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Santucci R.,Building Detroit | Chen M.,University of Pittsburgh
Current Bladder Dysfunction Reports | Year: 2013

Female urethral stricture disease is very rare, but can cause bothersome urinary tract symptoms. Because of rarity, knowledge of how to treat true female urethral strictures can be lacking. Strictures can be caused by infection, trauma, instrumentation, or prior urethral surgery. Treatment options vary depending on patient goals and overall health, as well as the location, length, and severity of the stricture. These include serial dilation, internal urethrotomy, or urethroplasty. Local vaginal flaps and buccal free grafts can be used for onlay urethroplasty with good success rates, although many other techniques are described. Pelvic fracture urethral distraction defects (PFUDs) in women are especially rare. Acutely, they may require urgent repair with primary anastomosis (in contradistinction to male PFUDs which are not reanastomosed acutely), and chronic cases may require urethroplasty. © 2013 Springer Science+Business Media New York.


Littrup P.J.,Building Detroit | Bang H.J.,Wayne State University | Currier B.P.,St. George's University | Goodrich D.J.,Building Detroit | And 3 more authors.
Journal of Vascular and Interventional Radiology | Year: 2013

Purpose To assess whether diverse tumor location(s) show differences in percutaneous cryoablation (PCA) outcomes of cancer control, morbidity, and ablation volume reduction for many soft-tissue tumor types. Materials and Methods A total of 220 computed tomography (CT)- and/or ultrasonography-guided percutaneous cryotherapy procedures were performed for 251 oligometastatic tumors from multiple primary cancers in 126 patients. Tumor location was grouped according to regional sites: retroperitoneal, superficial, intraperitoneal, bone, and head and neck. PCA complications were graded according to Common Terminology Criteria for Adverse Events (version 4.0). Local tumor recurrence and involution were calculated from ablation zone measurements, grouped into 1-, 3-, 6-, 12-, 18-, and 24-month (or later) statistical bins. Results Tumor and procedure numbers for each site were 75 and 69 retroperitoneal, 76 and 62 superficial, 39 and 32 intraperitoneal, 34 and 34 bone, and 27 and 26 head and neck. Average diameters of tumor and visible ice during ablation were 3.4 and 5.5 cm, respectively. Major complications (ie, grade >3) attributable to PCA occurred after five procedures (2.3%). At 11 months average follow-up (range, 0-82 mo), a 10% total recurrence rate (26 of 251) was noted; three occurred within the ablation zone, for a local progression rate of 1.2%. Average time to recurrence was 4.9 months, and, at 21 months, the initial ablation zone had reduced in volume by 93%. Conclusions CT-guided PCA is a broadly safe, effective local cancer control option for oligometastatic disease with soft-tissue tumors in most anatomic sites. Other than bowel and nerve proximity, PCA also shows good healing if proper visualization and precautions are followed. © 2013 SIR.


Lamont R.F.,Perinatology Research Branch | Lamont R.F.,Building Detroit | Sobel J.D.,Wayne State University | Akins R.A.,Wayne State University | And 5 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2011

Vaginal microbiome studies provide information that may change the way we define vaginal flora. Normal flora appears dominated by one or two species of Lactobacillus. Significant numbers of healthy women lack appreciable numbers of vaginal lactobacilli. Bacterial vaginosis (BV) is not a single entity, but instead consists of different bacterial communities or profiles of greater microbial diversity than is evident from cultivation-dependent studies. BV should be considered a syndrome of variable composition that results in different symptoms, phenotypical outcomes, and responses to different antibiotic regimens. This information may help to elucidate the link between BV and infection-related adverse outcomes of pregnancy. Journal compilation © RCOG 2011 BJOG An International Journal of Obstetrics and Gynaecology.


Santucci R.A.,Building Detroit | Bartley J.M.,Botsford Hospital
Nature Reviews Urology | Year: 2010

Trauma is the leading cause of death between the ages of 1 and 44 years in the USA. While stabilization of life-threatening injuries is the primary goal in the evaluation of all trauma patients, subsequent diagnosis and treatment of secondary injuries are requirements for good trauma care. The genitourinary system is involved in 10% of trauma cases, and these injuries can be associated with considerable morbidity and mortality. Accordingly, physicians involved in the initial evaluation and subsequent management of trauma patients should be aware of the diagnosis and treatment of injuries that can occur in the genitourinary system. In 2009, the European Association of Urology provided specific recommendations for the evaluation, diagnosis and management of genitourinary trauma. Here, we review and discuss these recommendations in order to provide a concise summary for clinicians involved in the evaluation and management of trauma patients and their associated genitourinary injuries. © 2010 Macmillan Publishers Limited. All rights reserved.


Bridges T.S.,U.S. Army | Nadeau S.C.,Building Detroit | Mcculloch M.C.,Building Detroit
Integrated Environmental Assessment and Management | Year: 2012

Contaminated sediments are a pervasive problem in the United States. Significant economic, ecological, and social issues are intertwined in addressing the nation's contaminated sediment problem. Managing contaminated sediments has become increasingly resource intensive, with some investigations costing tens of millions of dollarsand the majority of remediation projects proceeding at a slow pace. At present, the approaches typically used toinvestigate, evaluate, and remediate contaminated sediment sites in the United States have largely fallen short of producing timely, risk-based, cost-effective, longterm solutions. With the purpose of identifying opportunities for accelerating progress at contaminated sediment sites, the US Army Corps of Engineers-Engineer Research and Development Center and the Sediment ManagementWork Group convened a workshop with experienced experts from government, industry, consulting, and academia. Workshop participants identified 5 actions that, if implemented, would accelerate the progress and increase the effectiveness of risk management at contaminated sediment sites. These actions included: 1) development of a detailed and explicit project vision and accompanying objectives, achievable short-term and long-term goals, and metrics of remedy success at the outset of a project, with refinement occurring as needed throughout the duration of the project; 2) strategic engagement of stakeholders in a more direct and meaningful process; 3) optimization of risk reduction, risk management processes, and remedy selection addressing 2 important elements: a) the deliberate use of early action remedies, where appropriate, to accelerate risk reduction; and b) the systematic and sequential development of a suite of actions applicable to the ultimate remedy, starting with monitored natural recovery and adding engineering actions as needed to satisfy the project's objectives; 4) an incentive process that encourages and rewards risk reduction; and 5) pursuit of sediment remediation projects as a public-private collaborative enterprise. These 5 actions provide a clear path for connecting current US regulatory guidance to improved practices that produce better applications of science and risk management and more effective and efficient solutions at contaminated sediment sites. Integr Environ Assess Manag 2012;8:331-338. © 2011 SETAC.


Burks F.N.,William Beaumont Hospital | Santucci R.A.,Building Detroit
Nature Reviews Urology | Year: 2010

Although straightforward male urethral stricture disease is commonly encountered in the scope of general urologic practice, complex urethral strictures are less common and require a more systematic approach. Complex urethral stricture surgery for long and panurethral strictures, after failed hypospadias repair, and for recurrent posterior urethral distraction defects requires a dynamic treatment paradigm. A multistaged urethral reconstruction is often necessary owing to hostile urethral tissue, especially after multiple previous procedures. A perineal urethrostomy sometimes offers improved quality of life for patients with complex urethral stricture disease, particularly if they have undergone previous failed repairs. Recurrent posterior urethral distraction defects are best treated with excision of the scarred urethral segment and re-anastomosis. Urethral stricture disease after treatment for prostate cancer requires multiple treatment approaches given the often poor tissue quality and likelihood of stricture recurrence. © 2010 Macmillan Publishers Limited. All rights reserved.


Edelman D.A.,Building Detroit | Mattos M.A.,Building Detroit | Bouwman D.L.,Building Detroit
Journal of Surgical Research | Year: 2010

Background: Fundamentals of Laparoscopic Surgery (FLS) certification is reliable and valid; the American Board of Surgery requires FLS certification. Dynamics of skill retention after FLS training effect training schedules for residents. We hypothesized that the initial elevation of performance levels after FLS training would deteriorate predictably with time. Methods: FLS performance data on 16 new surgical residents (R01s) was examined retrospectively. These R01s trained at 16 weekly sessions. Training included 4 FLS tasks, VR simulator tasks, and open surgical skills. FLS skills were practiced weekly with feedback but no instruction. Performance was tested PRE, POST, and DELAY. Outcome metrics were task completion times (TCTs). Results: POST TCTs were below PRE TCTs in all R01s for all FLS tasks (P < 0.05). No difference was seen between the DELAY TCT and POST TCT for peg transfer (P = 0.726) and pattern cut (P = 0.114). The DELAY TCTs were longer than POST TCTs for extra- and intra corporeal knot-tying (P < 0.0001 and P = 0.029). Relative retention was 103% for peg transfer, 85% for pattern cut, 47% for extracorporeal knot tying, and 59% for intracorporeal knot tying. However, many individual's displayed DELAY TCT equal to or lower than POST TCT implying full retention. Conclusions: This study extends the data on FLS skill retention to an actual "production" training curriculum. This FLS training provided effective learning in R01s. Although performance levels fell across these tasks on average and for the majority of individual R01s, significant skill retention remained at 7-8 months. Early training will enable R01s to maintain or elevate skill levels with additional training sessions. © 2010 Elsevier Inc. All rights reserved.


The 2015 William H. Harridge lecture of the 2015 Midwest Surgical Association concentrated on the evolution and performance characteristics of nonoperative management of even severe renal injury. One of the first mentions of nonoperative renal trauma occurs after World War II. Since that time through the early 2000s, only 1 or fewer papers per year appeared in the literature. The mid-2000s had an explosion of interest and publications on the subject, resulting in our modern understanding of the principles. The principles of nonoperative management are as follows: (1) operate immediately if the patient is bleeding to death; (2) observe initially, but step in with metered responses as necessary; (3) use ureteral stents for symptomatic or growing urinoma; (4) use angioembolization for nonemergent bleeding or for urgent bleeding if your center can manage this; and (5) do open surgery when needed (not "never"). © 2016 Elsevier Inc. All rights reserved.


Ford J.,Building Detroit | Hanna M.,Michigan State University | Boston A.,Building Detroit | Berri R.,Building Detroit
American Journal of Surgery | Year: 2016

Background Patients who undergo cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) can return to an acceptable performance status (PS) and quality of life 3 months postoperative. Methods An HIPEC specific questionnaire was developed based on the validated Functional Assessment of Cancer Therapy Questionnaire. Each patient was contacted and questionnaire completed. An averaged score was calculated and stratified to an Eastern Cooperative Oncology Group PS. A retrospective chart review gathered patient characteristics and correlated to the patient's 3 months postoperative PS. Results Between October 2011 and July 2014, 43 patients underwent complete CRS with HIPEC. The most common indications for surgery were colorectal (35%) and appendiceal malignancy (47%). Average scores were: physical well-being 15.4 of 20, social well-being 17.5 of 20, recovery 15 of 20, mental well-being 13.4 of 20, and functional well-being 18.1 of 24. These correlated to an Eastern Cooperative Oncology Group PS of 1, 0, 1, 1, and 1. Patient's age (P =.235), operative length (P =.181), hospital duration (P =.43), complications or peritoneal carcinomatosis index (P =.815) demonstrated no significance relative to postoperative PS. Conclusions Patients can recovery well from CRS with HIPEC. It is possible to return to an acceptable functional status within 3 months postoperative. Age, operative time, length of hospital stay, or peritoneal carcinomatosis index have no prohibitive effects on a long-term recovery. © 2016 Elsevier Inc. All rights reserved.


Crane C.,Building Detroit | Santucci R.A.,Building Detroit
Archivos Espanoles de Urologia | Year: 2011

Approximately 4-14% pelvic fractures cause a posterior urethral injury. Pelvic fractures associated with straddle injuries or large trauma accidents are more frequently involved with this kind of lesions. Primary open repair of the urethral injury is discouraged in the acute setting. 3-6 months after urinary diversion a formal open reconstruction can be safely attempted. This gives time for scar maturation, reabsorption of pelvic hematomas, and relative restoration of anatomical fascial layers. The complexity of such interventions can be minimized following proper diagnostic and surgical protocols. Anastomotic urethroplasty under the precepts of the progressive perineal approach provides an excellent treatment option for these patients. The aim of this paper is the detailed description of the procedure for the treatment of such injuries.

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