Dr. Sean Elliott, MD
Reconstructive Urologist
High Impact or Recent Articles -- 5 per subject area
Urethroplasty
Defining Success after Anterior Urethroplasty: An Argument for a Universal Definition and Surveillance Protocol
Anderson KT, Vanni AJ, Erickson BA, Myers JB, Voelzke B, Breyer BN, Broghammer JA, Buckley JC, Zhao LC, Smith TG 3rd, Alsikafi NF, Rourke KF, Elliott SP. J Urol. 2022 Jul;208(1):135-143. doi: 10.1097/JU.0000000000002501. Epub 2022 Mar 3. PMID: 35239415.
We compared success rates with urethroplasty in 712 men and compared how the success rate varied with how success was defined. Success was variously defined by questionnaires, urinary flow rate, appearance on cystoscopy or receipt of any repeat urethral surgery. https://pubmed.ncbi.nlm.nih.gov/35239415/
Minimizing Antibiotic Use in Urethral Reconstruction
Kim S, Cheng KC, Alsikafi NF, Breyer BN, Broghammer JA, Elliott SP, Erickson BA, Myers JB, Smith TG 3rd, Vanni AJ, Voelzke BB, Zhao LC, Buckley JC. J Urol. 2022 Jul;208(1):128-134. doi: 10.1097/JU.0000000000002487. Epub 2022 Feb 25. PMID: 35212569.
We prospectively treated 900 patients undergoing urethroplasty or perineal urethrostomy at 11 centers over 2 years. The first-year cohort A received prolonged postoperative antibiotics. Year 2, cohort B, did not receive prolonged antibiotics. A standardized protocol following the American Urological Association guidelines for perioperative antibiotics was used. The 30-day postoperative infectious complications were determined. The use of a standardized protocol minimized antibiotic use and demonstrated no benefit to prolonged antibiotic use. There were no identifiable risk factors when considering surgical characteristics. Given the concern of antibiotic over-prescription, we do not recommend prolonged antibiotic use after urethral reconstruction. https://pubmed.ncbi.nlm.nih.gov/35212569/
Urethroscopic Findings following Urethroplasty Predict the Need for Secondary Intervention in the Long Term: A Multi-Institutional Study from Trauma and Urologic Reconstructive Network of Surgeons
Amend GM, Nabavizadeh B, Hakam N, Voelzke BB, Smith TG 3rd, Erickson BA, Elliott SP, Alsikafi NF, Vanni AJ, Buckley JC, Zhao LC, Myers JB, Peterson AC, Rourke KF, Broghammer JA, Breyer BN. J Urol. 2022 Apr;207(4):857-865. doi: 10.1097/JU.0000000000002353. Epub 2021 Dec 2. PMID: 34854754.
This study of 304 men demontrates the value of examining the urethra with a scope in the first year after urethroplasty. If we saw narrowing on this scope exam then those men were more likely to need another surgery in the future for narrowing of the urethra. https://pubmed.ncbi.nlm.nih.gov/34854754/
One-Year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume® Drug-Coated Balloon for Anterior Urethral Strictures
Elliott SP, Coutinho K, Robertson KJ, D'Anna R, Chevli K, Carrier S, Aube-Peterkin M, Cantrill CH, Ehlert MJ, Te AE, Dann J, DeLong JM, Brandes SB, Hagedorn JC, Levin R, Schlaifer A, DeSouza E, DiMarco D, Erickson BA, Natale R, Husmann DA, Morey A, Olsson C, Virasoro R. J Urol. 2022 Apr;207(4):866-875. doi: 10.1097/JU.0000000000002346. Epub 2021 Dec 2. PMID: 34854748.
We conducted a multicenter randomized trial where 127 men received either dilation of the urethral stricture with a regular balloon or a balloon coated with paclitaxel (to inhibit scar growth). We showed that the men who received the drig-coated balloon were much less likely to have their scar tissue return. https://pubmed.ncbi.nlm.nih.gov/34854748/
Development and Validation of A Male Anterior Urethral Stricture Classification System
Erickson BA, Flynn KJ, Hahn AE, Cotter K, Alsikafi NF, Breyer BN, Broghammer JA, Buckley JC, Elliott SP, Myers JB, Peterson AC, Rourke KF, Smith TG 3rd, Vanni AJ, Voelzke BB, Zhao LC; Trauma and Urologic Reconstruction Network of Surgeons (TURNS). Urology. 2020 Sep;143:241-247. doi: 10.1016/j.urology.2020.03.072. Epub 2020 Jun 21. PMID: 32580016.
We developed a system to classify urethral strictures into different categories based on the length of the stricture, the location of the stricture and the cause of the stricture. This will be used to help predict which type of surgery will be needed and might help us predict the success rate of surgeries. https://pubmed.ncbi.nlm.nih.gov/32580016/
Neurogenic Bladder
Bladder Management is the Top Health Concern Among Adult with Spinal Cord Injury. Loftus CJ, Ratanawong JP, Myers JB, Lenherr SM, Stoffel JT, Welk B, Grove S, Elliott SP. Neurourol Urodyn. 2023 Dec 20. doi: 10.1002/nau.25369. Epub ahead of print. PMID: 38116927.
Many people don't realize that bladder management is a hufe priority for people with spinal cord injury. In this and in other publiations, bladder management consistently ranks above walking again as the top helath priority. This is powerful information for patients to understand; but it is also key for doctors to understand. If we don't address bladder management actively and compassionately, our patients will suffer needlessly.
This review article summarizes our current thinking neurogenic bladder. We have a clinic dedicated just to caring for people with neurogenic bladder. We discuss testing we perform to decide on the best treatment. We discuss our algorithm we follow for which surgery to perform. https://pubmed.ncbi.nlm.nih.gov/35931441/
Association of stone surgery with patient-reported complications after spinal cord injury
Kasabwala K, Borofsky M, Grove S, Lenherr SM, Myers JB, Stoffel JT, Welk B, Elliott SP. Neurourol Urodyn. 2022 Mar;41(3):820-829. doi: 10.1002/nau.24887. Epub 2022 Feb 3. PMID: 35114016.
People with spinal cord injury get more urinary stones (kidney stones and bladder stones) than the general population. Using a large dataset of people with spinal cord injury we examined risk factors for stones and assessed how often stones occured. https://pubmed.ncbi.nlm.nih.gov/35114016/
Multicenter urethroplasty outcomes for urethral stricture disease for patients with neurogenic bladder or bladder dysfunction requiring clean intermittent catheterization
Cohen AJ, Cheng PJ, Song S, Patino G, Myers JB, Roy SS, Elliott SP, Pariser J, Drobish J, Erickson BA, Fuller TW, Buckley JC, Vanni AJ, Baradaran N, Breyer BN. Transl Androl Urol. 2021 May;10(5):2035-2042. doi: 10.21037/tau-20-988. PMID: 34159084; PMCID: PMC8185657.
Men who self-catheterize to empty their bladder due to neurogenic bladder can form urethral strictures after many years of catheterizing. We reviewed our techniques and outcomes of urethroplasty to repair these strictures in 37 men. https://tau.amegroups.com/article/view/69695/html
People with spinal cord injury get more urinary tract infections than the general population. Using a large dataset of people with spinal cord injury we examined risk factors for urinary tract infections and assessed how these infections negatively impact one's quality of life. https://pubmed.ncbi.nlm.nih.gov/32409777/
Bladder Augmentation / Mitrofanoff
Long-term Follow-up of Patients With Cerebral Palsy Undergoing Catheterizable Channel Creation Without Concurrent Bladder Augmentation
DeWitt-Foy ME, Gotlieb R, Elliott SP. Urology. 2022 Dec;170:234-239. doi: 10.1016/j.urology.2022.09.008. Epub 2022 Sep 25. PMID: 36170904.
We care for a large volume of people with neurogenic bladder due to cerebral palsy. We have noted that when we perform a Mitrofanoff procedure without a bladder augmentation in people who have large bladders pre-operatively, many of them develop small bladders later and require more treatment. https://pubmed.ncbi.nlm.nih.gov/36170904/
Technique and Outcomes of Hand-Assist Laparoscopic Continent Cutaneous Ileocecocystoplasty
Stout TE, Roth JD, Gor RA, Pariser JJ, Elliott SP. Urology. 2021 Jun;152:200. doi: 10.1016/j.urology.2021.01.019. Epub 2021 Jan 20. PMID: 33482132.
When we perform a bladder augmentation and Mitrofanoff at the same time, a CCIC is one way to do this. The CCIC has certain advantages, especially that it can be used when other types of Mitrofanoff are impossible due to missing appendix or very small bladder. We review our outcomes in 53 people who have had this procedure with us. https://pubmed.ncbi.nlm.nih.gov/33482132/
The effects of augmentation cystoplasty and botulinum toxin injection on patient-reported bladder function and quality of life among individuals with spinal cord injury performing clean intermittent catheterization
Myers JB, Lenherr SM, Stoffel JT, Elliott SP, Presson AP, Zhang C, Rosenbluth J, Jha A, Patel D, Welk B; Neurogenic Bladder Research Group (NBRG. org). Neurourol Urodyn. 2019 Jan;38(1):285-294. doi: 10.1002/nau.23849. Epub 2018 Oct 30. PMID: 30375055.
Among 879 people with spinal cord injury who were performing intermittent catheterization we compared satisfaction between those combining catheterization with Botox injection vs. catheterization with bladder augmentation surgery. We show that satisfication was higher with augmenation. https://pubmed.ncbi.nlm.nih.gov/30375055/
Opportunities for augmentation cystoplasty revision without additional bowel harvest: "Hourglass" deformity or non-detubularized augment
Pariser JJ, Elliott SP. Can Urol Assoc J. 2019 May;13(5):E140-E144. doi: 10.5489/cuaj.5548. Epub 2018 Oct 15. PMID: 30332596; PMCID: PMC6520056.
We describe a unique situation wherein some people who had a prior bladder augmentation that was not working well were found to have an "hourglass deformity" of their bladder. This means there was a narrow "waist" between the augment and the bladder. We were able to return their bladders to good function without having to add mroe intestine to the bladder. We were able to fix the hourglass deformity and re-use the existing augmentation segment. https://pubmed.ncbi.nlm.nih.gov/30332596/
Reconstructive techniques for creation of catheterizable channels: tunneled and nipple valve channels
Levy ME, Elliott SP. Transl Androl Urol. 2016 Feb;5(1):136-44. doi: 10.3978/j.issn.2223-4683.2016.01.04. PMID: 26904419; PMCID: PMC4739983.
Two types of channel continence mechanisms are discussed at length in this review-the tunneled channel, and the nipple valve. The appendicovesicostomy (Mitrofanoff), and reconfigured ileum (Yang-Monti) are both tunneled channels. The ileocecal valve is a commonly used nipple valve and provides continence when reinforced. The continent catheterizable ileal cecocystoplasty (CCIC) is an example of this channel technique. https://pubmed.ncbi.nlm.nih.gov/26904419/
Radiation Cystitis and Cystectomy
Urinary Diversion for Severe Urinary Adverse Events of Prostate Radiation: Results from a Multi-Institutional Study
Bassett MR, Santiago-Lastra Y, Stoffel JT, Goldfarb R, Elliott SP, Pate SC, Broghammer JA, Gaither T, Breyer BN, Vanni AJ, Voelzke BB, Erickson BA, McClung CD, Presson AP, Tward JD, Myers JB; Neurogenic Bladder Research Group; Trauma and Urologic Reconstructive Network of Surgeons. J Urol. 2017 Mar;197(3 Pt 1):744-750. doi: 10.1016/j.juro.2016.10.091. Epub 2016 Nov 1. PMID: 27810450.
We describe our outcomes with urinary diversion for radiation cystitis in men with previous radiation treatment for prostate cancer. We acknowledge that there is a risk of certain complications. Understanding these complications, we can properly prepare to avoid them. https://pubmed.ncbi.nlm.nih.gov/27810450/
Urinary Diversion With vs Without Bowel Anastomosis in Patients With an Existing Colostomy: A Multi-institutional Study
Cotter KJ, Gor RA, Kwaan MR, Fan Y, Pathak P, Myers JB, Elliott SP. Urology. 2017 Nov;109:190-194. doi: 10.1016/j.urology.2017.06.036. Epub 2017 Jul 6. PMID: 28689778.
When performing a non-continent urinary diversion (a.k.a. "conduit") it is common to use the ileum. However, prior radiation or other diseases may make the ileal conduit risky due to the need for a bowel anastomosis. We present our experience with using the terminal colon for a urinary diversion in people who either already have a colostomy or who are undergoing a colostomy creation at the same. In these people, a colon conduit urinary diversion avoids a bowel anastomosis and the inherent risks. https://pubmed.ncbi.nlm.nih.gov/28689778/
Propensity-weighted long-term risk of urinary adverse events after prostate cancer surgery, radiation, or both
Jarosek SL, Virnig BA, Chu H, Elliott SP. Eur Urol. 2015 Feb;67(2):273-80. doi: 10.1016/j.eururo.2014.08.061. Epub 2014 Sep 10. PMID: 25217421.
Using data from a national cancer registry (SEER) and linking it to Medicare data we were able to measure the risk of men developing urinary complications from radiation for prostate cancer. We show that the risk of events such as urethral stricture or radiation cystitis is high and it keeps climbing throughout the man's lifetime. https://pubmed.ncbi.nlm.nih.gov/25217421/
Comparison of Long-Term Risk of Urinary Adverse Events in Elderly Women Treated For Cervical Cancer
Elliott SP, Fan Y, Jarosek S, Chu H, Downs L, Dusenbery K, Geller MA, Virnig BA. Propensity-Weighted Int J Radiat Oncol Biol Phys. 2015 Jul 1;92(3):586-93. doi: 10.1016/j.ijrobp.2015.02.025. Epub 2015 Apr 16. PMID: 25890845.
Using data from a national cancer registry (SEER) and linking it to Medicare data we were able to measure the risk of women developing urinary complications from radiation for cervical cancer. We show that the risk of events such as ureteral stricture or radiation cystitis is high and it keeps climbing throughout the woman's lifetime. https://pubmed.ncbi.nlm.nih.gov/25890845/
Artificial Urinary Sphincter
We compared our outcomes among 182 recent AUS implantations. We have developed a less invasive technique we call the sub-inguinal approach. The sub-inguinal approach to PRB placement during AUS is safe and can be successfully completed over 90% of the time. We show that this approach is not faster than traditional placement but that is partly skewed by the fact that when we cannot place the PRB sub-inguinally there is extra time spent converting to abdominal placement. https://pubmed.ncbi.nlm.nih.gov/35931240
The "Fragile" Urethra as a Predictor of Early Artificial Urinary Sphincter Erosion
Mann RA, Kasabwala K, Buckley JC, Smith TG, Westney OL, Amend GM, Breyer BN, Erickson BA, Alsikafi NF, Broghammer AJ, Elliott SP. Urology. 2022 Nov;169:233-236. doi: 10.1016/j.urology.2022.06.023. Epub 2022 Jul 5. PMID: 35798184.
The fragile urethra is one that has had a prior urethroplasty, prior artificial urinary sphincter or radiation. We demosntrate that fragile urethras experience an early erosion of the AUS than non-fragile urethras. This information can help in counseling patients about options for surgery and can help surgeons create novel ways of protecting the high-risk urethra. https://pubmed.ncbi.nlm.nih.gov/35798184/
We use a large database of AUS surgeries to explore risk factors for failure of revision/replacement AUS. https://pubmed.ncbi.nlm.nih.gov/31951498
Using a large database of men undergoing AUS implantation, we explored risk factors for device erosion. Erosion occurred in 8%. Risk factors included radiation, 3.5cm cuff, prior Urolume urethral stent, and prior erosion. https://pubmed.ncbi.nlm.nih.gov/25109562
We invented a new artificial urinary sphincter based on the concept of a circumferential tape (or "belt") that wraps around the urethra. Tightening and loosening of the tape is controlled by a switch located in the scrotum. The device was tested in dogs and human cadavers. Although this device never made it to the commercialization stage, elements of its design can be found in other AUS devices in development. Specifically, this device developed the concept of an "on/off" switch for AUS opening and closing. https://pubmed.ncbi.nlm.nih.gov/21067799