Publications by authors named "Amy Krambeck"

Purpose: Bipolar TURP is regarded as the gold standard for treatment of BPH. Historically, when compared to HOLEP, bTURP has been found to have shorter operative times and is considered more efficient. We sought to compare the efficiency, efficacy, and safety of current era HOLEP with MOSES 2.

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Objective: To compare the outcomes between those who held or continued antiplatelet or anticoagulation therapy (APAC) for holmium laser enucleation of the prostate (HoLEP).

Methods: We retrospectively reviewed patients on APAC who underwent HoLEP between January 2021 and August 2023 by a single surgeon at a high-volume center. APAC was further categorized to the specific medication: clopidogrel, apixaban, warfarin, rivaroxaban.

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Objective: To compare anesthetic parameters using a novel prone single transverse chest roll technique (STR) to the standard thoraco-pelvic dual transverse roll technique (DTR).

Methods: A retrospective review of 441 patients who underwent PCNL between 2018 and 2022 was performed. A total of 4 surgeons were included-surgeon 1 utilized the STR technique while surgeons 2, 3, and 4 used the DTR technique.

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Background: To evaluate contemporary preoperative risk factors and subsequent postoperative management of incidental prostate cancer (iPCa) and incidental clinically significant prostate cancer (icsPCa, Grade Group [GG] ≥ 2 PCa).

Methods: A retrospective cohort of 811 men undergoing Holmium enucleation of the prostate (HoLEP) (January 2021-July 2022) were identified. Advanced preoperative testing was defined as prostate health index (PHI), prostate MRI, and/or negative preoperative biopsy.

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Article Synopsis
  • Kidney stones during pregnancy are rare but difficult to manage, and there's no comprehensive survey on current management practices globally.
  • A 19-item survey was developed to evaluate how different regions handle kidney stones in pregnant patients, covering demographics, diagnosis, and treatment options.
  • Results showed that most hospitals lack a clear protocol, with ultrasound as the preferred imaging method, but the use of CT scans is growing, especially when ultrasound results are unclear.
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Introduction And Objectives: Prostate magnetic resonance imaging (MRI) is used for prostate cancer (PCa) screening and risk stratification and is helpful for surgical planning for patients undergoing holmium laser enucleation of the prostate (HoLEP). There are few studies investigating the correlation between MRI Prostate Imaging-Reporting and Data System (PIRADS) lesion characteristics and HoLEP pathology and outcomes.

Methods: We performed retrospective review of patients who underwent HoLEP between January 2021 and August 2023 by a single surgeon.

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Objectives: This work aims to determine the efficacy and safety of preoperative alpha-blocker therapy on ureteroscopy (URS) outcomes.

Methods: In this systematic review and meta-analysis of randomised trials of URS with or without preoperative alpha-blocker therapy, outcomes included the need for ureteral dilatation, stone access failure, procedure time, residual stone rate, hospital stay, and complications. Residual stone rates were reported with and without adjustments for spontaneous stone passage, medication noncompliance, or adverse events leading to patient withdrawal.

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Article Synopsis
  • - The study investigates the outcomes of holmium laser enucleation of the prostate (HoLEP) in patients with neurologic diseases (ND) versus those without, using data from over 118 ND patients.
  • - ND patients showed higher rates of preoperative complications like indwelling catheters (57% vs. 39%) and urinary tract infections (32% vs. 19%) and had worse postoperative outcomes such as higher failure rates in void trials and acute urinary retention.
  • - Despite initially increased UTI rates in ND patients, HoLEP effectively reduced these rates and catheter use over time, though ND patients still faced higher overall complication rates than non-ND patients post-surgery.
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Background: The stone burden based management strategy reported in the guidelines published by different associations is well known for a long time. Staghorn calculi, representing the largest burden and most complex stones, is one of the most challenging cases to practicing urologists in clinical practice. The International Alliance of Urolithiasis (IAU) has released a series of guidelines on the management of urolithiasis.

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Introduction: The completion of residency and start of fellowship training marks a critical transition for urologists in the pursuit of subspeciality training. Most graduating urology residents are under contract until June 30, and most fellowships are scheduled to begin on July 1. There has been no investigation into the practical implications of fellowship delays in urology from a trainee perspective.

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Objective: To scrutinize the definitions of minimal invasive surgical therapy (MIST) and to investigate urologists' knowledge, attitudes, and practices for benign prostatic obstruction surgeries.

Methods: A 36-item survey was developed with a Delphi method. Questions on definitions of MIST and attitudes and practices of benign prostatic obstruction surgeries were included.

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Purpose: To identify laser lithotripsy settings used by experts for specific clinical scenarios and to identify preventive measures to reduce complications.

Methods: After literature research to identify relevant questions, a survey was conducted and sent to laser experts. Participants were asked for preferred laser settings during specific clinical lithotripsy scenarios.

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Holmium laser enucleation of the prostate (HoLEP) has emerged as a new gold standard for treatment of benign prostatic hyperplasia; however, its steep learning curve hinders generalization of this technique. Therefore, there is a need for a benchtop HoLEP simulator to reduce this learning curve and provide training. We have developed a nonbiohazardous HoLEP simulator using modern education theory and validated it in a multicenter study.

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Holmium laser enucleation of the prostate (HoLEP) is routinely performed with a 24F, 26F, or a 28F scope. Proponents of the larger scopes propose that a bigger sheath size allows for superior flow and visibility leading to a more efficient operation and better hemostasis. Those utilizing the smaller scopes suggest that the smaller sheath is less traumatic, resulting in lower stricture rates and temporary incontinence.

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The American Urological Association guidelines state that continuing anticoagulant (AC) and antiplatelet (AP) agents during ureteroscopy (URS) is safe. Through a multi-institutional retrospective study, we sought to determine whether pre-stenting in patients on AP or AC was associated with fewer URS bleeding-related complications. A series of 8614 URS procedures performed across three institutions (April 2010 to September 2017) was electronically reviewed for AC/AP use at time of URS.

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Purpose: To identify expert laser settings for BPH treatment and evaluate the application of preventive measures to reduce complications.

Methods: A survey was conducted after narrative literature research to identify relevant questions regarding laser use for BPH treatment (59 questions). Experts were asked for laser settings during specific clinical scenarios.

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Article Synopsis
  • Holmium laser enucleation of the prostate (HoLEP) has proven advantages for treating benign prostatic hyperplasia (BPH), but its adoption in Medicare and similar populations remains low despite advancements allowing for same-day discharge.
  • A study analyzing data from the Nationwide Ambulatory Surgery Sample (NASS) from 2016 to 2019 revealed a 20% overall drop in BPH surgeries, yet HoLEP's usage increased from 4.7% to 8.3% of total surgeries, becoming the second most common procedure.
  • The increase in HoLEP procedures was notably seen in the South and Midwest regions, highlighting a growing acceptance of this technique even as the total number of BPH surgeries
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Introduction: Prostatic urethral lift (PUL) accounts for approximately one-quarter of all surgical benign prostatic hyperplasia (BPH) procedures performed in the U.S. Within five years of a patient's PUL procedure, approximately 1/7 patients will require surgical BPH retreatment.

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Purpose Of Review: We aimed to examine the role of low-dose CT (LDCT) in the diagnostic work-up for suspected urolithiasis in pregnancy. We reviewed contemporary urologic recommendations for CT in pregnancy, its utilization for suspected urolithiasis, and explored barriers to its use.

Recent Findings: National urologic guidelines and the American College of Obstetricians and Gynecologists recommend the judicious use of LDCT imaging in pregnancy when necessary.

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Article Synopsis
  • * This research analyzed data from two multicenter studies, focusing on PCNL patients and assessing clinical signs within the first day after surgery.
  • * Results showed both qSOFA and SIRS had 100% sensitivity, but qSOFA demonstrated higher specificity (90.8%) versus SIRS (72.4%) for predicting ICU admissions for vasopressor support.
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Purpose: Ureteral stone impaction is associated with unfavorable endourological outcomes; however, reliable predictors of stone impaction are limited. We aimed to assess the performance of ureteral wall thickness on noncontrast computed tomography as a predictor of ureteral stone impaction and failure rates of spontaneous stone passage, shock wave lithotripsy, and retrograde guidewire and stent passage.

Materials And Methods: This study was completed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines.

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