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Article: Dual balloon adjustable continence therapy for urinary incontinence.

Feloney, Michael P / Klock, Julie A / Zhang, Yuanyuan

American journal of clinical and experimental urology

2023 Volume 11, Issue 4, Page(s) 334–338

Abstract: Dual balloon adjustable continence therapy (DBACT) has emerged as a promising option for treating stress urinary incontinence. DBACT is a minimally invasive and easily reversible procedure in which two periurethral balloons are placed just distal to the ... ...

Abstract	Dual balloon adjustable continence therapy (DBACT) has emerged as a promising option for treating stress urinary incontinence. DBACT is a minimally invasive and easily reversible procedure in which two periurethral balloons are placed just distal to the bladder neck to increase bladder outflow resistance. The device is connected to a small titanium port placed under the scrotal or labial skin. The port is used for adjustment to balloon volume in the clinic setting, allowing for refinement and optimization of urinary continence. DBACT placement is typically performed under general anesthesia and is considered an outpatient procedure. Several studies have evaluated the effectiveness of DBACT in treating urinary incontinence, and the results are promising. DBACT was effective in 91% of patients who underwent the procedure, 80% reported a significant improvement in their symptoms, and 70% reported being completely dry after the procedure. DBACT is a safe procedure with few reported complications. The most common complication is mild pain or discomfort at the site of device placement, which usually resolves within a few days. Overall, DBACT is minimally invasive, adjustable, and highly successful in restoring urinary continence.
Language	English
Publishing date	2023-08-15
Publishing country	United States
Document type	Journal Article
ISSN	2330-1910
ISSN	2330-1910
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Article: Focal Cryoablation of the Prostate: Primary Treatment in 163 Patients With Localized Prostate Cancer.

Khan, Anwar / Khan, Ansar U / Siref, Larry / Feloney, Michael

Cureus

2023 Volume 15, Issue 4, Page(s) e37172

Abstract: ... the Kaplan-Meier method, with significance considered at p < 0.05. Select focal cryotherapy patients were ...

Abstract	Objective Whole gland treatment of the prostate has known efficacy in treating many grades of prostate cancer. However, it is often associated with increased morbidity, including erectile dysfunction and urinary incontinence. Focal ablative therapies, including focal cryoablation (FC), are utilized to minimize the risk of tumor progression and preserve erectile and urinary function. There is little to no consensus on whether intermediate or high-risk prostate cancer should be treated with focal therapy. However, there is a growing body of literature on the effectiveness of FC as an effective means of prostate cancer control. We characterize our experience with 163 patients who underwent FC with a median follow-up of 39 months (IQR: 24-60). Methods A 163-patient retrospective cohort underwent FC of the prostate at a single clinic by a physician from November 2008 to December 2020. Each of these T1c patients in this single-tail study was monitored for biochemical recurrence (BCR) and oncologic outcomes. American Society for Radiation Oncology (ASTRO) definition of BCR is three consecutive prostate-specific antigens (PSA) increases of more than 0.5 ng/mL or, along with the utilization of the Phoenix definition, a PSA greater than nadir by 2 ng/mL was used to define BCR. This study's primary endpoint includes BCR or biochemical disease-free survival rates. Secondary endpoints include patient side effects, such as measuring for urinary incontinence and outcomes of salvage treatments. Cox proportional hazard analyses defined univariate HRs and 95% CIs for pre-operative PSA (POPSA), Decipher, and Gleason Grade Groups (GGGs) to determine the prognostic impact of pathologic factors. Statistical analysis and BCR timeline analysis also included logistic regression and the Kaplan-Meier method, with significance considered at p < 0.05. Select focal cryotherapy patients were monitored utilizing genomic sequencing tests. Results Our cohort included 27 patients (16.5%) with D'Amico low, 115 patients (70.5%) with intermediate, and 23 patients (14.1%) with high-risk prostate cancers. One month after FC, a 73% reduction in PSA resulted in a median post-operative PSA of 1.39 ng/mL (IQR: 0.46-2.80 ng/mL). At five years, our cohort yielded biochemical disease-free recurrence rates of 78%, 74%, and 55% for low, intermediate, and high-grade cancers, respectively. Genetic risk stratification results showed very similar BCR rates to patients whose tissues did not undergo genomic testing, at 27%, 26%, and 46% for low, intermediate, and high-grade cancers, respectively. Log-rank tests to map for BCR and HRs for pathologic factors did not yield any statistically significant predictive results. Urinary incontinence and erectile dysfunction were reported in 1.8% and 3.1% of patients in the focal cohort. Conclusions Our results add to the expanding body of literature around the efficacy of focal ablative therapies in contrast to whole gland treatment. The definitive extent of FC's efficacy still remains to be explored, but our conclusions demonstrate favorable PSA kinetics at five years follow-up.
Language	English
Publishing date	2023-04-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.37172
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Article ; Online: Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cysts: What we learned and a review of the literature.

Zhang, Zejian / Chen, Dong / Deng, Ling / Li, Wei / Wang, Xisheng / Zhang, Yixiang / Liekui, Fang / Feloney, Michael P / Zhang, Yuanyuan

Journal of X-ray science and technology

2021 Volume 29, Issue 1, Page(s) 185–196

Abstract: Purpose: To avoid Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cyst (diameter > 70 mm), we present two cases of iatrogenic ureteral injury and discuss their clinical courses and final outcomes.: Patients and methods: ... ...

Abstract	Purpose: To avoid Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cyst (diameter > 70 mm), we present two cases of iatrogenic ureteral injury and discuss their clinical courses and final outcomes. Patients and methods: Two male patients (47 years old and 74 years old) with large left simple renal cysts underwent a retroperitoneal laparoscopic operation to treat the cysts. In the first patient, the left proximal ureter was partially transected (Grade 3) during the operation. The injury was identified intraoperatively. The transection was managed with a primary ureteroureterostomy (end to end) along with a double J ureteral stent. In the second patient, the left proximalureter was partially transected (Grade 4). However, the injury was unrecognized postoperatively for two days. After recognition of the complication, the injury was managed with an early primary ureteroureterostomy, which followed a failed attempt to place ureteral stent endoscopically. Results: In the first patient, a postoperative urinary leakage developed and lasted for 13 days. During long term follow-up of the first patient after the urine leak resolved, there were no reports of pain in the lumbar region or other discomfort. No recurrence of the renal cyst occurred, which was confirmed with an ultrasound at one year postoperatively. In the second patient a ureteral fistula and severe perirenal infection occurred and lasted for 86 days. The patient ultimately underwent a left nephrectomy after conservative management for this surgical complication failed. This patient developed a chronic wound infection that lasted for 3.14 months following the nephrectomy. During follow-up post nephrectomy, the patient developed stage 3B moderate chronic kidney disease (CKD) (GFR = 30 -44 ml/min). Conclusions: For single large (diameter > 70 mm) renal cysts located at the lower pole of the kidney, it is recommended to not completely dissect out and mobilize the entire renal cyst for cyst decortication in order to avoid injuring the ureter. Iatrogenic ureteral injury increases the risk of readmission and serious life-threatening complications. The immediate diagnosis and proper management ureteric injury can reduce complications and long term sequalae.
MeSH term(s)	Cysts ; Humans ; Iatrogenic Disease ; Kidney Diseases, Cystic/diagnostic imaging ; Kidney Diseases, Cystic/surgery ; Laparoscopy/adverse effects ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Ureter/diagnostic imaging ; Ureter/surgery
Language	English
Publishing date	2021-01-17
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2012019-9
ISSN	1095-9114 ; 0895-3996
ISSN (online)	1095-9114
ISSN	0895-3996
DOI	10.3233/XST-200804
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Article: Sexual Dysfunction in Patients With Urinary Bladder Stones but no Bladder Outlet Obstruction.

Gong, Zhi-Cheng / Wu, Zhi-Liang / Wen, Yao-An / Zou, Jie-Peng / Wang, Xisheng / Leng, Xiaoyan / Bleyer, Anthony J / Deng, Chunhua / Feloney, Michael P / Zhang, Yuanyuan / Zhao, Shan-Chao

Frontiers in medicine

2021 Volume 8, Page(s) 704360

Abstract: Objective: ...

Abstract	Objective:
Language	English
Publishing date	2021-09-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2021.704360
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Article ; Online: Sexual Dysfunction in Patients With Urinary Bladder Stones but no Bladder Outlet Obstruction

Zhi-Cheng Gong / Zhi-Liang Wu / Yao-An Wen / Jie-Peng Zou / Xisheng Wang / Xiaoyan Leng / Anthony J. Bleyer / Chunhua Deng / Michael P. Feloney / Yuanyuan Zhang / Shan-Chao Zhao

Frontiers in Medicine, Vol

2021 Volume 8

Abstract: ... and between bladder stone and LUTS (p < 0.05). There was no significant association between the course ... of illness, size and number of bladder stones, or urinary tract infection with sexual function (p > 0.05 ...

Abstract	Objective: To explore the correlates of sexual dysfunction and lower urinary tract symptoms (LUTS) in male patients with urinary bladder stones and to determine the effect of stone extraction on recovery of sexual function.Materials and Methods: A total of 87 male patients with primary bladder stones were studied from January 2015 to May 2016. All patients underwent pneumatic lithotripsy for bladder stones. Sexual dysfunction was assessed based on sexual function assessment scales. The relationship of bladder stones with sexual dysfunction or LUTS was assessed using a two-sample t-test. Postoperative improvement of sexual function was assessed by repeated measures Analysis of Variance (ANOVA).Results: Forty-one patients had primary bladder stones and 46 had secondary stones from the kidneys. Eighty-three of 87 patients (95%) had sexual dysfunction; 79 patients (91%) had both sexual dysfunction and LUTS. There was a significant association between bladder stones and sexual dysfunction, between sexual dysfunction and LUTS, and between bladder stone and LUTS (p < 0.05). There was no significant association between the course of illness, size and number of bladder stones, or urinary tract infection with sexual function (p > 0.05). In addition, among 83 patients with both bladder stone and sexual dysfunction, 61 patients (73%) had benign prostatic hyperplasia (BPH) and 22 patients (27%) had no BPH. On postoperative evaluation at 3 months, sexual dysfunction scores were significantly improved in 77 patients (88.5%)Conclusion: Patients with bladder stones have a high incidence of sexual dysfunction, particularly those with co-existing LUTS and BPH. About 1/3 patients without BPH had sexual dysfunction and surgical removal of bladder stones significantly improved sexual function and LUTS.
Keywords	sexual dysfunction ; bladder stones ; lower urinary tract symptoms ; surgical treatment ; benign prostatic hyperplasia ; Medicine (General) ; R5-920
Subject code	616
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
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Article ; Online: Immunological basis in the pathogenesis and treatment of bladder cancer.

Thompson, David B / Siref, Larry E / Feloney, Michael P / Hauke, Ralph J / Agrawal, Devendra K

Expert review of clinical immunology

2014 Volume 11, Issue 2, Page(s) 265–279

Abstract: The pathogenesis and transition of normal urothelium into bladder carcinoma are multifactorial processes. Chronic inflammation causes initiation and progression of the underlying pathophysiology of invasive and metastatic cancer. A dichotomy is observed ... ...

Abstract	The pathogenesis and transition of normal urothelium into bladder carcinoma are multifactorial processes. Chronic inflammation causes initiation and progression of the underlying pathophysiology of invasive and metastatic cancer. A dichotomy is observed in the role of immune cells in bladder cancer. While the immune response defends the host by suppressing neoplastic growth, several immune cells, including neutrophils, macrophages and T-lymphocytes, promote tumor development and progression. The levels of human neutrophil peptide-1, -2 and -3, produced by neutrophils, increase in bladder cancer and might promote tumor angiogenesis and growth. The effect of macrophages is primarily mediated by pro-inflammatory cytokines, IL-6 and TNF-α. In addition, the underlying immunological mechanisms of two treatments, BCG and cytokine gene-modified tumor vaccines, and future directions are critically discussed.
MeSH term(s)	Cancer Vaccines/genetics ; Cancer Vaccines/immunology ; Cancer Vaccines/therapeutic use ; Humans ; Interleukin-6/immunology ; Leukocytes/immunology ; Leukocytes/pathology ; Mycobacterium bovis ; Tumor Necrosis Factor-alpha/immunology ; Urinary Bladder Neoplasms/immunology ; Urinary Bladder Neoplasms/pathology ; Urinary Bladder Neoplasms/therapy ; alpha-Defensins/immunology
Chemical Substances	Cancer Vaccines ; IL6 protein, human ; Interleukin-6 ; Tumor Necrosis Factor-alpha ; alpha-Defensins
Language	English
Publishing date	2014-11-13
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	2274260-8
ISSN	1744-8409 ; 1744-666X
ISSN (online)	1744-8409
ISSN	1744-666X
DOI	10.1586/1744666X.2015.983082
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Article ; Online: Assessment of sexual dysfunction and sexually related personal distress in patients who have undergone orthotopic liver transplantation for end-stage liver disease.

Park, Eugene S / Villanueva, Carlos A / Viers, Boyd R / Siref, Andy B / Feloney, Michael P

The journal of sexual medicine

2011 Volume 8, Issue 8, Page(s) 2292–2298

Abstract: Introduction: Sexual dysfunction (SD) status post-orthotopic liver transplant (OLT) for end-stage liver disease (ESLD) has long been recognized. To date, there are no studies examining how sexually related personal distress (SRPD) impacts sexual ... ...

Abstract	Introduction: Sexual dysfunction (SD) status post-orthotopic liver transplant (OLT) for end-stage liver disease (ESLD) has long been recognized. To date, there are no studies examining how sexually related personal distress (SRPD) impacts sexual function in this population. Aims: To assess SD and SRPD in men and women who have undergone OLT for ESLD and to compare them with previously published reports on subjects without SD. Methods: 283 subjects (182 men and 101 women) who underwent OLT since 2005 were mailed a survey. Men received the International Index of Erectile Function (IIEF) and Female Sexual Distress Scale-Revised (FSDS-R). Women received the Female Sexual Function Index (FSFI) and the FSDS-R. All surveys asked about the presence of a current sexual partner. Main outcome measures: Total and subscale scores on the IIEF, the FSFI, and the FSDS-R. Results: Ninety-six patients (33.9%) completed and returned the surveys consisting of 34 women (33.7%) and 62 men (34.0%). Also, 83.9% of men and 88.2% of women reported having an available sexual partner. Two-thirds of men and three-quarters of women were sexually active. In all domains, IIEF demonstrates that men have mild to moderate SD. FSFI demonstrates that women also have SD. Both genders reported relatively mild SRPD based on FSDS-R. Compared to previously published controls, all domain values were lower in both genders. Conclusion: The IIEF, FSFI, and SDS-R results demonstrate that men and women who undergo OLT do exhibit mild to moderate SD. Their distress, though, is also mild to moderate, as evidenced by a high rate of continued sexual activity after OLT. Therefore, although SD may be widely prevalent in people who undergo OLT, aggressive intervention may not be warranted so long as the level of sexual distress remains low.
MeSH term(s)	End Stage Liver Disease/surgery ; Female ; Health Surveys ; Humans ; Liver Transplantation ; Male ; Sexual Dysfunction, Physiological/diagnosis ; Sexual Dysfunctions, Psychological/diagnosis
Language	English
Publishing date	2011-08
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2251959-2
ISSN	1743-6109 ; 1743-6095
ISSN (online)	1743-6109
ISSN	1743-6095
DOI	10.1111/j.1743-6109.2011.02264.x
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Article ; Online: Twelve-year survival after multiple recurrences and repeated metastasectomies for renal cell Carcinoma

Wang Jue / Talmon Geoffrey A / Feloney Michael / Morris Michael C

World Journal of Surgical Oncology, Vol 9, Iss 1, p

2011 Volume 155

Abstract: Abstract Background Metastatic renal cell carcinoma (RCC) presents a therapeutic challenge for clinicians because of the unpredictable clinical course, resistance to chemotherapy or radiotherapy and the limited response to immunotherapy. Patients and ... ...

Abstract	Abstract Background Metastatic renal cell carcinoma (RCC) presents a therapeutic challenge for clinicians because of the unpredictable clinical course, resistance to chemotherapy or radiotherapy and the limited response to immunotherapy. Patients and Methods We report a case of a 62-year-old woman who underwent nephrectomy for T4N0 RCC, clear cell type, Fuhrman grade 3/4 in 1999. The patinet subsequently had multiple tumor recurrences. Results The patient underwent eight metastasectomies, including multiple partial left nephrectomies, right adrenalectomy, a complete left nephrectomy, and distal pancreatectomy. She remains well and tumor free 12 years after initial diagnosis. Conclusion Repeated resections after initial metastasectomy can be carried out safely and provide long-term survival in selected patients with recurrent metastasis from RCC. The findings from our case indicate that close follow-up for the early detection of recurrence and complete resection of metastases can improve the results after repeated resection.
Keywords	Renal cell carcinoma (RCC) ; Recurrence ; Metastatic disease ; Metastasectomy ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Oncology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	610
Language	English
Publishing date	2011-11-01T00:00:00Z
Publisher	BioMed Central
Document type	Article ; Online
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Article: Abnormal expression of molecular markers for bladder impermeability and differentiation in the urothelium of patients with interstitial cystitis.

Slobodov, Gennady / Feloney, Michael / Gran, Christopher / Kyker, Kimberly D / Hurst, Robert E / Culkin, Daniel J

The Journal of urology

2004 Volume 171, Issue 4, Page(s) 1554–1558

Abstract: ... 1 of 7 (p = 0.085), for E-cadherin (over expressed) in 18 of 27 vs 0 of 7 (p = 0.0021), for ZO-1 ... in 11 of 27 vs 0 of 7 (p = 0.046) and for chondroitin sulfate in 15 of 27 vs 0 of 7 (p = 0.0054 ... The morphology/polarity score significantly correlated with ZO-1 (Pearson r = 0.3935, p = 0.0423) and ...

Abstract	Purpose: Despite a lack of consensus concerning the etiology of interstitial cystitis (IC) the loss of impermeability and other abnormalities of the urothelium are features of the disease. In this study the distribution of proteins involved with epithelial adhesion, cellular differentiation and bladder impermeability in urothelial biopsies were explored by the immunohistochemical assessment of E-cadherin, ZO-1, uroplakin and chondroitin sulfate. Materials and methods: Biopsies obtained from 27 patients with IC and 7 controls were immediately fixed in formalin, immunohistochemically labeled for the described proteins and scored for protein expression, morphology and differentiation. Results: Only 3 IC samples appeared completely normal, while 24 of the 27 showed an abnormality in at least 1 marker and in 6 all 4 markers were abnormal. In patients vs controls findings were abnormal for uroplakin in 13 of 27 vs 1 of 7 (p = 0.085), for E-cadherin (over expressed) in 18 of 27 vs 0 of 7 (p = 0.0021), for ZO-1 in 11 of 27 vs 0 of 7 (p = 0.046) and for chondroitin sulfate in 15 of 27 vs 0 of 7 (p = 0.0054). The morphology/polarity score significantly correlated with ZO-1 (Pearson r = 0.3935, p = 0.0423) and chondroitin sulfate (Pearson r = 0.7079, p <0.0001) expression. Chondroitin sulfate and ZO-1 showed a high correlation with each other (Pearson r = 0.5587, p = 0.0025). Uroplakin and E-cadherin expression were independent of all other markers. Conclusions: The findings reported strongly suggest abnormal differentiation in the IC bladder. The disruption of ZO-1 is similar to that reported in feline IC. Elevated E-cadherin may represent an adaptation to increased bladder permeability.
MeSH term(s)	Adult ; Aged ; Antibodies, Monoclonal ; Biomarkers/analysis ; Cadherins/analysis ; Cadherins/biosynthesis ; Chondroitin Sulfates/analysis ; Chondroitin Sulfates/biosynthesis ; Cystitis, Interstitial/metabolism ; Cystitis, Interstitial/pathology ; Cystitis, Interstitial/physiopathology ; Female ; Humans ; Male ; Membrane Proteins/analysis ; Membrane Proteins/biosynthesis ; Middle Aged ; Urinary Bladder/metabolism ; Urinary Bladder/pathology ; Urinary Bladder/physiopathology ; Uroplakin II ; Urothelium/metabolism ; Urothelium/pathology
Chemical Substances	Antibodies, Monoclonal ; Biomarkers ; Cadherins ; Membrane Proteins ; UPK2 protein, human ; Uroplakin II ; Chondroitin Sulfates (9007-28-7)
Language	English
Publishing date	2004-04
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	3176-8
ISSN	1527-3792 ; 0022-5347
ISSN (online)	1527-3792
ISSN	0022-5347
DOI	10.1097/01.ju.0000118938.09119.a5
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