Surgical Specialist, Urologist
6 years of experience
Video profile
Accepting new patients
5735 Ridge Ave
Suite C307
Philadelphia, PA 19128
Locations and availability (3)

Education ?

Medical School Score
State University of New York at Buffalo (2004)
  • Currently 1 of 4 apples

Affiliations ?

Dr. Viterbo is affiliated with 6 hospitals.

Hospital Affilations

Score

Rankings

  • Montgomery Hospital XXXXX
    900 E Fornance St, Norristown, PA 19401
    • Currently 3 of 4 crosses
    Top 50%
  • Abington Memorial Hospital
    Medical Oncology
    1200 Old York Rd, Abington, PA 19001
    • Currently 3 of 4 crosses
    Top 50%
  • Elkins Park Hospital
    60 Township Line Rd, Elkins Park, PA 19027
  • Fox Chase Cancer Center
    333 Cottman Ave, Philadelphia, PA 19111
  • Temple University Hospital - Episcopal Campus
    100 E Lehigh Ave, Philadelphia, PA 19125
  • Mossrehab & Albert Einstein Med Ctr
    60 Township Line Rd, Elkins Park, PA 19027
  • Publications & Research

    Dr. Viterbo has contributed to 18 publications.
    Title Small Renal Masses Progressing to Metastases Under Active Surveillance: a Systematic Review and Pooled Analysis.
    Date April 2012
    Journal Cancer
    Excerpt

    The authors systematically reviewed the literature and conducted a pooled analysis of studies on small renal masses who underwent active surveillance to identify the risk progression and the characteristics associated with metastases.

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

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

    Title Long-term Survival After Radical Prostatectomy Versus External-beam Radiotherapy for Patients with High-risk Prostate Cancer.
    Date August 2011
    Journal Cancer
    Excerpt

    The long-term survival of patients with high-risk prostate cancer was compared after radical prostatectomy (RRP) and after external beam radiation therapy (EBRT) with or without adjuvant androgen-deprivation therapy (ADT).

    Title Routine Adrenalectomy is Unnecessary During Surgery for Large And/or Upper Pole Renal Tumors when the Adrenal Gland is Radiographically Normal.
    Date May 2011
    Journal The Journal of Urology
    Excerpt

    Concurrent adrenalectomy during renal surgery for renal cell carcinoma was once routine. More recent data suggest that adrenalectomy should be reserved for tumors 7 cm or greater, particularly those involving the upper pole. We evaluated the radiographic and pathological incidence of adrenal involvement in patients undergoing renal surgery for renal cell carcinoma 7 cm or greater.

    Title Racial Differences in Prediction of Time to Prostate Cancer Diagnosis in a Prospective Screening Cohort of High-risk Men: Effect of Tmprss2 Met160val.
    Date March 2011
    Journal Bju International
    Excerpt

    To evaluate the TMPRSS2-ERG gene polymorphism with respect to self-identified race or ethnicity (SIRE), time to prostate cancer (PCA) diagnosis, and screening parameters in the Prostate Cancer Risk Assessment Program, a prospective screening program for high-risk men.

    Title Clinicopathological Outcomes After Radical Cystectomy for Clinical T2 Urothelial Carcinoma: Further Evidence to Support the Use of Neoadjuvant Chemotherapy.
    Date February 2011
    Journal Bju International
    Excerpt

    To evaluate the clinicopathological outcomes for patients with clinical T2 (cT2) urothelial carcinoma treated with radical cystectomy (RC) without neoadjuvant chemotherapy (NC).

    Title Baseline Renal Function Status Limits Patient Eligibility to Receive Perioperative Chemotherapy for Invasive Bladder Cancer and is Minimally Affected by Radical Cystectomy.
    Date January 2011
    Journal Urology
    Excerpt

    To evaluate the proportion of patients with muscle-invasive urothelial carcinoma (UC) who would be eligible to receive cisplatin-based chemotherapy before and after radical cystectomy based on renal function.

    Title Use of Systemic Therapy and Factors Affecting Survival for Patients Undergoing Cytoreductive Nephrectomy.
    Date August 2010
    Journal Bju International
    Excerpt

    To present a multi-institutional experience evaluating the use of systemic therapy in patients undergoing cytoreductive nephrectomy (CN), as prospective randomized trials showed a survival benefit for CN in patients with metastatic renal cell carcinoma treated with immunotherapy, and these data have been extrapolated to support CN in the era of targeted therapy, but the likelihood that patients with metastatic kidney cancer who undergo CN will receive systemic treatment afterward remains poorly defined.

    Title Robot-assisted Partial Nephrectomy: a Large Single-institutional Experience.
    Date June 2010
    Journal Urology
    Excerpt

    To report experience with 100 robot-assisted partial nephrectomy (RAPN) operations performed at our institution. Nephron-sparing surgery is an established treatment for patients with small renal masses. The laparoscopic approach has emerged as an alternative to open nephron-sparing surgery, but it is recognized to be technically challenging. The robotic surgical system may enable faster and greater technical proficiency, facilitating a minimally invasive approach to more difficult lesions while reducing ischemia time.

    Title Evaluation of the Prostate Cancer Prevention Trial Risk Calculator in a High-risk Screening Population.
    Date March 2010
    Journal Bju International
    Excerpt

    Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b.

    Title Natural History, Growth Kinetics, and Outcomes of Untreated Clinically Localized Renal Tumors Under Active Surveillance.
    Date July 2009
    Journal Cancer
    Excerpt

    The growth kinetics of untreated solid organ malignancies are not defined. Radiographic active surveillance (AS) of renal tumors in patients unfit or unwilling to undergo intervention provides an opportunity to quantify the natural history of untreated localized tumors. The authors report the radiographic growth kinetics of renal neoplasms during a period of surveillance.

    Title Residual Prostate Cancer After Radiotherapy: a Study of Radical Cystoprostatectomy Specimens.
    Date September 2008
    Journal Urology
    Excerpt

    The incidence of histologic prostate cancer (CaP) after definitive radiation therapy (RT) for localized disease is rarely quantitated. We investigated the relationship between prostate-specific antigen (PSA) and histologically residual CaP after definitive RT in patients undergoing radical cystoprostatectomy (RCP) for unrelated indications.

    Title Delayed Intervention of Sporadic Renal Masses Undergoing Active Surveillance.
    Date March 2008
    Journal Cancer
    Excerpt

    Prompt surgical management remains the standard of care for renal cell carcinoma (RCC). Occasionally, it is necessary to postpone or delay surgical treatment. The authors of this report assessed whether delayed intervention following a period of active surveillance altered minimally invasive or nephron-sparing treatment plans, increased the risk of stage progression, and/or decreased recurrence-free survival rates.

    Title Prior Abdominal Surgery and Radiation Do Not Complicate the Retroperitoneoscopic Approach to the Kidney or Adrenal Gland.
    Date September 2005
    Journal The Journal of Urology
    Excerpt

    Laparoscopic renal and adrenal surgery is an accepted standard of care. This can be accomplished by a transperitoneal or retroperitoneal approach. In patients with extensive prior intra-abdominal surgery with or without radiation the retroperitoneal laparoscopic approach may avoid bowel adhesions and potential operative complications. We compared clinical outcomes of the laparoscopic retroperitoneal approach in patients with prior open abdominal surgery with or without radiation to outcomes in those with no surgical history.

    Title Use of Combined Intracorporal Injection and a Phosphodiesterase-5 Inhibitor Therapy for Men with a Suboptimal Response to Sildenafil And/or Vardenafil Monotherapy After Radical Retropubic Prostatectomy.
    Date May 2005
    Journal Bju International
    Excerpt

    OBJECTIVE: To report experience with combined therapy using intracorporal injection (ICI) of alprostadil and oral phosphodiesterase 5 (PDE-5) inhibitors for the minimally invasive treatment of erectile dysfunction (ED) after radical prostatectomy (RP), as PDE-5 inhibitors are effective but a few patients may have a suboptimal response. PATIENTS AND METHODS: In a retrospective study, 34 men (aged 46-66 years) had a nerve-sparing retropubic RP and subsequent ED. Patients were titrated on sildenafil citrate or vardenafil to maximum doses. All had a suboptimal response after a maximum of eight doses of oral therapy and were then treated with ICI therapy using 15 or 20 microg alprostadil. Erectile function was assessed with the Sexual Health Inventory for Men (SHIM). RESULTS: Of the 32 patients who continued combined therapy, 22 (68%) had an improvement in erectile function after ICI therapy, as assessed by the SHIM score. On follow-up, 36% of these patients used ICI therapy only intermittently, instead of regularly, as they felt that this was adequate enough for good results. CONCLUSIONS: PDE-5 oral pharmacotherapy is the most commonly used effective therapy for ED but may not be as effective in patients who have radical surgery; the addition of testosterone patches may have side-effects or be considered a risk in patients with a history of prostate cancer. The use of ICI therapy as an adjunct or maintenance therapy to their oral medication may be another alternative in these patients.

    Title Incidence and Management of Dialysis Patients with Renal Calculi.
    Date June 2003
    Journal Urologia Internationalis
    Excerpt

    OBJECTIVE: The incidence of renal stones in patients on dialysis, while lower in number compared to the general population because of decreased renal function, is nonetheless a clinical dilemma. We wanted to evaluate the incidence and management of stone disease in patients on hemodialysis. METHODS: We reviewed the literature from 1966 to the present using Medline. Study inclusion criteria were detection and treatment of stone disease in both hemodialysis and peritoneal dialysis patients. RESULTS: It is estimated that between 5 and 13% of all dialysis patients will develop symptomatic renal calculi and many more asymptomatic calculi. Many of the stone-forming dialysis patients will have recurring stone disease with one study finding an 83.3% recurrence rate. CONCLUSION: Since dialysis patients have a wide range of urine output, the clinician should be alert to the possibility of stone formation. We recommend yearly ultrasound examinations on all dialysis patients as well as citrate and magnesium supplements with careful follow-up of laboratory results and urine electrolytes. We also recommend careful follow-up of all patients on aluminum-hydroxide phosphate binders as they are predisposed to form Al-Mg-urate stones. For those dialysis patients that form renal calculi, watchful waiting and symptomatic treatment is recommended since almost all patients will spontaneously pass their stones. However, ESWL and other current modalities may be used with no greater morbidity compared to nondialysis cohorts. We also suggest that patients with severe recurring intractable stone disease who are candidates for renal transplantation should be offered bilateral nephrectomies.

    Title Percutaneous Vs Surgical Cryoablation of the Small Renal Mass: is Efficacy Compromised?
    Date
    Journal Bju International
    Excerpt

    Study Type - Therapy (systematic review)
Level of Evidence 1b OBJECTIVE: To review and analyse the cumulative literature to compare surgical and percutaneous cryoablation of small renal masses (SRMs). METHODS: A MEDLINE search was performed (1966 to February 2010) of the published literature in which cryoablation was used as therapy for localized renal masses. Residual disease was defined as persistent enhancement on the first post-ablation imaging study, while recurrent disease was defined as enhancement after an initially negative postoperative imaging study, consistent with the consensus definition by the Working Group on Image-Guided Tumor Ablation. Data were collated and analysed using the two-sample Mann-Whitney test and random-effects Poisson regression, where appropriate. RESULTS: In all, 42 studies, representing 1447 lesions treated by surgical (n= 28) or percutaneous (n= 14) cryoablation were pooled and analysed. No significant differences were detected between approaches regarding patient age (median 67 vs 66 years, P= 0.55), tumour size (median 2.6 vs 2.7 cm, P= 0.24),or duration of follow-up (median 14.9 vs 13.3 months, P= 0.40). Differences in rates of unknown pathology also failed to reach statistical significance (14 vs 21%, P= 0.76). The difference in the rate of residual tumour was not statistically different (0.033 vs 0.046, P= 0.25), nor was the rate of recurrent tumour (0.008 vs 0.009, P= 0.44). The reported rate of metastases was negligible in both groups, precluding statistical analysis. CONCLUSIONS: Cryoablation has shown acceptable short-term oncological results as a viable strategy for SRMs. Analysis of the cumulative literature to date shows that surgical and percutaneous cryoablation have similar oncological outcomes.

    Title Long-term Survival After Radical Prostatectomy Versus External-beam Radiotherapy for Patients with High-risk Prostate Cancer.
    Date
    Journal Cancer
    Excerpt

    BACKGROUND:: The long-term survival of patients with high-risk prostate cancer was compared after radical prostatectomy (RRP) and after external beam radiation therapy (EBRT) with or without adjuvant androgen-deprivation therapy (ADT). METHODS:: In total, 1238 patients underwent RRP, and 609 patients received with EBRT (344 received EBRT plus ADT, and 265 received EBRT alone) between 1988 and 2004 who had a pretreatment prostate-specific antigen (PSA) level ≥ 20 ng/mL, a biopsy Gleason score between 8 and 10, or clinical tumor classification ≥ T3. The median follow-up was 10.2 years, 6.0 years, and 7.2 years after RRP, EBRT plus ADT, and EBRT alone, respectively. The impact of treatment modality on systemic progression, cancer-specific survival, and overall survival was evaluated using multivariate Cox proportional hazard regression analysis and a competing risk-regression model. RESULTS:: The 10-year cancer-specific survival rate was 92%, 92%, and 88% after RRP, EBRT plus ADT, and EBRT alone, respectively (P = .06). After adjustment for case mix, no significant differences in the risks of systemic progression (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.51-1.18; P = .23) or prostate cancer death (HR, 1.14; 95% CI, 0.68-1.91; P = .61) were observed between patients who received EBRT plus ADT and patients who underwent RRP. The risk of all-cause mortality, however, was greater after EBRT plus ADT than after RRP (HR, 1.60; 95% CI, 1.25-2.05; P = .0002). CONCLUSIONS:: RRP alone and EBRT plus ADT provided similar long-term cancer control for patients with high-risk prostate cancer. The authors concluded that continued investigation into the differing impact of treatments on quality-of-life and noncancer mortality will be necessary to determine the optimal management approach for these patients. Cancer 2011. © 2011 American Cancer Society.

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