Amos Shapiro

Hebrew University of Jerusalem | HUJI · Department of Urology

Objectives: To report our experience with the active surveillance policy in patients with recurrent low-risk bladder tumors. Methods: The files of 52 patients who underwent active surveillance instead of immediate surgical resection were reviewed. Different variables concerning tumor growth rate were evaluated. Results: A total of 75 surveilla...

Objectives: To evaluate the prognosis of patients who underwent surgery for invasive bladder cancer and to search for prognostic factors. Methods: The files of all the patients who underwent radical or partial cystectomy for invasive bladder cancer between 1992 and 2014 were reviewed. The effect of various prognostic factors was evaluated by uni...

Background: High-grade urothelial carcinomas (UCs) often show foci of variant differentiation. There is limited information in the literature about the response of these variant urothelial tumors to immunotherapy with bacillus Calmette-Guerin (BCG). We compared the response, to treatment with BCG, of UC containing glandular, squamous, nested, and...

Muscle-invasive bladder cancer is most commonly treated by radical cystectomy. Patients who are too sick to go through this surgery or who are unwilling to accept the mutilation associated with it are referred to chemoradiation. We compared the results of these 2 modalities using age-matched populations. Between 1998 and 2008, 33 patients were trea...

Background Partial cystectomy provides oncological results comparable with those of radical cystectomy in selected patients with invasive bladder cancer without the morbidity associated with radical cystectomy and urinary diversion. We describe a novel technique of partial cystectomy that allows accurate identification of tumor margins while minimi...

The pathological grade of bladder cancer has an immense impact on patient management and prognosis. While most bladder tumors show pure high or low grade patterns, some tumors show a mixed pattern. We aimed to explore the incidence and the clinical significance of this phenomenon. Between June 1998 and December 2008, 642 patients (mean age of 67.5...

Background The management of patients with high-grade non muscle invasive bladder cancer (NMIBC) brings diagnostic and therapeutic challenges. In the current study, we sought to study the natural history of progression to "secondary" muscle-invasive bladder cancer (MIBC)-cancer that developed during follow up of patients presenting with non-muscle...

The objective of the study is to assess the etiology and prognosis of gross hematuria (GH) in patients with carcinoma of the prostate (CAP). From 1991 to 2011, 81 men (mean age 74.3 years, SD 6.5) with CAP were hospitalized with GH. Primary treatment of CAP was radical surgery in 13 patients (group 1) and nonsurgical therapy in 68 (group 2), mostly...

Background: The aim of radical prostatectomy (RP) is the complete removal of the prostate gland with negative surgical margins. The presence of cancer at the surgical margin is associated with higher probability of disease progression. Current methods of intraoperative margin assessment are inaccurate or time-consuming.The study goal was to evalua...

To examine the hypothesis that the risk of high-grade bladder cancer can be predicted using noninvasively obtained data. We retrospectively analyzed the database of 431 patients that had transurethral resection of first-time bladder tumors between June 1998 and December 2009. Pre-operative parameters evaluated were: patients' age; gender; sonograph...

Urothelial carcinomas have an established propensity for divergent differentiation. Most of these variant tumors are muscle invasive but not all. The response of non muscle invasive variant tumors to intravesical immunotherapy with BCG is not established in the literature, and is reported here. Between June 1995 and December 2007, 760 patients (mea...

Raman molecular imaging (RMI) is an optical technology that combines the molecular chemical analysis of Raman spectroscopy with high-definition digital microscopic visualization. This approach permits visualization of the physical architecture and molecular environment of cells in the urine. The Raman spectrum of a cell is a complex product of its...

From 1985 to August 2007 we have performed 15,324 shockwave lithotripsy (SWL) treatments using the Dornier HM3 lithotripter. We studied trends in the characteristics of treatments and patients. Patient data were recorded in a computerized database. Changes in characteristics of patients and stones treated during this period were reviewed. A total o...

Most urothelial carcinomas are exophytic, but some tumors exhibit subepithelial components, either in the form of endophytic growth pattern (EGP) or as von Brunn's nests involvement (VBNI). The purpose of this study was to investigate the frequency, inter-relations and clinical significance of these forms of subepithelial neoplasia in urothelial ca...

To identify risk factors for fever after shockwave lithotripsy (SWL) and suggest guidelines for prophylactic antimicrobial treatment. Between 1985 and 2007, a total of 15,324 SWL procedures were performed in our institution using the Dornier HM3 lithotripter. Because stone analyses were not available in the majority of patients, management of stone...

This study aimed to evaluate the accuracy of urine cytology, bladder ultrasound (US), urine cytokeratin 19 fragment assay (CYFRA 21-1) and the combination of these noninvasive modalities in the detection of recurrent bladder cancer. In a total of 154 patients that were followed with cystoscopy after endoscopic resection of non-muscle-invasive bladd...

The sophistication of percutaneous nephrolithotomy and ureteroscopy challenges the efficacy of ESWL for urolithiasis in prepubertal patients. We evaluated our long-term experience with ESWL in these patients and determined its efficiency. We retrospectively reviewed the charts of all prepubertal patients who underwent ESWL. We evaluated the need fo...

Purpose The recent advancements in ureteroscopy, with reported success rate between 77% and 100%, have challenged the efficacy of ESWL monotherapy for ureterolithiasis in prepubertal children (PC). We, therefore, evaluated our long-term experience with ESWL in these patients, and determined its efficiency. Material and Methods We conducted a retro...

Surveillance studies of enhancing renal masses report on a mean tumor growth rate of about 0.3 cm/year. In most of these studies however, only small tumors in elderly patients were followed. In the current report, we attempt to evaluate the growth rate of “clinically significant” renal carcinomas defined as tumors that were treated immediately upon...

Dissection of the seminal vesicles during radical prostatectomy has the potential to damage the pelvic plexus, thus compromising trigonal, bladder neck and cavernous innervation, and contributing to delayed gain of continence and erectile function. The rate of prostate cancer invasion into the seminal vesicles in currently operated patients is low...

This study was done in order to evaluate the safety of an active surveillance program, without resection of the tumor, in patients with recurrent small bladder cancer. Active surveillance was offered to patients with small (<10 mm) papillary, asymptomatic tumor(s) with negative urinary cytology that was found on routine follow-up in patients who ha...

To evaluate the efficacy of transurethral prostatectomy (TURP) followed by bacillus Calmette-Guérin (BCG) immunotherapy in patients with prostatic urothelial carcinoma (PUC) and compare the results of studies using combined TURP and BCG with studies in which TURP was not performed. Patients with bladder cancer and PUC were treated with TURP followe...

Transrectal ultrasound-guided needle biopsy of the prostate is the only method for diagnosing prostate cancer. Although tolerated by most patients, 65–90% of patients complain of pain during the procedure. Most urologists utilize ultrasound-guided transrectal injection of lignocaine. Intravenous sedation with short-acting medications such as midazo...

The objective of this study was to define recurrence patterns after nephro-ureterectomy (NU) for urothelial upper tract tumor (UUTT), and to suggest guidelines for follow-up. The effects of age, gender, UUTT grade, stage, size, location in the urinary system, and the administration of adjuvant chemotherapy on disease-free survival were assessed ret...

To explore patterns of recurrence, muscle invasion, and disease specific mortality in patients with bladder carcinoma in situ (CIS) who responded to an induction course with intravesical bacillus Calmette-Gúerin (BCG) immunotherapy. Between June 1985 and December 2003, 104 patients (mean age 67 years) were diagnosed with either pure (38 patients) o...

To study the significance of inflammatory pseudotumor (IPT) in patients with a history of bladder cancer. We surveyed our hospital database for patients who developed IPT during follow-up of bladder cancer. The original histologic blocks were reviewed and immunostained for vimentin, anaplastic large cell lymphoma (ALK), and pancytokeratin. Between...

Renal cell carcinoma invading the perinephric fat is classified as a stage T3a tumor in the 2002 TNM version. Based on long-term followup we examined the prognostic significance of this definition. We evaluated the outcome in 237 consecutive patients with localized renal cell carcinoma operated on between January 1985 and December 1997. Median foll...

Current imaging modalities for preoperative staging of advanced transitional cell carcinoma of the bladder or upper urinary tract are not sensitive for detection of metastases. This study examines the contribution of 11C-choline positron emission tomography/computerized tomography to preoperative staging of transitional cell carcinoma. We prospecti...

Objective: To determine whether thrombocytosis after urologic surgery is a random phenomenon or if it is related to postoperative complications. We evaluated the postoperative course of patients who had a normal platelet count before surgery and developed significant thrombocytosis (platelet count> 500 x 10(9)/l) after surgery during the years 1991...

To determine the outcome of a watchful waiting policy in patients suffering from small, recurrent, papillary bladder tumors. Watchful waiting has been considered an option when a small (<10 mm) papillary, asymptomatic tumor with negative urinary cytology was found on follow-up cystoscopy in patients who had previous resection(s) of superficial, low...

Reactive thrombocytosis can be found in patients with different types of infections, including upper urinary tract infection (UTI). In this study, we determined whether thrombocytosis in patients with upper UTI is a random phenomenon or is related to complications associated with the UTI. We reviewed the charts of patients admitted to the urology d...

Introduction: The association between staghorn calculus of the kidney long-standing and urothelial tumors of the renal pelvis is well documented. We describe 3 patients with urothelial cancer in a kidney who underwent percutaneous nephrolithotomy (PCNL). Patients and methods: Retrospective analysis of our series of more than 500 PCNLs revealed 3...

Since laparoscopic nephrectomy was introduced by Clayman et al, it has been doubted whether it should be employed in patients with extensive perirenal fibrosis. In this series, 20 consecutive patients underwent laparoscopic nephrectomy for obstructed, infected, non-functioning kidneys. Preoperative assessment included urine cultures, abdominal sono...

To evaluate the effectiveness of combined local bladder hyperthermia and intravesical chemotherapy for the treatment of patients with high-grade (G3) superficial bladder cancer. Patients with G3 bladder tumors (Stage Ta or T1) were treated with combined intravesical chemotherapy with mitomycin-C and local radiofrequency hyperthermia of the bladder...

Extracorporeal shock wave lithotripsy (ESWL) in older children appears to have comparable results when compared to adults, no study has focused on its use in younger children. We reviewed our ESWL experience in children under age 3.5 years to evaluate its safety, and define optimal treatment parameters. We retrospectively reviewed consecutive medic...

To report the treatment of patients who presented with vesico-ureteric stricture after kidney transplantation, using a minimally invasive endourological approach. Patients (10 men and four women, mean age 34 years, range 22-55) were assessed at presentation by serum creatinine level, ultrasonography and intravenous pyelography when the serum creati...

Retroperitoneal fibrosis (RPF) is an uncommon disease complicated by ureteral entrapment. Its etiology includes several medications, periaortic inflammation, abdominal and retroperitoneal operations, radiotherapy, and malignancy. We present 18 patients, 14 of whom developed RPF after surgery and radiotherapy. During the past 12 years, we treated 7...

Morbidly obese or debilitated patients do not tolerate the prone position used for percutaneous nephrolithotripsy (PCNL) well and may suffer from severe cardiorespiratory compromise in this position. The purpose of this study is to demonstrate a simple way to overcome this difficulty. Two morbidly obese patients, ages 48 and 32 years, with Body Mas...

The urinary concentration of soluble cytokeratin 19 fragments, measured by the CYFRA 21-1 assay, may be used for the noninvasive, early detection of bladder carcinoma. This prospective study examined urine samples from 325 patients. The authors included 152 patients who presented with hematuria or irritative voiding symptoms (Group 1), 107 patients...

We determined whether the thin ureter of the young child transports stone fragments after extracorporeal shockwave lithotripsy (ESWL) as efficiently as the adult ureter does. This determination was done by comparing the outcome after lithotripsy of renal stones greater than 10 mm. between young children and adults. Our study group consisted of 38 c...

We evaluated the tumor recurrence pattern after radical or nephron-sparing surgery for localized renal cell carcinoma. Based on this pattern, we suggest a surveillance protocol after surgery. The outcome of 200 consecutive patients with localized renal cell carcinoma (RCC) that were operated on between January 1982 and December 1997 was evaluated r...

Treatment of ureteral calculi in the pediatric population represents a unique challenge. Extracorporeal shock wave lithotripsy (ESWL*) and ureteroscopy have been advocated for the treatment of such stones. We present our experience with ESWL monotherapy for ureteral stones in children in the last decade. Between 1989 and 1999 we treated 21 boys and...

Cytokeratin 20 is a cytoskeletal protein expressed in colon and bladder cancer cells but only rarely in normal urothelium. Previous studies have shown that identification of RNA coded for cytokeratin 20 in urine samples using polymerase chain reaction is highly sensitive for detection of bladder tumors. We examined the efficacy of immunocytology on...

Our armamentarium for the treatment of erectile dysfunction has recently been expanded by addition of Viagra and the MUSE. However, their long-term results are still unknown. The insertion of a penile prosthesis is invasive, expensive, and irreversible, but under optimal condition provides an acceptable, definitive solution for erectile dysfunction...

We assess the sensitivity and specificity of the noninvasive BTA stat urine test for detection of primary and recurrent bladder cancer with special reference to the size, grade and stage of the tumors, and examine the effect of intravesical bacillus Calmette-Guerin treatment on the results. A total of 250 patients recruited from 3 medical centers p...

To assess the long-term results of the Stamey vesicourethral suspension for stress urinary incontinence. A total of 72 case records of women who underwent the Stamey procedure in the years 1985-1991 was reviewed. Every patient had a full preoperative evaluation including filling cystometry, urethral pressure profilometry and imaging of the kidneys...

Testicular infarction not associated with torsion is rare and segmental infarction is even more rare. The causes of testicular infarction in adults include trauma, sequela of epididymo-orchitis, polycythemia, hypersensitive angiitis, intimal fibroplasia of the spermatic artery and idiopathic etiology.(1,2) In most reported cases the diagnosis of te...

We examined the use of immunostaining of the Lewis X antigen in exfoliated cells from voided urine samples, cytopathology and bladder ultrasound for noninvasive detection of bladder tumors as a potential substitute for cystoscopy. A total of 260 patients were included, of whom 80 were evaluated because of irritative symptoms or hematuria and 180 we...

In a study examining the relationship between patient participation in clinical decision making and levels of anxiety, patients were offered a choice of treatment for ureteral calculus. 42 received information about 2 treatment options, ultrasound fragmentation of the stone through a ureteroscope and extracorporeal shock wave lithotripsy (ESWL), an...

Radical prostatectomy may cure most patients in whom the malignant tumor has not invaded through the prostatic capsule. Advances in surgical technique and accumulation of experience have decreased the complication rate significantly. Long-term results of surgical treatment are now better than those of other forms of treatment; hence radical prostat...

Ninety-six patients with a ureteral calculus participated in a study whose purpose was to identify those subjects who would benefit from participation in clinical decision-making. Forty-two of the subjects (the experimental group) were given information about two alternative treatments, Extra Corporeal Shock Wave Lithotripsy (ESWL) and ureteroscopy...

We determined the preferred treatment of staghorn calculi. Between January 1992 and December 1994 we performed a prospective, randomized, single center study involving 50 kidneys with complete staghorn calculi: 27 renal units were treated with extracorporeal shock wave lithotripsy (ESWL) monotherapy (group 1) and 23 were treated with combined (init...

Superficial bladder carcinoma, treated by resection and intravesical administration of bacillus Calmette-Guérin (BCG), yields a remission rate that approaches 70%. We examined whether expression of interleukin-2 (IL-2) or interferon-gamma (IFN-gamma) genes can serve to predict response. During BCG treatment, we analyzed induction of IL-2 and IFN-ga...

A study was made to determine the sensitivity and specificity of immunostaining of the Lewis X antigen in exfoliated urothelial cells from voided urine, for the detection and surveillance of bladder tumors. Three consecutive voided urine specimens were obtained from 101 patients, 78 of whom were under surveillance because of a history of bladder tu...

Cystinuria is a hereditary metabolic disorder which causes urinary lithiasis. Patients with cystinuria present at an earlier age (17 years), and with larger stones than patients with other types of urinary stones. As a result of frequent formation of new stones and multiple operations, many patients suffer from obstructive nephropathy and deteriora...

In an attempt to detect prostate cancer when the tumor is still confined to the prostate, a screening program was established. We studied the efficacy of digital rectal examination (DRE) and serum prostate-specific antigen (PSA) in the early detection of prostate cancer. One thousand men aged 50-75 years underwent DRE and serum PSA determination. T...

The development of high definition transrectal ultrasound probes has led to an increased interest in the ability of transrectal ultrasound of the prostate (TRUS) to assist in the diagnosis and management of prostate cancer. The present study was designed to examine the correlation of TRUS with digital rectal examination (DRE). The study group compr...

Urethral strictures are difficult to cure. In 1988, a new treatment was reported, consisting of dilation or incision of the stricture followed by implantation of a specially designed stent meant to allow the urethral epithelium to heal and cover the stent while preventing shrinkage of the scar and reappearance of the stricture. Two cases are report...

The intravesical instillation of lidocaine solution has been used as a topical form of anesthesia for bladder biopsies. We performed 63 ambulatory procedures in which multiple cold-cup biopsies were obtained during cystoscopy. There was no need for electrocautery. All patients tolerated the procedure well and were discharged from the office immedia...

Extracorporeal shock-wave lithotripsy (ESWL) has been accepted as the method of choice for most upper urinary tract calculi. However, in cases of stones in the lower ureter, ureteroscopic procedures have generally been preferred. Using the Dornier HM3 lithotriptor with modifications in the patient's position, we were able to successfully treat 155...

A case of grade 3 renal trauma which nearly halved the kidney was managed successfully without need for surgical intervention.

A case of grade 3 renal trauma which nearly halved the kidney was managed successfullywithout need for surgical intervention.

We treated 12 patients with sixteen renal and one ureteral cystine stones primarily with extracorporeal shock-wave lithotripsy (ESWL). Among the stones thirteen were greater than 25 mm. In four stones less than 25 mm, three stones completely disappeared and 1 was reduced to small fragments, following ESWL. In thirteen stones greater than 25 mm, twe...

Complete rupture of the female urethra is rare. We found only 30 such cases described in the literature, 19 of which were in children. In most of these patients, the proximal urethra and bladder neck were injured. Herein we report on the complete rupture of the distal part of the urethra in a female child with a pelvic fracture. This diagnosis shou...

Four patients underwent extracorporeal shock wave lithotripsy (ESWL) for large stones in the kidney resulting in disappearance of the radiopaque stones from the plain film. However, contrast study revealed that the collecting system was occupied by radiolucent filling defects, which were found to be composed of stone matrix material. All four patie...

Blast injury to the lungs is one of the most overwhelming threats to survival following exposure to powerful explosions. The pathophysiology of blast injuries differs significantly from other forms of trauma. Using the extracorporeal shock-wave lithotriptor, originally designed for the noninvasive treatment of nephrolithiasis, we were able to produ...

Intrapleural marcaine has been described as an effective method of analgesia following upper abdominal and thoracic operations and is no longer regarded as experimental. We have shown that the same quality of analgesia can be achieved by injecting the drug through a catheter inserted intraoperatively through the surgical incision. In our method, ap...

We report a case of renal adenocarcinoma diagnosed by percutaneous biopsy, under computerized tomography (CT) guidance. The pathology following nephrectomy revealed only hemorrhagic necrosis. The implications of this occurrence are presented.

Combined extradural bupivacaine and methadone analgesia was investigated in 144 patients who underwent extracorporeal shock wave lithotripsy (ESWL). Patients were assigned randomly to one of three groups: group I--extradural 0.5% bupivacaine hydrochloride 0.75 mg kg-1; group II--extradural 0.1% methadone hydrochloride 4 mg after the bupivacaine; gr...

Infected renal stones can be treated by extracorporeal shock wave lithotripsy but it still is not clear whether successful stone fragmentation and the disappearance of all macroscopic stone fragments guarantee eradication of the infection. Therefore, a prospective study was done in 135 patients with renal or upper ureteral stones associated with pe...

Extracorporeal shock wave lithotripsy monotherapy was used to treat 41 patients with complete staghorn calculi. In 20 patients polyethylene angiographic pigtail catheters were inserted prophylactically as ureteral stents and the other 21 patients did not receive stents. Prophylactic stenting reduced the incidence of complications and the need for p...

Changes in urine cytology and bladder mucosal architecture were observed during and following BCG treatment. Urine cytology changed from neoplastic to a normal pattern on the third, fourth and fifth treatments. In the first few hours after BCG treatment there was an increase in mononuclear cells in the urine. This increased with every treatment. A...

Vesicouterine fistula is a rare complication of cesarean section. Most patients present early postoperatively, while others are seen months later with urinary incontinence. Recurrent urinary infections, menstruation through the bladder (menouria), secondary infertility and amenorrhea are less common reasons for consultation. Although more than 100...

We report a case of recurrent adenocarcinoma in an ileal loop 13 years after cystectomy for adenocarcinoma of the urethra. The method of diagnosis is discussed.

We report on our first 6 months' experience with the extracorporeal shock-wave lithotripter (ESWL). During this period, 410 treatments were given to 350 kidneys and ureters. Our series was characterized by a particularly high proportion (40%) of multiple and large calculi and included 25 complete staghorns. The latter required multiple treatments (...