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J Stephen Jones

Publications and source records attributed to J Stephen Jones.

At least 19 recordsLinked to original sources
PubMed2007

Reflex UroVysion testing of bladder cancer surveillance patients with equivocal or negative urine cytology: a prospective study with focus on the natural history of anticipatory positive findings.

A proportion of patients under surveillance for recurrent bladder carcinoma with no immediate evidence of bladder tumor recurrence have positive multitarget fluorescence in situ hybridization (FISH; UroVysion, Vysis, Downers Grove, IL) results. The course of these "anticipatory positive" cases and the time to bladder tumor recurrence remains unknown. We followed up 250 patients with urine cytologic results, concurrent multitarget FISH, and cystoscopic examination for recurrent urothelial carcinoma. Of 81 cases (32.4%) with FISH-positive results, tumor recurrence developed in 60 (74.0%). Of 169 (67.6%) FISH-negative cases, recurrent urothelial carcinoma developed in 22 (13.0%). Of 211 patients (84.4%) with negative cystoscopic examination results, 56 (26.5%) had positive FISH results, and in 35 (62.5%) of these patients, recurrent urothelial carcinoma developed. Approximately 27% of patients under bladder carcinoma surveillance without immediate evidence of tumor recurrence will have a positive FISH result, defining the anticipatory positive subset. In about 65% of this anticipatory positive group, recurrent bladder urothelial carcinoma developed within 29 months.

Cystoscopy↗
PubMed2006

Comparison of traditional basal and apical periprostatic block: impact on injection pain and biopsy pain.

OBJECTIVE: To compare the pain of injection and biopsy when lidocaine is injected periprostatically either at a basal or apical site, as the former is commonly used to anaesthetise the prostate, based on several reports showing that it can eliminate most of the pain associated with prostate biopsy, and this site has been favoured over apical injection because the nerves enter the prostate from the basal aspect. PATIENTS AND METHODS: In all, 143 patients scheduled for biopsy were randomized to receive a periprostatic block either at the apex or base of the prostate. Immediately before biopsy 5 mL of 1% lidocaine was injected under transrectal ultrasonographic (TRUS) guidance into the periprostatic nerves bilaterally. Patients were immediately given a 100 mm visual analogue scale (VAS, 0-100) to assess the pain associated with both the block and the subsequent biopsy. RESULTS: The mean VAS scores for the anaesthetic block were 21.1 and 22.0 (P = 0.79) and the biopsy VAS scores were 17.6 and 28.7 (P < 0.001) for the apical and basal groups, respectively. There was no statistically significant difference between patients who had a 12- or 20-core biopsy. CONCLUSIONS: Apical periprostatic injection with anaesthetic provides better anaesthesia for TRUS biopsy than basal injection, and without increasing the pain associated with injection at the potentially more sensitive apical site.

Anesthetics, Local↗
PubMed2006

Radical prostatectomy as primary treatment modality for locally advanced prostate cancer: a prospective analysis.

OBJECTIVES: Locally advanced prostate cancer is frequently treated with radiotherapy and androgen deprivation because of the greater rate of extracapsular disease and the concern that radical prostatectomy (RP) may not be curative in most cases. A case for surgery for locally advanced disease may be made on the basis of a lower rate of local recurrence compared with radiotherapy in our comparative database, data suggesting a survival advantage with pelvic lymph node dissection in those with positive nodes, and the observation of improved survival in those with metastatic disease treated by RP compared with radiotherapy. We report on the feasibility of RP as a primary treatment modality for locally advanced disease. METHODS: A total of 281 consecutive patients treated by RP between January 1998 and June 2004 were reviewed. Locally advanced disease was defined as clinical Stage T2b or worse, prostate-specific antigen level greater than 15 ng/mL, and/or a Gleason score of 8 or greater. Data on the pathologic characteristics, operative complications, and follow-up were obtained from a prospectively maintained institutional review board-approved database. RESULTS: Pathologic examination demonstrated organ-confined disease in 11.7%, extracapsular extension in 56.9%, seminal vesicle involvement in 23.1%, and positive lymph nodes in 8.9%. The overall complication rate was 9.7% compared with 6.9% for all patients undergoing RP. At a mean follow-up of 34 months (range 1 to 78), 198 (70.4%) of 281 patients had an undetectable prostate-specific antigen level at the last follow-up examination. CONCLUSIONS: RP for locally advanced prostate cancer is feasible, with acute morbidity similar to RP for more localized disease. Furthermore, RP results in short-term biochemical recurrence-free survival similar to that of combined radiotherapy and androgen ablation.

Feasibility Studies↗
PubMed2006

DNA-based molecular cytology for bladder cancer surveillance.

Surveillance strategies for urothelial cancer (UC) recurrence have historically relied on the diagnostic combination of cystoscopy and conventional urinary cytology. In this review, results of studies evaluating the role of the fluorescence in situ hybridization (FISH) assay in bladder cancer surveillance are critically examined. The published research on FISH compared with conventional cytology and cystoscopy for bladder cancer was identified using a Medline search and was critically analyzed. Sensitivity and specificity data were tabulated and compared. FISH outperformed conventional cytology across all stages and grades in all published reports, and it detected malignancy before the development of lesions visible by cystoscopy. Although overall sensitivity was 48% for cytology and 74% for FISH, its greatest advantage was in the detection of high-grade UC, including carcinoma in situ (CIS). Cumulative data from comparative studies showed the sensitivity of cytology compared with FISH was 19% versus 58% for grade 1, 50% versus 77% for grade 2, and 71% versus 96% for grade 3. Similar findings occurred by stage, where cytology compared with FISH sensitivity was 35% versus 64% for Ta, 66% versus 83% for T1, and 76% versus 94% for muscle-invasive carcinoma. Notably, cytology detected only 67% of CIS versus 100% detection by FISH. Specificity data were comparable. Unlike conventional urinary cytology and cystoscopy, which depend on subjective visible microscopic or macroscopic changes, FISH allows identification of chromosomal abnormalities associated with malignant development before phenotypic expression of those alterations. Use of morphologic cellular changes allows more rapid detection of such alterations, combining the benefits of conventional cytology with molecular diagnostics. It is apparent that we are in the early phases of realizing the potential of molecular diagnostics.

DNA, Neoplasm↗
PubMed2006

Saturation technique does not improve cancer detection as an initial prostate biopsy strategy.

PURPOSE: We reported on the results of a sequential cohort study comparing office based saturation prostate biopsy to traditional 10-core sampling as an initial biopsy. MATERIALS AND METHODS: Based on improved cancer detection of office based saturation prostate biopsy repeat biopsy, we adopted the technique as an initial biopsy strategy to improve cancer detection. Two surgeons performed 24-core saturation prostate biopsies in 139 patients undergoing initial biopsy under periprostatic local anesthesia. Indication for biopsy was an increased PSA of 2.5 ng/dl or greater in all patients. Results were compared to those of 87 patients who had previously undergone 10-core initial biopsies. RESULTS: Cancer was detected in 62 of 139 patients (44.6%) who underwent saturation biopsy and in 45 of 87 patients (51.7%) who underwent 10-core biopsy (p >0.9). Breakdown by PSA level failed to show benefit to the saturation technique for any degree PSA increase. Men with PSA 2.5 to 9.9 ng/dl were found to have cancer in 53 of 122 (43.4%) saturation biopsies and 26 of 58 (44.8%) 10-core biopsies. Complications included 3 cases of prostatitis in each group. Rectal bleeding was troublesome enough to require evaluation only in 3 men in the saturation group and 1 in the 10-core group. CONCLUSIONS: Although saturation prostate biopsy improves cancer detection in men with suspicion of cancer following a negative biopsy, it does not appear to offer benefit as an initial biopsy technique. These findings suggest that further efforts at extended biopsy strategies beyond 10 to 12 cores are not appropriate as an initial biopsy strategy.

Adult↗
PubMed2006

The interval to spontaneous delivery following discontinuation of maintenance tocolysis.

OBJECTIVE: To determine the interval to spontaneous delivery following discontinuation of continuous subcutaneous terbutaline (SQT). METHODS: Singleton and twin gestations receiving outpatient preterm labor management services with SQT were identified from a database. Patients having SQT discontinued at 33.0-35.9 weeks (in a stable condition, not hospitalized and with known cervical status at discontinuation) with subsequent spontaneous labor and delivery were included (n = 1420). Data were compared by gestation type, week of SQT discontinuation and cervical dilatation using Kruskal-Wallis and Fisher's exact test analyses (p < 0.05 statistically significant). RESULTS: Spontaneous preterm delivery occurred in 63.0% of singletons and 87.9% of twins. Although stable at SQT discontinuation, 32.5% of singletons and 59.9% of twins delivered within three days. The interval from discontinuation of SQT to delivery was less for twin than singleton gestations (5.1 +/- 6.5 vs. 11.0 +/- 10.5 days, respectively, p < 0.001). CONCLUSIONS. Preterm discontinuation of SQT should be avoided if additional pregnancy prolongation is desired.

Adult↗
PubMed2006

Determining the success of vasectomy.

OBJECTIVES: To examine patient compliance, significance of rare nonmotile sperm (RNMS) and to determine the timing and number of semen analyses required to confirm sterility. PATIENTS AND METHODS: From November 2001 to November 2004, 436 consecutive primary vasectomies were performed by one surgeon. All patients were instructed to submit two initial semen specimens for analysis (2 and 3 months after vasectomy) and additional samples (at 1-month intervals) if sperm were identified on the initial and subsequent analyses. RESULTS: A quarter of the patients submitted no semen specimens and only 21% followed the full instructions to provide two consecutive negative semen analyses. Three-quarters of the patients provided a semen specimen at 8 weeks after vasectomy; of these, 75% were azoospermic and 25% contained sperm. At 12 weeks after vasectomy half the patients provided a semen specimen; of these, 91% were azoospermic and 9% contained sperm. Of the 83 patients with semen containing sperm at 8 weeks, 80 had RNMS and three had rare motile sperm (one of whom subsequently proved to have vasectomy failure). Of the 80 patients with RNMS, at 3, 4, 5, 6, 8, 10 and 11 months, 65, four, three, four, two, one and one, respectively were azoospermic. CONCLUSIONS: The present results indicate that many patients are not compliant with the protocol after vasectomy. Provided patients have been adequately counselled, we think that one negative semen analysis at 3 months or one with RNMS at 2 months may be adequate to determine the success of vasectomy. This should reduce the number of semen analyses, including reducing the number of men who must undergo repeat testing, without sacrificing the accuracy of determining paternity. Simplifying the follow-up after vasectomy is important; not only would it be cost-effective but it may also improve patient compliance.

Cost-Benefit Analysis↗
PubMed2005

Management of ureteral injuries associated with vaginal surgery for pelvic organ prolapse.

Due to the anatomic proximity of the urinary and genital tracts, iatrogenic ureteral injury during pelvic organ prolapse repairs is a serious complication that we have managed in increasing number at our institution. However, few centers have reported on their experience with ureteric injuries associated with gynecologic reconstructive surgery. These ureteral injuries may lead to much morbidity, in particular the formation of ureterovaginal fistula, and the potential loss of renal function especially when diagnosed postoperatively. It is necessary, therefore, for surgeons to have a thorough knowledge of ureteral anatomy and to take precautions to prevent such injuries. The purpose of this article is to review this pertinent anatomy and the key principles of management of ureteric complications of transvaginal surgery for pelvic organ prolapse. The present study illustrates the application of our treatment algorithm based on the time of presentation and the patient condition.

Female↗
PubMed2005

Sling may hasten return of continence after radical prostatectomy.

OBJECTIVES: To place absorbable slings in 15 men at radical retropubic prostatectomy in an attempt to hasten recovery of continence. METHODS: Fifteen men underwent placement of a sling immediately after prostatectomy by a single surgeon. A strip of either porcine small intestine submucosa (SIS) or polyglactin mesh was placed beneath the anastomosis. The initial five slings were tension free. The last 10 were tightened just to the point they began to elevate the anastomosis. A comparison was made with the same number of men who underwent radical retropubic prostatectomy immediately before beginning this project. The average follow-up was 28.9 months. RESULTS: The first 5 sling patients (no tension) recovered complete bladder control in an average of 5.8 weeks. The 10 men with slings placed under slight tension were dry an average of 2.6 weeks after catheter removal, including 4 within 24 hours. One month later, 10 sling patients (67%) were continent, including 8 (80%) who had had the sling placed under slight tension. Six (40%) of 15 control patients were completely dry in that interval. Three months later, all but 1 sling patient (93%) was dry, but only 7 (47%) of 15 controls. All, except 1 control, were dry at 12 and 24 months. No complications were attributed to this maneuver, specifically no bladder neck contracture or retention occurred. No one in either group received incontinence treatment, although 2 control patients had either stricture or bladder neck contracture. CONCLUSIONS: The early results have been encouraging, but must be confirmed. Slight tension on the sling may be beneficial.

Absorbable Implants↗
PubMed2005

Porcine small intestinal submucosa as a percutaneous mid-urethral sling: 2-year results.

OBJECTIVE: To report the 2-year follow-up results on patients treated with a novel minimally invasive outpatient procedure for placing a mid-urethral sling, using porcine small intestinal submucosa (SIS). PATIENTS AND METHODS: Thirty-four women with urodynamic evidence of stress urinary incontinence (SUI, 19) or of SUI with a positive cough test (15) were treated. A curved ligature carrier was used to create a tract between bilateral suprapubic stab incisions and a 2-cm mid-urethral vaginal incision. A suture secured to each end of the SIS sling was placed through the eyelet of the ligature carrier. Extraction was used to position the sling at the mid-urethra, providing a backboard of support that was remodelled with ingrowth of the patient's autologous tissue. RESULTS: SUI was reportedly cured in 27 of the 34 women (79%) at the 2-year follow-up; three (9%) of those with no complete resolution were pleased with their results, because the improvement allowed them to wear an average one or fewer pads per day. One patient developed de novo urge incontinence. Three patients (9%) developed suprapubic inflammation at 10, 21 and 45 days after surgery; all resolved, but one had a recurrence of SUI. No prolonged retention, erosion or other complications were noted. CONCLUSIONS: Early results with the percutaneous mid-urethral placement of SIS are promising and potentially comparable with those after using synthetic minimally invasive slings.

Animals↗
PubMed2005

Use of a visual analog scale to assess pain of injection with intracavernous injection therapy.

AIM: Fear of pain with intracavernosal injection (ICI) therapy may discourage its use in patients with erectile dysfunction (ED). METHODS: We prospectively analyzed patient self-report of discomfort with ICI therapy for ED utilizing a visual analog scale from 0 to 10. RESULTS: Patient self-report using a visual analog scale revealed minimal discomfort, with 59 consecutive patients reporting an average pain score of 1.93 +/- 1.76. There was no statistical difference between self-administered or nurse-administered injections. The volume of the injection also had no statistical effect on pain score, and there was no difference observed between those who received alprostadil alone or combination treatment. Patients with diabetes mellitus did have significantly higher pain scores than other patients (3.31 +/- 2.25 vs. 1.62 +/- 1.39, P = 0.009), even when controlling for other factors. CONCLUSION: Clinicians should be aware of the greater potential for discomfort in ED patients with diabetes. In the majority of ED patients, however, discomfort is minimal, and this information should be helpful in alleviating fear of injection in those who may benefit from this therapy.

Adult↗
PubMed2004

Parasagittal biopsies add minimal information in repeat saturation prostate biopsy.

OBJECTIVES: To compare the outcome and efficacy of lateral biopsies with parasagittal biopsies in detecting prostate cancer during repeated biopsies performed using the "saturation" technique, which includes 24 cores per biopsy. Prostate biopsy may miss cancer in up to 38% of men eventually found to harbor the disease. Lateral biopsies are more likely than parasagittal biopsies to detect adenocarcinoma according to the findings of several studies. METHODS: A total of 100 patients, average age 62.1 +/- 7.9 years, underwent repeated transrectal ultrasound-guided saturation biopsy. The study group included 31 patients with previous biopsy results demonstrating high-grade prostatic intraepithelial neoplasia, 7 with atypia, and 62 with benign prostatic tissue but persistently elevated prostate-specific antigen levels. Patients had undergone an average of 1.65 previous biopsies. The average prostate-specific antigen level was 9.4 +/- 6.8 ng/mL. Biopsies were obtained from five sectors on each side and examined histologically. RESULTS: Cancer was detected in 25 (25%) of the 100 patients. Malignancy was identified in the lateral cores of all patients with positive biopsies. Parasagittal biopsy cores were positive in association with a lateral-based biopsy in 9 (36%) of the 25 malignancies, for an overall parasagittal biopsy core rate of 9% (9 of 100 patients). No cancers were detected in the parasagittal biopsy cores alone. CONCLUSIONS: Inclusion of parasagittal zone biopsy cores proved to have a low yield in detecting cancer on repeated biopsy. As all patients found to have cancer in the parasagittal biopsy cores also had cancer on the lateral biopsy cores, most time and effort can be spent obtaining lateral biopsy cores to increase the sensitivity on repeated saturation biopsy.

Adenocarcinoma↗
PubMed2004

Sexual function after male radical cystectomy in a sexually active population.

OBJECTIVES: To assess sexual dysfunction in sexually active men after radical cystectomy (RC) and to determine whether sildenafil citrate can improve erectile dysfunction after surgery. METHODS: The baseline and follow-up data from 49 sexually active male patients (mean age 57.8 +/- 9.1 years) undergoing RC (1995 to 2002) were obtained. Of the 49 patients, 16 (33%) had undergone nerve-sparing RC; 38 (78%) had undergone orthotopic diversion; 8 (16%) had undergone ileal conduit diversion; and 3 (6%) had undergone cutaneous continent diversion. The data were assessed using the abridged 5-item International Index of Erectile Function questionnaire, referred to as the Sexual Health Inventory for Men (SHIM). RESULTS: At a mean follow-up of 47.6 +/- 22.7 months, the total mean SHIM score decreased from 22.08 +/- 3.96 to 4.33 +/- 5.72 after RC (P <0.05). Of the 49 patients, 42 (86%) did not have erections sufficient for vaginal penetration. Of these 42 patients, 22 (52%) tried sildenafil citrate. Of these 22 patients, only 2 (9%) responded positively, with a total mean SHIM score of 23.50 +/- 2.12. Although the mean SHIM score after orthotopic substitution (5.24 +/- 6.21) was statistically significant compared with that after ileal conduit (1.13 +/- 0.33) and cutaneous continent (1.33 +/- 0.58) diversions, this was not clinically significant. CONCLUSIONS: Male erectile dysfunction after RC is a prevalent problem. In our series, only 9 (14%) of 49 sexually active men were potent after surgery. Of these 9 potent patients, 8 (89%) had undergone nerve-sparing RC. Of concern, only 52% of the patients with erectile dysfunction sought treatment after RC.

Aged↗
PubMed2004

Prostate cancer detection with office based saturation biopsy in a repeat biopsy population.

PURPOSE: Patients at increased risk for prostate cancer with previously negative biopsies pose a diagnostic challenge. We have previously demonstrated that extensive saturation biopsy can be performed in an office setting. We now report the diagnostic yield of office saturation biopsy in patients at increased risk for prostate cancer and at least 1 negative prior biopsy. MATERIALS AND METHODS: We performed saturation prostate biopsy with local anesthesia in the office in 116 patients with at least 1 prior negative biopsy and with certain risk factors, namely persistently elevated prostate specific antigen, abnormal digital rectal examination, or prior atypia or PIN on prior biopsy. RESULTS: A total of 34 cancers were detected for an overall diagnostic yield of 29%. A 64% detection rate was noted when a patient had undergone a single prior sextant biopsy. Subgroup analysis revealed a cancer detection rate of 41% when only prior sextant biopsies were performed, and a 24% detection rate when 10 or more cores were taken on prior biopsy. The detection rate was 33% when only 1 prior biopsy was taken and it was 24% when 2 or more prior biopsies were performed. CONCLUSIONS: Saturation biopsy can be performed safely and effectively in the office with a significant diagnostic yield even in patients with previous extended biopsy schemes. We believe that it should be the next diagnostic step after an initial negative biopsy in patients in whom the diagnosis of prostate cancer is strongly suspected.

Aged↗