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108
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857
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Introduction
Skills and Expertise
Current institution
Education
August 2012 - May 2016
August 2008 - May 2012
Publications
Publications (108)
Introduction:
The US supply disruption of surgical irrigation fluids in September 2024 prompted the need for fluid conservation and potential deferral of urology procedures. We characterized fluid use in common endoscopic procedures to articulate recommendations for irrigation fluid stewardship and case prioritization during fluid shortages.
Meth...
Introduction:
We aimed to characterize patient portal messaging use after urologic surgery to identify administrative burden and evaluate postoperative clinical associations.
Methods:
Epic was queried for all urologic surgeries performed at the Mayo Clinic enterprise between 2019 and 2022. Data from the highest volume procedures were extracted i...
Background:
Contemporary prostate cancer (PCa) screening uses first-line prostate-specific antigen (PSA) testing, possibly followed by multiparametric magnetic resonance imaging (mpMRI) for men with elevated PSA levels. First-line biparametric MRI (bpMRI) screening has been proposed as an alternative.
Objective:
To evaluate the comparative effec...
Introduction: There are minimal data to guide antibiotic management of patients undergoing holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia. Specifically, management of high-risk patients who are catheter dependent or have positive preoperative urine cultures varies widely. We aimed to evaluate the effect of preope...
Purpose
The Manufacturer and User Facility Device Experience database contains anonymous, voluntary medical device reports. A review of device-related adverse events associated with Benign Prostatic Hyperplasia surgeries was completed. The objective was to evaluate the occurrence and contributing factors to clinically significant complications in a...
Purpose
Isolated recurrence in remnants of the seminal vesicles (SV) after treatment of primary prostate cancer (PCa) has become a more frequent entity with the widespread use of more sensitive next-generation imaging modalities. Salvage vesiculectomy is hypothesized to be a worthwhile management option in these patients. The primary goal of this s...
572
Background: Bladder preservation with trimodal therapy (TMT), which consists of maximal transurethral resection of bladder tumors followed by chemoradiation, is now included in guidelines with radical cystectomy (RC) as options for definitive management of muscle-invasive bladder cancer (MIBC). Prospective randomized controlled trial data to he...
Background
The Surgery in Early Metastatic Seminoma (SEMS) trial examined retroperitoneal lymph node dissection (RPLND) as first-line treatment for patients with isolated 1-3cm retroperitoneal lymphadenopathy. To date, the standard of care for these patients has been either chemotherapy or radiotherapy (XRT). Herein, we evaluated the relative cost-...
Introduction:
We aimed to assess the impact of discharge instruction (DCI) readability on 30-day postoperative contact with the healthcare system.
Materials and methods:
Utilizing a multidisciplinary team, DCI were modified for patients undergoing cystoscopy, retrograde pyelogram, ureteroscopy, laser lithotripsy, and stent placement (CRULLS) fro...
Purpose:
Post-ureteroscopy stent placement carries significant morbidity which can interfere with daily life. This discomfort unfortunately leads to high utilization of opioid pain medications, which have a known risk of addiction. Cannabidiol oil represents an alternative analgesic that has proven anti-inflammatory and antinociceptive effects. Th...
Objective
To determine if same day catheter removal is feasible in a population of HoLEP patients who received paralysis and if bladder pressure monitoring could predict successful catheter removal.
Methods
From February 2021 to February 2022, we evaluated same day catheter removal for patients undergoing HoLEP. Criteria for proceeding with same d...
Background
The VESPER trial demonstrated improved progression‐free (PFS) and (preliminarily) overall survival (OS) with six cycles of neoadjuvant dose‐dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVACx6) versus four cycles of gemcitabine and cisplatin (GCx4) before radical cystectomy (RC) for muscle‐invasive bladder cancer (MIBC),...
Objective
To compare the cost-effectiveness of surgical interventions for BPH.
Methods
Using a Markov model, a cost-utility analysis was performed comparing HoLEP, B-TURP, WVTT, and PUL for prostate size <80cc (index patient 1) and HoLEP and SP for prostate size >80cc (index patient 2). Model probabilities and utility values were drawn from the li...
Purpose:
The KEYNOTE-564 trial demonstrated that adjuvant pembrolizumab after nephrectomy for clear cell renal cell carcinoma (ccRCC) decreased the risk of disease progression and potentially overall mortality as well. Herein, we used a Markov model to weigh the costs, toxicities, and efficacy of pembrolizumab to further investigate its utility....
Introduction and Objective
Upper tract urothelial carcinoma (UTUC) represents 5% of all urothelial malignancies (¹1 Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017; 67:7-30.–³3 Sharma G, Yadav AK, Pareek T, Kaundal P, Tyagi S, Devana SK, et al. Impact of pathological factors on survival in patients with upper tract ur...
Objective:
The aim of this study was to perform a cost-effectiveness analysis comparing the management for ongoing voiding dysfunction after midurethral sling placement, including early sling loosening and delayed sling lysis.
Methods:
A Markov model was created to compare the cost-effectiveness of early sling loosening (2 weeks) versus delayed...
Objective: To evaluate the impact of personality traits and institutional factors on burnout among a population of practicing urologists.
Methods: From 2017-2019 a voluntary survey was distributed to practicing urologists across the United States. The survey evaluated demographics, education, social factors, practice types and work satisfaction. Pe...
321
Background: KEYNOTE-564 demonstrated that adjuvant pembrolizumab after nephrectomy for high-risk clear cell renal cell carcinoma (RCC) decreased the risk of disease progression and – albeit with immature follow-up (2 years) – found a signal of improved overall survival as well. Herein, we used extrapolations from a Markov-model, accounting for...
Objective
To perform a cost-effectiveness evaluation comparing the management options for mid-size (1-2cm) renal stones including percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and shockwave lithotripsy (SWL).
Methods
A Markov model was created to compare cost-effectiveness of PCNL, mini-PCNL, RIRS, and SWL for 1-2cm lo...
395
Background: Patients with BCG-unresponsive carcinoma in situ (CIS) are treated with radical cystectomy (RCx) or salvage intravesical chemotherapy (SIC). Recently, the FDA approved pembrolizumab for BCG-unresponsive CIS +/- papillary tumors. Given the costs and toxicities of pembrolizumab, it remains unclear whether its benefits are sufficient t...
Purpose:
Patients with BCG-unresponsive carcinoma in situ (CIS) are treated with radical cystectomy (RCx) or salvage intravesical chemotherapy (SIC). Recently, pembrolizumab was approved for BCG-unresponsive CIS.
Materials and methods:
We used a decision-analytic Markov model to compare pembrolizumab, SIC (with gemcitabine-docetaxel induction+mo...
Background:
Non-guideline-directed care (NGDC) is seen in ∼30% of testicular cancer patients and has been identified as a significant predictor of relapse. However, the potential impact of mismanagement on patient quality of life (QoL) is yet to be established.
Objective:
To explore the impact of NGDC on long-term QoL in testicular cancer surviv...
Objective:
To develop a risk score utilizing CRP and procalcitonin to better predict a clinical infection for patients with obstructive urolithiasis.
Methods:
A retrospective review was performed of patients presenting to the emergency room from December 2017 to February 2019 who underwent upper urinary tract decompression due to concern for inf...
Introduction:
While guidelines support the use of maintenance BCG(mBCG) for patients with intermediate- and high-risk non-muscle invasive bladder cancer(NMIBC), in an era of BCG shortage we explored the cost-effectiveness of mBCG.
Methods:
A Markov model compared the cost-effectiveness of mBCG to surveillance after induction BCG for intermediate...
Cutaneous metastases of genitourinary malignancies are an extremely rare phenomenon. Few cases of skin metastasis from urothelial carcinoma of the bladder have been reported. We report a case of 71-year-old female with primary bladder transitional cell carcinoma who presented with the initial presentation of cutaneous skin lesions that covered the...
Objectives:
To describe a minimal incision modified fenestration technique" (MIMFeT) for symptomatic hydroceles utilizing local anesthesia.
Methods:
A database was maintained for men undergoing in-office MIMFeT for symptomatic hydroceles between June 2015 and August 2018. Following local anesthesia, the hydrocele was sequentially everted through...
Purpose:
The primary rationale for antimicrobial prophylaxis (AP) is to decrease the incidence of surgical site infection (SSI) and other preventable periprocedural infections, with the secondary goal of reducing antibiotic overuse. This Best Practice Statement (BPS) updates the prior American Urological Association (AUA) BPS and creates a compreh...
Background
Traditionally, surgery has been considered the gold standard treatment for Peyronie’s disease (PD). Less-invasive alternatives, such as collagenase Clostridium histolyticum (CCH) and traction therapy, have been proposed and proven effective.
Aim
To compare cost-effectiveness of management options for PD.
Methods
A Markov analytic model...
Background:
Despite increasing emphasis on value-based care, the cost-effectiveness of prostate cancer (PCa) management options has not been compared using prospective clinical trial data. The prostate testing for cancer and treatment (ProtecT) trial demonstrated no difference in survival for patients randomized to active surveillance (AS), extern...
Objective:
To compare outcomes of men with or without calcified plaques undergoing collagenase clostridium histolyticum (CCH) injections for Peyronie's Disease (PD) and identify predictors of CCH success.
Material and methods:
From March 2014 through January 2017, data were prospectively collected on 192 patients who underwent 1-4 cycles of CCH...
Purpose:
Testicular cancer is the most common malignancy among young men and well-established treatment guidelines exist to optimize outcomes. We characterized errors in the management of testicular cancer observed among patients seen at three referral centers in the United States.
Methods:
We retrospectively reviewed data from 593 patients pres...
