Ramiro J. Madden-Fuentes
Duke University
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Featured researches published by Ramiro J. Madden-Fuentes.
Pediatrics | 2013
Ramiro J. Madden-Fuentes; Erin R. McNamara; Jessica C. Lloyd; John S. Wiener; Jonathan C. Routh; Patrick C. Seed; Sherry S. Ross
OBJECTIVE: Urinary tract infections (UTIs) are a common source of morbidity among children with spina bifida (SB) and are a frequently reported outcome in studies of this patient population. However, the criteria for a diagnosis of UTI are often not stated. We evaluated the literature on SB patients for the criteria that authors use to define parameters in reporting UTI outcomes. METHODS: Embase and Medline were queried with the medical subject heading terms “spinal dysraphism,” “myelomeningocele,” “infection,” and “urinary tract infection.” A second search with the exploded term “spina bifida” and “urinary tract infection” was performed. Original research studies reporting a UTI outcome in SB patients were included and evaluated by 2 independent reviewers for the presence of a UTI definition and diagnostic criteria. RESULTS: We identified 872 publications, of which 124 met inclusion criteria. Forty-five of 124 (36.3%) studies reporting UTI as an outcome provided a definition of UTI. Of 124 studies, 28 (22.6%) were published in pediatric journals and 69 (55.6%) in urology journals. A definition of UTI was provided in 11 (39.3%) and 26 (37.7%) studies, respectively. “Fever, culture, and symptoms” defined a UTI in 17 of 45 studies. Journal category and presence of UTI definitions did not correlate (P = .71). CONCLUSIONS: Explicit definitions for UTI are heterogeneous and infrequently applied in studies of SB patients, limiting study reliability and estimates of true UTI rates in this population. Future studies will benefit from the development and application of a standard definition for UTI in this population.
The Journal of Urology | 2014
Rajeev Chaudhry; Ramiro J. Madden-Fuentes; Tara K. Ortiz; Zarine R. Balsara; Yuping Tang; Unwanaobong Nseyo; John S. Wiener; Sherry S. Ross; Patrick C. Seed
PURPOSE Urinary tract infections cause significant morbidity in patients with spinal cord injury. An in vivo spinal cord injured rat model of experimental Escherichia coli urinary tract infection mimics human disease with enhanced susceptibility to urinary tract infection compared to controls. We hypothesized that a dysregulated inflammatory response contributes to enhanced susceptibility to urinary tract infection. MATERIALS AND METHODS Spinal cord injured and sham injured rats were inoculated transurethrally with E. coli. Transcript levels of 84 inflammatory pathway genes were measured in bladder tissue of each group before infection, 24 hours after infection and after 5 days of antibiotic therapy. RESULTS Before infection quantitative polymerase chain reaction array revealed greater than twofold up-regulation in the proinflammatory factor transcripts slc11a1, ccl4 and il1β, and down-regulation of the antimicrobial peptides lcn2 and mpo in spinal cord injured vs control bladders. At 24 hours after infection spinal cord injured bladders showed an attenuated innate immune response with decreased expression of il6, slc11a1, il1β and lcn2, and decreased il10 and slpi expression compared to controls. Despite clearance of bacteriuria with antibiotics spinal cord injured rats had delayed induction of il6 transcription and a delayed anti-inflammatory response with decreased il10 and slpi transcript levels relative to controls. CONCLUSIONS Spinal cord injured bladders fail to mount a characteristic inflammatory response to E. coli infection and cannot suppress inflammation after infection is eliminated. This may lead to increased susceptibility to urinary tract infection and persistent chronic inflammation through neural mediated pathways, which to our knowledge remain to be defined.
Journal of Pediatric Urology | 2014
Ramiro J. Madden-Fuentes; Erin R. McNamara; Unwanaobong Nseyo; John S. Wiener; Jonathan C. Routh; Sherry S. Ross
OBJECTIVE Diagnosis of low-grade hydronephrosis often occurs prenatally, during evaluation after urinary tract infection (UTI), or imaging for non-urologic reasons within the first year of life. Its significance in terms of resolution, need for antibiotic prophylaxis, or progression to surgery remains uncertain. We hypothesized that isolated low-grade hydronephrosis in this population frequently resolves, UTIs are infrequent, and progression to surgical intervention is minimal. PATIENTS AND METHODS Children < 12 months old diagnosed hydronephrosis (Society for Fetal Urology [SFU] grade 1 or 2) between January 2004 and December 2009 were identified by ICD9 code. Patients with other urological abnormalities were excluded. Stability of hydronephrosis, UTI (≥ 100,000 CFU/mL bacterial growth) or need for surgical intervention was noted. RESULTS Of 1496 infants with hydronephrosis, 416 (623 renal units) met inclusion criteria. Of 398 renal units with grade 1 hydronephrosis, 385 (96.7%) resolved or remained stable. Only 13 (3.3%) worsened, of which one underwent ureteroneocystostomy. Of 225 renal units with grade 2 hydronephrosis, 222 (98.7%) resolved, improved or remained stable, three (1.3%) worsened, of which one required pyeloplasty. Only 0.7% of patients in the ambulatory setting had a febrile UTI. CONCLUSIONS Low-grade hydronephrosis diagnosed within the first year of life remains stable or improves in 97.4% of renal units. Given the low rate of recurrent UTI in the ambulatory setting, antibiotic prophylaxis has a limited role in management.
Urology | 2012
Ramiro J. Madden-Fuentes; John S. Wiener; Sherry S. Ross; Jonathan C. Routh
Testicular masses in prepubescent children are typically benign. Most masses are mature teratomas, epidermoid cysts, and stromal tumors. Synchronous bilateral testicular masses in children are rare. The etiology of these includes synchronous primary testicular masses, lymphoma, leukemia, and adrenocortical rest hyperplasia. Partial orchiectomy, or testis-sparing surgery, is now preferred in the management of testicular masses deemed to be benign. We present a case of benign bilateral testicular masses managed with testis-sparing surgery. Six-month follow-up revealed no residual tumor, normal contour of the testes, and no evidence of atrophy.
Urology | 2015
John Patrick Selph; Ramiro J. Madden-Fuentes; Andrew C. Peterson; George D. Webster; Aaron Lentz
OBJECTIVE To determine the long-term outcomes of artificial urinary sphincter (AUS) implantation following a successful rectourethral fistula (RUF) repair. MATERIALS AND METHODS Between January 1, 2006 and January 1, 2012, a total of 26 patients underwent successful repair of an RUF. Stress urinary incontinence was treated in 6 patients (23%) with implantation of an AUS. Preoperative and postoperative evaluation included demographic variables, voiding diaries, 24-hour pad weight, urodynamic characteristics, operative time, estimated blood loss, complication rates, follow-up time, and cuff selection. RESULTS All 6 patients underwent successful RUF repair using a perineal approach. Mean age was 64.3 years (range 58-74). Mean follow-up after repair was 51.5 months (range 34-64). RUF etiology included radical prostatectomy (4), brachytherapy + external beam radiotherapy (1), and cryotherapy + external beam radiotherapy (1). The median time between RUF repair and AUS placement was 12 months (range 2-41). No intraoperative complications occurred during AUS implantation. The average operative time was 61.8 minutes with an estimated blood loss of 24 mL. The initial cuff size selected was 4.0 or 4.5 cm, and no patient required transcorporal cuff placement. Pad use was reported as ≤1 pad per day in all 6 patients at the initial 3-month follow-up. Median follow-up after AUS placement was 43.5 months (5-55). No patient required revision or removal for mechanical complications, infection, or erosion. No patient had recurrence of their previously repaired RUF or new-onset fecal incontinence. CONCLUSION Patients who require placement of an AUS after an RUF repair seem to fare just as well as patients who undergo primary AUS implantation with no increased rate of complications postoperatively.
Urology | 2017
Rajeev Chaudhry; Zarine R. Balsara; Ramiro J. Madden-Fuentes; John S. Wiener; Jonathan C. Routh; Patrick C. Seed; Sherry S. Ross
OBJECTIVE To identify risk factors for recurrent urinary tract infection (UTI) in patients who perform clean intermittent catheterization (CIC). METHODS A 6-year retrospective chart review of patients with spina bifida or tethered cord who perform clean intermittent catheterization (8 months to 58 years) was conducted. A strict case definition for UTI was applied, and per-subject UTI events, demographic, and clinical data were abstracted. Data were compared between groups defined by no or infrequent UTI (≤1.0 UTI/study year) and frequent UTI (>1.0 UTI/study year). RESULTS Of 194 total patients, 146 (75%) had no UTIs or infrequent UTIs, and 48 (25%) patients had frequent UTIs. On univariate analysis, only younger age and suprasacral cord lesions were associated with frequent UTIs (P = .002 and P = .007, respectively). Among the 128 patients with urodynamic studies, bladder capacity, compliance, detrusor overactivity, and detrusor leak point pressure were not associated with frequent UTI on univariate analysis. On multivariate analysis, increasing age was found to be associated with decreased odds of UTI by 7% per year (odds ratio 0.93, P = .016). CONCLUSION The risk of UTI among individuals with spina bifida or tethered cord declines with increasing age. Bladder function based on urodynamic parameters did not correlate with frequent UTIs.
Journal of Pediatric Urology | 2014
Erin R. McNamara; Ramiro J. Madden-Fuentes; Jonathan C. Routh; Douglas C. Rouse; John F. Madden; John S. Wiener; Harry G. Rushton; Sherry S. Ross
OBJECTIVE We hypothesized that cold ischemia during partial orchiectomy would lead to higher serum testosterone levels and preservation of testicular architecture than warm ischemia in a prepubescent rat model. MATERIALS AND METHODS Eighteen prepubescent male Sprague-Dawley rats were randomized to three different surgical groups: sham surgery, bilateral partial orchiectomy with 30 min of cord compression with cold ischemia, or bilateral partial orchiectomy with 30 min of cord compression with warm ischemia. Animals were killed at puberty, and serum, sperm, and testicles were collected. Histological tissue injury was graded by standardized methodology. RESULTS Mean serum testosterone levels were 1445 ± 590 pg/mL for the sham group, 449 ± 268 pg/mL for the cold ischemia group and 879 ± 631 pg/mL for the warm ischemia group (p = 0.12). Mean sperm counts were 2.1 × 10(7) for sham, 4.4 × 10(6) for cold ischemia, and 9.9 × 10(6) for the warm ischemia groups (p = 0.48). Histological evaluation revealed significant difference in tissue injury grading with more injury in the cold ischemia than in the warm ischemia group (p = 0.01). CONCLUSIONS In our preclinical rat model, we found no benefit for cold ischemia over warm ischemia at 30 min.
Urology | 2018
John M. Lacy; Ramiro J. Madden-Fuentes; Adam Dugan; Andrew C. Peterson; Shubham Gupta
Objective: To determine the characteristics and predictors of perioperative complications after male anterior urethroplasty. Materials and Methods: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) is a validated outcomes-based program comprising academic and community hospitals in the United States and Canada. Data from 2007-2015 were queried for single-stage anterior urethroplasty using Current Procedure Terminology (CPT) codes. The primary outcome was frequency of complications within the 30-day postoperative period. Preoperative and intraoperative parameters were correlated with morbidity measures and univariate and multivariate regression analyses were used. Results: 556 patients underwent anterior urethroplasty, of whom 180 (32.4%) had graft/flap placement. 127 patients (22.9%) went home the same day after surgery, 255 patients (45.9 %) stayed 1 night, and 173 (31.2%) stayed for 2 or more nights. No deaths, cardiovascular complications, or sepsis were noted. 47 (8.5%) patients had complications in the 30-day period. The most common complications were infection (57.4%), readmission (42.9%) and return to the operating room (17%). On univariate analysis, patients who had substitution urethroplasty (p=0.04) and longer operative times (p=0.002) were more likely to have complications, but only longer operative time showed significance on multivariate analysis (p=0.006). Age, American Society of Anesthesiologists (ASA) score and length of stay were not predictive of complication frequency. Conclusions: Anterior urethroplasty has low postoperative morbidity. Longer operative times were associated with increased rate of complications. Longer hospital stay after surgery is not protective against perioperative complications.OBJECTIVE To determine the characteristics and predictors of perioperative complications after male anterior urethroplasty. MATERIALS AND METHODS The American College of Surgeons-National Surgical Quality Improvement Program is a validated outcomes-based program comprising academic and community hospitals in the United States and Canada. Data from 2007 to 2015 were queried for single-stage anterior urethroplasty using Current Procedure Terminology codes. The primary outcome was frequency of complications within the 30-day postoperative period. Preoperative and intraoperative parameters were correlated with morbidity measures, and univariate and multivariate regression analyses were used. RESULTS A total of 555 patients underwent anterior urethroplasty, of whom 180 (32.4%) had graft or flap placement. Of the patients, 127 (22.9%) went home the same day after surgery, 255 (45.9%) stayed for 1 night, and 173 (31.2%) stayed for 2 or more nights. No deaths, cardiovascular complications, or sepsis were noted. Forty-seven patients (8.5%) had complications in the 30-day period. The most common complications were infection (57.4%), readmission (42.9%), and return to the operating room (17%). On univariate analysis, patients who had substitution urethroplasty (P = .04) and longer operative times (P = .002) were more likely to have complications, but only longer operative time showed significance on multivariate analysis (P = .006). Age, American Society of Anesthesiologists score, and length of stay were not predictive of complication frequency. CONCLUSION Anterior urethroplasty has low postoperative morbidity. Longer operative times were associated with increased rate of complications. Longer hospital stay after surgery is not protective against perioperative complications.
Journal of the American Geriatrics Society | 2017
Kim G. Johnson; Adedayo Fashoyin; Ramiro J. Madden-Fuentes; Andrew J. Muzyk; Jane P. Gagliardi; Mamata Yanamadala
Studies show inpatient geriatric patients with reversible conditions like delirium may continue on antipsychotic medications without clear indications after hospital discharge. We conducted this study to determine how often geriatric patients were discharged on a newly started antipsychotic during admission with a plan for discontinuation of the antipsychotic documented in the discharge summary.
Current Bladder Dysfunction Reports | 2017
Stephanie J. Sexton; Andrew C. Peterson; Ramiro J. Madden-Fuentes
Purpose of ReviewUrinary incontinence is a burdensome sequelae of prostate cancer treatment with a significant impact on quality of life. The artificial urinary sphincter has been the gold standard for management of incontinence. A variety of modifications to the implantation technique to improve continence and minimize infections have been implemented. Herein, we review these changes.Recent FindingsPost-prostatectomy incontinence requires a detailed evaluation in order to determine the best method of treatment. Despite alternative devices on the market, the success and side effect profile continues to favor the artificial urinary sphincter (AUS) for management of most men with post-prostatectomy incontinence. While the overall risk of complications from the AUS is low, recent efforts have focused on measures to reduce infection and erosion rates.SummaryThe AUS is a commonly utilized method to treat post-prostate cancer treatment incontinence. This remains the gold standard for management given its low side effect profile.