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Satya Narayan Sankhwar - One of the best experts on this subject based on the ideXlab platform.
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Use of holmium:YAG laser in posterior urethral valves: another method of Fulguration.
Journal of pediatric urology, 2013Co-Authors: Swarnendu Mandal, Apul Goel, Manoj Kumar, Manish Kumar Singh, Vishwajeet Singh, Satya Narayan Sankhwar, Bhupender P. Singh, Divakar DalelaAbstract:To evaluate the use of holmium:YAG laser for posterior urethral valve (PUV) Fulguration and compare with electro-Fulguration. Forty boys underwent primary Fulguration of PUV using 20-25 W holmium laser (Group 1) from January 2009 to December 2011. Data of last 40 boys (retrospective cohort: January 2005 to December 2008) who underwent electro-Fulguration (Group 2) for PUV were compared with group 1. Ultrasonography was done at 2 weeks and 3 months and voiding cystourethrography at 3 and 6 months respectively after Fulguration and as needed thereafter. DTPA scan and urodynamic study were performed during follow-up in select patients, as required. Pre-operative parameters were comparable between groups. Improvement in voiding occurred in 38 and 34 boys in group 1 and 2, respectively. Hydroureteronephrosis and vesico-ureteric reflux resolved in 53% and 60% in group 1 and 51% and 53% in group 2, respectively. Boys in group 1 had statistically significant greater success in voiding after catheter removal (40 vs 32), shorter period of catheterization (1 vs 1.8 days), lower mean operative time (15 vs 20 min), needed re-Fulguration less commonly (2 vs 6), and were less likely to develop urethral stricture (0 vs 2) and urinary incontinence (0 vs 1). PUV Fulguration using holmium:YAG laser is a feasible, safe and effective alternative for endoscopic transurethral ablation with similar success, and appears to have fewer complications than electro-Fulguration. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
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Use of holmium:YAG laser in posterior urethral valves: Another method of Fulguration
Journal of Pediatric Urology, 2013Co-Authors: Swarnendu Mandal, Apul Goel, Manoj Kumar, Manish Kumar Singh, Vishwajeet Singh, Satya Narayan Sankhwar, Bhupender P. Singh, Divakar DalelaAbstract:Abstract Objective To evaluate the use of holmium:YAG laser for posterior urethral valve (PUV) Fulguration and compare with electro-Fulguration. Methods Forty boys underwent primary Fulguration of PUV using 20–25 W holmium laser (Group 1) from January 2009 to December 2011. Data of last 40 boys (retrospective cohort: January 2005 to December 2008) who underwent electro-Fulguration (Group 2) for PUV were compared with group 1. Ultrasonography was done at 2 weeks and 3 months and voiding cystourethrography at 3 and 6 months respectively after Fulguration and as needed thereafter. DTPA scan and urodynamic study were performed during follow-up in select patients, as required. Results Pre-operative parameters were comparable between groups. Improvement in voiding occurred in 38 and 34 boys in group 1 and 2, respectively. Hydroureteronephrosis and vesico-ureteric reflux resolved in 53% and 60% in group 1 and 51% and 53% in group 2, respectively. Boys in group 1 had statistically significant greater success in voiding after catheter removal (40 vs 32), shorter period of catheterization (1 vs 1.8 days), lower mean operative time (15 vs 20 min), needed re-Fulguration less commonly (2 vs 6), and were less likely to develop urethral stricture (0 vs 2) and urinary incontinence (0 vs 1). Conclusion PUV Fulguration using holmium:YAG laser is a feasible, safe and effective alternative for endoscopic transurethral ablation with similar success, and appears to have fewer complications than electro-Fulguration.
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bladder neck contracture after antegrade Fulguration of posterior urethral valves unusual long term complication
Urology, 2009Co-Authors: Rahul Janak Sinha, Vishwajeet Singh, Divakar Dalela, Satya Narayan SankhwarAbstract:Bladder neck contracture after antegrade Fulguration of posterior urethral valves has not been reported in English studies to date to the best of our knowledge. A couple of reports have mentioned late-onset bladder neck contracture after retrograde valve Fulguration. The present case report describes an unusual complication of bladder neck contracture that occurred long after antegrade Fulguration of posterior urethral valves, which was done at an early age. This case report also discusses the possible mechanisms of bladder neck contracture, its management in brief, and highlights the importance of long-term follow-up of these patients.
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Bladder Neck Contracture After Antegrade Fulguration of Posterior Urethral Valves—Unusual Long-term Complication
Urology, 2009Co-Authors: Rahul Janak Sinha, Vishwajeet Singh, Divakar Dalela, Satya Narayan SankhwarAbstract:Bladder neck contracture after antegrade Fulguration of posterior urethral valves has not been reported in English studies to date to the best of our knowledge. A couple of reports have mentioned late-onset bladder neck contracture after retrograde valve Fulguration. The present case report describes an unusual complication of bladder neck contracture that occurred long after antegrade Fulguration of posterior urethral valves, which was done at an early age. This case report also discusses the possible mechanisms of bladder neck contracture, its management in brief, and highlights the importance of long-term follow-up of these patients.
Rahul Janak Sinha - One of the best experts on this subject based on the ideXlab platform.
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bladder neck contracture after antegrade Fulguration of posterior urethral valves unusual long term complication
Urology, 2009Co-Authors: Rahul Janak Sinha, Vishwajeet Singh, Divakar Dalela, Satya Narayan SankhwarAbstract:Bladder neck contracture after antegrade Fulguration of posterior urethral valves has not been reported in English studies to date to the best of our knowledge. A couple of reports have mentioned late-onset bladder neck contracture after retrograde valve Fulguration. The present case report describes an unusual complication of bladder neck contracture that occurred long after antegrade Fulguration of posterior urethral valves, which was done at an early age. This case report also discusses the possible mechanisms of bladder neck contracture, its management in brief, and highlights the importance of long-term follow-up of these patients.
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Bladder Neck Contracture After Antegrade Fulguration of Posterior Urethral Valves—Unusual Long-term Complication
Urology, 2009Co-Authors: Rahul Janak Sinha, Vishwajeet Singh, Divakar Dalela, Satya Narayan SankhwarAbstract:Bladder neck contracture after antegrade Fulguration of posterior urethral valves has not been reported in English studies to date to the best of our knowledge. A couple of reports have mentioned late-onset bladder neck contracture after retrograde valve Fulguration. The present case report describes an unusual complication of bladder neck contracture that occurred long after antegrade Fulguration of posterior urethral valves, which was done at an early age. This case report also discusses the possible mechanisms of bladder neck contracture, its management in brief, and highlights the importance of long-term follow-up of these patients.
Divakar Dalela - One of the best experts on this subject based on the ideXlab platform.
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Use of holmium:YAG laser in posterior urethral valves: another method of Fulguration.
Journal of pediatric urology, 2013Co-Authors: Swarnendu Mandal, Apul Goel, Manoj Kumar, Manish Kumar Singh, Vishwajeet Singh, Satya Narayan Sankhwar, Bhupender P. Singh, Divakar DalelaAbstract:To evaluate the use of holmium:YAG laser for posterior urethral valve (PUV) Fulguration and compare with electro-Fulguration. Forty boys underwent primary Fulguration of PUV using 20-25 W holmium laser (Group 1) from January 2009 to December 2011. Data of last 40 boys (retrospective cohort: January 2005 to December 2008) who underwent electro-Fulguration (Group 2) for PUV were compared with group 1. Ultrasonography was done at 2 weeks and 3 months and voiding cystourethrography at 3 and 6 months respectively after Fulguration and as needed thereafter. DTPA scan and urodynamic study were performed during follow-up in select patients, as required. Pre-operative parameters were comparable between groups. Improvement in voiding occurred in 38 and 34 boys in group 1 and 2, respectively. Hydroureteronephrosis and vesico-ureteric reflux resolved in 53% and 60% in group 1 and 51% and 53% in group 2, respectively. Boys in group 1 had statistically significant greater success in voiding after catheter removal (40 vs 32), shorter period of catheterization (1 vs 1.8 days), lower mean operative time (15 vs 20 min), needed re-Fulguration less commonly (2 vs 6), and were less likely to develop urethral stricture (0 vs 2) and urinary incontinence (0 vs 1). PUV Fulguration using holmium:YAG laser is a feasible, safe and effective alternative for endoscopic transurethral ablation with similar success, and appears to have fewer complications than electro-Fulguration. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
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Use of holmium:YAG laser in posterior urethral valves: Another method of Fulguration
Journal of Pediatric Urology, 2013Co-Authors: Swarnendu Mandal, Apul Goel, Manoj Kumar, Manish Kumar Singh, Vishwajeet Singh, Satya Narayan Sankhwar, Bhupender P. Singh, Divakar DalelaAbstract:Abstract Objective To evaluate the use of holmium:YAG laser for posterior urethral valve (PUV) Fulguration and compare with electro-Fulguration. Methods Forty boys underwent primary Fulguration of PUV using 20–25 W holmium laser (Group 1) from January 2009 to December 2011. Data of last 40 boys (retrospective cohort: January 2005 to December 2008) who underwent electro-Fulguration (Group 2) for PUV were compared with group 1. Ultrasonography was done at 2 weeks and 3 months and voiding cystourethrography at 3 and 6 months respectively after Fulguration and as needed thereafter. DTPA scan and urodynamic study were performed during follow-up in select patients, as required. Results Pre-operative parameters were comparable between groups. Improvement in voiding occurred in 38 and 34 boys in group 1 and 2, respectively. Hydroureteronephrosis and vesico-ureteric reflux resolved in 53% and 60% in group 1 and 51% and 53% in group 2, respectively. Boys in group 1 had statistically significant greater success in voiding after catheter removal (40 vs 32), shorter period of catheterization (1 vs 1.8 days), lower mean operative time (15 vs 20 min), needed re-Fulguration less commonly (2 vs 6), and were less likely to develop urethral stricture (0 vs 2) and urinary incontinence (0 vs 1). Conclusion PUV Fulguration using holmium:YAG laser is a feasible, safe and effective alternative for endoscopic transurethral ablation with similar success, and appears to have fewer complications than electro-Fulguration.
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bladder neck contracture after antegrade Fulguration of posterior urethral valves unusual long term complication
Urology, 2009Co-Authors: Rahul Janak Sinha, Vishwajeet Singh, Divakar Dalela, Satya Narayan SankhwarAbstract:Bladder neck contracture after antegrade Fulguration of posterior urethral valves has not been reported in English studies to date to the best of our knowledge. A couple of reports have mentioned late-onset bladder neck contracture after retrograde valve Fulguration. The present case report describes an unusual complication of bladder neck contracture that occurred long after antegrade Fulguration of posterior urethral valves, which was done at an early age. This case report also discusses the possible mechanisms of bladder neck contracture, its management in brief, and highlights the importance of long-term follow-up of these patients.
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Bladder Neck Contracture After Antegrade Fulguration of Posterior Urethral Valves—Unusual Long-term Complication
Urology, 2009Co-Authors: Rahul Janak Sinha, Vishwajeet Singh, Divakar Dalela, Satya Narayan SankhwarAbstract:Bladder neck contracture after antegrade Fulguration of posterior urethral valves has not been reported in English studies to date to the best of our knowledge. A couple of reports have mentioned late-onset bladder neck contracture after retrograde valve Fulguration. The present case report describes an unusual complication of bladder neck contracture that occurred long after antegrade Fulguration of posterior urethral valves, which was done at an early age. This case report also discusses the possible mechanisms of bladder neck contracture, its management in brief, and highlights the importance of long-term follow-up of these patients.
Vishwajeet Singh - One of the best experts on this subject based on the ideXlab platform.
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Use of holmium:YAG laser in posterior urethral valves: another method of Fulguration.
Journal of pediatric urology, 2013Co-Authors: Swarnendu Mandal, Apul Goel, Manoj Kumar, Manish Kumar Singh, Vishwajeet Singh, Satya Narayan Sankhwar, Bhupender P. Singh, Divakar DalelaAbstract:To evaluate the use of holmium:YAG laser for posterior urethral valve (PUV) Fulguration and compare with electro-Fulguration. Forty boys underwent primary Fulguration of PUV using 20-25 W holmium laser (Group 1) from January 2009 to December 2011. Data of last 40 boys (retrospective cohort: January 2005 to December 2008) who underwent electro-Fulguration (Group 2) for PUV were compared with group 1. Ultrasonography was done at 2 weeks and 3 months and voiding cystourethrography at 3 and 6 months respectively after Fulguration and as needed thereafter. DTPA scan and urodynamic study were performed during follow-up in select patients, as required. Pre-operative parameters were comparable between groups. Improvement in voiding occurred in 38 and 34 boys in group 1 and 2, respectively. Hydroureteronephrosis and vesico-ureteric reflux resolved in 53% and 60% in group 1 and 51% and 53% in group 2, respectively. Boys in group 1 had statistically significant greater success in voiding after catheter removal (40 vs 32), shorter period of catheterization (1 vs 1.8 days), lower mean operative time (15 vs 20 min), needed re-Fulguration less commonly (2 vs 6), and were less likely to develop urethral stricture (0 vs 2) and urinary incontinence (0 vs 1). PUV Fulguration using holmium:YAG laser is a feasible, safe and effective alternative for endoscopic transurethral ablation with similar success, and appears to have fewer complications than electro-Fulguration. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
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Use of holmium:YAG laser in posterior urethral valves: Another method of Fulguration
Journal of Pediatric Urology, 2013Co-Authors: Swarnendu Mandal, Apul Goel, Manoj Kumar, Manish Kumar Singh, Vishwajeet Singh, Satya Narayan Sankhwar, Bhupender P. Singh, Divakar DalelaAbstract:Abstract Objective To evaluate the use of holmium:YAG laser for posterior urethral valve (PUV) Fulguration and compare with electro-Fulguration. Methods Forty boys underwent primary Fulguration of PUV using 20–25 W holmium laser (Group 1) from January 2009 to December 2011. Data of last 40 boys (retrospective cohort: January 2005 to December 2008) who underwent electro-Fulguration (Group 2) for PUV were compared with group 1. Ultrasonography was done at 2 weeks and 3 months and voiding cystourethrography at 3 and 6 months respectively after Fulguration and as needed thereafter. DTPA scan and urodynamic study were performed during follow-up in select patients, as required. Results Pre-operative parameters were comparable between groups. Improvement in voiding occurred in 38 and 34 boys in group 1 and 2, respectively. Hydroureteronephrosis and vesico-ureteric reflux resolved in 53% and 60% in group 1 and 51% and 53% in group 2, respectively. Boys in group 1 had statistically significant greater success in voiding after catheter removal (40 vs 32), shorter period of catheterization (1 vs 1.8 days), lower mean operative time (15 vs 20 min), needed re-Fulguration less commonly (2 vs 6), and were less likely to develop urethral stricture (0 vs 2) and urinary incontinence (0 vs 1). Conclusion PUV Fulguration using holmium:YAG laser is a feasible, safe and effective alternative for endoscopic transurethral ablation with similar success, and appears to have fewer complications than electro-Fulguration.
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bladder neck contracture after antegrade Fulguration of posterior urethral valves unusual long term complication
Urology, 2009Co-Authors: Rahul Janak Sinha, Vishwajeet Singh, Divakar Dalela, Satya Narayan SankhwarAbstract:Bladder neck contracture after antegrade Fulguration of posterior urethral valves has not been reported in English studies to date to the best of our knowledge. A couple of reports have mentioned late-onset bladder neck contracture after retrograde valve Fulguration. The present case report describes an unusual complication of bladder neck contracture that occurred long after antegrade Fulguration of posterior urethral valves, which was done at an early age. This case report also discusses the possible mechanisms of bladder neck contracture, its management in brief, and highlights the importance of long-term follow-up of these patients.
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Bladder Neck Contracture After Antegrade Fulguration of Posterior Urethral Valves—Unusual Long-term Complication
Urology, 2009Co-Authors: Rahul Janak Sinha, Vishwajeet Singh, Divakar Dalela, Satya Narayan SankhwarAbstract:Bladder neck contracture after antegrade Fulguration of posterior urethral valves has not been reported in English studies to date to the best of our knowledge. A couple of reports have mentioned late-onset bladder neck contracture after retrograde valve Fulguration. The present case report describes an unusual complication of bladder neck contracture that occurred long after antegrade Fulguration of posterior urethral valves, which was done at an early age. This case report also discusses the possible mechanisms of bladder neck contracture, its management in brief, and highlights the importance of long-term follow-up of these patients.
Harry W Herr - One of the best experts on this subject based on the ideXlab platform.
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a cost effectiveness analysis of management of low risk non muscle invasive bladder cancer using office based Fulguration
Urology, 2015Co-Authors: Richard K. Lee, Bilal Chughtai, Machele S Donat, Jaspreet S Sandhu, Harry W HerrAbstract:Objective To examine the cost-effectiveness of endoscopic treatment of low-risk non–muscle-invasive bladder cancer (NMIBC) via office-based Fulguration vs operating room–based transurethral resection of the bladder (TURB). Methods A Markov state-transition model was created to simulate and compare the economic burden of managing patients with office-based Fulguration vs TURB. Direct procedural and hospitalization costs were queried from our institution. Patients were modeled as being followed up routinely with flexible cystoscopy, whereas tumor recurrences were treated with either Fulguration or TURB. Results A strategy of office-based Fulguration was more cost-effective than TURB ($1171 per quality-adjusted life year [QALY] vs $1208 per QALY) to treat recurrent NMIBC over a 5-year period. Fulguration was both more effective (14.94 vs 14.91 QALYs) as well as less expensive ($17,494 vs $18,005), thus dominating TURB. The incremental cost-effectiveness ratio was −$18,440 per QALY. Sensitivity analysis demonstrates that the relative costs of the procedures are more significant in determining cost-effectiveness than their respective utilities. Conclusion Office-based cystoscopy and Fulguration was more cost-effective than TURB for treating recurrent low-risk NMIBC. Adherence to an office-based treatment plan can lead to significant cost savings with a decreased therapeutic burden over the lifetime of a patient with NMIBC.
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A Cost-effectiveness Analysis of Management of Low-risk Non–muscle-invasive Bladder Cancer Using Office-based Fulguration
Urology, 2015Co-Authors: Richard K. Lee, Bilal Chughtai, Jaspreet S Sandhu, S. Machele Donat, Harry W HerrAbstract:Objective To examine the cost-effectiveness of endoscopic treatment of low-risk non–muscle-invasive bladder cancer (NMIBC) via office-based Fulguration vs operating room–based transurethral resection of the bladder (TURB). Methods A Markov state-transition model was created to simulate and compare the economic burden of managing patients with office-based Fulguration vs TURB. Direct procedural and hospitalization costs were queried from our institution. Patients were modeled as being followed up routinely with flexible cystoscopy, whereas tumor recurrences were treated with either Fulguration or TURB. Results A strategy of office-based Fulguration was more cost-effective than TURB ($1171 per quality-adjusted life year [QALY] vs $1208 per QALY) to treat recurrent NMIBC over a 5-year period. Fulguration was both more effective (14.94 vs 14.91 QALYs) as well as less expensive ($17,494 vs $18,005), thus dominating TURB. The incremental cost-effectiveness ratio was −$18,440 per QALY. Sensitivity analysis demonstrates that the relative costs of the procedures are more significant in determining cost-effectiveness than their respective utilities. Conclusion Office-based cystoscopy and Fulguration was more cost-effective than TURB for treating recurrent low-risk NMIBC. Adherence to an office-based treatment plan can lead to significant cost savings with a decreased therapeutic burden over the lifetime of a patient with NMIBC.
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reduced bladder tumour recurrence rate associated with narrow band imaging surveillance cystoscopy
BJUI, 2011Co-Authors: Harry W Herr, Sherri M DonatAbstract:Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Narrow-band imaging cystoscopy is a new imaging modality developed to enhance conventional standard white-light cystoscopy to evaluate bladder tumors. The current paper suggests that Fulguration of low-risk papillary bladder tumours using NBI cystoscopy results in fewer subsequent tumour recurrences than Fulguration using standard cystoscopy. How, or if, NBI cystoscopy will become integrated into routine management of non-invasive bladder tumours remains for further study. OBJECTIVE To evaluate frequency of recurrences among patients with papillary bladder tumours followed sequentially with conventional white-light (WLI) cystoscopy and narrow-band imaging (NBI) cystoscopy. PATIENTS AND METHODS A cohort of 126 patients with recurrent low-grade papillary bladder tumours were followed every 6 months for 3 years by conventional WLI cystoscopy, and then over the next 3 consecutive years by NBI cystoscopy. Recurrent tumours detected were treated by outpatient Fulguration or transurethral resection. We compared the tumour recurrence rate during follow-up with WLI and NBI cystoscopy, using patients as their own controls. RESULTS Of the 126 patients, 94% had tumour recurrences during WLI cystoscopy vs 62% during NBI cystoscopy. The mean number of recurrent tumours was 5.2 with WLI cystoscopy vs 2.8 with NBI cystoscopy, and the median recurrence-free survival time was 13 vs 29 months (P= 0.001). CONCLUSION Compared with follow-up with WLI cystoscopy, NBI cystoscopy was associated with fewer patients having tumour recurrences, fewer numbers of recurrent tumours, and a longer recurrence-free survival time.
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efficacy of office Fulguration for recurrent low grade papillary bladder tumors less than 0 5 cm
The Journal of Urology, 2004Co-Authors: Machele S Donat, Amanda North, Guido Dalbagni, Harry W HerrAbstract:ABSTRACTPurpose: Recurrent superficial papillary bladder tumors are most commonly treated with transurethral resection with the patient under anesthesia. We report our experience with office Fulguration of small, recurrent, low grade papillary tumors using flexible cystodiathermy.Materials and Methods: We conducted a prospective single institution analysis of 267 consecutive patients with superficial bladder cancer undergoing routine bladder cancer surveillance between January 1998 and December 2001. Cytological and histological recurrences were recorded. Selection criteria for office Fulguration were less than 5 low grade appearing papillary tumors, tumor size less than 0.5 cm, negative urine cytology and patient desire. All patients completed initial treatment (transurethral resection, partial cystectomy and/or intravesical therapy) and a minimum of 6 months on surveillance without recurrence (median 11.57 months).Results: Flexible cystodiathermy for small, low grade, recurrent papillary tumors was effi...
