Surgical Specialist, Urologists
30 years of experience
Video profile
Accepting new patients
3 Cooper Plz
Rm 411
Camden, NJ 08103
856-342-2270
Locations and availability (3)

Education ?

Medical School
Universidad De Sevilla (1980)
Urology
Foreign school

Awards & Distinctions ?

Awards  
One of America's Leading Experts on:
Laparoscopy
Lymph Node Excision
Appointments
Mayo Medical School
Professor and Chairman of Urology
Ohsu, Portland Or (2001 - Present)
Robert Wood Johnson School Of Medicine (2004 - Present)
Saint Louis University School Of Medicine (1985 - Present)
Associations
Society of Urologic Oncology
American Board of Urology
American Urological Association
American College of Surgeons

Affiliations ?

Dr. Parra is affiliated with 6 hospitals.

Hospital Affilations

Score

Rankings

  • Memorial Sloan-Kettering
    Urology
    1275 York Ave, New York, NY 10065
    • Currently 4 of 4 crosses
    Top 25%
  • Cooper University Hospital
    Urology
    1 Cooper Plz, Camden, NJ 08103
    • Currently 1 of 4 crosses
  • Memorial Sloan Kettering Cancer Center
  • St. Luke's Hospital
  • St. Luke`s Hospital
  • Cooper Medical Center
  • Publications & Research

    Dr. Parra has contributed to 75 publications.
    Title Squamous Cell Carcinoma Arising in an Augmented Bladder in a Patient with Bladder Exstrophy.
    Date April 2006
    Journal The Journal of Urology
    Title Contemporary Appraisal of Radical Perineal Prostatectomy.
    Date June 2005
    Journal The Journal of Urology
    Excerpt

    PURPOSE: In the age of minimally invasive surgery there has been renewed interest in the perineal approach for the surgical treatment of prostate cancer. We reviewed recent publications regarding radical perineal prostatectomy (RPP) in an effort to define its role in the current management of localized prostate malignancy. At the same time we reviewed the relevant perineal anatomy and surgical approach necessary to perform this operation. MATERIALS AND METHODS: We performed a review of the literature with respect to RPP and included our own extensive experience with this operation, emphasizing patient selection, the current role of pelvic lymph node dissection, surgical anatomy, oncological outcomes and complications. RESULTS: RPP is an effective treatment for localized adenocarcinoma of the prostate with oncological outcomes similar to those of the retropubic technique. In comparison to RRP, patients undergoing RPP have less postoperative discomfort, more rapid return of bowel function, more rapid return to work and a decreased transfusion rate. In addition, RRP is now often performed with cavernous nerve sparing. Prostate specific antigen screening has made the rate of lymph node metastasis low enough to omit lymphadenectomy in many cases. CONCLUSIONS: There is still a role for RPP in the treatment of localized prostate cancer. Erectile dysfunction after nerve sparing and incontinence rates are similar to those of RRP. In addition, it is less morbid then RRP without being as technically challenging as laparoscopic radical prostatectomy.

    Title Renal Cell Carcinoma in Cross Renal Ectopia with Fusion: Diagnosis and Operative Planning by Multidetector Three-dimensional Computed Tomography.
    Date December 2004
    Journal Urology
    Title Primary Bilateral Parenchymal Renal Aspergillus Infection.
    Date August 2002
    Journal Urology
    Excerpt

    Isolated renal fungal infection is rare. Most patients with either an opportunistic or primary fungal infection have an altered immune status. Common predisposing factors include malignancy, corticosteroid use, diabetes, and iatrogenic or infective immunosuppression. We report a previously healthy patient with bilateral, recurrent renal Aspergillus infection requiring left total and right partial nephrectomies to adequately manage his disease process.

    Title Delayed Transcaval Renal Penetration of a Greenfield Filter Presenting As Symptomatic Hydronephrosis.
    Date May 2002
    Journal The Journal of Urology
    Title Martius Flap Harvest Site: Patient Self-perception.
    Date April 2002
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We elucidated patient perception of the external genitalia after Martius flap harvesting. MATERIALS AND METHODS: We identified 8 women in whom a Martius interposition flap was used in association with transvaginal urethrolysis. Patients were contacted by an independent nurse and asked to evaluate the cosmetic appearance of the labium majus harvest site. They were also queried on any associated pain, numbness or altered sensation, or perceived interference with vaginal sexual relations. RESULTS: Of the 8 patients 2 (25%) believed that the harvest site appeared to be identical to its preoperative appearance, 2 (25%) believed that there were only minimal changes from the preoperative appearance, 1 (12%) believed that it appeared markedly different from the contralateral side and 3 (38%) stated that they had never performed self-examination. Of the 8 patients 1 (13%) complained of dyspareunia, 3 (38%) had intermittent discomfort in the harvest area 1 year after the operation and 5 (62%) perceived permanently decreased sensation or numbness at the harvest site. CONCLUSIONS: The Martius flap is not associated with a significant amount of perceived cosmetic disfigurement. It has relatively little effect on sexual relations. Postoperatively discomfort is minimal but there may be associated numbness or decreased sensation at the harvest site.

    Title Incidence of Postoperative Adhesion Formation After Transperitoneal Genitourinary Laparoscopic Surgery.
    Date February 2002
    Journal Urology
    Excerpt

    OBJECTIVES: To evaluate adhesion formation after urologic laparoscopy, a multi-institutional review was conducted among adult patients who underwent a second procedure after an initial transperitoneal laparoscopic procedure. Adhesion formation after abdominal surgery remains a major cause of postoperative morbidity. Peritoneal adhesions result in hospitalizations and interventions that result in healthcare costs of more than 1 billion dollars annually. The risk of adhesion formation from transperitoneal genitourinary laparoscopy in adults has not been previously studied. METHODS: Twenty-seven patients (mean age 45.5 years, range 24 to 71) were identified who underwent a second laparoscopic procedure after their initial urologic laparoscopic procedure was performed. The mean time between the procedures was 11.4 months (range 8 days to 38 months). At the time of the repeated laparoscopy or open surgery, the peritoneal cavity was examined and mapped for type (grade), extent (length), and location of any adhesions at the operative and trocar sites. The adhesions were graded as 0, no adhesions; 1, flimsy; 2, dense; and 3, cohesive. The extent was graded as 0, no adhesions; 1, less than 2 cm; 2, 2.1 to 10 cm; 3, greater than 10.1 cm. RESULTS: Overall, adhesions occurred in 6 (22.2%) of 27 patients. Operative site adhesions occurred in only 3 (8.2%) of 34 possible operative sites (gastric augmentation cystoplasty, renal cyst ablation, nephropexy). Trocar site adhesions occurred in 4 (3.5%) of 114 possible sites (two nephrectomies, one cyst decortication, and one orchiectomy). All adhesions were classified as grade 1 and extent 1, except for a single grade 2, extent 2 adhesion. In most patients, retroperitonealization occurred with minimal or no scarring noted. None of the patients developed symptoms as a result of the adhesion formation. CONCLUSIONS: Although intraperitoneal adhesions do occur with adult urologic laparoscopy, the incidence is low. Also, in the few patients who do form adhesions, they are flimsy and short. This evidence, when contrasted with the available data on adhesion formation after open surgery, suggests that transperitoneal laparoscopic approaches to genitourinary surgery may have advantages over traditional open transperitoneal approaches by lowering the incidence and severity of adhesion formation.

    Title Systematic Transperineal Ultrasound Guided Template Biopsy of the Prostate in Patients at High Risk.
    Date May 2001
    Journal The Journal of Urology
    Excerpt

    PURPOSE: A negative biopsy result does not necessarily equate with cancer in specific high risk groups. We describe an alternative systematic biopsy technique for evaluating this subgroup of patients. MATERIALS AND METHODS: From March 1997 to May 1999 a total of 88 men underwent systematic ultrasound guided biopsy using the transperineal template technique. All patients had undergone at least 1 and 75 (85%) had undergone 2 or more previous sets of biopsies. In addition, study inclusion required high risk parameters, including prostate specific antigen (PSA) velocity greater than 0.75 ng./ml., PSA greater than 10 ng./ml. or previous prostatic intraepithelial neoplasia on biopsy, and/or atypical small cell acinar proliferation. RESULTS: Cancer was identified in 38 of the 88 men (43%) in this high risk subgroup undergoing repeat biopsy. A mean of 15.1 previous biopsy cores had been obtained. The most common biopsy grade was 6 (range 4 to 9). Adenocarcinoma was identified in the transition zone area in 29 of 38 cases (76%), including 15 (39%) in which disease was detected in the transition zone only. Persistent PSA acceleration greater than 0.75 ng./ml. was the major indicator for transperineal template biopsy in 83 of the 88 patients (94%). The only significant independent variable predictive of positive biopsy was prostate volume. Mean prostate volume in the positive and negative biopsy groups was 48 and 73 gm., respectively (p <0.001). Complications were rare and self-limiting, consisting primarily of hematuria and urinary retention requiring overnight catheterization in 2 patients. CONCLUSIONS: Systematic transperineal template biopsy of the prostate is a safe and precise repeat biopsy technique in patients who remain at high risk for adenocarcinoma.

    Title Survey of Neuromuscular Injuries to the Patient and Surgeon During Urologic Laparoscopic Surgery.
    Date July 2000
    Journal Urology
    Excerpt

    OBJECTIVES: Laparoscopy may be complicated by neuromuscular injuries, both to the patient and to the surgeon. We used a survey to estimate the incidence of these injuries during urologic laparoscopic surgery, to assess risk factors for these injuries, and to determine preventive measures. METHODS: A survey of neuromuscular injuries associated with laparoscopy submitted to 18 institutions in the United States was completed by 18 attending urologists from 15 institutions. RESULTS: From among a total of 1651 procedures, there were 46 neuromuscular injuries in 45 patients (2.7%), including abdominal wall neuralgia (14), extremity sensory deficit (12), extremity motor deficit (8), clinical rhabdomyolysis (6), shoulder contusion (4), and back spasm (2). Neuromuscular injuries were twice as common with upper retroperitoneal as with pelvic laparoscopy (3. 1% versus 1.5%). Among patients with neuromuscular injuries, those with rhabdomyolysis were heavier (means 91 versus 80 kg) and underwent longer procedures (means 379 versus 300 minutes), and those with motor deficits were older (means 51 versus 42 years of age). Of the surgeons, 28% and 17% reported frequent neck and shoulder pain, respectively. CONCLUSIONS: Although not common, neuromuscular injuries during laparoscopy do contribute to morbidity. Abdominal wall neuralgias, injuries to peripheral nerves, and joint or back injuries likely occur no more frequently than during open surgery, but risk of rhabdomyolysis may be increased. Positioning in a partial rather than full flank position may reduce the incidence of some injuries. Measures to reduce neuromuscular strain on the surgeon during laparoscopy should be considered.

    Title Massive Hydrothorax and Hydro-abdomen Complicating Percutaneous Nephrolithotomy.
    Date January 2000
    Journal The Journal of Urology
    Title Laparoscopic V Laparoscopy-assisted Donor Nephrectomy in the Porcine Model.
    Date December 1999
    Journal Journal of Endourology / Endourological Society
    Excerpt

    PURPOSE: Laparoscopic donor nephrectomy is an established procedure in the porcine model. We sought to compare intraoperative variables between live laparoscopic (LAP) and laparoscopy-assisted (LAP-A) donor nephrectomy. MATERIALS AND METHODS: Eight domestic pigs underwent either traditional laparoscopic donor nephrectomy (N = 4) or laparoscopy-assisted donor nephrectomy (N = 4) using the Pneumosleeve followed by conventional heterotopic autotransplantation. RESULTS: No significant differences were noted between the groups with regard to vessel length, ureteral length, or postoperative urine output. The operating room time was 108+/-12 minutes in the LAP group v 75.8+/-10.3 minutes in the LAP-A group (P = 0.0065). Although the difference was not statistically significant, warm ischemic time, tended to be lower in the LAP-A than the LAP group: 70+/-3.0 seconds v 135+/-57 seconds, respectively (P = 0.059). Graft survival was identical in the two groups. CONCLUSION: Laparoscopy-assisted (via Pneumosleeve) live donor nephrectomy shortens the operative time without affecting graft survival in the domestic swine model.

    Title Benign Prostatic Hyperplasia (the Aging Prostate).
    Date October 1999
    Journal The Medical Clinics of North America
    Excerpt

    BPH is a common phenomenon of the aging process. Clinical manifestations may range from minimally bothersome symptoms to urinary retention and renal failure. Tailoring of treatment based on the individual patient is required for successful management. For mild symptoms, watchful waiting is a valid option. For severe symptoms, surgical therapy is most appropriate. For men complaining of moderate symptoms, medical therapy has become front-line therapy, with other less invasive treatment modalities being available or in development.

    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 Repair of Ureteral Gunshot Injury with Appendiceal Interposition.
    Date May 1999
    Journal The Journal of Urology
    Title Role of Chronic Catheterization in the Development of Bladder Cancer in Patients with Spinal Cord Injury.
    Date March 1999
    Journal Urology
    Excerpt

    OBJECTIVES: Patients with spinal cord injury (SCI) and chronic indwelling catheters are known to be at increased risk of bladder malignancy. "Decatheterization" by clean intermittent catheterization, external condom catheterization, or spontaneous voiding is thought to reduce the risk by decreasing the chronic mucosal irritation and rate of infection. We examined two Department of Veterans Affairs (DVA) data bases to test this theory. METHODS: A population-based retrospective analysis of invasive treatments for carcinoma of the bladder in all DVA hospitals was conducted using computerized inpatient files from fiscal years 1988 to 1992. RESULTS: One hundred thirty patients with bladder malignancy were identified from a pool of 33,565 patients with SCI (0.39%). All 130 patients underwent either radical cystectomy (n = 63, 48%) or transurethral resection of bladder tumor (n = 67, 52%). The 30-day perioperative mortality and overall 5-year survival rates were 2 (1.5%) and 49 (38%) of 130, respectively. Of the 130 patients analyzed, 42 (32%) had adequate data available regarding tumor pathologic findings and method of bladder management for analysis. The average age at diagnosis was 57.3 years. The histologic finding was transitional cell carcinoma in 23 (55%), squamous cell carcinoma in 14 (33%), and adenocarcinoma in 4 (10%) of 42. Bladder management was an indwelling urethral catheter in 18 (43%), suprapubic catheter in 8 (19%), clean intermittent catheterization in 8 (19%), and condom catheter in 6 (14%) of 42 patients. Squamous cell carcinoma was more common in patients with indwelling urethral catheters and suprapubic tubes (11 of 26, 42%) than in those using clean intermittent catheterization, condom catheterization, or spontaneous voiding (3 of 16, 19%). CONCLUSIONS: Bladder cancer was diagnosed in approximately 0.39% of this large SCI population during a 5-year period. Most cancers (55%) were transitional cell carcinomas. Squamous cell carcinoma was more common in patients with SCI and indwelling catheters than those without chronic catheterization. These data continue to suggest that avoidance of indwelling catheters, when feasible, is the preferred method of bladder management in patients with SCI.

    Title Schwannoma of the Urinary Bladder: a Case Report.
    Date December 1998
    Journal International Journal of Urology : Official Journal of the Japanese Urological Association
    Excerpt

    The urinary bladder is an extremely rare site for primary schwannomas. They are most often associated with von Recklinghausen disease. This patient was found to have a schwannoma of the bladder in the absence of evidence of von Recklinghausen disease and was successfully treated with a partial cystectomy. This represents only the third such case in the literature of this entity.

    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 Development of a Malignant Peripheral Nerve Sheath Tumor Following Treatment for Testicular Seminoma.
    Date September 1997
    Journal Urology
    Excerpt

    A novel case is reported in which an S2 nerve root malignant peripheral nerve sheath tumor was diagnosed approximately 8 years after treatment for Stage I testicular seminoma. This patient underwent right orchiectomy and subsequent irradiation therapy to the periaortic region, including the sacrum. Postoperative radiation therapy likely played a role in the development of this second malignancy.

    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 [neodymium Yag Laser in Treating Prostatic Adenoma]
    Date March 1997
    Journal Revista Médica De Chile
    Excerpt

    BACKGROUND: Conventional surgery and transurethral ablation are the treatments of choice for benign prostatic hyperplasia. AIM: To report our experience with Neodynium: YAG laser ablation of prostatic adenomas. PATIENTS AND METHODS: Revision of 182 patients subjected to Laser ablation of benign prostatic adenoma of whom 28 had a complete urinary retention and 50 were considered of high surgical risk. RESULTS: One hundred eighty patients had spontaneous voiding after surgery, there were no intraoperatory complications and were discharged 6 to 24 hours after the procedure. Urinary flow increased from 8 ml/sec in the preoperative period to 20 and 21 ml/sec, two and six months after surgery. Symptom score decreased from 12 to 1.2 points. Seven patients had late hematuria and two required vesical lavage and cystoscopic clot drainage. Ten patients had a positive urine culture. 12 had lack of ejaculation and 75%, had some degree of dysuria. CONCLUSIONS: Neodynium YAG laser ablation of benign prostatic adenoma seems to be efficient and safe.

    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 Accurate Staging of Carcinoma of the Penis in Men with Nonpalpable Inguinal Lymph Nodes by Modified Inguinal Lymphadenectomy.
    Date February 1996
    Journal The Journal of Urology
    Excerpt

    PURPOSE: The accuracy and safety of a modified inguinal lymphadenectomy in the staging of penile cancer cases with nonpalpable groin nodes were assessed. MATERIALS AND METHODS: A modified inguinal lymph node dissection in which the saphenous vein is preserved together with reduction of the lateral, distal and proximal margins of dissection was performed on 12 consecutive men with invasive squamous carcinoma of the penis and negative inguinal nodes. RESULTS: Five patients were identified with nodal metastasis. The sites of inguinal node involvement were localized within the boundaries of the dissection in all patients. No major complications occurred, and no permanent lymphedema or flap necrosis was encountered. With a followup of 14 to 72 months no patient has had recurrent disease. CONCLUSIONS: The modified inguinal dissection is a reliable staging technique that also provides therapeutic benefit to patients with penile cancer and clinically negative nodes.

    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 [is There a Place for Radical Prostatectomy Without Lymphadenectomy?]
    Date September 1995
    Journal Archivos Españoles De Urología
    Excerpt

    OBJECTIVES: Herein we present the procedure we have followed to determine N+ low-risk factors which allow us to identify those patients with prostate cancer in whom radical perineal prostatectomy (RPP) can be performed without a previous staging lymphadenectomy, thereby maintaining the oncological principles but with less morbidity. METHODS: In a series of 88 patients who underwent RPP, we identified an N+ low-risk factor group; i.e., patients with clinically localized tumor of the prostate gland, a Gleason score of < or = 7 and PSA < or = 10 ng/ml. The foregoing criteria were based on the findings reported by Stamey and the status of the lymph nodes of our own series of radical prostatectomies. RESULTS: In 71 of the 88 patients with a follow up of more than one year, RPP was performed after laparoscopic pelvic lymphadenectomy. Of these 71 patients, 17 (19.3%) presented the above-mentioned low-risk characteristics and were all pN-. Since then, the subsequent patients who met this low-risk criteria (n = 17; 19.3% of the total) were submitted to RPP alone without previous staging lymphadenectomy. The rate of positive margins in this group was 17.6%, all cases maintaining PSA within feminization levels after a mean follow-up of 21.7 months. Considering the overall series, 38.6% of the patients could have avoided lymphadenectomy according to our criteria. CONCLUSIONS: We have found RPP without previous staging lymphadenectomy to be a valid therapeutic option for patients with clinically localized prostate cancer, preoperative PSA < or = 10 ng/ml and a Gleason score of < or = 7. According to our data, this group accounts for approximately 40% of the patients in whom radical prostatectomy had been recommended.

    Title Laparoscopic Simple Cystectomy in a Man.
    Date July 1995
    Journal Surgical Laparoscopy & Endoscopy
    Excerpt

    Laparoscopic surgery is rapidly being assimilated into the urologic armamentarium. Already many operations commonly done by an open approach are being performed laparoscopically. We report on the laparoscopic performance of a simple cystectomy in a spinal cord-injured male patient suffering from recurrent pyocystis. The procedure proved to be technically feasible, with the patient experiencing a short convalescence period.

    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 Laparoscopic Surgery in Urology: Refining Indications and Techniques.
    Date March 1995
    Journal The Journal of Urology
    Title Nontraumatic Elevation of Prostate Specific Antigen Following Cardiac Surgery and Extracorporeal Cardiopulmonary Bypass.
    Date December 1994
    Journal The Journal of Urology
    Excerpt

    We recently treated a number of patients with markedly elevated prostate specific antigen (PSA) levels associated with acute urinary retention in a post-cardiac surgery setting. A controlled study was conducted to determine if this elevation is secondary to trauma from urethral catheterization or more directly associated with the cardiac surgery and extracorporeal bypass. In 68 patients undergoing cardiac surgery serum PSA levels were determined preoperatively and 12 to 18 hours postoperatively (after urethral catheterization). The control patients were 23 men undergoing evaluation for chest pain in the cardiac care unit. The serum PSA level was markedly elevated in 38 patients (56%) after cardiac surgery. In contrast, only 1 control patient (4.3%) had an elevated level after urethral catheterization (p = 0.0001). The mean post-cardiac surgery PSA concentration was 9.14 +/- 16.08 ng./ml. (range 0.1 to 94.8) with a mean elevation of 528% (range -50 to 5,155%). This finding was statistically different from the mean post-catheterization level of 1.86 +/- 2.26 ng./ml. (range 0.2 to 9.1, p = 0.034) and mean elevation of 6% (range -50 to 100%, p = 0.0001) in the control patients. We conclude that cardiac surgery and extracorporeal cardiopulmonary bypass can cause a marked elevation in serum PSA that appears to be unrelated to urethral catheterization. Presently, the etiology of this elevation is unknown, although PSA measurements may eventually find use as a marker for prostatic damage associated with acute urinary retention in the postoperative setting.

    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 Chronic Hematospermia: Assessment by Transrectal Ultrasound.
    Date May 1994
    Journal Urology
    Excerpt

    OBJECTIVE. To evaluate transrectal ultrasound in the assessment of chronic hematospermia. METHODS. Twenty-six patients aged between twenty-five and seventy-seven years (mean, 55.6 years) presenting with persistent hematospermia of an average duration of 10.2 months (range, 3 to 20 months) underwent transrectal ultrasound. Twenty-five asymptomatic men aged thirty-nine to eighty-two years (mean, 63 years) self-referred to our institution seeking transrectal ultrasound as a screening method for prostate cancer and with no previous history of hematospermia were used as controls. RESULTS. Significant sonographic findings not present in the control group were detected in 24 patients with hematospermia. These consisted of dilated seminal vesicles in 8, ejaculatory duct cysts in 4, ejaculatory or seminal vesicle calculi in 4, the presence of ejaculatory duct and seminal vesicle dilatation in 4, seminal vesicle cysts with ipsilateral renal agenesis and absence of the vas in 2, and an intraprostatic müllerian duct remnant in 2. Of the patients having biopsies, none was found to have malignancy. CONCLUSIONS. Transrectal ultrasound is the imaging modality of choice in the assessment of chronic hematospermia.

    Title [perineal Radical Prostatectomy in the Age of Laparoscopy]
    Date April 1994
    Journal Archivos Españoles De Urología
    Excerpt

    With the advent of laparoscopic lymphadenectomy, attention has been focussed again to the perineal approach for cancer of the prostate. The high rate of postoperative impotence and the abdominal incision required had made radical perineal prostatectomy unpopular. From August 1990 to July 1991, 76 patients with localized prostate cancer were surgically treated at the University of St. Louis. These patients were divided into three groups; group A comprised 26 patients who were submitted to laparoscopic lymphadenectomy and radical perineal prostatectomy, group B comprised patients treated by laparoscopic lymphadenectomy and radical retropubic prostatectomy, and group C or controls underwent open lymphadenectomy and radical retropubic prostatectomy. Fifty-three patients were sexually potent preoperatively but only 20 (7 from group A, 5 from group B and 8 from group C) were considered for preservation of the neurovascular bands. All the patients were followed for a minimum of one year. Comparison of these three groups revealed significant differences for perioperative bleeding and postoperative hospital stay in favor of Group A. The overall stress incontinence rate was 5.3% and the complications ranged from 4.1% for group C and 29.1% for group B. The postoperative sexual potency ranged from 57% for group A to 75% for group C, the differences not being statistically significant. Radical perineal prostatectomy is as valid as radical retropubic prostatectomy for localized prostatic cancer and has the advantages of less bleeding and a faster recovery, particularly if combined with laparoscopic lymphadenectomy.

    Title Laparoscopic Repair of Intraperitoneal Bladder Perforation.
    Date April 1994
    Journal The Journal of Urology
    Excerpt

    Most intraperitoneal bladder injuries require a formal laparotomy for repair. With the rapid assimilation of laparoscopic techniques into urological surgery, procedures that otherwise would have included a standard open operation are now being performed on an endo-cavitary basis. A case is described of an intraperitoneal bladder rupture incurred during endoscopic surgery, which was successfully managed laparoscopically with significant benefits to the patient.

    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 Laparoscopic Intraperitoneal Marsupialization: Report on a New Treatment for Lymphoceles.
    Date January 1994
    Journal Surgical Laparoscopy & Endoscopy
    Excerpt

    Lymphocele formation, a common complication of pelvic surgery, can produce considerable morbidity. Treatment is problematic, with no single procedure considered optimal. We recently treated a 67-year-old man with a symptomatic lymphocele by laparoscopic internal marsupialization. Total operative time was 45 min, and the patient was discharged home the same day with minimal need for pain medications. Total resolution of the symptoms occurred within 24 h. In comparison to other methods compiled and analyzed from the literature, this highly effective, minimally invasive procedure offers a significant advantage to the patient.

    Title Simultaneous Laparoscopic Varicocelectomy and Removal of an Intrascrotal Atrophic Testicle.
    Date January 1994
    Journal Surgical Laparoscopy & Endoscopy
    Excerpt

    We report on the concomitant removal of an atrophic intrascrotal left testicle secondary to mumps orchitis and a right varicocelectomy for athenospermia done laparoscopically. The procedure proved to be quite simple to complete, avoiding the need for secondary incisions, which would have been required otherwise if a standard open approach was chosen. The convalescence period was uneventful with the patient returning to regular activities within 72 h of the procedure. We feel that in selected cases a laparoscopic orchiectomy offers distinct advantages to conventional open surgical approaches.

    Title Testicular Circulatory Isolation: a Phase I Study.
    Date January 1994
    Journal Surgical Oncology
    Excerpt

    Antineoplastic agents may damage germinal epithelium. Testicular circulatory isolation (TCI) is a regional drug exclusion technique designed to minimize this. We evaluated the technical and anaesthetic aspects of TCI in 10 patients who underwent bilateral orchiectomy immediately thereafter. A modified aortic clamp was placed trans-scrotally across the left testicular pedicle without pre-medication or anaesthesia and left in place for 1 h, occluding testicular blood flow. Minimal pain and anxiety were reported during the procedure. There were no complications related to TCI in any patient. This study supports the institution of trials of TCI in young men about to receive fertility-threatening chemotherapy.

    Title Spontaneous Voiding of a Bullet After a Gunshot Wound to the Bladder: Case Report.
    Date December 1993
    Journal The Journal of Trauma
    Title The Titanium Intraprostatic Stent: the United States Experience.
    Date November 1993
    Journal The Journal of Urology
    Excerpt

    This multicenter, cooperative study represents the initial United States experience using an expandable, titanium intraprostatic stent in 68 patients (60 to 93 years old). The stents were inserted under direct vision and expanded to 33F using a balloon catheter. All patients had a symptom score analysis, and underwent measurement of peak urine flow and rate and post-void residual urine volume as part of the initial evaluation. Patients were seen at approximately 1, 3, 6 and 18 months after stent insertion (mean followup 16 months). Of the 68 patients 38 presented in urinary retention. The type of anesthesia used included general anesthesia in 6 patients, spinal or epidural anesthesia in 24, intravenous sedation in 20 and intraurethral lidocaine only in 18. All patients were able to void spontaneously within 36 hours after stent insertion. Symptom scores decreased from 16.8 to 3.9, 6.3, 5.0, 5.7 and 3.2 at approximately 1, 3, 6, 12 and 18 months, respectively. Peak urine flow rate increased from 3.9 to 13.8, 11.5, 11.2, 12.4 and 14.4 ml. per second at approximately 1, 3, 6, 12 and 18 months, respectively. Post-void residual urine volume decreased from 74.4 to 30.1, 29.2, 19.8 and 40.2 ml. at approximately 1, 3, 6 and 12 months, respectively. Of the initial 68 patients 5 died of the underlying disorder (all voiding satisfactorily with the stent in place) and 17 underwent uneventful stent removal (10 for technical failure and 7 for treatment failure). Technical failures were secondary to either inaccurate positioning or improper stent sizing. Of the 58 patients with proper placement of the stent and no technical failures 46 (79%) had improvement in symptom scores and urine flow rate. Transient hematuria was noted in 43 patients (63%) and usually resolved within 48 hours. None of the 6 urinary tract infections (9%) was recurrent. In conclusion, the titanium intraprostatic stent, when properly placed, is a promising therapeutic alternative to prostatectomy or long-term catheterization in high risk obstructed patients or those in urinary retention. Studies are currently in progress to determine the long-term efficacy of this therapeutic modality.

    Title Endoluminal Urethral Stents: a Review.
    Date July 1993
    Journal Journal of Endourology / Endourological Society
    Excerpt

    Although Fabian first introduced the concept of an endourethral stent in 1980, recent developments in biomedical technology and the treatment philosophy of urethral obstruction has led to a resurgence of this concept. We review the past and current literature with regard to both temporary and permanent stents. Available stents are described, clinical results summarized, and indications discussed.

    Title Transrectal Ultrasound in the Evaluation of Men with Low Volume Azoospermia.
    Date May 1993
    Journal The Journal of Urology
    Excerpt

    The evaluation of the subfertile man has changed with the advent of noninvasive imaging techniques. We used high resolution transrectal ultrasound early in the evaluation of 25 men 24 to 35 years old with probable ductal obstruction represented by azoospermia or severe oligospermia (less than 1 million sperm per cc) and low volume ejaculate. Of these patients 13 were found to have a post-testicular obstructive cause including ejaculatory duct obstruction (5), voluminous seminal vesicle dilatation with obstruction (3), seminal vesicle aplasia (2), nonpalpable vas (2) or epididymal obstruction (1). The other 12 men had either a varicocele (8) or testicular failure (4). Except for vasal or epididymal pathology, the other causes of post-testicular azoospermia presented with an ejaculate volume consistently less than 1.0 cc. All 10 patients with low volume and an abnormal ultrasound had normal follicle stimulating hormone levels and testicular biopsy findings. Sonography not only was helpful in establishing the diagnosis but also in determining the distal extent of the obstruction. Transrectal ultrasound is an important noninvasive diagnostic tool that minimizes the need for more invasive studies in the evaluation of azoospermia, particularly when associated with low ejaculate volume.

    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 Laparoscopic Internal Spermatic Vein Ligation: Report of a New Technique.
    Date January 1993
    Journal Fertility and Sterility
    Excerpt

    Over the past 22 months, 51 laparoscopic internal vein ligations have been performed to determine its application and practicality in treating the infertile male with varicoceles. Of the 33 cases available for a follow-up of greater than 6 months, 16 pregnancies are reported. Five patients reporting pregnancies refused to submit a postoperative semenogram. Of the reportable series, 17 of 33 had significant improvement in sperm density (51%), 15 of 33 (45%) in sperm viability, and 15 of 33 (45%) in sperm motility. No major complications were seen and minor complications were few and transient. Morbidity was extremely low. Laparoscopic internal spermatic vein ligations would appear to be a reasonable, practical, and effective method to correct varicoceles.

    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 Kock Pouch. An Internal Ileal Reservoir for Continent Urinary Diversion.
    Date November 1992
    Journal Aorn Journal
    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 Laparoscopic Diverticulectomy: Preliminary Report of a New Approach for the Treatment of Bladder Diverticulum.
    Date September 1992
    Journal The Journal of Urology
    Excerpt

    Laparoscopic techniques have expanded the possibilities of endo-surgically approaching urological abnormalities that would otherwise be managed via an open operation. We report on another useful application of the laparoscope, bladder diverticulectomy. A large bladder diverticulum, responsible for incomplete bladder emptying and recurrent urinary tract infections in an 87-year-old man, was successfully excised endoscopically. The technique and possible future indications are described.

    Title Malignant Tumor of the Colon Metastatic to the Epididymis As a First Sign of Recurrence of Colon Cancer.
    Date July 1992
    Journal Missouri Medicine
    Excerpt

    Metastatic tumors to the epididymis are rare. Most reported cases represent another occurrence of widespread disease. This is a report and review of the literature of a case of adenocarcinoma of the colon three years post resection in which the only site of recurrence was in the epididymis.

    Title Staging Laparoscopic Pelvic Lymph Node Dissection: Comparison of Results with Open Pelvic Lymphadenectomy.
    Date March 1992
    Journal The Journal of Urology
    Excerpt

    A total of 24 men scheduled for radical prostatectomy was alternately designated to undergo either a modified open (12 men) or laparoscopic (12 men) lymphadenectomy. Both groups were similar in regard to age and clinical stage. Tumor grade and serum prostate specific antigen level for each group are reported. Nodal metastases were found in 1 patient in the open and 3 in the endoscopic group. The average total number of lymph nodes retrieved by open dissection was 11 +/- 5.7, which was not statistically different from the average number of 10.7 +/- 5.7 obtained laparoscopically. No statistically significant variance in the number of nodes harvested in regard to site of dissection was observed. In the 9 men who underwent radical prostatectomy after laparoscopic dissection no additional lymphatic tissue was obtained from the surgical margins. No morbidity related to either procedure occurred. The data suggest that laparoscopic pelvic lymphadenectomy offers a reliable and minimally invasive alternative to open node dissection in selected patients.

    Title Laparoscopic Varicocelectomy: Preliminary Report of a New Technique.
    Date February 1992
    Journal The Journal of Urology
    Excerpt

    The use of varicocelectomy for the treatment of subfertility seems to be incontrovertible. However, there is a difference of opinion as to the proper surgical method of varicocele ablation. The inguinal and high retroperitoneal approaches are the most commonly accepted methods to date. However, significant postoperative morbidity is common and return to normal activity often is prolonged. Also, bilateral operations are being performed more commonly. These considerations have prompted many to search for alternative techniques. We developed a laparoscopic procedure that is as simple and effective as more traditional methods. In addition, it offers lower morbidity, allows for microscopic dissection with preservation of the spermatic artery and is amenable to bilateral ligation without a second incision. Ten patients 16 to 54 years old underwent laparoscopic ligation of the spermatic veins at the internal inguinal ring. The diagnosis was based on physical examination. Indications for the operation were infertility with a stress sperm pattern in 5 patients, testicular atrophy in 4 and scrotal pain in 1. Four patients underwent bilateral ligation. Preliminary followup showed resolution of the varicocele in all patients and disappearance of pain in the patient treated for this symptom. No morbidity related to this procedure has been encountered and all patients resumed normal activity within 2 days. We believe that this new method is a viable alternative for varicocelectomy.

    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.

    Title A Simplified Technique for Continent Urinary Diversion: an All-stapled Colonic Reservoir.
    Date December 1991
    Journal The Journal of Urology
    Excerpt

    A simple continent colonic reservoir was constructed in its entirety with the aid of surgical stapling techniques in 17 men and 10 women. In 5 men an orthotopic pouch was created and in the rest a continent stoma was designed. Detubularization of the entire colonic segment assures a low pressure system with disruption of directional peristaltic activity. The ureters are implanted by simply burying them in a mucosal furrow. Operative time required for the creation of the reservoir (excluding time for cystectomy) has ranged between 70 and 140 minutes (mean 95.4 minutes). With a followup of 9 to 60 months (mean 22.8 months) continence has been achieved in all but 1 patient with no ureteral reflux or obstruction. Urodynamically the pouch has achieved a large capacity (mean 750 cc) with low filling pressures (8.1 cm. water) because of technical ease of construction together with a shortened operative time due to the stapling techniques. This form of bladder replacement offers an option for select patients in whom continent urinary diversion is contemplated.

    Title Treatment of Posterior Urethral Strictures with a Titanium Urethral Stent.
    Date October 1991
    Journal The Journal of Urology
    Excerpt

    A total of 5 patients with recurrent posterior urethral strictures underwent endoscopic placement of an expandable endourethral stent made of titanium. Patient age ranged from 17 to 66 years (mean age 42.6 years). Followup ranged from 13 to 20 months (mean 14.1 months). Of the patients 4 presently have unobstructed voiding with no incontinence. To date no side effects have been directly related to the stents and no incrustations or calculi have formed. Our preliminary study supports the use of titanium urethral stents as an alternative form of treatment for selected urethral strictures.

    Title Camey Procedure. A Continent Urinary Diversion Technique.
    Date October 1991
    Journal Aorn Journal
    Title The Present Role of Prostatic Specific Antigen (psa) As a Tumor Marker in Carcinoma of the Prostate.
    Date August 1991
    Journal Missouri Medicine
    Excerpt

    Prostatic specific antigen (PSA) is an important tumor marker for prostate cancer and is being used more frequently in men suspected of having this disease. Although PSA cannot be recommended by itself for either screening or staging of prostate cancer, its present role is discussed by the author.

    Title Testicular Seminoma in a Long-term Survivor of the Prune Belly Syndrome.
    Date April 1991
    Journal European Urology
    Excerpt

    Patients with the prune belly syndrome have cryptorchidism as a constant feature of the constellation of anomalies. Testes that do not spontaneously descend represent a well-known risk factor for the development of testicular cancer. In this paper, we present the second case of a primary testicular germ cell tumor in a long-term survivor with prune belly syndrome.

    Title Vesico-psoas Hitch Procedure. A Method of Repairing Ureteral Injuries.
    Date March 1991
    Journal Aorn Journal
    Title Experience with a Simplified Technique for the Treatment of Female Stress Urinary Incontinence.
    Date February 1991
    Journal British Journal of Urology
    Excerpt

    Over a 9-year period a simple procedure for the correction of stress urinary incontinence was performed in 86 consecutive patients, 31 of whom had failed a previous anti-incontinence procedure. Success was achieved in 81 cases (94%). Of the 5 failures, 2 were successfully treated with a repeat procedure. Operative time ranged from 14 to 49 min (median 27). The average hospital stay was 2 days. Because of its simplicity and reliability, this technique is recommended for the surgical correction of female stress urinary incontinence.

    Title Simple Technique for Securing Ureteral Stents During Urinary Diversion [corrected]
    Date October 1990
    Journal Surgery, Gynecology & Obstetrics
    Title The Use of Transrectal Ultrasound in the Detection and Evaluation of Local Pelvic Recurrences After a Radical Urological Pelvic Operation.
    Date September 1990
    Journal The Journal of Urology
    Excerpt

    Transrectal ultrasound was performed in 20 patients with suspected local pelvic recurrence after a radical pelvic operation: 9 had undergone radical prostatectomy and 11 had undergone radical cystoprostatectomy. Transrectal sonography verified the presence of recurrence in 19 of 20 patients (95%) and this was confirmed by biopsy of the visualized lesions. Analysis of the sonographic echo patterns encountered revealed that in 14 of 19 recurrent neoplasms (71.5%) the echogenic pattern was hypoechoic. In the remaining 6 patients (31.5%) the echo pattern was isoechoic. No hyperechoic lesions were noted. Based upon our findings and because of the low costs compared to other diagnostic modalities transrectal ultrasound represents an ideal technique to compliment the digital rectal examination in evaluation of patients suspected of harboring a local pelvic recurrence after a radical pelvic operation.

    Title Treatment of Post-orchiectomy Hot Flashes with Transdermal Administration of Clonidine.
    Date April 1990
    Journal The Journal of Urology
    Excerpt

    The occurrence of hot flashes in men after bilateral orchiectomy for prostatic carcinoma can be bothersome and difficult to treat. Transdermal clonidine was administered to 7 patients with such symptoms. In 3 patients the hot flashes were ablated and in the remaining 4 the number and frequency of attacks were considerably reduced. No significant side effects were encountered. We suggest that transdermal clonidine (0.1 mg.) administered weekly can safely control undesirable hot flashes in men after bilateral orchiectomy.

    Title Transrectal Ultrasound in Stage A1 Prostate Carcinoma.
    Date January 1990
    Journal Urology
    Excerpt

    Transrectal ultrasound of the prostate was employed on 6 patients found to have Stage A1 carcinoma of the prostate after transurethral resection in order to identify those patients with residual tumor. Two patients were found to have residual tumor by transrectal ultrasound; this was confirmed by ultrasonic guided biopsy of the prostate. Of the remaining patients, an additional 2 on whom the ultrasound did not detect the tumor had tumor less than 1 cm in size, and in 1 patient no residual disease was found in the pathologic specimen. We conclude that ultrasound of the prostate offers another dimension in the staging of patients with Stage A1 carcinoma of the prostate.

    Title Pressure Necrosis from Intermittent-pneumatic-compression Stockings.
    Date January 1990
    Journal The New England Journal of Medicine
    Title Impotence. An Historic Perspective.
    Date March 1989
    Journal Asaio Transactions / American Society for Artificial Internal Organs
    Title Surgical Implantation of the Artificial Urinary Sphincter.
    Date March 1989
    Journal Asaio Transactions / American Society for Artificial Internal Organs
    Excerpt

    The surgery necessary for sphincter placement is much more difficult than that required during the placement of penile prostheses, and there is definitely an associated learning curve. The risks of complications are present, but for a patient with the severe social and psychological disability of urinary incontinence, these risks are generally acceptable.

    Title Diagnosis and Surgical Treatment of Erectile Dysfunction.
    Date March 1989
    Journal Asaio Transactions / American Society for Artificial Internal Organs

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