Arun Z. Thomas

Imperial College Healthcare NHS Trust

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José A. Karam

The University of Texas MD Anderson Cancer Center

Rustom P. Manecksha

Tallaght University Hospital

Mehrad Adibi

The University of Texas MD Anderson Cancer Center

Robert J. Flynn

University of Derby

Christopher G. Wood

The University of Texas MD Anderson Cancer Center

Leonardo D. Borregales

Mount Sinai Medical Center

Surena F. Matin

The University of Texas MD Anderson Cancer Center

Rowan G. Casey

Tallaght University Hospital

Pheroze Tamboli

The University of Texas MD Anderson Cancer Center

Lisa G. Smyth

Tallaght University Hospital

Cooperative Institutions

Tallaght University Hospital

The University of Texas MD Anderson Cancer Center

Trinity College Dublin

St. James's Hospital

St. Vincent's University Hospital

Beaumont Hospital

Royal College of Surgeons in Ireland

Johannes Gutenberg University Mainz

University Medical Center of the Johannes Gutenberg University Mainz

Boston Children's Hospital

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Urological service provision during the COVID-19 period: the experience from an Irish tertiary centre

Irish Journal of Medical Science (1971 -) (2020)

Patrick M. Collins Aideen Madden Clare O’Connell Shawgi Abdelrazig Omer M.S. Inder

Urological service provision has changed dramatically with the advent of the SARS-CoV-2, necessitating restructuring and reorganization. The aim of this study was to review the reorganization of our unit, map the change in volume of departmental activities and discuss potential solutions.Departmental activities over the months of April and May 2020 and 2019 were analysed. Details of admissions, operations, diagnostic procedures, outpatient reviews, morbidities and mortalities were recorded. Operations were performed on two sites, with elective operation transferred to an offsite, COVID-free hospital.Seventy-four emergency operations were performed onsite, with 85 elective operations outsourced. A total of 159 operations were performed, compared with 280 in the same period in 2019. Five (5.0%) of 101 admitted patients to the COVID hospital contracted COVID-19. No patients outsourced to the COVID-free hospital were infected there. Outpatient referrals to urology service decreased from 928 to 481. There was a 66% decrease in new cancer diagnoses. A virtual review clinic was established, with remaining outpatients reviewed through a telephone clinic platform.Compared with 2019, we performed fewer operations and outpatient procedures, had fewer admissions and diagnosed fewer patients with new cancers. However, outsourcing elective operation to designated non-COVID hospitals prevented the infection of any patient with COVID-19 in the post-operative period. The use of virtual clinic and telephone clinic has had some success in replacing traditional outpatient visits. The overall significant decrease in operative volume will likely precipitate a mismatch between demand and service provision in the coming months, unless capacity is increased.

Economic shortage

Outpatient clinic

10.1007/s11845-020-02352-x

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Citations (12)

Avoidable iatrogenic complications of urethral catheterization and inadequate intern training in a tertiary‐care teaching hospital

BJU International (2009)

Arun Z. Thomas Subhasis Giri David Meagher Tom Creagh

To examine the magnitude of potentially avoidable iatrogenic complications of male urethral catheterization (UC) within a tertiary-care supra-regional teaching hospital, and to evaluate risk factors and subjective feeling of interns in our institution on the adequacy of training on UC.Male UC-related morbidities were retrospectively identified from our computerized inpatient urology consultation system over a 1-year period from July 2006 to June 2007. Relevant medical records were also reviewed. An anonymous questionnaire was used for the subjective assessment of interns about their training on UC. The primary outcome measures were the prevalence of urethral trauma secondary to UC by a non-urological team member in non-urological departments, risk factors and intern-perceived adequacy of practical and theoretical training on UC during their intern year, and finally the supervision of interns during first UC.Of 864 urological consultations, 51 (6%) were related to complications arising from male UC during the 1-year period. The most common indication for UC was monitoring urinary output for acute medical illness (34/51, 67%). The most common complication was urethral trauma (35/51, 67%). The balloon was accidentally inflated in the urethra in six patients (12%). Of the 51 cases of UC-related morbidity, 38 (74%) resulted from interns performing UC, and of these 28 (73%) occurred during the first 6 months of internship. Overall, 76% of interns felt that their practical training was none or inadequate; 52% (26/50) did not receive any supervision during their first UC.UC-related iatrogenic morbidity is not uncommon even in a tertiary-care teaching hospital. This study identified that interns receive inadequate training on UC. Finally, most of the complications are potentially avoidable and can be prevented by adopting a proper technique of catheterization. Adequate training and supervision of medical students and interns can achieve this.

Tertiary care

10.1111/j.1464-410x.2009.08494.x

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Citations (91)

Percentage of sarcomatoid component as a prognostic indicator for survival in renal cell carcinoma with sarcomatoid dedifferentiation

Urologic Oncology Seminars and Original Investigations (2015)

Mehrad Adibi Arun Z. Thomas Leonardo D. Borregales Megan M. Merrill Rebecca Slack

Histology

Univariate analysis

Sarcomatoid Carcinoma

Lymphovascular invasion

Log-rank test

10.1016/j.urolonc.2015.04.011

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Citations (50)

The utility of stent on strings in clinical practice

Irish Journal of Medical Science (1971 -) (2019)

Olwyn Lynch Elaine J. Redmond M.S. Inder Robert J. Flynn Arun Z. Thomas

10.1007/s11845-019-02079-4

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Digital rectal examination in primary care is important for early detection of prostate cancer: a retrospective cohort analysis study

British Journal of General Practice (2014)

Anna Walsh S. Considine Arun Z. Thomas Thomas Lynch Rustom P. Manecksha

Currently, there is no standardised screening for prostate cancer in Europe. Assessment of risk is opportunistically undertaken in consultation with the GP or urologist. Evaluation of the prostate gland consists of a prostate-specific antigen (PSA) serum level and a digital rectal examination (DRE) of the gland. DRE is an essential part of the assessment that can independently predict prostate cancer in the setting of a normal PSA level.To evaluate the clinical usefulness of the DRE in general practice and urology clinics, and to ascertain its positive predictive value and sensitivity.A retrospective analysis study of a cohort of Irish men who underwent TRUS guided biopsy of the prostate in a single Irish tertiary referral centre, despite a normal PSA level. Patients were identified from a Rapid Access Prostate Clinic patient database. Pathological biopsy results were correlated with clinical DRE findings.Patient demographics, PSA levels, and DRE findings from a prospectively established database and hospital data systems from May 2009 to October 2013 were analysed.Of 103 men referred over a 53-month period with a normal age-adjusted PSA level, 67% were referred on the basis of an abnormal DRE alone. Thirty-five per cent of males with a normal PSA had prostate cancer. DRE alone had a sensitivity and specificity of 81% and 40% respectively in diagnosing prostate cancer, with a positive predictive value of 42%. Seventy-six per cent of these men had high-grade disease.DRE is a key part of the assessment for prostate cancer. It can independently identify patients at risk of prostate cancer, with a substantial proportion of these having clinically significant disease requiring treatment. This study reinforces the importance of DRE in the primary care setting in the assessment for prostate cancer. An abnormal DRE, even in the setting of a normal PSA level, necessitates referral.

Rectal examination

10.3399/bjgp14x682861

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Citations (56)

Predicting pulmonary metastases among patients with indeterminate pulmonary nodules with renal cell carcinoma.

Journal of Clinical Oncology (2015)

Mehrad Adibi Patrick A. Kenney Arun Z. Thomas Catherine Devine José A. Karam

505 Background: Indeterminate pulmonary nodules (IPN) are of uncertain significance in renal cell carcinoma (RCC) patients. We sought to determine the natural history of IPN in patients undergoing radical nephrectomy and to identify clinical variables associated with the development of lung metastases. Methods: We reviewed all radical nephrectomy patients at a single institution from 2005 – 2009 who had ≥1 IPN on chest computed tomography (CT) within 6 months prior to surgery and no evidence of distant metastates. All chest CTs were re-reviewed by a radiologist who was blinded to outcomes to independently determine number, size, location of nodules and whether the IPN appeared concerning for metastases based on nodule size, tissue density, and morphology. Univariate and multivariate Cox regression was used to assess associated predictive factors. Results: Of 258 patients with IPN, 73 (28%) developed pulmonary metastases. Median follow−up was similar in the groups at 36 months. Patients who developed pulmonary metastases had significantly poorer survival compared to those who did not (3-year DSS 54.5 versus 86.5 months, p<0.001), and 39 (53%) developed pulmonary metastases at the same location as the largest IPN. On univariate analysis, larger renal tumor diameter (HR 1.12, p<0.001), number of pulmonary nodules CT (HR 1.12, p 0.001), presence of hilar lymphadenopathy on chest CT were associated with both lung metastasis development and cancer-specific mortality. After adjusting for age, performance status, comorbidities, histology, and smoking status, higher tumor grade (HR 5.11, p 0.007), presence of tumor thrombus above the diaphragm (HR 4.38, p 0.013), perinephric (HR 4.29, p 0.002) or renal sinus (HR 2.16, p 0.045) fat invasion, and a chest CT concerning for metastasis by the radiologist (HR 2.91, p<0.001) were associated with development of pulmonary metastases. Conclusions: RCC patients with IPN who develop pulmonary metastases have a significantly poorer outcome. Independent predictors of developing lung metastases include tumor grade, presence of tumor thrombus above the diaphragm, perinephric or renal sinus fat invasion, and a chest CT concerning for metastasis.

Univariate analysis

Nodule (geology)

10.1200/jco.2015.33.7_suppl.505

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Citations (2)

Giant cell arteritis of the prostate

Lara D. Veeken (2023)

Sharon Cowley Patricia Harkins Colm Kirby Micheal Hanly Arun Z. Thomas

Journal Article Giant cell arteritis of the prostate Get access Sharon Cowley, Sharon Cowley Rheumatology Department, Tallaght University Hospital, Dublin, Ireland Correspondence to: Sharon Cowley, Rheumatology Department, Tallaght University Hospital, Dublin 24, Ireland. E-mail: sharoncowley111@gmail.com https://orcid.org/0000-0002-7788-8322 Search for other works by this author on: Oxford Academic PubMed Google Scholar Patricia Harkins, Patricia Harkins Rheumatology Department, Tallaght University Hospital, Dublin, Ireland Search for other works by this author on: Oxford Academic PubMed Google Scholar C Kirby, C Kirby Rheumatology Department, Tallaght University Hospital, Dublin, Ireland https://orcid.org/0000-0001-7131-6721 Search for other works by this author on: Oxford Academic PubMed Google Scholar Micheal Hanly, Micheal Hanly Department of Medicine, St Vincent’s University Hospital, Dublin, Ireland Search for other works by this author on: Oxford Academic PubMed Google Scholar Arun Thomas, Arun Thomas Department of Urology, Beacon Hospital, Sandyford, Dublin, Ireland Search for other works by this author on: Oxford Academic PubMed Google Scholar David Kane David Kane Rheumatology Department, Tallaght University Hospital, Dublin, Ireland Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, Volume 62, Issue 12, December 2023, Pages e343–e344, https://doi.org/10.1093/rheumatology/kead226 Published: 16 May 2023 Article history Accepted: 29 April 2023 Published: 16 May 2023 Corrected and typeset: 10 June 2023

10.1093/rheumatology/kead226

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Urologic Emergencies in Pregnancy

Urology (2010)

Anil A. Thomas Arun Z. Thomas Steven C. Campbell Jeffrey S. Palmer

Maternal morbidity

10.1016/j.urology.2010.01.047

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Citations (29)

Novel Presentation of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19

Journal of Pediatric Neurology (2021)

Arun Z. Thomas Hiremath Sagar M.M. Baju

Abstract Pediatric inflammatory multisystem syndrome temporally associated with coronavirus disease 2019 (COVID-19) is an emerging rare disease reported in children 4 to 6 weeks after a usually asymptomatic COVID-19 infection. Though it usually presents as a Kawasaki-like illness or toxic shock syndrome, other multisystem presentations have been reported. Presentation as hemiplegia, however, is rare. Here, we describe a child with acute hemiplegia and rapidly progressive shock, who responded dramatically to steroids and intravenous immunoglobulin and experienced a full recovery. By reporting this case, we wish to add to the literature this atypical presentation of this novel disease, and highlight the importance of quickly diagnosing and treating this life-threatening disease.

Presentation (obstetrics)

Multisystem disease

Toxic shock syndrome

Case presentation

2019-20 coronavirus outbreak

10.1055/s-0041-1725982

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Citations (3)

Retained Upper Genitourinary Gossypiboma Can Mimic Renal Neoplasms. A Review Of The Literature

The Internet Journal of Urology (2012)

Derek Hennessey Arun Z. Thomas Thomas Lynch Rowan G. Casey

Introduction: Retained iatrogenic foreign bodies (RIFB) are uncommon, preventable errors that carry serious professional and medico-legal consequences. Urological surgery is at increased risk of RIFB; due to the increasing complexity of endoscopic and minimally invasive procedures. Aim: We analysed all reported cases of RIFB in world literature and have compiled the first comprehensive review on the management of upper tract RIFB. Methods: A literature review using medical search engines was performed. Publications reporting non iatrogenic foreign bodies were excluded from the review. Retained foreign bodies are referred to by their name, except for retained surgical swabs which are referred to as gossypiboma. Data is presented as median (interquartile range). Results: Data was obtained and analysed on 40 cases. 37 cases (92.5%) were related to previous urological surgery; 14 (35%) percutaneous renal surgery, 11 (30%) open stone surgery (30%), 5 (13.5%) urinary diversion, 5 (13.5%) ureteroscopic surgery, 3 (8%) pyeloplasty surgery (8%). 7 (17.5%) patients with upper tract RIFB represented with symptomatic renal masses, 85% underwent a radical nephrectomy. Gossypiboma accounted for 85.8% of these renal lesions. Median interval between initial surgery and representation is 60 months (12 – 216). Of these patients 5 (71.4%) underwent a previous pyelolithotomy or nephrolithotomy. Conclusion: RIFB are preventable errors and measures should be put in place to reduce the incidence. When confronted with a patient who has renal mass and a history of previous surgery close to the area. One must consider the possibility of a gossypiboma.

Gossypiboma

Pyeloplasty

Upper urinary tract

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Citations (5)