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Article: Factors Affecting Robotic Partial Nephrectomy Conversion to Radical Nephrectomy: A Retrospective Multi-Institutional Analysis in the Michigan Urologic Surgery Improvement Collaborative (MUSIC).

Goldman, Benjamin / Rudoff, Michael / Qi, Ji / Wenzler, David

2021 Volume 13, Issue 12, Page(s) e20477

Abstract: Objective: To identify factors related to the conversion of robot-assisted partial nephrectomy (RPN) to robot-assisted radical nephrectomy (RRN) based on data collected by a statewide database in Michigan.: Methods: Using the Michigan Urological ... ...

Abstract	Objective: To identify factors related to the conversion of robot-assisted partial nephrectomy (RPN) to robot-assisted radical nephrectomy (RRN) based on data collected by a statewide database in Michigan. Methods: Using the Michigan Urological Surgery Improvement Collaborative-Kidney mass: Identifying and Defining Necessary Evaluation and therapY (MUSIC-KIDNEY) database we identified 574 patients for whom RPN was planned. Patient and tumor characteristics were obtained including body mass index (BMI), Charlson comorbidity index (CCI), RENAL nephrometry score, tumor size, and pathologic staging. Treating centers were subdivided by annualized case volume and academic status. Bivariate and multivariate analyses were performed to assess the impact of these factors on the risk of conversion to RRN from RPN. Results: The conversion rate of RPN to RN was 5.75% (33/574). The difference in RENAL nephrometry score, tumor stage, and size reached statistical significance on bivariate analysis (p<0.001). The tumor stage also reached statistical significance on multivariate analysis [odds ratio (OR); 95%CI (8.97; 3.93-20.48) p<0.001]. The conversion rate was lower among high-volume versus low-volume practices; however, statistical significance was not reached [5.2% (27/520) vs.11% (6/54); p=0.11]. Conclusions: Patient factors such as tumor size and renal nephrometry score are likely related to the conversion of RPN to RRN decisions. The data shows that Michigan urologists appear to appropriately assess intra-operative findings and convert to RRN in cases of more advanced kidney tumors. Lower volume centers appear to trend towards a higher conversion rate. Continued quality improvement tracking analysis may further clarify this relationship.
Language	English
Publishing date	2021-12-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.20477
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Article: Multiplex Polymerase Chain Reaction/Pooled Antibiotic Susceptibility Testing Was Not Associated with Increased Antibiotic Resistance in Management of Complicated Urinary Tract Infections.

Korman, Howard J / Mathur, Mohit / Luke, Natalie / Wang, Dakun / Zhao, Xihua / Levin, Michael / Wenzler, David L / Baunoch, David

Infection and drug resistance

2023 Volume 16, Page(s) 2841–2848

Abstract: Objective: To compare antibiotic resistance results at different time points in patients with urinary tract infections (UTIs), who were either treated based upon a combined multiplex polymerase chain reaction (M-PCR) and pooled antibiotic susceptibility ...

Abstract	Objective: To compare antibiotic resistance results at different time points in patients with urinary tract infections (UTIs), who were either treated based upon a combined multiplex polymerase chain reaction (M-PCR) and pooled antibiotic susceptibility test (P-AST) or were not treated. Methods: The M-PCR/P-AST test utilized here detects 30 UTI pathogens or group of pathogens, 32 antibiotic resistance (ABR) genes, and phenotypic susceptibility to 19 antibiotics. We compared the presence or absence of ABR genes and the number of resistant antibiotics, at baseline (Day 0) and 5-28 days (Day 5-28) after clinical management in the antibiotic-treated (n = 52) and untreated groups (n = 12). Results: Our results demonstrated that higher percentage of patients had a reduction in ABR gene detection in the treated compared to the untreated group (38.5% reduction vs 0%, Conclusion: Our results with both resistance gene and phenotypic antibiotic susceptibility results demonstrated that treatment based upon rapid and sensitive M-PCR/P-AST resulted in reduction rather than induction of antibiotic resistance in symptomatic patients with suspected complicated UTI (cUTI) in an urology setting, indicating this type of test is valuable in the management of these types of patients. Further studies of the causes of gene reduction, including elimination of ABR gene-carrying bacteria and loss of ABR gene(s), are warranted.
Language	English
Publishing date	2023-05-09
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2494856-1
ISSN	1178-6973
ISSN	1178-6973
DOI	10.2147/IDR.S406745
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Article: A Diagnostic Test Combining Molecular Testing with Phenotypic Pooled Antibiotic Susceptibility Improved the Clinical Outcomes of Patients with Non-

Korman, Howard J / Baunoch, David / Luke, Natalie / Wang, Dakun / Zhao, Xihua / Levin, Michael / Wenzler, David L / Mathur, Mohit

Research and reports in urology

2023 Volume 15, Page(s) 141–147

Abstract: Purpose: Complicated UTIs (cUTIs) cause significant morbidity and healthcare resource utilization and cost. Standard urine culture has limitations in detecting polymicrobial and non-: Methods: Patients who had symptoms typical of cUTI and positive M- ... ...

Abstract	Purpose: Complicated UTIs (cUTIs) cause significant morbidity and healthcare resource utilization and cost. Standard urine culture has limitations in detecting polymicrobial and non- Methods: Patients who had symptoms typical of cUTI and positive M-PCR/P-AST test results were recruited from urology clinics. Symptom reduction and clinical cure rates were measured from day 0 through day 14 using the American English Acute Cystitis Symptom Score (ACSS) Questionnaire. Clinical cure was defined based on the sum of the scores of four US Food and Drug Administration (FDA) symptoms and the absence of visible blood in the urine. Results: Of 264 patients with suspected cUTI, 146 (55.4%) had exclusively non- Conclusion: Patients with cUTIs treated based on the M-PCR/P-AST diagnostic test had significantly improved symptom reduction and clinical cure rates compared to untreated patients among those with non-
Language	English
Publishing date	2023-05-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2649530-2
ISSN	2253-2447
ISSN	2253-2447
DOI	10.2147/RRU.S404260
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Article ; Online: Conversion to Radical Nephrectomy From Robotic Partial Nephrectomy Is Most Commonly Due to Anatomic and Oncologic Complexity.

Wang, Yuzhi / Wilder, Samantha / Butaney, Mohit / Hijazi, Mahmoud / Gandham, David / Van Til, Monica / Goldman, Benjamin / Qi, Ji / Mirza, Mahin / Johnson, Anna / Rudoff, Michael / Wenzler, David / Rogers, Craig G / Lane, Brian R

The Journal of urology

2024 Volume 211, Issue 5, Page(s) 669–676

Abstract: Purpose: Partial nephrectomy is standard-of-care treatment for small renal masses. As utilization of partial nephrectomy increases and includes larger and complex tumors, the risk of conversion to radical nephrectomy likely increases. We evaluated ... ...

Abstract	Purpose: Partial nephrectomy is standard-of-care treatment for small renal masses. As utilization of partial nephrectomy increases and includes larger and complex tumors, the risk of conversion to radical nephrectomy likely increases. We evaluated incidence and reason for conversion to radical nephrectomy in patients scheduled for partial nephrectomy by surgeons participating in MUSIC (the Michigan Urologic Surgery Improvement Collaborative). Materials and methods: All patients in whom robotic partial nephrectomy was planned were stratified by completed procedure (robotic partial nephrectomy vs radical nephrectomy). Preoperative and intraoperative records were reviewed for preoperative assessment of difficulty and reason for conversion. Patient, tumor, pathologic, and practice variables were compared between cohorts. Results: Of 650 patients scheduled for robotic partial nephrectomy, conversion to radical nephrectomy occurred in 27 (4.2%) patients. No conversions to open were reported. Preoperative documentation indicated a plan for possible conversion in 18 (67%) patients including partial with possible radical (n = 8), partial vs radical (n = 6), or likely radical nephrectomy (n = 4). Intraoperative documentation indicated that only 5 (19%) conversions were secondary to bleeding, with the remaining conversions due to tumor complexity and/or oncologic concerns. Patients undergoing conversion had larger (4.7 vs 2.8 cm, Conclusions: There was a low rate of conversion from robotic partial to radical nephrectomy in the MUSIC-KIDNEY (Kidney mass: Identifying and Defining Necessary Evaluation and therapY) collaborative, and an even lower risk of conversion due to uncontrolled bleeding. Targeted review of each conversion identified appropriate decision-making based on oncologic risk in most cases.
MeSH term(s)	Humans ; Kidney Neoplasms/surgery ; Kidney Neoplasms/pathology ; Robotic Surgical Procedures/adverse effects ; Robotic Surgical Procedures/methods ; Treatment Outcome ; Robotics ; Nephrectomy/adverse effects ; Nephrectomy/methods ; Retrospective Studies
Language	English
Publishing date	2024-04-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	3176-8
ISSN	1527-3792 ; 0022-5347
ISSN (online)	1527-3792
ISSN	0022-5347
DOI	10.1097/JU.0000000000003860
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Article: Methodology to Determine Melt Pool Anomalies in Powder Bed Fusion of Metals Using a Laser Beam by Means of Process Monitoring and Sensor Data Fusion.

Harbig, Jana / Wenzler, David L / Baehr, Siegfried / Kick, Michael K / Merschroth, Holger / Wimmer, Andreas / Weigold, Matthias / Zaeh, Michael F

Materials (Basel, Switzerland)

2022 Volume 15, Issue 3

Abstract: Additive manufacturing, in particular the powder bed fusion of metals using a laser beam, has a wide range of possible technical applications. Especially for safety-critical applications, a quality assurance of the components is indispensable. However, ... ...

Abstract	Additive manufacturing, in particular the powder bed fusion of metals using a laser beam, has a wide range of possible technical applications. Especially for safety-critical applications, a quality assurance of the components is indispensable. However, time-consuming and costly quality assurance measures, such as computer tomography, represent a barrier for further industrial spreading. For this reason, alternative methods for process anomaly detection using process monitoring systems have been developed. However, the defect detection quality of current methods is limited, as single monitoring systems only detect specific process anomalies. Therefore, a new methodology to evaluate the data of multiple monitoring systems is derived using sensor data fusion. Focus was placed on the causes and the appearance of defects in different monitoring systems (photodiodes, on- and off-axis high-speed cameras, and thermography). Based on this, indicators representing characteristics of the process were developed to reduce the data. Finally, deterministic models for the data fusion within a monitoring system and between the monitoring systems were developed. The result was a defect detection of up to 92% of the melt track defects. The methodology was thus able to determine process anomalies and to evaluate the suitability of a specific process monitoring system for the defect detection.
Language	English
Publishing date	2022-02-08
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2487261-1
ISSN	1996-1944
ISSN	1996-1944
DOI	10.3390/ma15031265
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Article ; Online: Practice patterns and outcomes of urgent versus elective ureteroscopy in a statewide surgical collaborative.

DiBianco, John Michael / Conrado, Bronson / Daignault-Newton, Stephanie / Witzke, Karla / Wenzler, David / Pimentel, Hector / Ghani, Khurshid R / Dauw, Casey A

World journal of urology

2022 Volume 41, Issue 1, Page(s) 221–227

Abstract: Purpose: Urgent indications for nephrolithiasis treatment include obstruction with intractable pain or renal impairment without untreated infection. Patients and hospitals may benefit from urgent primary ureteroscopy. We aimed to examine variation in ... ...

Abstract	Purpose: Urgent indications for nephrolithiasis treatment include obstruction with intractable pain or renal impairment without untreated infection. Patients and hospitals may benefit from urgent primary ureteroscopy. We aimed to examine variation in urgent ureteroscopy utilization and associated outcomes. Methods: Using Reducing Operative Complications from Kidney Stones (ROCKS), we identified all ureteroscopy's between 2016 and 2019. Cases were classified by acuity (elective versus urgent). We assessed practice/urologist variation in urgent ureteroscopy performance. We characterized patients demographic, operative and outcomes data, making bivariate comparisons with elective ureteroscopy to understand implications of urgent surgery. We performed multilevel modeling to understand factors associated with unplanned healthcare encounters after urgent ureteroscopy. Results: 12,859 cases were identified from 33 practices and 204 urologists, 10,854 (84.4%) elective and 2005 (15.6%) urgent. Urgent ureteroscopy was performed on younger patients (53 vs 57, p < 0.001), with higher rates of ureteral stones (72.8% vs 56.8%, p < 0.001). Urgent ureteroscopy rates varied widely by practice (2-70%) and urologist (0-98%). Urgent ureteroscopy had higher stenting rates (77.4% vs 72.5%, p < 0.001), stone free rates (66% vs 58.4%, p < 0.001), and postoperative ED visits (11% vs 7.2%, p < 0.001). There were no differences in intraoperative complications or unplanned hospitalizations. Factors predictive of ED visits in urgent ureteroscopy included concomitant ureteral/renal stone location (OR = 1.53, CI = 1.05-2.23, p = 0.035). Conclusions: In Michigan elective ureteroscopy is performed 5 times more frequently than urgent ureteroscopy with wide variation. Urgent ureteroscopy demonstrated low morbidity. Urgent ureteroscopy produced modestly higher stone free rates with a slightly increased frequency of unscheduled ED visits particularly for ureteral stones.
MeSH term(s)	Humans ; Ureteroscopy/adverse effects ; Ureter ; Ureteral Calculi/surgery ; Kidney Calculi/surgery ; Kidney Calculi/etiology ; Hospitalization ; Treatment Outcome
Language	English
Publishing date	2022-11-03
Publishing country	Germany
Document type	Journal Article
ZDB-ID	380333-8
ISSN	1433-8726 ; 0724-4983
ISSN (online)	1433-8726
ISSN	0724-4983
DOI	10.1007/s00345-022-04203-z
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Article ; Online: Stent Omission in Pre-stented Patients Undergoing Ureteroscopy Decreases Unplanned Health Care Utilization.

DiBianco, John Michael / Daignault-Newton, Stephanie / Dupati, Ajith / Hiller, Spencer / Kachroo, Naveen / Seifman, Brian / Wenzler, David / Dauw, Casey A / Ghani, Khurshid R

Urology practice

2023 Volume 10, Issue 2, Page(s) 163–169

Abstract: Introduction: Despite AUA guidelines providing criteria for ureteral stent omission after ureteroscopy for nephrolithiasis, stenting rates in practice remain high. Because pre-stenting may be associated with improved patient outcomes, we assessed the ... ...

Abstract	Introduction: Despite AUA guidelines providing criteria for ureteral stent omission after ureteroscopy for nephrolithiasis, stenting rates in practice remain high. Because pre-stenting may be associated with improved patient outcomes, we assessed the impact of stent omission vs placement in pre-stented and non-pre-stented patients undergoing ureteroscopy on postoperative health care utilization in Michigan. Methods: Using the MUSIC (Michigan Urological Surgery Improvement Collaborative) registry (2016-2019), we identified pre-stented and non-pre-stented patients with low comorbidity undergoing single-stage ureteroscopy for ≤1.5 cm stones with no intraoperative complications. We assessed variation in stent omission for practices/urologists with ≥5 cases. Using multivariable logistic regression, we evaluated whether stent placement in pre-stented patients was associated with emergency department visits and hospitalizations within 30 days of ureteroscopy. Results: We identified 6,266 ureteroscopies from 33 practices and 209 urologists, of which 2,244 (35.8%) were pre-stented. Pre-stented cases had higher rates of stent omission vs non-pre-stented cases (47.3% vs 26.3%). Among the 17 urology practices with ≥5 cases, stent omission rates in pre-stented patients varied widely (0%-77.8%). Among the 156 urologists with ≥5 cases, stent omission rates in pre-stented patients varied substantially (0%-100%); 34/152 (22.4%) never performed stent omission. Adjusting for risk factors, stent placement in pre-stented patients was associated with increased emergency department visits (OR 2.24, 95% CI:1.42-3.55) and hospitalizations (OR 2.19, 95% CI:1.12-4.26). Conclusions: Pre-stented patients undergoing stent omission after ureteroscopy have lower unplanned health care utilization. Stent omission is underutilized in these patients, making them an ideal group for quality improvement efforts to avoid routine stent placement after ureteroscopy.
MeSH term(s)	Humans ; Ureteroscopy/adverse effects ; Ureter/surgery ; Kidney Calculi/etiology ; Patient Acceptance of Health Care ; Stents/adverse effects
Language	English
Publishing date	2023-01-23
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2352-0787
ISSN (online)	2352-0787
DOI	10.1097/UPJ.0000000000000376
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Article ; Online: Development of a Surgical Decision Aid for Patients with Nephrolithiasis: Shockwave Lithotripsy

DiBianco, John Michael / Conrado, Bronson / Daignault-Newton, Stephanie / Hawley, Sarah T / Lane, Giulia / Wenzler, David / Seifman, Brian / Phelps, Jessica R / Cotant, Michael / Ghani, Khurshid R / Dauw, Casey A

Journal of endourology

2023 Volume 37, Issue 2, Page(s) 212–218

Abstract: Introduction and Objective: ...

Abstract	Introduction and Objective:
MeSH term(s)	Humans ; Ureteroscopy/methods ; Retrospective Studies ; Kidney Calculi/surgery ; Lithotripsy/methods ; Decision Support Techniques ; Treatment Outcome ; Ureteral Calculi/therapy
Language	English
Publishing date	2023-01-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	356931-7
ISSN	1557-900X ; 0892-7790
ISSN (online)	1557-900X
ISSN	0892-7790
DOI	10.1089/end.2022.0494
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Zs.A 2628: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Urologists' personal feelings on PSA screening and prostate cancer treatment.

Wenzler, David L / Rosenberg, Bradley H

Journal of evaluation in clinical practice

2014 Volume 20, Issue 4, Page(s) 408–410

Abstract: Rationale, aims and objective: This study aimed to determine if urologists' feelings on prostate cancer screening with prostate-specific antigen (PSA) and treatment on themselves are consistent with what they recommend to patients.: Methods: A survey ...

Abstract	Rationale, aims and objective: This study aimed to determine if urologists' feelings on prostate cancer screening with prostate-specific antigen (PSA) and treatment on themselves are consistent with what they recommend to patients. Methods: A survey regarding prostate cancer screening and treatment was assembled using the SurveyMonkey web site. The link to the survey was then emailed to urologists. Participation was voluntary. Results: The survey was sent to 2672 American urologists and completed by 215 urologists; response rate was 8%. One hundred ninety-eight (92%) were male. Most (56%) urologists recommend PSA screening beginning at age 50 for patients, and this corresponded with the age at which survey responders began their PSA screening. Two urologists did not recommend screening, and 10% were 'not sure' if screening saves lives. Of those that had not had their PSA checked, 34% plan to begin screening at 40-44 with 11% stating they 'never' plan to be screened. One hundred thirty-eight (70%) men completing the survey had their PSA checked. The majority (86%) had it drawn for screening. Nineteen respondents had an elevated PSA with nine men diagnosed with prostate cancer. Eight of these had radical prostatectomy. When faced with the hypothetical diagnosis of an elevated PSA and low-grade prostate cancer, respondents favoured repeat PSA (94%) and surveillance (48%), respectively, than any other option. Conclusion: Despite recommendations from the American Urologic Association to screen men for prostate cancer, a significant percentage of urologists do not wish to be screened with PSA. Almost all, however, continue to recommend prostate cancer screening for their patients. Treatment recommendations also varied among the respondents.
MeSH term(s)	Adult ; Aged ; Attitude of Health Personnel ; Data Collection ; Early Detection of Cancer ; Female ; Humans ; Male ; Middle Aged ; Physicians/psychology ; Practice Patterns, Physicians' ; Prostate-Specific Antigen/blood ; Prostatic Neoplasms/diagnosis ; Prostatic Neoplasms/therapy ; Surveys and Questionnaires ; United States ; Urology
Chemical Substances	Prostate-Specific Antigen (EC 3.4.21.77)
Language	English
Publishing date	2014-08
Publishing country	England
Document type	Journal Article
ZDB-ID	1327355-3
ISSN	1365-2753 ; 1356-1294
ISSN (online)	1365-2753
ISSN	1356-1294
DOI	10.1111/jep.12149
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Article: Removal of a penile constriction device with a large orthopedic pin cutter.

Chennamsetty, Avinash / Wenzler, David / Fischer, Melissa

Case reports in urology

2014 Volume 2014, Page(s) 347285

Abstract: Penile strangulation is an infrequent clinical condition that has widely been reported. It usually results following placement of a constriction device to enhance sexual stimulation. Early treatment is essential to avoid potential complications, ... ...

Abstract	Penile strangulation is an infrequent clinical condition that has widely been reported. It usually results following placement of a constriction device to enhance sexual stimulation. Early treatment is essential to avoid potential complications, including ischemic necrosis and autoamputation. We describe the use of a Large Orthopedic Pin Cutter to remove a metal penile constriction device in the Emergency Department (ED). This case report describes the relatively safe technique of using an instrument available in many hospitals that can be added to the physician's arsenal in the removal of metal constriction devices.
Language	English
Publishing date	2014-02-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2627659-8
ISSN	2090-6978 ; 2090-696X
ISSN (online)	2090-6978
ISSN	2090-696X
DOI	10.1155/2014/347285
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