Stephen F. Lieberman
Oregon Health & Science University
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Featured researches published by Stephen F. Lieberman.
The Journal of Urology | 1997
Bruce A. Lowe; Stephen F. Lieberman
PURPOSE Optimal management of pathologic T3 prostate cancer is poorly defined. We conducted a prospective study of untreated pT3 patients to improve understanding of the natural history of this disease and to identify clinical parameters useful in patient selection for adjuvant therapy. MATERIALS AND METHODS Of 583 consecutive patients with clinical stage T1 to 2 disease managed by total prostatectomy, 206 had pT3 disease. Excluding patients requesting immediate adjuvant treatment or neoadjuvant therapy, 156 subjects were eligible for the study, including 34 with pT3a, 80 pT3b, 22 pT3c, and 20 pT3N+ disease. Patients were followed for prostate-specific antigen (PSA) recurrence of greater than 0.2 ng./ml. and biopsy proved local or distant tumor progression demonstrated by imaging studies. RESULTS After a median of 45 months, PSA recurrence was seen in 29.4% of pT3a (10/34), 30% of pT3b (24/80), 27.3% of pT3c (6/22), and 80% of pT3N+ (16/20 cases). Local or distant progression was seen in 2.9% of pT3a (1), 6.2% of pT3b (5), 9.1% of pT3c (2), and 55% of pT3N+ (11 cases). Recurrence and progression correlated with the number of surgical margins involved by tumor, pathological Gleason score and baseline pre-prostatectomy PSA levels. PSA recurrence was seen in 20.8% (10/48) patients with 1 surgical margin involved, 40.9% (9/22) with 2 margins involved and 50% (5/10) with 3 or more margins involved. PSA recurrence was 20.3% (14/69) with Gleason scores of less than 7, 33.9% (19/56) with a score of 7 and 74.2% (23/31) with scores of greater than 7. Pre-prostatectomy PSA levels less than 10 ng./ml. were associated with a PSA recurrence of 17.3% (14/81) and 45.4% (25/55), with levels greater than 10 ng./ml. Selecting patients for high or low risk based upon the results of these parameters allowed accurate prediction of PSA recurrence; 8.5% (4/47) for low risk patients and 44.8% (30/67) for high risk. Tumor progression was seen in no low risk patient and in 9% (6) with high risk. The difference between the 2 risk groups was highly significant (p <0.0001). CONCLUSIONS The majority of patients with pT3 prostate cancer will not experience recurrent disease for many years if ever. Immediate use of adjuvant treatment should be reserved for those patients with a high risk of recurrent disease.
Mayo Clinic Proceedings | 2013
Ronald Loo; Stephen F. Lieberman; Jeff M. Slezak; Howard M. Landa; Albert J. Mariani; Gary Nicolaisen; Ann Michelle Aspera; Steven J. Jacobsen
OBJECTIVE To identify patients who could safely avoid unnecessary radiation and instrumentation after the detection of microscopic hematuria. PATIENTS AND METHODS We conducted a prospective cohort study of patients who were referred to urologists and underwent a full evaluation for asymptomatic microscopic hematuria during a 2-year period in an integrated care organization in 3 regions along the West Coast of the United States. A test cohort and validation cohort of patients with hematuria evaluations between January 9, 2009, and August 15, 2011, were identified. Patients were followed passively through their electronic health records for a diagnosis of urothelial or renal cancer. The degree of microscopic hematuria, history of gross hematuria, smoking history, age, race, imaging findings, and cystoscopy findings were evaluated as risk factors for malignant tumors. RESULTS The test cohort consisted of 2630 patients, of whom 55 (2.1%) had a neoplasm detected and 50 (1.9%) had a pathologically confirmed urinary tract cancer. Age of 50 years or older and a recent diagnosis of gross hematuria were the strongest predictors of cancer. Male sex was also predictive of cancer, whereas smoking history and 25 or more red blood cells per high-power field on a recent urinalysis were not statistically significant. A Hematuria Risk Index developed from these factors had an area under the receiver operating characteristic curve of 0.809. In the validation cohort of 1784 patients, the Hematuria Risk Index performed comparably (area under the curve = 0.829). Overall, 32% of the population was identified as low risk and 0.2% had a cancer detected; 14% of the population was identified as high risk, of whom 11.1% had a cancer found. CONCLUSION These results suggest that a considerable proportion of patients could avoid extensive evaluations with the use of the Hematuria Risk Index.
The Journal of Urology | 1982
Stephen F. Lieberman; Frederick S. Keller; John M. Barry; Josef Rösch
Abstract Mid ureteral stenosis in a kidney transplant 16 years after grafting was treated successfully with percutaneous antegrade ureteral dilation with a balloon catheter followed by antegrade placement of a temporary double pigtail ureteral stent. Significant obstruction did not recur during a 7-month followup.
The Journal of Urology | 1982
Stephen F. Lieberman; John M. Barry
A direct vision urethrotome was used to incise the perineal membrane and join the proximal bulbous urethra to the dorsal prostate in 4 men with totally obliterated posterior urethras following pelvic fractures. All 4 patients have maintained patent urethras for 2 to 9 months. Progressive dilation has not been required in 3 men. A repeat internal urethrotomy was necessary in 1 patient who currently requires urethral sounding every 6 weeks. A comparison with 8 previous transpubic urethroplasties for the same surgical problem revealed a significant decrease in blood loss and hospital stay with direct vision urethrotomy. Transurethral incision of the obliterated posterior urethra following a crushing injury to the pelvis may be a reasonable initial procedure for restoring urethral continuity prior to more extensive urethroplasty.
Journal of Trauma-injury Infection and Critical Care | 1987
Gregory B. McCoy; John M. Barry; Stephen F. Lieberman; Harper D. Pearse; Roger Wicklund
Acute placement of a suprapubic bladder tube followed months later by open urethroplasty has been the traditional manner for managing traumatic disruption of the proximal urethra. The latter procedure has generally been performed via the transpubic or perineal approach. These procedures have been complicated by excessive blood loss, impotence, incontinence, strictures, and extended hospitalizations. Since 1979, 12 patients with obliterated urethras (ten membranous, two bulbous) have been treated by direct vision urethrotomy using a second cystoscope or sound passed through the previously placed suprapubic tract as a guide. Mean blood loss, hospital stay, and followup were 70 ml, 6 days, and 22 months, respectively. Six patients required at least one additional internal urethrotomy. With the exception of one patient who still requires intermittent self-catheterization, all have stable strictures. Ten are continent (one was incontinent secondary to previous radical prostatectomy before urethrotomy and one became incontinent after a TURP performed 3 years after urethrotomy). Five are potent and none lost potency as a result of urethrotomy. Flow rates range from 15-25 ml/second in the continent patients. This is a reasonable first procedure for restoring continuity of traumatically obliterated membranous and bulbous urethras.
Transplantation | 1981
John M. Barry; Stephen F. Lieberman; Curtis G. Wickre; Carol Lieberman; Susan Fischer; Dawn Craig
Many transplant teams are reluctant to accept kidneys preserved with intracellular electrolyte flushing followed by simple cold storage when preservation time exceeds 24 hr. This study from one center is a comparison of 63 primary cadaver kidney grafts preserved with Collins 2 solution flush followed by cold storage for 9 to 23 1/2 hr to 42 primary cadaver kidney grafts preserved by the same method for 24 to 44 1/2 hr. Kidneys cold-stored for over 24 hr had a significantly increased requirement for dialysis in the first week following transplantation (55% versus 30%). One-month serum creatinine nadirs and actuarial graft survivals were not significantly different. Cadaver donor methylprednisolone (30 to 60 mg/kg) 2 to 9 hr prior to kidney removal reduced the requirement for first-week hemodialysis in the kidneys cold-stored for over 24 hr (23% versus 69%, P under 0.05). A human kidney preserved by the same method and cold-stored for 61 hr was successfully transplanted into a 38-year-old myelodysplastic. Satisfactory human kidney preservation can occur with intracellular electrolyte flush solutions followed by cold storage for over 24 hr when the warm ischemia time is very short.
The Journal of Urology | 1983
Stephen F. Lieberman; Frederick S. Keller; Harper D. Pearse; Eugene F. Fuchs; Josef Rösch; John M. Barry
Transarterial renal embolization has been used in the management of renal cancer. We report on 9 patients who underwent selective and superselective renal arterial embolization for nonmalignant renal lesions. Embolization was done in 5 patients for hemorrhage owing to renal angiomas, renal artery, pseudoaneurysm, percutaneous renal biopsy and adult polycystic kidney disease, and in 2 patients with end stage renal disease because of massive proteinuria. Another chronic renal failure patient with severe hypertension was treated successfully with bilateral renal embolization. A postoperative renal arteriovenous fistula was treated successfully by catheter vaso-occlusion. Renal embolization may be a suitable alternative to surgery in poor operative risk patients and for technically difficult benign lesions. Renal infection is a contraindication to embolization.
Journal of Clinical Oncology | 2013
Ronald Loo; Violeta Rabrenovich; Ann Michelle Aspera; Steven J. Jacobsen; Howard Landa; Stephen F. Lieberman; Albert J. Mariani; Gary Nicolaisen; Jeff Slezak; Mark StLezin
223 Background: AMH in the general population is common, occurring in up to 9-18%. Even low degrees of AMH have been considered a risk factor for UTMT. Although the prevalence of UTMT is low (.01-3%), many asymptomatic patients undergo unnecessary and hazardous evaluations. In 2007, the Kaiser Permanente (KP) Urologists started a multi-year QI effort to research and develop a risk stratified evidence-based approach in the evaluation of AMH. METHODS The group first conducted a retrospective analysis to determine the incidence of urinary cancer, and stratify risk according to age, gender, smoking history, and degree of hematuria. A multi-regional prospective, observational study was then conducted over a two year period. We used a data collection tool embedded within an EMR to determine patients with AMH who are at greatest risk for UTMT, and patients who might benefit from urologic evaluation or safely avoid unnecessary workup and radiation exposure. RESULTS 4,414 patients had full urologic work up. Overall, 100 bladder cancers were diagnosed among 4,414 patients (2.3%), and only 11 renal cancers (0.2%) were pathologically confirmed. Multivariable logistic regression was conducted for 5 common parameters: age, gender, smoking history, degree of microscopic hematuria, and history of gross hematuria within the past 6 months. The two most important risk factors were age > 50, and prior history of gross hematuria. A hematuria risk index (HRI) was developed, which significantly improved predictability (AUC = .809-HRI vs .532-AUA guideline). Overall, 32% of the population was identified as low risk with only 0.2% cancer detected; 14% of the population was identified as high risk, of whom 11.1% had a cancer diagnosed. CONCLUSIONS These results suggest that a considerable proportion of patients may safely avoid hazardous evaluation using multivariate risk stratification. An evidence-based algorithm was developed for the management of asymptomatic microscopic hematuria and implemented within KP. We expect to significantly improve patient safety and improve reliability of patient evaluation.
Scandinavian Journal of Public Health | 2015
Stephen F. Lieberman; Ingvar Karlberg
The Journal of Urology | 2014
Casey Ng; Jeff Slezak; Howard Jung; Richard E. Lee; Mark St. Lezin; Stephen F. Lieberman; Howard M. Landa; Stephen A. Poon; Albert J. Mariani; Ann Michelle Aspera; Daniel A. Barocas; Steven J. Jacobsen; Ronald Loo