Taha A. Abdel-Meguid^1,2, Hisham A. Mosli¹, Hasan Farsi¹, Ahmad Alsayyad¹, Abdulmalik Tayib¹, Moataz Sait¹, Ahmad Abdelsalam^1,3

Canadian Journal of Urology, Vol.25, No.2, pp. 9273-9280, 2018

Abstract Introduction: To evaluate the efficacy and safety of intraprostatic injections of onabotulinumtoxinA (onaBoNT-A) to treat refractory chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).
Materials and methods: Prospective two-group controlled study. Treatment group included adult men with refractory category-III nonbacterial CP/CPPS who underwent transurethral intraprostatic injections of onaBoNT-A (200 U). Control group included comparable patients who underwent cystoscopy only. Primary outcome was the proportion of 6-point responders (≥ 6 points reduction of total score of National Institutes of Health-Chronic Prostatitis Symptom Index [NIH-CPSI]) at 3 months. Secondary outcomes included proportions of quality of life (QoL) responders (≤ 2 points… More >

Austin J. Lee¹, Jonathan G. Yabes², Nathan Hale³, Ronald L. Hrebinko³, Jeffrey R. Gingrich³, Jodi K. Maranchie³, Mina M. Fam³, Robert M. Turner II³, Benjamin J. Davies³, Bruce Ben-David⁴, Bruce L. Jacobs³

Canadian Journal of Urology, Vol.25, No.2, pp. 9255-9261, 2018

Abstract Introduction: Multimodal analgesia is an effective strategy for managing postoperative pain and reducing opioid dependence. The quadratus lumborum block (QLB) and paravertebral block (PVB) are two regional anesthesia techniques that enhance multimodal pain management. In this study, we aimed to compare the efficacy of these two approaches in patients undergoing radical cystectomy. Materials and methods: A retrospective review was conducted on patients who underwent radical cystectomy between 2014 and 2016. Patients were divided into two groups based on the type of regional anesthesia received: bilateral continuous paravertebral blocks (n = 125) or bilateral single-shot quadratus lumborum blocks… More >

Alice Crane, Jessica Lloyd, Daniel A. Shoskes

Canadian Journal of Urology, Vol.25, No.2, pp. 9250-9254, 2018

Abstract Introduction: The UPOINT phenotyping system has proven effective in classifying patients with urologic pelvic pain syndromes in a clinically meaningful way and guiding multimodal therapy. While highly successful in men with chronic prostatitis/chronic pelvic pain syndrome (CPPS), its utility is more limited in patients with interstitial cystitis/painful bladder syndrome (IC/PBS). This is because all IC/PBS patients, by definition, exhibit urinary and organ-specific symptoms. Furthermore, the AUA guidelines recommend a sequential tiered approach to treatment rather than the concurrent multimodal strategy used in UPOINT. Therefore, we aimed to modify the UPOINT system to make it more practical… More >

Karen M. Doersch¹, G. Luke Machen², Kim H. Thai², John Sung², Marawan M. El Tayeb²

Canadian Journal of Urology, Vol.25, No.6, pp. 9596-9600, 2018

Abstract Introduction: Stent placement is a common procedure for addressing obstructive uropathy. However, lack of operating room (OR) availability can substantially delay this procedure. In this study, we sought to assess the feasibility, safety, and efficacy of this procedure in a clinical setting using nitrous oxide (N₂O) and local anesthesia.
Materials and methods: Patients included in this study included those who were determined to need management of urinary obstruction with a JJ (“double J”) stent and had their procedure performed in the clinic procedure suite with N₂O anesthesia.
Results: We present a case series of 565 patients undergoing ureteral stent… More >

Soham Dasgupta¹, Megan Stark², Sonal Bhatt³, Peter Fischbach¹, Shriprasad Deshpande¹

Congenital Heart Disease, Vol.13, No.6, pp. 1058-1063, 2018, DOI:10.1111/chd.12681

Abstract Introduction: A cardiac cause is an extremely rare etiology of pediatric chest pain. Despite its low sensitivity/specificity, exercise stress testing (EST) is widely used to determine the prognosis in patients with suspected/established coronary disease. We aimed to look at the utility of a combined cardiopulmonary EST in the evaluation of pediatric patients with chest pain.
Methods: After institutional review board approval, a retrospective chart review was performed of all pediatric patients who were referred for an EST for chest pain from January 2014 to 2017. Patients with incomplete records, severe congenital heart disease, and a prior EST… More >

Susan F. Saleeb¹, Sarah R. McLaughlin², Dionne A. Graham², Kevin G. Friedman¹, David R. Fulton¹

Congenital Heart Disease, Vol.13, No.1, pp. 46-51, 2018, DOI:10.1111/chd.12539

Abstract Objective: Using a Standardized Clinical Assessment and Management Plan (SCAMP) for pediatric patients presenting to clinic with chest pain, we evaluated the cost impact associated with implementation of the care algorithm. Prior to introduction of the SCAMP, we analyzed charges for 406 patients with chest pain, seen in 2009, and predicted 21% reduction of overall charges had the SCAMP methodology been used. The SCAMP recommended an echocardiogram for history, examination, or ECG findings suggestive of a cardiac etiology for chest pain.
Design: Resource utilization was reviewed for 1517 patients (7-21 years) enrolled in the SCAMP from July… More >

Adam J. Rensing¹, Anand Mohapatra¹, Aaron M. Potretzke¹, Jennifer K. Sehn², Robert S. Figenshau¹

Canadian Journal of Urology, Vol.24, No.1, pp. 8673-8675, 2017

Abstract Lymphoepithelioma-like carcinoma (LELC) is a rare finding in the upper urinary tract. The presenting clinical findings mimic those of other more common upper-tract tumors, such as urothelial carcinoma. Preoperative imaging has not been shown to reliably predict the diagnosis of LELC. This tumor can be misdiagnosed as a reactive inflammatory lesion or lymphoma if the proper immunohistochemical stains for cytokeratin are not used. More >

Nazih Khater, Mohamed Keheila, Michelle Lightfoot, Jim Shen, Samuel Abourbih, Muhannad Alsyouf, Roger Li, D. Duane Baldwin

Canadian Journal of Urology, Vol.24, No.1, pp. 8634-8640, 2017

Abstract Introduction: Percutaneous nephrolithotomy (PCNL) is associated with significant variability in postoperative pain and subsequent narcotic use. The purpose of this study was to determine the factors associated with high narcotic use following PCNL.
Materials and methods: A single-center retrospective review of patients undergoing initial PCNL between 2004 and 2014 was performed. Preoperative, intraoperative and postoperative factors associated with postoperative narcotic usage were analyzed. The primary outcome variable was mean narcotic usage, standardized to intravenous morphine-equivalents. Patients in the lowest 75th percentile were compared to those in the highest 25th percentile. Univariate and multivariate statistical analyses were performed, with… More >

James Furr¹, Ryan Baker¹, Quy Pham¹, Puneet Sindhwani²

Canadian Journal of Urology, Vol.24, No.2, pp. 8744-8748, 2017

Abstract Introduction: Advances in vasectomy technique have minimized patient discomfort; however fear of pain remains a primary concern. The objective is to determine how the anticipation of pain associated with vasectomy compares with patient's actual intraoperative experienced pain levels.
Materials and methods: A cohort of patients undergoing clinic vasectomy was analyzed. Using visual analog pain scale patients were asked to rate their anticipated pain score (APS) pre-procedure and then an experienced pain score (EPS) post-procedure. Patients were also stratified by APS scores (high versus low). Changes in pain score were compared across these groups. Pain scores stratified by… More >

Ram A. Pathak¹, David D. Thiel¹, Alexander Parker², Michael G. Heckman³, Julia E. Crook³, Nancy N. Diehl³, Andrea Tavlarides², Scott W. Alford¹, Todd C. Igel¹

Canadian Journal of Urology, Vol.24, No.3, pp. 8795-8801, 2017

Abstract Introduction: To compare visual analog scale (VAS) pain scores between patients with a 2-minute versus 10-minute delay of peri-prostatic lidocaine injection prior to transrectal ultrasound-guided prostate biopsies (TRUS-bx).
Materials and methods: Eighty patients who underwent standard 12-core TRUS-bx by a single surgeon were prospectively randomized into four different treatment arms: bibasilar injection with a 2-minute delay, bibasilar injection plus a single apical injection with a 2-minute delay, bibasilar injection with a 10-minute delay, and bibasilar injection plus a single apical injection with a 10-minute delay. Patients were asked to report their level of pain on the VAS… More >