of 3.7 +/- 1.1 L/minute/m2. The collected baseline data will be useful in assessing prosthetic heart valves, cardiac assist pumps, new cannulation techniques, and robotics applications in the anesthetized calf model and in developing calf models of various cardiovascular diseases.

    Title Thrombogenicity of Mechanical Aortic Valves in an Animal Model: Site Specific Testing is Crucial.
    Date October 2004
    Journal Asaio Journal (american Society for Artificial Internal Organs : 1992)
    Excerpt

    We evaluated a new trileaflet prosthesis and a control bileaflet prosthesis in the mitral and aortic positions in 27 calves. The prototype trileaflet valve (TV1) functioned satisfactorily in the mitral position (TV1m, n = 7) but later yielded thrombogenic complications in the aortic position (TV1a, n = 4). The valve was redesigned (TV2) and retested in the mitral (TV2m n = 4) and aortic (TV2a, n = 5) positions, along with control valves (Cm, n = 4; Ca, n = 3). At necropsy, the valves were graded on a scale of 0 (no visible thrombi) to 4 (thrombi greater than 5 mm and/or obstructed leaflets). The TV1m, TV2m, and Cm animals, respectively, had implant durations of 215+/-112, 140+/-63, and 159+/-89 days and thrombus grades of 0.71+/-0.76, 0.33+/-0.58, and 1.50+/-0.58. The TV1a, TV2a, and Ca animals had implant durations of 18+/-12, 159+/-61, and 108+/-62 days and thrombus grades of 2.75+/-1.00, 0.50+/-0.58, and 0.67+/-0.58 (p < .005; TV2a vs. TV1a). Three TV1a calves died early of valve related complications. A design irregularity, undetected in the mitral position but revealed in the aortic position, caused a high early mortality in the TV1a animals. Redesigning the prosthesis eliminated valve related mortality and significantly reduced the thrombus grade. Because satisfactory performance in the mitral position does not guarantee safety or efficacy in the aortic position, site specific preclinical testing is crucial for mechanical heart valves.

    Title Do the New Limitations on Resident Work Hours Impact Professionalism?
    Date July 2003
    Journal Michigan Medicine
    Title Functional P53 Mutation As a Molecular Determinant of Paclitaxel and Gemcitabine Susceptibility in Human Bladder Cancer.
    Date August 2001
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Paclitaxel and gemcitabine are promising new agents for treatment of human bladder cancer. We determine how the presence or absence of p53 function impacts the cytotoxic effects of these chemotherapeutic agents in human bladder cancer. MATERIALS AND METHODS: The J82 human bladder cancer (TCC) cell line was transfected with a temperature sensitive p53 (tsp53) mutant that functions as mutated p53 at 37C but functions as wild-type (normal) p53 at 32C. Susceptibility of these inducible p53 TCC cells to paclitaxel and gemcitabine induced cytotoxicity was evaluated and kill significance determined between sub-lethal and lethal doses. RESULTS: Significant paclitaxel dose dependent cytotoxicity was observed in J82 TCC cells lacking normal p53 and tsp53 transfected cells at 37C, which was the mutant p53 temperature in transfectants between maximal and minimal kill concentrations for either (p <0.001). Likewise, significant cytotoxicity was observed in parental J82 TCC at 32C (p <0.001), while restoration of p53 function in tsp53 transfected cells on shift to 32C abrogated significant dose dependent cytotoxicity. Gemcitabine caused significant cell death in the cell lines incubated at either temperature and, thus, was equally effective regardless of cellular p53 function (p <0.001, respectively). CONCLUSIONS: Paclitaxel requires functionally mutated p53 to induce cell death in human bladder cells, indicating that it may be more effective against TCC with p53 mutations than against TCC, which lacks p53 abnormalities, while gemcitabine is effective regardless of p53 function. These findings provide a rationale for selecting chemotherapy based on the p53 status of individual bladder cancers.

    Title "bull's-eye" Sign on Gadolinium-enhanced Magnetic Resonance Venography Determines Thrombus Presence and Age: a Preliminary Study.
    Date December 1997
    Journal Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
    Excerpt

    PURPOSE: Venous thrombosis is associated with a significant inflammatory response, which can be visualized by gadolinium magnetic resonance venography (MRV). Gadolinium extravasates into tissue during inflammation, producing perithrombus enhancement on magnetic resonance scanning. This study determines (1) whether gadolinium enhancement occurs during deep venous thrombosis (DVT); and (2) whether this enhancement changes with time and can therefore establish the age of thrombus. METHODS: Patients with a diagnosis of iliofemoral DVT by duplex ultrasound who were referred for MRV to document central thrombus extent were studied. T1 weighted images were obtained before and after gadolinium injection (0.1 mmol/kg); repeat scans were obtained up to 3 months thereafter. At the level of maximum thrombus, measurements of signal intensity were made at the periphery (rim), and the center of the thrombosed vein, as well as the contralateral normal vein, on images after gadolinium enhancement. Rim-center vein signal intensity ratios were then calculated and followed. RESULTS: A total of 39 scans were obtained in 14 patients (eight men, six women). The thrombosed veins were enlarged, with a peripheral rim of enhancement ("bull's-eye" sign). The rim-center ratio for thrombosed veins (2.16 +/- 0.18) was different from that of normal veins (0.66 +/- 0.10; n = 39; p < 0.001). For all acute studies (< or = 14 days) the rim-center ratio was 2.38 +/- 0.17 (n = 31), whereas for all chronic studies (> 14 days) the rim-center ratio was 1.29 +/- 0.44 (n = 8; p = 0.001). Among patients who underwent both early and late studies, the rim-center ratio dropped significantly, from 2.33 +/- 0.20 acutely to 1.29 +/- 0.44 in chronic studies (n = 8; p = 0.03). One patient with active malignancy had a paradoxic increase in rim-center ratio over time and a clinical recurrence of symptoms, suggesting active thrombosis. CONCLUSIONS: We conclude that (1) a pattern of peripheral gadolinium enhancement (bull's-eye sign) is seen around acutely thrombosed veins on gadolinium-enhanced MRV, facilitating DVT diagnosis; and (2) the ratio of signal intensity at the rim versus the center of the thrombosed vein may be a good discriminator of acute compared with chronic DVT, which may help direct therapy.

    Title Effect of Independent Changes in Mixed-venous Pco2 or Po2 on Cardiac Output in Anesthetized Sheep.
    Date October 1997
    Journal The Journal of Surgical Research
    Excerpt

    To determine whether changes mixed-venous PCO2 or PO2 affect cardiac output independent of changes in arterial blood gases, we used extracorporeal gas exchange to increase mixed-venous PCO2 or decrease mixed-venous PO2 in adult sheep. Sheep were anesthetized, mechanically ventilated, and connected to a veno-venous extracorporeal circuit. The circuit included a gas exchanger which was used to increase mixed-venous PCO2 or decrease mixed-venous PO2; the native lungs were ventilated to maintain arterial PCO2 and PO2 at control levels. When mixed-venous PCO2 was increased by 32% above control levels for a period of 60 min, cardiac output increased significantly to 28% above control levels. Cervical vagotomy abolished this response. In contrast, decreasing mixed-venous PO2 by 29% did not increase cardiac output. These results demonstrate that increasing mixed-venous PCO2 can increase cardiac output independent of changes in arterial blood gases and that intact vagus nerves are necessary for this response to occur.

    Title Uncommon Splanchnic Artery Aneurysms: Pancreaticoduodenal, Gastroduodenal, Superior Mesenteric, Inferior Mesenteric, and Colic.
    Date February 1997
    Journal Annals of Vascular Surgery
    Title Deep Venous Thrombosis Complicating a Congenital Absence of the Inferior Vena Cava.
    Date December 1996
    Journal Surgery
    Title Common Splanchnic Artery Aneurysms: Splenic, Hepatic, and Celiac.
    Date November 1996
    Journal Annals of Vascular Surgery
    Title Primary Unifocalization for the Absence of Intrapericardial Pulmonary Arteries in the Neonate.
    Date August 1993
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Excerpt

    The management of the neonate with absence of intrapericardial pulmonary arteries in association with complex intracardiac anomalies presents a challenging surgical problem. The more traditional approach of palliation with unilateral or bilateral systemic-pulmonary artery shunts may result in peripheral pulmonary artery stenoses and uneven distribution of pulmonary blood flow. In addition, this approach may lead to complicated reconstructive procedures necessitating reconstruction of the branch pulmonary artery with prosthetic material, which restricts pulmonary artery growth and often complicates reoperation. To avoid these potential limitations, we have performed primary unifocalization for absence of intrapericardial pulmonary arteries in eight consecutive neonates (median age 9 days) between May 1990 and December 1991. Absence of intrapericardial pulmonary arteries occurred in association with tetralogy of Fallot (n = 4), truncus arteriosus (n = 2), and transposition of the great arteries with pulmonary atresia (n = 2). Four patients had unilateral absence of the right (n = 1) or left (n = 3) intrapericardial pulmonary artery. In the remaining four patients, there was complete absence of both intrapericardial pulmonary arteries. Wide mobilization and excision of all ductal tissue before anastomosis was performed from a midline approach in seven patients. In one patient, a preliminary right thoracotomy was required. Primary unifocalization was performed simultaneously with complete repair in five patients. In the remaining three patients, unifocalization was part of a staged repair and included insertion of a systemic-pulmonary artery shunt to the reconstructed central pulmonary artery confluence. No operative or late cardiac deaths occurred, although one death occurred during subsequent repair of a tracheoesophageal fistula. Three patients underwent reoperation, and only one patient required revision of an anastomotic pulmonary artery stenosis. All survivors were growing normally at 2 to 22 months after operation (mean follow-up 10 months). Our experience suggests that primary reconstruction for the absence of intrapericardial pulmonary arteries can be successfully accomplished in the neonate. This approach provides uniform bilateral pulmonary blood flow, avoids prosthetic material in the branch pulmonary arteries, and may eliminate, or at least simplify, future reconstructive procedures.

    Title Prolonged Extracorporeal Circulation Without Heparin. Evaluation of the Medtronic Minimax Oxygenator.
    Date January 1993
    Journal Asaio Journal (american Society for Artificial Internal Organs : 1992)
    Excerpt

    Bleeding remains the most common complication of prolonged extracorporeal life support (ECLS). This study evaluated the Medtronic Minimax (Annaheim, CA) microporous oxygenator with the Carmeda Bio Active (heparin bonded) Surface (Stockholm, Sweden) for use in prolonged neonatal ECLS. Eight adult sheep were maintained on venovenous extracorporeal circulation (ECC) for a period of 4 days without systemic heparin. After 4 days of venovenous ECC without anticoagulation, there was no evidence of significant bleeding, circuit thrombosis, or systemic embolism. Gas exchange, hydrodynamic performance, coagulation, and biocompatibility studies suggest that the Minimax is safe and reliable for short-term or long-term ECLS in neonates.

    Title Health-related Quality of Life in Treatment for Prostate Cancer: Looking Beyond Survival.
    Date
    Journal Supportive Cancer Therapy
    Excerpt

    Improvements in detecting and treating prostate cancer account for the need to evaluate strategies for optimizing quality of life (QOL) among survivors of prostate cancer. Several management options are available when prostate cancer is diagnosed at an early stage. However, the optimal treatment for localized prostate cancer is unknown, and reports in the literature are controversial regarding the best treatment modality. In this article, the authors will review the standard therapies used to treat localized prostate cancer and the effects of these therapies on a patient's QOL. Ultimately, the decision of which treatment modality to choose will be a decision based largely on individual patient preferences in concert with his physician and family members, in view of a thorough understanding of the available treatments and the full range of possible treatment-related side effects.


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