Hitendra R H Patel

East Coast Community Healthcare CIC

Introduction: The minimally invasive UroLift® System procedure in moderate-to-severe benign prostate hyperplasia (BPH) refractory to medical treatment may be superior over other prostate procedures regarding its preserved sexual function post-operatively. We aimed to optimise patient selection criteria for the UroLift® System. Material and method...

Prostate cancer (PCa) is a highly prevalent malignancy and constitutes a major cause of cancer-related morbidity and mortality. It emerges through the acquisition of genetic and epigenetic alterations. Epigenetic modifications include DNA methylation, histone modifications and microRNA deregulation. These generate heritable transformations in the e...

Background: Telementoring is a technique that has shown potential as a surgical training aid. Previous studies have suggested that telementoring is a safe training modality. This review aimed to review both the technological capabilities of reported telementoring systems as well as its potential benefits as a mentoring modality. Methods: A syste...

Due to insufficient prognostic tools, failure to predict aggressive prostate cancer (PC) has left patient selection for radical treatment an unsolved challenge. This has resulted in overtreatment with radical therapy. Better prognostic tools are urgently warranted. MicroRNAs (miRs) have emerged as important regulators of cellular pathways, resultin...

Few quantifiable tissue biomarkers for the diagnosis and prognosis of prostate cancer exist. Using an unbiased, quantitative approach, this study evaluates the potential of three proteins of the 40S ribosomal protein complex as putative biomarkers of malignancy in prostate cancer. Prostate tissue arrays, constructed from 82 patient samples (245 tis...

Specificity controls. Antibody specificity controls showing representative human prostate tissue stained using Mouse IgG2b at 0.5ug/ml or Rabbit IgG at 2ug/ml and representative images of prostate tissue sections stained following omission of primary antibody used as negative controls to determine background signal. Scale bar 250μm. (TIF)

Nuclear staining of RPS24. TA slides containing non-malignant (A, B and C) and malignant (E, F and G) CaP tissue cores were stained for RPS24 using an Ox-DAB staining protocol and imaged using a Nano-zoomer (Hamamatsu) slide scanner at 40x magnification. Nuclear staining can be seen in images of both non-malignant (B and C) and malignant (F and G)...

Due to a lack of sufficient diagnostic tools to predict aggressive disease, there is a significant overtreatment of patients with prostate cancer. Platelet derived growth factors (PDGFs) and their receptors (PDGFRs) are key regulators of mesenchymal cells in the tumor microenvironment, and has been associated with unfavorable outcome in several oth...

Urinary incontinence is a common and debilitating problem, and post-prostatectomy incontinence (PPI) is becoming an increasing problem, with a higher risk among elderly men. Current treatment options for PPI include pelvic floor muscle exercises and surgery. Conservative treatment has disputable effects, and surgical treatment is expensive, is not...

Background: Totally intracorporeal robotic-assisted radical cystectomy (RARC) has perceived difficulties compared to open radical cystectomy (ORC). As the technique is increasingly adopted around the world, the benefits of RARC with intra- or extracorporeal urinary diversion or ORC for the patients are still unclear. In this article, we consider t...

Technological barriers of telemedicine and surgical telementoring have decreased during recent years, and high-quality videoconference equipment is accessible on a commercial basis. Surgical telementoring has been described as a natural fit in surgery, with solutions demonstrated for laparoscopic and robotic surgery, and mobile telemetering solutio...

The introduction of laparoscopic technique in pelvic surgery has improved patient outcome and reduced the impact of surgery on the patients’ quality of life. At the same time, the requirements for surgeons have changed profoundly. Traditional surgical training cannot meet the complexity of laparoscopic pelvic surgery and demands of high quality out...

Enhanced Recovery After Surgery (ERAS) is a multimodal concept combining pre-, peri- and postoperative care evidence based elements aiming to reduce surgical stress. ERAS has been shown to significantly reduce morbidity, length of hospital stay and total costs when applied to colonic surgery. It is therefore considered standard of care in this surg...

Dissection of the pudendal nerve (PN) and its branches in 71 cadavers revealed anatomic variations not previously described. Knowledge of this variation is necessary to prevent nerve injury resulting in sexual of sensory dysfunction. Because descriptions vary, this study re-evaluated the anatomy of the PN as implicated in perineal procedures in Sou...

Penile squamous cell carcinoma (PeCa) is a rare malignancy and little is known regarding the molecular mechanisms involved in carcinogenesis of PeCa. The Wnt signaling pathway, with the transcription activator ß-catenin as a major transducer, is a key cellular pathway during development and in disease, particularly cancer. We have used PeCa tissue...

The technique for performing RRP has improved considerably since Millin fi rst introduced the retropubic approach in 1945 [ 1 ]. The morbidity of RRP, since described by Reiner and Walsh in 1979, has also decreased dramatically due to technical improvements [ 2 ] and better understanding of periprostatic anatomy [ 3 ]. RRP still remains the gold st...

Enhanced recovery after surgery (ERAS) for radical cystectomy seems logical, but our study has shown a paucity in the level of clinical evidence. As part of the ERAS Society, we welcome global collaboration to collect evidence that will improve patient outcomes.

Prostate carcinoma is the most common cancer in men with few, quantifiable, biomarkers. Prostate cancer biomarker discovery has been hampered due to subjective analysis of protein expression in tissue sections. An unbiased, quantitative immunohistochemical approach provided here, for the diagnosis and stratification of prostate cancer could overcom...

The performance of professionals in the health-care or any other industry is subject to human error. The acknowledgment of human error as ubiquitous and inevitable is the key premise for understanding the importance of human factors. Nontechnical skills (NTS) can improve performance, and attempts have been made to quantify this ambiguous quality. T...

Instructional methods that aim to optimize teaching outside of the operating room are becoming increasingly important due to the reduction in traditional hospital training hours. One such method is the use of multimedia-based portable learning tools. In developing these tools, due consideration should be given to the features that define effective...

Enhanced recovery after surgery (ERAS) pathways have significantly reduced complications and length of hospital stay after colorectal procedures. This multimodal concept could probably be partially applied to major urological surgery. The primary objective was to systematically assess the evidence of ERAS single items and protocols applied to cyste...

The potential rehabilitative and protective effect of phosphodiesterase type 5 inhibitors (PDE5-Is) on penile function after nerve-sparing radical prostatectomy (NSRP) remains unclear. The primary objective was to compare the efficacy of tadalafil 5mg once daily and tadalafil 20mg on demand versus placebo taken over 9 mo in improving unassisted ere...

To report and identify the predictors of early and long-term complications in a large series of extraperitoneal robot-assisted radical prostatectomy using the standardized Martin criteria. A total of 1503 patients underwent extraperitoneal robot-assisted radical prostatectomy for the treatment of clinically localized prostate cancer from July 2003...

Background: Over the past 5 years, minimal access surgery has been moved toward a new less invasive single port access surgery. Like any new technique, there is a need to ensure that basic tenets of safety and efficacy are maintained. In this study, we demonstrate the efficacy and safety of single port laparoscopic surgery for cholecystectomy in 22...

The field of minimally invasive surgery (MIS) has now taken centre stage in modern clinical practice. With ever changing technologies in the field of MIS, such as robotics, there is now the need to train the surgeon to the next degree. Training by simulation, whether virtual, hybrid, or real, allows the surgeon to rehearse, learn, improve or mainta...

Surgical training has, for the most part, remained relatively stagnant for a significant length of time. The see one, do one, teach one methodology, based within the Halstedian apprentice-type framework, has, until recently, stood the test of time. In this chapter, we discuss the need to enhance the medical education in general and surgical trainin...

Background: Training within a proficiency-based virtual reality curriculum has been proven to be an effective enhancement to supplement the conventional surgical training schemes that have been stagnant for a significant period of time. In our study, we investigated the time and attempts needed by novices to reach proficiency in laparoscopic cholec...

Checklists are the foundation for safety and quality control in the aviation industry. The concept developed from a disaster in 1935 and to date checklists are a dynamic tool within aviation and aircraft maintenance, regularly audited and adjusted to prevent avoidable error or accidents. Other high-risk industries such as nuclear and oil drilling i...

Laparoscopy and robotic surgery have provided much excitement in our operating theaters over the last two decades. Continued technological improvements have added a number of new tools to our surgical armamentarium promising to better the care we deliver to our patients. From open surgery, to multiport laparoscopic surgery, to needlescopic, and mos...

Retroperitoneal Robotic and Laparoscopic Surgery provides urologists with an easy way to learn the extraperitoneal alternative when performing laparoscopic or robot assisted procedures. There are significant technical differences between intra-peritoneal and retroperitoneal surgery. There are occasions, particularly with a history of prior intra-ab...

A robot functioning in an environment may exhibit various forms of behavior emerge from the interaction with its environment through sense, control and plan activities. Hence, this paper introduces a behaviour selection based navigation and obstacle avoidance algorithm with effective method for adapting robotic behavior according to the environment...

There has been an explosion in the development of microscopic and miniaturized technology over the past decade and we have long awaited their arrival and integration into clinical practice. We have now reached the stage where promises are beginning to be delivered. This article reviews their place in modern medicine and looks toward the future. Min...

Robotic technologies have had a significant impact on surgery. We report what is to our knowledge the first use of microrobots to perform laparoscopic urological surgery in a canine model. Nonsurvival laparoscopic radical prostatectomy and radical nephrectomy were performed using microrobotic camera assistance. Following the administration of gener...

Fatigue has been implicated in medical errors. There has not been any report in the surgical literature addressing the impact of case order on patient outcomes. The purpose of this study was to determine whether the order of robot-assisted radical prostatectomy (RARP) has an influence on surgical outcomes. All patients undergoing RARP by a single s...

New technologies are regularly being used for surgical treatment of prostate cancer, however the cost associated is often a secondary issue. We assessed the operative costs incurred by using the daVinci robot assisted prostatectomy (RAP) method compared to pure laparoscopic radical prostatectomy (LRP) and open radical prostatectomy (ORP). We retros...

The relationship between lipids and breast cancer is obscure. Until now, conflicting results have been reported on the association between lipids and risk of breast cancer in women. Therefore, the major aim of this study is to examine the role of alterations in lipid profile in breast cancer. Plasma lipids (ie, total cholesterol [TC], high-density...

The Page kidney phenomenon, whilst a known condition, is in itself a rare entity. This report illustrates a case following partial nephrectomy which presented as post-operative renal failure. The authors present a case of renal cell carcinoma in a solitary kidney that after partial nephrectomy resulted in a subcapsular haematoma formation and acute...

Although extraperitoneal robot-assisted radical prostatectomy (RARP) is gaining popularity, the majority of these procedures are performed transperitoneally. The purpose of this study was to compare the transperitoneal and extraperitoneal approaches for RARP. We randomized 62 consecutive patients undergoing RARP into two equal groups according to t...

We review important aspects of nanotechnology, and discuss the wide range of research and clinical applications of nanomedicine in the field of urology. There is particular emphasis on key clinical and pre-clinical studies to provide an update on recent and potential applications in the care of urological patients. A directed Medline literature rev...

Pure laparoscopic urologic surgery is becoming the standard of care for many urologic procedures. Training surgeons without any experience in the field is still a challenge. It is well recognized that two-dimensional optics causes difficulty for the novice. Thus, we assessed a new-generation, three-dimensional (3D) visualization system. Fifteen lap...

A large prostate can complicate an extraperitoneal robot-assisted radical prostatectomy (RARP). We report our experience with RARP and evaluate the effects of prostate size on treatment outcomes after extraperitoneal RARP. Information on 355 consecutive patients undergoing extraperitoneal RARP was gathered, and patients with prostate weight <75 g (...

Erectile function after prostate surgery is an important criterion for patients when they are choosing a treatment modality for prostate cancer. Improved visualization, dexterity, and precision afforded by the da Vinci robot allow a precise dissection of the neurovascular bundles. We objectively assessed erectile function after robot-assisted extra...

Oral cancer is the leading malignancy in India, with tobacco playing a major role in the etiology. The aim of the present study was to quantify nitrate+nitrite (NO2+NO3) in tobacco products as well as to study tobacco exposure related biomarkers in controls, patients with oral precancers (OPC) and oral cancer patients. Healthy individuals (n=90) we...

Few centers perform extraperitoneal robot assisted radical prostatectomy. The average patient weight is increasing to the mildly obese. Little is known as to the difficulty-impact, obesity may have on robot-assisted extraperitoneal prostatectomy (RAP). We assess our own experience with obese patients undergoing RAP. Information on 375 consecutive p...

Overactive bladder is a syndrome characterised by urinary urgency, with or without urge incontinence, and usually with frequency and nocturia. It affects millions of people of all ages worldwide and causes significant morbidity, especially in terms of health-related quality of life. It poses a huge economic burden on health resources. Managing such...

In the first part of this review the potential pathophysiological factors involved in the overactive bladder were outlined, and the wide range of first-line anticholinergic pharmacotherapies available for such patients were reviewed. The second part will focus on the intravesical instillation of resiniferatoxin and injections of botulinum toxin int...

We review important aspects of TMA methodology and discuss its wide range of clinical applications with particular emphasis on key clinical studies. We also provide an update on recent and projected uses of this technology to help the urologist improve care in oncology patients. A directed MEDLINE literature review of TMAs was performed. Important...

This article is an expert review of bladder cancer genetics focusing on genetic changes and their significance in the pathogenesis and progression of bladder transitional cell carcinoma, in particular, muscle-invasive disease. Alongside the relevant genetic markers and their products, new therapeutic targets and agents that are being developed are...

To compare our experience of pure laparoscopic radical prostatectomy (LRP) with robot-assisted radical prostatectomy (RAP). The two techniques were compared retrospectively in 100 patients with localized prostate cancer who had LRP or RAP (50 each). Both groups were similar in age, serum prostate-specific antigen level, Gleason score and clinical s...

Autonomic dysreflexia (AD) is a potentially dangerous complication of spinal cord injury (SCI). In AD, an individual's blood pressure may rise to dangerous levels and, if not treated, can lead to stroke and possibly death. All medical personnel, especially those interacting with SCI patients, must have a good understanding of its aetiology, complic...

Real-time quantitative PCR allows the sensitive, specific and reproducible quantitation of nucleic acids. Since its introduction, real-time quantitative PCR has revolutionized the field of molecular diagnostics and the technique is being used in a rapidly expanding number of applications. This exciting technology has enabled the shift of molecular...

Chemokines or chemotactic cytokines are known to be important in the directional migration or chemotaxis of leucocytes in conditions of homeostasis and in inflammatory or immunological responses. However, the role of chemokines is extending beyond their involvement in mediating leucocyte trafficking with an increasing body of evidence suggesting th...

The management of metastatic renal cell carcinoma (mRCC) remains a therapeutic challenge; less than 10% of patients survive for longer than 5 years. The resistance of renal cancer to chemotherapy may be explained by high levels of the multidrug resistance gene, MDR1. Immune-based treatments for renal cancer have been explored because of their unusu...

Sildenafil revolutionised the treatment of erectile dysfunction (ED) on its introduction in 1998. Not only is it effective, but is, perhaps even more importantly, an extremely acceptable manner in which to treat ED (i.e., oral pharmacotherapy), compared to the other treatments that were available at that time (e.g., intracavernosal injection). Whil...

Laparoscopic techniques performed in the urologic setting have received great attention in the past decade. With the development of improved laparoscopic instrumentation, approaches to gonadal, renal, prostate, and bladder diseases have been successfully performed. A discussion of urologic laparoscopy (UL) with particular attention to potential com...

Metastatic renal-cell carcinoma (RCC) is resistant to chemotherapy, and patients with this disease have a poor outlook. Immunotherapy by use of cytokines and vaccines against tumour antigens has shown encouraging results in a small group of patients. Advances in the understanding of the graft-versus-tumour effect in haematological malignant disorde...

Many malignancies metastasise to the skeleton. This often results in a relatively unique pain process, which dramatically affects a patient's quality of life. With one in three members of the population likely to develop cancer at some stage in their lives, the prevalence of bone metastases is high. Despite the large financial investment on therapi...

To present a new method of identifying the anatomy of posterior urethral distraction defects (PUDDs) using three-dimensional spiral computed tomography/cysto-urethrography (CTCUG), as conventional two-dimensional CUG can give a false interpretation of the exact anatomy. Twenty-one patients presenting with a PUDD were assessed between February 2001...

Botulinum toxin A is used in the treatment of lower urinary tract symptoms due to detrusor sphincter dysynergia and detrusor hyper-reflexia (neurogenic detrusor deficiency). The toxin acts by producing paralysis of muscle tissue and has been shown to be safe and effective in the treatment of conditions caused by increased muscle tonicity and spasti...

Peyronie's disease (PD) is characterised by penile plaque formation, pain, penile deformity and erectile dysfunction. It is a fibrotic disorder of the tunica albuginea with a poorly understood aetiology and epidemiology. PD may be classified into inflammatory (acute) and chronic stages. Medical treatment is usually instigated during the inflammator...

Priapism is characterised by the presence of prolonged, often painful penile erection in the absence of a sexual stimulus. This rare condition has a range of aetiologies, but is most common following self-administration of injection therapy for impotence. Priapism may be classified into high- and low-flow states. Low-flow priapism is an emergency i...

In the UK, 10,000 new cases of bladder cancer are reported per annum. Earlier diagnosis and better care have improved survival rates, but the incidence is still rising. This article updates the current understanding of bladder cancer diagnosis and management.