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- 저자 : Akshay Sood (검색결과 3 건)
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Akshay Sood,Dane E. Klett,Firas Abdollah,Jesse D. Sammon,Dan Pucheril,Mani Menon,Wooju Jeong,James O. Peabody 대한비뇨의학회 2016 Investigative and Clinical Urology Vol.57 No.3
Purpose: To describe a novel modification to robot-assisted partial cystectomy (RAPC) that allows for intraoperative surgical margin assessment by bimanual-examination and frozen-section analysis. Materials and Methods: A total of 7 patients underwent RAPC at a single tertiary-care institution between 2008 and 2013. The technique evolved over the study-period and permitted real-time intraoperative surgical margin evaluation in the last 5 patients via bimanual-examination and frozen-section analysis, utilizing the GelPOINT platform (a hand-assist device). The GelPOINT platform was placed through a 4- to 5-cm vertical supraumbilical incision and allowed for rapid retrieval of the bladder specimen without compromising the pneumoperitoneum or prolonging the operative time. Perioperative, oncological and functional outcomes were evaluated; all patients had a minimum 12-month follow-up. At the time of last follow-up, a cross-sectional survey of patients was performed to evaluate regret/satisfaction utilizing validated questionnaires. Results: The mean age was 72.5 years; 71.4% of the patients were men (n=5). All patients underwent RAPC for a malignant indication. The mean operative and console times were 291 and 217 minutes, respectively. No patient had a positive surgical margin. Mean length-of-stay was 1.7 days. At a median follow-up of 38.9 months, 1 patient experienced a local recurrence 6 months postsurgery. The only mortality was secondary to Lewy-body disease, in the same patient, 1 year postoperatively. Patient assessment of regret and satisfaction indicated 0% regret and 0% dissatisfaction. Conclusions: The 'modified' technique of RAPC is technically feasible, safe, and reproducible; further, RAPC leads to favorable oncological, functional and quality-of-life outcomes in patients eligible for partial cystectomy.
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Inpatients hypospadias care: Trends and outcomes from the American nationwide inpatient sample
Christian Meyer,Shyam Sukumar,Akshay Sood,Julian Hanske,Malte Vetterlein,Jack S. Elder,Margit Fisch,Quoc-Dien Trinh,Ariella A. Friedman 대한비뇨의학회 2015 Investigative and Clinical Urology Vol.56 No.8
Purpose: Hypospadias is the most common congenital penile anomaly. Information about current utilization patterns of inpatienthypospadias repair as well as complication rates remain poorly evaluated. Materials and Methods: The Nationwide Inpatient Sample was used to identify all patients undergoing inpatient hypospadiasrepair between 1998 and 2010. Patient and hospital characteristics were attained and outcomes of interest included intra- and immediatepostoperative complications. Utilization was evaluated temporally and also according to patient and hospital characteristics. Predictors of complications and excess length of stay were evaluated by logistic regression models. Results: A weighted 10,201 patients underwent inpatient hypospadias repair between 1998 and 2010. Half were infants (52.2%),and were operated in urban and teaching hospitals. Trend analyses demonstrated a decline in incidence of inpatient hypospadiasrepair (estimated annual percentage change, –6.80%; range, –0.51% to –12.69%; p=0.037). Postoperative complication rate was4.9% and most commonly wound-related. Hospital volume was inversely related to complication rates. Specifically, higher hospitalvolume (>31 cases annually) was the only variable associated with decreased postoperative complications. Conclusions: Inpatient hypospadias repair have substantially decreased since the late 1990’s. Older age groups and presumablymore complex procedures constitute most of the inpatient procedures nowadays.
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