Clinical School (Austin Health) - Research Publications
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ItemCurrent role of salvage robotic-assisted laparoscopic prostatectomy(SPRINGER, 2013-06)OBJECTIVES: Salvage Robotic-Assisted Laparoscopic Prostatectomy (sRALP) is a treatment option for biochemical recurrence (BCR) in prostate cancer. It is a new and presently uncommonly performed procedure, which may be technically challenging. We aim to summarise the current literature regarding sRALP with specific reference to patient selection, complications and peri-operative functional and oncological outcomes. METHODS: A comprehensive and critical review of all peer-reviewed publications regarding sRALP. RESULTS: Within the body of literature, we identified six low-volume case-series studies analysing outcomes of sRALP. Overall, peri-operative outcomes were encouraging with low complication rates and estimated blood loss (EBL) equivocal to open and laparoscopic salvage radical prostatectomy (sRP). Long-term follow-up for functional and oncological outcomes was limited. From the limited follow-up data, the current sRALP studies show similar BCR compared to large-volume open sRP series. Potency outcomes were poor post-sRALP. CONCLUSIONS: Salvage Robotic-Assisted Laparoscopic Prostatectomy is a technically feasible operation with a low risk of significant associated complications. Robotic technology can aid the surgeon in salvage prostatectomy. Data on functional and oncological outcomes lack long-term information but initial results are encouraging. Larger series with longer follow-up periods are necessary to draw significant conclusions about the efficacy of sRALP.
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ItemRenal Structure in Normoalbuminuric and Albuminuric Patients With Type 2 Diabetes and Impaired Renal Function(AMER DIABETES ASSOC, 2013-11)OBJECTIVE: The structural basis of normoalbuminuric renal insufficiency in patients with type 2 diabetes remains to be elucidated. We compared renal biopsy findings in patients with type 2 diabetes and estimated glomerular filtration rate (eGFR) and measured GFR of <60 mL/min/1.73 m2, associated with either normo-, micro-, or macroalbuminuria. RESEARCH DESIGN AND METHODS: In patients with normo- (n = 8) or microalbuminuria (n = 6), renal biopsies were performed according to a research protocol. In patients with macroalbuminuria (n = 17), biopsies were performed according to clinical indication. Findings were categorized according to the Fioretto classification: category 1 (C1), normal/near normal; category 2 (C2), typical diabetic nephropathy (DN) with predominantly glomerular changes; and category 3 (C3), atypical with disproportionately severe interstitial/tubular/vascular damage and with no/mild diabetic glomerular changes. RESULTS: In our study population (mean eGFR 35 mL/min/1.73 m2), typical glomerular changes (C2) of DN were observed in 22 of 23 subjects with micro- or macroalbuminuria compared with 3 of 8 subjects with normoalbuminuria (P = 0.002). By contrast, predominantly interstitial or vascular changes (C3) were seen in only 1 of 23 subjects with micro- or macroalbuminuria compared with 3 of 8 normoalbuminuric subjects (P = 0.08). Mesangial area increased progressively from normal controls to patients with type 2 diabetes and normo-, micro-, and macroalbuminuria. Varying degrees of arteriosclerosis, although not necessarily the predominant pattern, were seen in seven of eight subjects with normoalbuminuria. CONCLUSIONS: Typical renal structural changes of DN were observed in patients with type 2 diabetes and elevated albuminuria. By contrast, in normoalbuminuric renal insufficiency, these changes were seen less frequently, likely reflecting greater contributions from aging, hypertension, and arteriosclerosis.