Yaniv Shilo

Publications (12)18.13 Total impact

• Article: Hyperbaric oxygen therapy for hemorrhagic radiation cystitis.

  Yaniv Shilo, Shay Efrati, Zvi Simon, Avishay Sella, Eliahu Gez, Eyal Fenig, Mark Wygoda, Arie Lindner, Gregori Fishlev, Kobi Stav, Amnon Zisman, Yoram I Siegel, Dan Leibovici
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  ABSTRACT: Hemorrhagic radiation cystitis (HRC) is a significant clinical problem that occurs after pelvic radiation therapy and is often refractory. To evaluate the efficacy and safety of hyperbaric oxygen therapy (HBO) for HRC. Daily 90 minute sessions of HBO at 2 ATM 100% oxygen were given to 32 HRC patients with ASTRO grades 3-4 hematuria. The median age was 72.5 (48-88 years). The median time interval between radiation therapy and HBO was 4 years (1-26 years). The patients received a median of 30 HBO sessions (3-53). Hematuria resolved in 27 patients (84%) and persisted in 5. Cystectomy was required in two, and ileal-conduit and bilateral percutaneous nephrostomies were performed in one and two patients, respectively. With a median follow-up of 12 months (5-74 months), the hematuria cleared completely in 16 patients (59%) and mild hematuria requiring no further treatment recurred in 10 others. Another patient with ASTRO grade 4 hematuria needed bladder irrigation and blood transfusions. Complications included eardrum perforation in four patients and transient vertigo and mild hemoptysis in one case each. None of them required HBO discontinuation. HBO controlled bleeding in 84% of the patients. A durable freedom from significant hematuria was achieved in 96% of the patients. HBO seems to be an effective and safe modality in patients with HRC.
  The Israel Medical Association journal: IMAJ 02/2013; 15(2):75-8. · 1.02 Impact Factor
• Article: Comparison Of Lower Urinary Tract Symptoms Between Women With Detrusor Overactivity With Impaired Contractility (DOIC) And Women With Detrusor Overactivity (DO) With Preserved Contractility.

  Kobi Stav, Yaniv Shilo, Amnon Zisman, Arie Lindner, Dan Leibovici
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  ABSTRACT: PURPOSE: to compare symptoms between women with detrusor overactivity with impaired contractility (DOIC) and women with detrusor overactivity (DO) and preserved contractility. METHODS: the study included 359 consecutive women with DO who had multichannel urodynamic test in our department between 2009 and 2011. The women were divided into two groups, those with DOIC (n=151, 42%) and those with DO and preserved contractility (n=208, 58%). Comparison between the two groups was performed. RESULTS: women with DOIC were older (73.2±17.3 years vs. 54.1±20.7 years, p<0.001) with high frequency of diabetes mellitus (49% vs. 31%, p<0.001). The prevalence of previous urinary retention and recurrent cystitis were significantly higher is women with DOIC (7% vs. 1% p<0.01 and 22% vs. 7% P<0.001, respectively). The mean post void residual (PVR) was higher in the DOIC group (89±42 ml vs. 21±18 ml, p<0.001). The mean maximal flow rate was lower in women with DOIC (11±6 ml/sec vs. 23±5 ml/sec, p<0.001). The frequency of storage symptoms was similar in both groups; however, voiding symptoms were more common in women with DOIC (slow stream 69% vs. 42%, intermittent stream (72% vs. 26%, hesitancy 35% vs. 22%, straining 84% vs. 26%, terminal dribble 73% vs. 42%, incomplete emptying 71% vs. 49%; p<0.001). CONCLUSIONS: women with DOIC are older than women with DO and preserved detrusor contractility. Urinary retention and recurrent cystitis are more frequent in women with DOIC. Voiding symptoms are significantly more common in women with DOIC.
  The Journal of urology 12/2012; · 4.02 Impact Factor
• Article: Is the diagnostic yield of prostate needle biopsies affected by prostate volume?

  Dan Leibovici, Yaniv Shilo, Orit Raz, Kobi Stav, Judith Sandbank, Michael Segal, Amnon Zisman
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  ABSTRACT: OBJECTIVES: To determine the effect of prostate volume on the diagnostic yield of prostate biopsies. MATERIALS AND METHODS: 155 consecutive patients underwent 12-core transrectal ultrasound guided needle biopsies. Data were collected prospectively on age, serum PSA, digital rectal examination (DRE), previous prostate biopsies, prostate volume and pathologic result. Univariate and multivariate logistic regressions were undertaken to determine the effect of prostate volume on the risk for a positive biopsy. RESULTS: 45 patients (29%) were diagnosed with cancer. The median patient age was 63 (range 48-82) years, the median PSA level was 6.7 ng/ml (0.5-156 ng/ml), and the median prostate volume was 57 ml (16-273 ml). 42 patients (27%) had an abnormal DRE and 51 (33%) had undergone previous prostate biopsies. Positive biopsy rates were 39%, 33%, and 14% for prostate volume below 46 ml, between 45 and 73 ml, and above 72 ml, respectively. Univariate analysis showed that age, serum PSA, DRE and prostate volume were all associated with a positive biopsy. Multivariate analysis adjusted for age, PSA and DRE showed a significant risk increase for a positive biopsy in smaller prostates. (OR = 5.6 95% CI 1.75-17.89; and 8.86 95% CI 2.72-28.82, for prostate volume between 45 and 72 ml and below 45 ml, respectively). CONCLUSION: The diagnostic yield of prostate biopsies is significantly lower in large prostates. As the result the standard 12-core biopsy may be insufficient for the diagnosis of cancer in large prostates.
  Urologic Oncology 09/2011; · 3.22 Impact Factor
• Article: [Female urethral diverticula--clinical and surgical aspects].

  Erez Lang, Meny Alcalay, Yaniv Shilo, Kobi Stav
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  ABSTRACT: Urethral diverticula are a common cause of chronic genitourinary symptoms in women. They occur in 5% of women overall, with higher frequencies in selected populations of symptomatic women. The classical presentation is with recurrent urinary tract infections and post-micturition dribbling but almost any urinary symptom may be a presenting feature. Newer imaging modalities such as magnetic resonance imaging and perineal ultrasound are now widely available and urethral diverticula, that were previously unrecognized, can now be more easily detected. However, despite the availability of effective diagnostic techniques, diagnosis is often delayed. This is due to a lack of awareness among clinicians. These patients are often inappropriately treated for other conditions, significantly delaying the proper management of their condition. A high index of suspicion, a careful examination and referral for appropriate investigation will improve the number correctly diagnosed and lead to considerable benefit since most symptomatic cases can be cured by appropriate surgery. This review aims to summarize the presentation, investigation and management of female urethral diverticulum. Hopefully, greater awareness will lead to more timely diagnosis and appropriate treatment.
  Harefuah 05/2011; 150(5):475-9, 489.
• Article: The predominance of benign histology in small testicular masses.

  Yaniv Shilo, Amnon Zisman, Arie Lindner, Orit Raz, Simon Strauss, Yoram I Siegel, Michael Segal, Judith Sandbank, Dan Leibovici
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  ABSTRACT: To evaluate the concordance between testicular tumor size and benign histology in order to identify a cut-off size, below which the rate of benign lesions would be highest. During the years 1995-2008, we performed 131 consecutive testicular operations for testicular tumors. Ten of these were testicular preserving surgery, whereas the other 121 patients had radical orchiectomy. We searched for the rate of benign lesions in the following 3 groups of tumor diameter: 10 mm or less, 11-20 mm, and greater than 20 mm. ROC analysis was used to find the optimal size cut-off below which the rate of benign lesions would be highest. Benign lesions were found in 11 patients (8%), including epidermoid cyst (n = 4), Leydig cell tumor (n = 3), fibrosis (n = 1), adenomatoid tumor (n = 2), and 1 patient with a simple cyst. Small tumor size strongly correlated with benign histology. The mean diameter of benign vs. malignant lesions was 15 mm and 41 mm, respectively (P < 0.05). The rate of benign lesions in tumors with a diameter of 10 mm or less, 11-20 mm and greater than 20 mm was 50%, 17%, and 2%, respectively. Receiver Operating characteristic (ROC) analysis with 87% sensitivity and 83% specificity revealed a cut-off value of 18.5 mm tumor diameter below which the proportion of benign lesions was 38.5% compared with 2% above it (P < 0.05). While benign lesions comprise only 8% of all testicular tumors, their proportion among small lesions is much higher. With a size cut-off of 18.5 mm, 38.5% of smaller lesions are benign. These findings support consideration of testicular exploration for small testicular lesions aiming at preservation rather than predetermined radical orchiectomy.
  Urologic Oncology 03/2011; 30(5):719-22. · 3.22 Impact Factor
• Article: Testicular sparing surgery for small masses.

  Yaniv Shilo, Amnon Zisman, Orit Raz, Erez Lang, Simon Strauss, Judith Sandbank, Michael Segal, Yoram I Siegel, Dan Leibovici
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  ABSTRACT: To determine the proportion of benign testicular lesions among candidates for testicular sparing surgery (TSS) and to assess the safety and efficacy of this procedure. Sixteen patients underwent surgical exploration for testicular tumors with TSS intent in our center. Surgery was performed via an inguinal approach with temporary cord occlusion and frozen section (FS) analysis of the lesions. Benign findings allowed for TSS, whereas cancer prompted total orchiectomy. The lesions measured 8-25 mm in the largest diameter. Eleven of the 16 lesions were benign (69%) and TSS was accomplished in these cases. Complete concordance was observed between the results of FS and permanent sections. Of the 5 patients with cancer, 3 had pure seminoma, and embryonal carcinoma and teratoma were found in 1 patient, each. Surveillance was applied in 4 of these patients, and chemotherapy was used in the patient with embryonal carcinoma. With an average follow-up duration of 48 months, all are alive and free of disease. All 11 patients in whom TSS was accomplished had an uneventful postoperative course, and with an average follow-up duration of 28 months, 9 have normal scrotal physical examination and ultrasound, whereas 2 patients were lost to follow-up. Sixty-nine percent of testicular lesions under 25 mm are benign. TSS is safe and effective in patients with small benign lesions. Cancer is reliably detected by FS, and testicular exploration is not associated with local or distant recurrence in any of our patients.
  Urologic Oncology 05/2010; 30(2):188-91. · 3.22 Impact Factor
• Article: Positive surgical margins with renal cell carcinoma have a limited influence on long-term oncological outcomes of nephron sparing surgery.

  Orit Raz, Sonia Mendlovic, Yaniv Shilo, Dan Leibovici, Judith Sandbank, Arie Lindner, Amnon Zisman
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  ABSTRACT: To define the rate of positive surgical margins (PSMs) and analyze the outcome of patients with PSMs. The outcome and proper management of patients with positive PSMs during nephron sparing surgery (NSS) are questionable. In this study we define the clinical outcomes of PSMs at NSS and suggest management. Clinical records of 114 renal units who underwent open NSS for a renal mass between May 1995 and September 2005 were reviewed. PSMs were suspected on frozen section in 17 of 114 renal units (15%). Tumors with suspected PSMs at frozen section were smaller (2.9 +/- 1.6) in comparison to those with negative surgical margins (3.4 +/- 1.8 cm) (P = .001). Nine of 17 (53%) cases underwent total nephrectomy (5 immediately, 4 delayed). In 4 (24%), immediate re-excision of the renal crater was performed. A total of 4 (24%) that were followed up clinically were with no evidence of disease. Therefore, in 13 of 17 (77%) cases, the presence of tumor cells at the remaining side of the kidney could be evaluated histologically. In 2 cases from the immediate response group, tumor cells were found in the side opposite to the resection. There was no residual tumor in any case subjected to delayed nephrectomy. At median follow-up of 71 months, 15 of 17 patients are alive and with no evidence of disease. Two patients died because of unrelated causes. The overall 5-year survival rate is 98.2% and there is no cancer-specific mortality. The true PSM rate is in the range of 1.75%-5.26%. No disease progression or deaths attributable to renal cell carcinoma were associated with PSMs. Total nephrectomy should be avoided as a response to PSMs.
  Urology 11/2009; 75(2):277-80. · 2.43 Impact Factor
• Article: Late migration of a retained bullet into the urinary bladder presenting with acute urinary retention.

  Orit Raz, Yaniv Shilo, Kobi Stav, Dan Leibovici
  The Israel Medical Association journal: IMAJ 07/2007; 9(6):484-5. · 1.02 Impact Factor
• Article: [Comparative morbidity for different accesses in percutaneous nephrolithotripsy].

  Yaniv Shilo, Judy Kleinmann, Amnon Zisman, Amir Peer, Arie Lindner, Yoram I Siegel
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  ABSTRACT: Over the last decades percutaneous nephrolithotripsy (PCNL) has been developed as an alternative for open renal operations in the treatment of complex renal stones. Currently, different approaches are used for the collecting system. To estimate the overall morbidity of different approaches to the collecting system during PCNL; to compare the complication rates for PCNL through the upper pole of the kidney with lower pole access and multiple access approaches. We retrospectively reviewed 174 patients (178 renal units) who underwent PCNL. They formed three groups according to surgical access: upper pole (n = 107), lower pole (n = 51) and multiple (n = 20). Inter-group data on procedure related complications were compared. Postoperative fever was more frequent in the upper pole group (34%) compared to the other two groups (25% each, p < 0.49). There was a higher rate of pulmonary complications in the upper pole and multiple access groups (21% and 20%, respectively) compared with the lower pole group (2%, p=0.007). The rate of bleeding and need for blood transfusion was significantly higher in the multiple access group than in the other groups (20% vs 5% and 6%, respectively, p < 0.05). The upper and multiple access approaches were associated with a higher overall incidence of pleural effusion compared with the lower pole access. The incidence of bleeding and transfusion rates were similar using the upper and lower pole accesses but higher in the multiple access group. Provision of an enhanced surgical field and greater maneuverability together with 'the treatable nature of the associated complications favor an upper pole access, especially for removing a large stone burden.
  Harefuah 03/2006; 145(2):107-10, 166.
• Article: [Multivariate analysis on radical retropubic prostatectomy associated blood loss: importance of prostate size, pelvic lymph-node dissection and percentage of carcinoma].

  Kobi Stav, Naomi Rahimi-Levene, Yaniv Shilo, Avraham Korenberg, Arie Lindner, Amnon Zisman
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  ABSTRACT: Radical retropubic prostatectomy (RRP) has been associated with blood loss requiring blood transfusion. To define risk factors for blood transfusion. The charts of 303 patients who underwent RRP between the years 1992 and 2002 were prospectively reviewed. Blood loss, blood requirements and correlative clinical data were recorded and a multivariate analysis model was applied. Data was available in 293 cases (97%). A total of 122 patients were transfused (42%) with a median of 2 units of packed cells. Median estimated blood loss was 766 ml (range 150-2800). Blood loss declined progressively during the study period (1220 ml in 1992 to 826 ml in 2002). Multivariate analysis reveals that estimated blood loss and transfusion rate are related to performance of pelvic lymph node dissection, prostate size and percentage of cancer in the prostatectomy specimen. Our series indicates that blood preparation may be spared in patients who are not candidates for pelvic lymph node dissection with prostate smaller than 57 gr. and with less than 77% in the biopsy specimen (equivalent to < 66% of cancer in the prostatectomy specimen).
  Harefuah 03/2006; 145(2):103-6, 166-7.
• Article: [Long-term follow-up of radical retropubic prostatectomy for prostate cancer in 400 consecutive patients].

  Kobi Stav, Judith Sandbank, Yaniv Shilo, Arie Lindner, Amnon Zisman
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  ABSTRACT: To evaluate the long-term outcomes following radical retropubic prostatectomy for localized prostate cancer. The charts of 401 patients who underwent radical retropubic prostatectomy between 1992 and 2004 were reviewed. The average age was 63 years with a median PSA of 8.5 and median Gleason score of 5. Ninety one percent of the cases were diagnosed by a single prostate biopsy set (average 7 cores, range 3-16). Pelvic lymph node dissection was performed in 84 patients (21.7%). Nodal involvement was noted in 5 (6%). Capsular invasion was found in 91 patients (24%), positive surgical margin in 78 (20.1%) and seminal vesicle involvement in 37 (9.5%). The average admission stay was 5.2 days (3-22). Fever (11.4%), urine leakage (8%), wound infection (4%) and pulmonary embolism (1.5%) were the most common early complications. One year after the operation 72% of the patients were fully continent. Of the 172 patients who underwent nerve-sparing procedure, 80 patients (46.5%) regained their sexual potency one year after the operation and did not require pharmacological assistance. Median follow-up time was 84 months. The five and eight years overall survival rates were 85% and 73%, respectively. Ten years survival of 136 patients (35%) with clinical stage T1C was 95%. Biochemical failure was observed in 68 patients (18%). The average time to biochemical failure was 12.5 months (range 0-76. median 12). Forty five patients (12%) died, twenty one (5.4%) due to metastatic disease. Mortality correlated to pre-operative PSA, clinical stage and Gleason score. At one year follow up, most of the patients are continent and 46.5% have spontaneous erection following nerve-sparing procedure. The overall survival and the long-term outcomes of radical retropubic prostatectomy are equal to those reported in the current literature.
  Harefuah 10/2005; 144(9):602-4, 680.
• Article: [Endourological treatment of ureteropelvic obstruction using holmium YAG laser].

  Yaniv Shilo, Amnon Zisman, Kobi Stav, Arie Lindner, Yoram I Siegel
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  ABSTRACT: Ureteropelvic junction obstruction (UPJO) is defined as an impairment of urine outflow from the pelvis to the ureter. Several treatment approaches are in use. To present the different endo-urological approaches--retrograde and antegrade techniques --for UPJO using the holmium: YAG laser. We followed 67 patients who underwent endopyelotomy between 1994 - 1997 and compared the different approaches for the treatment of UPJO. A total of 67 patients were operated, 52 patients using retrograde approach and 15 using antegrade approach. In the retrograde approach success was achieved in 48 patients (93%) and in 14 patients (94%) in the antegrade approach. Complications rate was 10% and 40%, respectively. Hospital stay was 2.2 days in the retrograde approach and 4.6 in the antegrade approach. The success rate in the different endourologic approaches was high and no difference between the two approaches was identified. From our experience, lower complication rate and shorter hospital stay make the retrograde approach more advantageous.
  Harefuah 10/2005; 144(9):616-8, 678.