Latest Publications

Our faculty’s research is frequently accepted for inclusion in the most prestigious peer-reviewed scientific journals, with over 330 articles published in 2015 alone. Below you will find the most recent publications.

The abstracts below are updated daily. For a more complete list, please visit this PubMed link.

Morbidity and Mortality of Radical Nephrectomy for Patients With Disseminated Cancer: An Analysis of the National Surgical Quality Improvement Program Database.

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Morbidity and Mortality of Radical Nephrectomy for Patients With Disseminated Cancer: An Analysis of the National Surgical Quality Improvement Program Database.

Urology. 2016 09;95:95-102

Authors: Wallis CJ, Bjarnason G, Byrne J, Cheung DC, Hoffman A, Kulkarni GS, Nathens AB, Nam RK, Satkunasivam R

Abstract
OBJECTIVE: To determine the effect of disseminated cancer on perioperative outcomes following radical nephrectomy.
METHODS: We conducted a retrospective cohort study of patients undergoing radical nephrectomy for kidney cancer from 2005 to 2014 using the American College of Surgeons National Surgical Quality Improvement Program, a multi-institutional prospective registry that captures perioperative surgical complications. Patients were stratified according to the presence (n = 657) or absence (n = 7143) of disseminated cancer at the time of surgery. We examined major complications (death, reoperation, cardiac event, or neurologic event) within 30 days of surgery. Secondary outcomes included pulmonary, infectious, venous thromboembolic, and bleeding complications; prolonged length of stay; and concomitant procedures (bowel, liver, spleen, pancreas, and vascular procedures). Adjusted odds ratio (aOR) and 95% confidence interval (95% CI) were calculated using multivariate logical regression models.
RESULTS: Patients with disseminated cancer were older and more likely to be male, have greater comorbidities, and have undergone open surgery. Major complications were more common among patients with disseminated cancer (7.8%) than those without disseminated cancer (3.2%; aOR 2.01, 95% CI 1.46-2.86). Mortality was significantly higher in patients with disseminated cancer (3.2%) than those without disseminated cancer (0.5%; P < .0001). Pulmonary (aOR 1.68, 95% CI 1.09-2.59), thromboembolic (aOR 1.72, 95% CI 1.01-2.96), and bleeding complications (aOR 2.12, 95% CI 1.73-2.60) were more common among patients with disseminated cancer as was prolonged length of stay (aOR 1.27, 95% CI 1.06-1.53).
CONCLUSION: Nephrectomy in patients with disseminated cancer is a morbid operation with significant perioperative mortality. These data may be used for preoperative counseling of patients undergoing cytoreductive nephrectomy.

PMID: 27292566 [PubMed - indexed for MEDLINE]

Pathological Upstaging of Clinical T1 to Pathological T3a Renal Cell Carcinoma: A Multi-institutional Analysis of Short-term Outcomes.

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Pathological Upstaging of Clinical T1 to Pathological T3a Renal Cell Carcinoma: A Multi-institutional Analysis of Short-term Outcomes.

Urology. 2016 Aug;94:154-60

Authors: Nayak JG, Patel P, Saarela O, Liu Z, Kapoor A, Finelli A, Tanguay S, Rendon R, Moore R, Black PC, Lacombe L, Breau RH, Kawakami J, Drachenberg DE

Abstract
OBJECTIVE: To determine the oncological impact of pathological upstaging among patients with clinical T1 (cT1) disease treated by partial nephrectomy or radical nephrectomy.
METHODS: The Canadian Kidney Cancer Information System comprises a prospectively maintained multi-institutional database for patients with renal cell carcinoma. Nonmetastatic, cT1 renal cell carcinoma cases were evaluated. Upstaging was defined as pathological T3a disease. Multivariate Cox regression analysis identified predictors for recurrence (local recurrence and/or metastatic disease) whereas logistic regression identified predictors of pathological upstaging. Kaplan-Meier methods estimated survival.
RESULTS: Of 1448 eligible cT1 patients, upstaging was observed in 134 (9%). One thousand fifty-eight (73%) were treated by partial nephrectomy. After a median follow-up of 23 months, the 3-year recurrence-free survival was 76% in upstaged patients compared with 93% in those not upstaged (P < .001). Controlling for age, gender, year of surgery, histology, tumor size, surgical approach, and margin status, pathological upstaging was independently associated with disease recurrence (hazard ratio 2.03, 95% confidence interval [CI] 1.12-3.68). Increasing age (odds ratio [OR] 1.02, 95% CI 1.00-1.05), Fuhrman grade (OR 2.47, 95% CI 1.47-4.14), and tumor size (OR 1.16, 95% CI 1.00-1.36) were independently associated with a risk of pathological upstaging.
CONCLUSION: Pathological upstaging confers a negative prognosis and highlights the importance of accurate clinical staging. A number of factors have been identified, including some attainable by renal biopsy, which may predict upstaging and provide valuable adjunct information to inform risk stratification and management decisions among patients with cT1 renal masses.

PMID: 27041471 [PubMed - indexed for MEDLINE]

International Consultation on Urological Diseases: Congenital Anomalies of the Genitalia in Adolescence.

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International Consultation on Urological Diseases: Congenital Anomalies of the Genitalia in Adolescence.

Urology. 2016 Aug;94:288-310

Authors: Higuchi T, Holmdahl G, Kaefer M, Koyle M, Wood H, Woodhouse C, Wood D

Abstract
OBJECTIVE: To provide a comprehensive overview of genital anomalies encountered among adolescents, including late effects of problems addressed earlier in childhood.
MATERIALS AND METHODS: The major congenital genital anomalies encountered in pediatric urology were identified. They include hypospadias, exstrophy-epispadias, cloacal malformations, disorders of sexual development, undescended testes, and some acquired penile anomalies seen in adolescence (priapism, adolescent varicocele). Recommendations of the International Consultation on Urological Diseases are provided on various aspects of these conditions, such as postpubertal cosmesis and function, fertility implications, and long-term nephrological considerations (when relevant).
RESULTS: Specific recommendations for care, including strength of clinical recommendation, are provided in this paper. Whereas the basis of this paper is to discuss specific management recommendations as they relate to several heterogeneous conditions, general recommendations include patient-centered discussions regarding operative treatment be deferred until the patient is able to articulate goals and participate in shared decision-making and utilization of multidisciplinary teams for conditions where multiple organ systems may be involved.
CONCLUSION: Congenital abnormalities of the genitalia are common and widely heterogeneous. Late effects and concerns often emerge after puberty, and patients should be followed throughout their adult lives to address such concerns.

PMID: 27015945 [PubMed - indexed for MEDLINE]

Influence of Metabolic Syndrome on Prostate Cancer Stage, Grade, and Overall Recurrence Risk in Men Undergoing Radical Prostatectomy.

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Influence of Metabolic Syndrome on Prostate Cancer Stage, Grade, and Overall Recurrence Risk in Men Undergoing Radical Prostatectomy.

Urology. 2016 07;93:77-85

Authors: Bhindi B, Xie WY, Kulkarni GS, Hamilton RJ, Nesbitt M, Finelli A, Zlotta AR, Evans A, van der Kwast TH, Alibhai SM, Trachtenberg J, Fleshner NE

Abstract
OBJECTIVE: Metabolic syndrome (MetS) is associated with an increased risk of finding prostate cancer overall and high-grade disease on biopsy. This study sought to determine if MetS is associated with adverse final pathology and risk of overall recurrence in men undergoing radical prostatectomy (RP).
METHODS: Men undergoing RP (2004-2013) were identified using our prospectively maintained institutional database. MetS was defined by ≥3 of 5 components (obesity, dysglycemia, hypertension, low high-density lipoprotein-cholesterol, and high triglycerides). Multivariable logistic regression models were created for prostate cancer grade and stage on final pathology. Kaplan-Meier and multivariable Cox regression analyses were performed to model overall recurrence, defined by biochemical recurrence (postoperative serum prostate-specific antigen ≥0.2 ng/mL) or use of salvage therapies.
RESULTS: Of 1939 men, 439 (22.6%) had MetS. MetS (≥3 vs. 0 components) was associated with an increased odds of Gleason 8-10 disease (odds ratio [OR] = 2.49, 95% confidence interval [CI] = 1.32-4.67, P = .005) and extraprostatic disease (OR = 1.35, 95% CI = 1.02-1.80, P = .04). Decreased use of nerve-sparing in men with MetS was noted. In unadjusted analyses, MetS was associated with a significantly increased risk of receiving salvage therapy (hazard ratio [HR] = 1.38, 95% CI = 1.04-1.83, P = .03) and a near-significant increased overall recurrence risk (HR = 1.20, 95% CI = 0.94-1.53, P = .15). These associations were attenuated upon adjusting for disease-specific parameters (salvage therapy: HR = 1.03, 95% CI = 0.76-1.40, P = .87; overall recurrence: HR = 0.94, 95% CI = 0.72-1.21, P = .62).
CONCLUSION: MetS is associated with an increased odds of extraprostatic and high-grade disease on final RP pathology, which appears to drive an increased risk of needing salvage therapy after RP. However, with more aggressive resection, differences in failure-free outcomes were attenuated, suggesting that men with MetS should not be precluded from RP.

PMID: 27015944 [PubMed - indexed for MEDLINE]