The Journal of urology
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The Journal of urology · Sep 2014
The importance of surgeon characteristics on impacting oncologic outcomes for patients undergoing radical cystectomy.
Given that the urologist has a major influence on outcomes of radical cystectomy, it is of interest to patients, trainees, urologists and administrators to understand the provider characteristics associated with favorable outcomes. Therefore, we assessed associations between various surgeon characteristics and long-term oncologic outcomes for patients undergoing radical cystectomy for bladder cancer. ⋯ While radical cystectomy volume, experience and uro-oncology fellowship are all likely important, we found that subspecialized focus in bladder cancer was independently associated with improved long-term oncologic outcomes. Our data support disease site differentiation among uro-oncologists at large institutions.
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The Journal of urology · Sep 2014
Validation of team performance assessment of multidisciplinary tumor boards.
We construct validated the instrument to evaluate assessor learning curves and the feasibility and interrater reliability of MTB-MODe for assessing the decision making process using video recorded multidisciplinary tumor board meetings. ⋯ A standardized method to assess the quality of multidisciplinary tumor board discussions can enhance the quality of cancer care and the ability of the boards to self-evaluate performance, thus, promoting good practice. Video recordings offer a feasible, reliable method of assessing how multidisciplinary tumor boards work.
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The Journal of urology · Sep 2014
Alterations in resting state oscillations and connectivity in sensory and motor networks in women with interstitial cystitis/painful bladder syndrome.
The pathophysiology of interstitial cystitis/painful bladder syndrome remains incompletely understood but is thought to involve central disturbance in the processing of pain and viscerosensory signals. We identified differences in brain activity and connectivity between female patients with interstitial cystitis/painful bladder syndrome and healthy controls to advance clinical phenotyping and treatment efforts for interstitial cystitis/painful bladder syndrome. ⋯ Findings suggest that women with interstitial cystitis/painful bladder syndrome have a sensorimotor component to the pathological condition involving an alteration in intrinsic oscillations and connectivity in a cortico-cerebellar network previously associated with bladder function.
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The Journal of urology · Sep 2014
Does robotic assistance confer an economic benefit during laparoscopic radical nephrectomy?
While robotic assisted radical nephrectomy is safe with outcomes and complication rates comparable to those of the pure laparoscopic approach, there is little evidence of an economic or clinical benefit. ⋯ Robotic assisted radical nephrectomy results in increased medical expense without improving patient morbidity. Assuming surgeon proficiency with pure laparoscopy, robotic technology should be reserved primarily for complex surgeries requiring reconstruction. Traditional laparoscopic techniques should continue to be used for routine radical nephrectomy.
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The Journal of urology · Sep 2014
Diffusion tensor magnetic resonance imaging and fiber tractography of the sacral plexus in children with spina bifida.
It is still largely unknown how neural tube defects in spina bifida affect the nerves at the level of the sacral plexus. Visualizing the sacral plexus in 3 dimensions could improve our anatomical understanding of neurological problems in patients with spina bifida. We investigated anatomical and microstructural properties of the sacral plexus of patients with spina bifida using diffusion tensor imaging and fiber tractography. ⋯ To our knowledge this 3 Tesla magnetic resonance imaging study showed for the first time sacral plexus asymmetry and disorganization in 10 patients with spina bifida using diffusion tensor imaging and fiber tractography. The observed difference in diffusion values indicates that these methods may be used to identify nerve abnormalities. We expect that this technique could provide a valuable contribution to better analysis and understanding of the problems of patients with spina bifida in the future.