Publications by authors named "Hemal A"

: The incidence of urinary tract infections (UTIs) after radical cystectomy (RC) with urinary diversion (UD), the typical pathogens, and associated patient risk factors have not been well documented. In this study, we examined the incidence of post-op UTIs after RC to identify associated risk factors. : Single-center, retrospective case series of 386 patients with bladder cancer who underwent RC with UD between 2012 and 2024.

View Article and Find Full Text PDF
Article Synopsis
  • Single-port (SP) robotic surgery is being compared to multi-port (MP) surgery to assess their effectiveness in robotic radical nephrectomy (RN), focusing on various outcomes like surgery time and recovery.* -
  • In a study of 341 patients, the SP group (14% of the total) had smaller tumors and longer operative times compared to the MP group but similar overall safety and recovery metrics.* -
  • SP robotic surgery may lead to shorter hospital stays and smaller incisions, despite longer surgery times, illustrating its potential benefits while maintaining safety comparable to MP methods.*
View Article and Find Full Text PDF

Introduction: Myeloid sarcoma (MS) is a tumor containing myeloid blasts, with or without maturation, involving any anatomical site other than the bone marrow. It can occur de novo or following a hematological malignancy.

Case: We report a 6-year-old female who presented with fever and a rapidly enlarging left thigh mass.

View Article and Find Full Text PDF
Article Synopsis
  • In 2012, the USPSTF classified PSA screening for prostate cancer as "category D," leading to a study on the effects of this change on metastatic prostate cancer (mPCa) diagnoses among different racial, ethnic, and socioeconomic groups.
  • The study used data from 2004 to 2017 and found that post-recommendation, there was an increase in mPCa cases at diagnosis, especially among Hispanics and non-Hispanic Blacks.
  • Factors like insurance status and household income significantly influenced the likelihood of presenting with mPCa, with uninsured minorities facing higher risks and low-income non-Hispanic Blacks showing increased rates of diagnosis.
View Article and Find Full Text PDF
Article Synopsis
  • - The study aimed to determine how serum hepcidin levels change and how these changes relate to hemoglobin levels in children with iron deficiency anemia during the first two weeks of oral iron therapy.
  • - Researchers observed 64 children aged 2-12 years with a starting average hemoglobin of 8.81 g/dL, finding that serum hepcidin levels significantly increased from 7.81 ng/mL at the start to 9.51 ng/mL by day 14 of treatment.
  • - Despite the rise in hepcidin levels, no significant correlation was found between the initial hepcidin levels and changes in hemoglobin after one or two weeks of therapy, suggesting that hepcidin may not be a
View Article and Find Full Text PDF

Objective: To assess if receiving sequential intravesical chemotherapy (Gemcitabine-Docetaxel, Gem-Doce) therapy was associated with similar oncologic efficacy to bacillus Calmette-Guérin (BCG) in patients with treatment-naïve, high-risk non-muscle invasive bladder cancer (HR-NMIBC).

Methods: Single-center, retrospective cohort study of 80 patients with HR-NMIBC initiating first-line Gem-Doce or BCG between August 2020 and August 2023. Surveillance was conducted with cystoscopy, urine cytology, and cross-sectional imaging.

View Article and Find Full Text PDF

To assess the oncologic efficacy and safety of robot-assisted approach to radical nephroureterectomy (RARNU) in geriatric versus younger patients with upper tract urothelial carcinoma (UTUC). A single-center, retrospective cohort study was conducted from 2009 to 2022 of 145 patients (two cohorts: < 75 and ≥ 75 years old) with non-metastatic UTUC who underwent RARNU. Primary endpoint was UTUC-related recurrence of disease during surveillance (bladder-specific and metastatic).

View Article and Find Full Text PDF
Article Synopsis
  • Upper tract urothelial carcinoma (UTUC) is difficult to diagnose and treat, but advances in robotic surgery have improved procedures like robot-assisted radical nephroureterectomy with bladder cuff excision (RNU/BCE) and lymph node removal.
  • The review focuses on refining this surgical technique, based on over 150 cases and 12 years of experience using da Vinci robotic systems.
  • The findings suggest that RNU/BCE and related procedures are effective and standardized, making them suitable even for elderly patients with health issues, and can be easily adopted by urologists skilled in robotic surgeries.
View Article and Find Full Text PDF

Background And Objective: Salvage robot assisted radical prostatectomy (sRARP) is performed for patients with biochemical or biopsy proven, localized prostate cancer recurrences after radiation or ablative therapies. Traditionally, sRARP has been avoided by lower volume surgeons due to technical demand and high complication rates. Post-radiation sRARP outcomes studies exist but remain few in number.

View Article and Find Full Text PDF

To evaluate the safety and feasibility of continued perioperative aspirin at the time of robotic assisted simple prostatectomy (RASP). We performed a retrospective review of our IRB approved institutional database of patients who underwent RASP between 2013 and 2022. Comparative groups included patients taking aspirin in the perioperative period and those not taking aspirin pre-operatively.

View Article and Find Full Text PDF

Background: Some patients with end stage renal disease are or will become narcotic-dependent. Chronic narcotic use is associated with increased graft loss and mortality following kidney transplantation. We aimed to compare the efficacy of continuous flow local anesthetic wound infusion pumps (CFLAP) with patient controlled analgesia pumps (PCA) in reducing inpatient narcotic consumption in patients undergoing kidney transplantation.

View Article and Find Full Text PDF

Background And Objective: Upper tract urothelial carcinoma (UTUC) is a relatively rare malignancy and radical nephroureterectomy (RNU) with bladder cuff excision (BCE) is considered as the standard of care for high-risk non-metastatic disease. Loss of the renal unit secondary to RNU, especially in elderly patients, causes significant decline in overall renal function which in turn negatively impacts the overall survival (OS). Such radical surgeries can be spared in a select group of the patients with segmental ureterectomy (SU) or distal ureterectomy to salvage the ipsilateral kidney.

View Article and Find Full Text PDF

Radical nephroureterectomy remains the gold standard treatment for high-risk upper tract urothelial carcinoma. The procedure is subdivided into six main steps: nephrectomy, ureterectomy, bladder cuff excision, cystorrhaphy, template-based lymph node dissection, and perioperative instillation of chemotherapy. Crucial in performing radical nephroureterectomy is successful management of the distal ureter and bladder cuff.

View Article and Find Full Text PDF

Objective: We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre- and peri-operative variables associated with length of stay (LOS) greater than 3 days and readmission within 30 days.

Methods: Records from 2008 to 2018 for "laparoscopy, surgical; partial nephrectomy" for prolonged LOS and readmission cohorts were compiled. Univariate analysis with Chi-square, -tests, and multivariable logistic regression analysis with odds ratios (ORs), -values, and 95% confidence intervals assessed statistical associations.

View Article and Find Full Text PDF

Ileal conduit (IC) is the most performed urinary diversion after radical cystectomy (RC) for urothelial carcinoma (UC) of the bladder. While UC recurrence after RC is well-described, recurrence of UC within a urinary diversion is much less prevalent, and thus, management of these lesions is not well understood. Here, we report the case of a 59-year-old male with a history of invasive UC with glandular differentiation of the urinary bladder who had carcinoma in situ recurrence after induction, intravesical Bacille Calmette-Guerin therapy.

View Article and Find Full Text PDF

Purpose: To calculate the frequency of infection and acute urinary retention (AUR) following transperineal (TP) prostate biopsy at a single high-volume academic institution and determine risk factors for developing these post-biopsy conditions.

Methods: Men undergoing TP prostate biopsy from 2012 to 2022 at our institution were retrospectively identified and chart reviewed. TP biopsies were performed with TR ultrasound (TRUS) guidance with anesthesia using a brachytherapy grid template.

View Article and Find Full Text PDF

To compare racial differences and pelvis dimensions between Caucasians and African Americans (AAs) and to develop a risk calculator and scoring system to predict the risk of prolonged operative time and presence of positive surgical margins (PSM) based on these dimensions. A retrospective review of 88 consecutive patients undergoing robot-assisted laparoscopic prostatectomy with a preoperative prostate MRI conducted. Data extraction included demographic, perioperative, and postoperative oncologic outcomes.

View Article and Find Full Text PDF

Background And Objective: Radical nephroureterectomy (RNU) represents the gold standard treatment for non-metastatic upper tract urothelial cancer. We sought to provide a comprehensive review of reported oncologic outcomes of the RNU procedure and of factors that might impact these outcomes.

Methods: A non-systematic review of the literature was conducted by performing an electronic literature search using PubMed with "radical nephroureterectomy" and "oncologic outcomes" as free text search terms.

View Article and Find Full Text PDF

Introduction: There is an ongoing debate as to the appropriate regimen of antibiotic prophylaxis with transperineal (TP) biopsy. The objective of this study was to report the rate of infection following TP biopsy at a high-volume institution and assess the impact of single dose antibiotics at the time of biopsy versus outpatient antibiotics in preventing postprocedural infections.

Materials And Methods: Records of men undergoing TP prostate biopsy from 2012 to 2022 were reviewed.

View Article and Find Full Text PDF
Article Synopsis
  • Nephron sparing surgery (NSS) is increasingly used for larger and more complex renal tumors, focusing on achieving optimal patient outcomes known as the "pentafecta."
  • Recent technological advances, such as improved imaging techniques, augmented reality, and novel fluorescence-guided imaging, have enhanced pre-, intra-, and post-operative management in patients undergoing partial nephrectomy.
  • A literature review from 2010 to 2022 underscores a shift in surgical approaches and educational tools, emphasizing the importance of advanced imaging in surgical precision and patient care.
View Article and Find Full Text PDF

We aim to compare transperitoneal (TP) and retroperitoneal (RP) robotic partial nephrectomy (RPN) in obese patients. Obesity and RP fat can complicate RPN, especially in the RP approach where working space is limited. Using a multi-institutional database, we analyzed 468 obese patients undergoing RPN for a renal mass (86 [18.

View Article and Find Full Text PDF

Introduction: Highly complex renal masses pose a challenge to urologic surgeons' ability to perform robotic partial nephrectomy (RPN). Given the increased utilization of the robotic approach for small renal masses, we sought to characterize the outcomes and determine the safety and feasibility of RPN for complex renal masses from our large multi-institutional cohort.

Methods: We performed a retrospective analysis of patients with R.

View Article and Find Full Text PDF