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Urology News Articles

Pre-emptive Pain Regimen Decreased Opioid Usage in Patients Undergoing Robotic Prostatectomy

June 30, 2010 - “We think this study paves the way for new pain management protocols,” said Edouard Trabulsi, MD, Associate Professor of Urology at Jefferson Medical College. “Though a larger prospective study is necessary to accurately characterize the benefit of reducing opioids, it could have significant implications not only for robotic prostatectomy, but also other laparoscopic procedures and more painful surgeries.”

Reporting in the journal Urology, researchers at Thomas Jefferson University have found that a pre-emptive multimodal pain regimen that included pregabalin (Lyrica) decreased the use of opioid analgesics in patients undergoing robotic-assisted laparoscopic radical prostatectomy.

Opioid usage, which involves narcotic pain medications, was significantly less in patients who received the multimodal regimen compared to patients who received a standard postoperative analgesic regimen. The mean opioid dose, which was measured in “total morphine equivalent dose,” was 75.3 mg for patients who received the standard regimen, versus 49.1 mg for patients who received the multimodal regimen.

“This is the first demonstration of the effectiveness of a pre-emptive pain management protocol using pregabalin in urologic surgery,” said Edouard J. Trabulsi, MD, associate professor of Urology at Jefferson Medical College of Thomas Jefferson University. “We think this study paves the way for new pain management protocols. Though a larger prospective study is necessary to accurately characterize the benefit of reducing opioids, it could have significant implications not only for robotic prostatectomy, but also other laparoscopic procedures and more painful surgeries.”

Dr. Trabulsi and colleagues from the Urology and Anesthesiology departments at Jefferson conducted a retrospective study of 60 patients, all undergoing robotic prostatectomy. Thirty of the patients received the multimodal pre-operative treatment and 30 previous patients received only the standard postoperative analgesic regimen.

The pre-operative treatment included pregabalin, acetaminophen and celecoxib given orally, two hours before the procedure, and continued postoperatively in combination with intravenous ketorolac. The standard postoperative analgesic regimen included intravenous ketorolac, without pregabalin or celecoxib. All patients received oxycodone as needed.

Importantly, in addition to the reduced opioid usage, patients who received the pre-operative regimen did not report any additional side effects.

Although laparoscopic surgical techniques typically are associated with a reduction of postoperative pain, patients still require opioid analgesia. The side effects of opioid analgesics often hinder the benefits of laparoscopic surgery. Side effects include nausea, vomiting, a delay in the return of bowel function, ileus, respiratory depression, pruritus, urinary retention and altered sensorium.

Other Jefferson staff members involved in the study included Jitesh Patela, MD, Eugene Viscusi, MD, Leonard Gomella, MD, and Costas Lallas, MD.

Dr. Bagley receives 2010 Karl Storz Lifetime Achievement Award in Endourology

June 2010 - Congratulations to Dr. Demetrius Bagley who has been selected as the 2010 recipient of the Karl Storz Lifetime Achievement Award in Endourology, which will be presented at the upcoming World Congress of Endourology in Chicago, Illinois. In announcing the award, the Executive Committee of the Endourological Society noted that Dr. Bagley's "...considerable body of work and pioneering advances in ureteroscopic management of upper tract pathology have benefitted not only the Society, but legions of endourologists throughout the world". More details on this important award will be announced during the World Congress meeting this September.

Three Urology Faculty in Philadelphia magazine’s 2010 “Top Doctors”

May 19, 2010 - The 2010 Philadelphia Magazine "Top Doctors" listing included three Jefferson Urology Faculty. Drs. Demetrius Bagley, Leonard Gomella and Patrick Shenot have all been recognized in this year's listing as determined by votes cast by other physicians.

Clue to switch of bladder cancer from locally contained to invasive found by Jefferson scientists

May 4, 2010 - The finding that IGF-IR is a critical regulator of motility and invasion of bladder cancer cells is promising, the researchers at Jefferson’s Kimmel Cancer Center report, because there are about a dozen agents targeted against the protein that are now undergoing clinical testing to treat a variety of patient tumors.

Bladder cancer often becomes aggressive and spreads in patients despite treatment, but now researchers at the Kimmel Cancer Center at Jefferson have identified a protein they believe is involved in pushing tumors to become invasive – and deadly.

“We have found that IGF-IR is a critical regulator of motility and invasion of bladder cancer cells, and this could offer us a novel molecular target to treat patients with this cancer in order to prevent metastasis,” says the lead investigator, Andrea Morrione, PhD, a research associate professor of Urology at Jefferson Medical College, and Director of Urology Research, Kimmel Cancer Center.

This finding is promising, they say in the June issue of American Journal of Pathology, because there are about a dozen agents targeted against the protein, the insulin-like growth factor receptor I (IGF-IR), that are now undergoing clinical testing to treat a variety of patient tumors.

“Testing presence of the protein could also serve as a novel tumor biomarker for diagnosis, and possibly prognosis of bladder tumors,” he adds.

Although bladder cancer is common, the molecular mechanisms that push the cancer to become invasive and to spread are still poorly understood, say the researchers. Although most bladder cancers are caught early and treated, they often come back and become aggressive, despite subsequent therapy with surgery, chemotherapy, or immunotherapy.

In this study, the researchers looked at the role of the protein receptor for the growth factor IGF-I, an important modulator of cell proliferation in bladder cancer cells. They found that although activation of IGF-IR did not affect growth of bladder cancer cells, it did promote the migration and invasion of these cells. The researchers showed that IGF-IR activated other molecules in cancer-promoting pathways (Akt and MAPK) that allow cancer cells to break its bond with other cells in a tumor in order to travel to others sites in the body.

“These data seem to indicate that this protein receptor may play a more prominent role in later stages of bladder cancer, not in the initiation of the cancer,” says Dr. Morrione.

Additional work is needed to validate the role of IGF-IR in pushing bladder cancer into an invasive form, but if the results continue to be promising, it might be possible to test anti IGF-IR therapies in bladder cancer and to see how effective a test for these proteins in bladder tumor biopsies might predict cancer spread, the researchers say.

The study was funded by the Benjamin Perkins Bladder Cancer Fund and the National Institute of Health.

Other members of the Jefferson research team included: David Metalli, PhD; Francesca Lovat, PhD; Farida Tripodi, PhD; Marco Genua, PhD; Shi-Qiong Xu, MD, PhD; Michela Spinelli, PhD; Lilia Alberghina, PhD; Marco Vanoni, PhD; Raffaele Baffa, MD; Leonard G. Gomella, MD; and Renato V. Iozzo, MD.

Dutasteride prostate cancer prevention trial reported in April 1, 2010 issue of NEJM

April 1, 2010 - Dr. Leonard G. Gomella and colleagues conducted a landmark international randomized, double-blind, placebo-controlled, parallel-group multi-center clinical trial to determine whether dutasteride reduces the risk of incident prostate cancer, as detected on biopsy, among men who are at increased risk for the disease. Over the course of the 4-year study period, dutasteride reduced the risk of incident prostate cancer detected on biopsy and improved the outcomes related to benign prostatic hyperplasia. These results were published in the New England Journal of Medicine on April 1, 2010 (Pubmed Abstract).

Dr. Gomella appointed Editor-in-Chief of The Canadian Journal of Urology

March 4, 2010 - Leonard Gomella, MD, FACS, the Bernard W. Godwin, Jr. Professor of Prostate Cancer, associate director for Clinical Affairs at the Kimmel Cancer Center (KCC) at Jefferson, and Chair of the Department of Urology at Jefferson Medical College of Thomas Jefferson University, has been appointed the new Editor-in-Chief of The Canadian Journal of Urology (CJU).

In announcing Dr. Gomella’s appointment, the publisher of CJU, George Georgieff noted that “Dr. Gomella’s expertise in all aspects of medical publishing is outstanding. We are honored and look forward to his leadership as we continue our journals expansion in the United States and international urologic community.”

Dr. Gomella is involved in both basic science and clinical research in the development of new diagnostic techniques and treatments for prostate, bladder and kidney cancer through KCC.  He has served on numerous journal editorial boards in the field of urology and oncology; has given almost 500 presentations at local, national and international meetings; and written over 300 papers, chapters and monographs in the field of urology.  Dr. Gomella has authored and edited 54 editions of 17 different books for medical students, residents and practicing physicians, many of which have been translated into foreign languages.  He is the editor-in-chief of the Five Minute Urology Consult, and laparoscopy section editor for Glenn’s Urologic Surgery.  Dr. Gomella also authored Recovering from Prostate Cancer, the first book for the public dedicated to this topic.

In the field of medicine, Dr. Gomella is known for the Clinician's Pocket Reference, now in its 11th edition, a widely used reference for medical students and health care providers.  “Best Doctors in America”, “Top Doctors for Cancer”, Philadelphiamagazine’s “Top Doctors” have all recognized him many times as one of the best doctors for urologic oncology and prostate cancer.  In 2007, Men’s Health magazine listed Dr. Gomella as one of the top 20 urologists in the country.  Awards received have included the American Cancer Society "Volunteer Achievement Award" and a “National Cancer Institute Achievement Award”.  He has served as president of the Mid-Atlantic Section of the American Urological Association, and was elected to membership in the American Association of Genitourinary Surgeons in 2008.  The University of Kentucky College of Medicine awarded him a "Distinguished Alumnus Award For Academic Excellence" in 2009.

Dr. Gomella is the third Editor-in-Chief of the The CJU, which is a peer-reviewed journal, published six times per year, beginning in 1994.  It is Indexed in Index Medicus/MEDLINE and Current Contents/Clinical Medicine.  Additional information on the journal can be found on its Web site: www.canjurol.com.

Dr. Gomella receives 2009 UKCOM Distinguished Alumnus Award

October 20, 2009 - Dr. Leonard G. Gomella, a 1980 University of Kentucky College of Medicine graduate, was the recipient of the 2009 UK Medical Alumni Association's Distinguished Alumnus Award for his accomplishments and commitment to academic medicine. This honor recognizes graduates of the medical school who have achieved a high level of distinction in their careers and have focused their efforts on the educational experience of medical students, residents, interns and/or fellows. Dr. Gomella was presented with his award at a reception on Friday, Oct. 16, 2009 at Spindletop Hall in Lexington, KY.  Dr. Gomella completed medical school (1980), general surgery (1980-1982), and urology (1982-1986) at UK. A letter of support was provided by Dean Mark Tykocinski and Associate Dean Karen Novielli to the committee.

Dr. Ward O. Griffen, former Chairman of The Department of Surgery at UK and past Executive Secretary of the American Board of Surgery, wrote the following testimonial:
“Since I had some contact with first-year medical students in the middle of their first year, I tried to imbue Lenny with an interest in a surgical career. While we accomplished that goal initially, as his general surgical career progressed, he had come under the magic spell of the chief of Urology at that time, Dr. Bill McRoberts, and he ultimately became fascinated about a disease that was not well-treated at that time – cancer of the prostate. It seems the rest is history. He has established himself as a premier prostate surgeon, a lifelong researcher in new approaches in cancer of the prostate and a well respected medical educator and prolific author. How great it is to have your peers recognize your accomplishments so a big congratulation to you, Lenny, to Tricia, and to your four boys who may be your best legacy.”

Dr. Knudsen receives Richard E. Weitzman Memorial Award

June 10, 2009 - Karen Knudsen, PhD, Associate Professor, Department of Cancer Biology and Urology at the Kimmel Cancer Center received the Richard E. Weitzman Memorial Award from the Endocrine Society. This annual Laureate Awards annual award recognizes an exceptionally promising young clinical or basic investigator. Knudsen is recognized for scientific achievements in the study of androgen action in the pathogenesis of prostate cancer, mentoring of students and fellows, and for her tremendous service to the scientific community. This year’s Laureate Awards were presented at ENDO 09, the 91st Annual Meeting of The Endocrine Society, being held June 10-13, in Washington, DC.

Founded in 1916, The Endocrine Society is the world’s oldest, largest and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, The Endocrine Society’s membership consists of more than 14,000 scientists, physicians, educators, nurses and students in more than 100 countries. Society members represent all basic, applied and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Maryland.

ACGME approves expansion of Urology Department Residency Program

Summer 2009 - We are pleased to announce that in the summer of 2009 the Residency Review Committee (RRC) of the ACGME approved the expansion of our program by one resident a year.