Juan Chipollini

Epidemiological Assessment of Hypospadias by Degree of Severity

PURPOSE Hypospadias is one of the most common congenital malformations, with reportedly increasing rates of prevalence but poorly defined etiological factors for the disease and the varying degrees of manifestation. We characterize the prevalence of hypospadias in Arkansas with consideration of the degree of hypospadias. MATERIALS AND METHODS Data from the Arkansas State Birth Defects Surveillance Program of the Arkansas Reproductive Health Monitoring System were used to identify hypospadias cases and all male births by women residing in Arkansas between 1998 and 2007. Categorization of hypospadias severity into first, second or third degree was determined by a common 6-digit birth defect coding system used by surveillance programs across the country. Prevalence rates were computed for maternal and infant characteristics, birth year and birth residence. RESULTS The prevalence of hypospadias in Arkansas for births between 1998 and 2007 was 74.2 cases per 10,000 live births. Degrees of hypospadias were graded as first (coronal/distal) in 60.7% of cases, second (mid penile/subcoronal) in 18.8%, third (perineal/proximal penile) in 4.6% and hypospadias not otherwise specified in 16%. The prevalence of hypospadias increased during the surveillance period, with 66.9 per 10,000 live births between 1998 and 2002, and 81.0 per 10,000 live births between 2003 and 2007 (p = 0.0003). While the prevalence rates for every degree of hypospadias also increased, the prevalence of hypospadias not otherwise specified decreased from 14.8 to 9.0 during these periods. CONCLUSIONS Hypospadias prevalence in Arkansas is increasing. Improvement in recognition and categorization of degrees of hypospadias may have an impact on the reported prevalence rates.

Advances in Understanding of Penile Carcinogenesis: The Search for Actionable Targets

Penile cancer (PeCa) is a rare malignancy with potentially devastating effects. Squamous cell carcinoma is the most common variant with distinct precancerous lesions before development into invasive disease. Involvement of the inguinal lymph nodes is the most important prognostic factor in PeCa, and once disease is present outside the groin, prognosis is poor. Metastatic PeCa is challenging to treat and often requires multidisciplinary approaches in management. Due to its rarity, molecular understanding of the disease continues to be limited with most studies based on small, single center series. Thus far, it appears PeCa has diverse mechanisms of carcinogenesis affecting similar molecular pathways. In this review, we evaluate the current landscape of the molecular carcinogenesis of PeCa and explore ongoing research on potential actionable targets of therapy. The emergence of anti-epidermal growth factor receptor (EGFR) and other immunotherapeutic strategies may improve outcomes for PeCa patients.

Management of Renal Masses in an Octogenarian Cohort: Is There a Right Approach?

Micro‐Abstract Although several guidelines have outlined the management options for patients with renal masses, these guidelines have largely been extrapolated from studies involving younger cohorts. We compared management strategies in an exclusively octogenarian population and found no differences in survival among active surveillance, partial nephrectomy, and radical nephrectomy for small renal masses. However, larger and clinically aggressive renal masses should undergo active treatment. Background: We reviewed the outcomes for an octogenarian population to investigate whether active surveillance (AS) provides comparable survival to partial nephrectomy (PN) or radical nephrectomy (RN). Patients and Methods: Data were collected from 115 octogenarian patients referred for management of renal masses at Moffitt Cancer Center from 2000 to 2013. Patients were treated with AS, PN, or RN. Univariable and multivariable Cox regression models measured the association between management modality and survival. Kaplan‐Meier survival analysis was used to calculate survival, and log‐rank tests were used to compare survival curves. Results: The median age was 82 years (interquartile range, 81‐85 years). The median follow‐up period was 51 months (interquartile range, 23‐81 months). Of the 115 patients, 31 (27%) underwent AS, 31 (27%) underwent PN, and 53 (46%) underwent RN. The patients who underwent RN had a larger mean tumor size at 5.5 cm, with 19 patients (36%) having stage ≥ pT3 (P < .001). We found no difference in overall survival or disease‐specific survival among the 3 management strategies on univariable analysis (P = .39 and P = .1, respectively). On multivariable analysis for overall survival, only the Charlson comorbidity index was associated with worse survival (hazard ratio, 1.2; 95% confidence interval, 1.1‐1.3; P = .002). In a subgroup analysis of cT1a patients, we also found no difference in overall or disease‐specific survival among the treatment arms on univariable analysis (P = .74 and P = .9, respectively). Conclusion: Active treatment with PN and RN might not provide a survival advantage compared with AS in the octogenarian population with a small renal mass. However, larger renal masses should undergo active treatment in appropriately selected patients.

Does Implementing an Enhanced Recovery After Surgery Protocol Increase Hospital Charges? Comparisons From a Radical Cystectomy Program at a Specialty Cancer Center

OBJECTIVE To compare perioperative charges induced at the initial phase of a standardized enhanced recovery after surgery (ERAS) program from a tertiary referral center. METHODS A multidisciplinary ERAS protocol was implemented in our department on July 2015. During the subsequent year, all patients were treated according to this protocol (ERAS group). The patients were compared in terms of real in-hospital charges per surgical episode with a control group consisting of consecutive patients before the start of ERAS. Individual charges were analyzed per sample population and compared with the Wilcoxon rank-sum test or t test. Additionally, cost variances for each group were evaluated. RESULTS A total of 257 consecutive patients were evaluated of which the last 112 were ERAS patients. The median length of stay for each group was 6 days (P = .748). ERAS patients incurred higher medication charges (

Relationship between human papillomavirus and penile cancer— implications for prevention and treatment

1939 vs

Delay to Inguinal Lymph Node Dissection Greater than 3 Months Predicts Poorer Recurrence-Free Survival for Patients with Penile Cancer

1729, P = .036). Control patients incurred higher supplies (

Patterns of Regional Lymphadenectomy for Clinically Node-negative Patients With Penile Carcinoma: Analysis From the National Cancer Database From 1998 to 2012

861 vs

Surgical management of penile carcinoma in situ: results from an international collaborative study and review of the literature

692), treatment (

Adjuvant pelvic radiation is associated with improved survival and decreased disease recurrence in pelvic node-positive penile cancer after lymph node dissection: A multi-institutional study

90 vs

Laser ablation as monotherapy for penile squamous cell carcinoma: A multi-center cohort analysis

72), and miscellaneous charges (