Priyanka Bearelly

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Journals/Publications

• Bearelly, P., & Avellino, G. (2022). Re: The role of benign prostatic hyperplasia treatments in ejaculatory dysfunction. Journal of Urology, 207(5). doi:10.1097/JU.0000000000002458
• Bearelly, P., Pan, S., Thirumavalavan, N., Gross, M., Maria, P., Munarriz, R., & D’Amico, M. (2022). Intraoperative use of vancomycin paste during penile prosthesis placement: initial outcomes. International Journal of Impotence Research, 34(1). doi:10.1038/s41443-020-00368-6
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  Penile prosthesis implantation is a safe and effective treatment option in the management of erectile dysfunction, associated with high satisfaction and low complication rates. Infection is a rare complication (0.5–3%), but devastating for the patient and surgeon when it occurs. Adapting from other surgical disciplines, we have utilized vancomycin paste to provide prolonged focal antibiotic exposure around the penile prosthesis pump, a site prone to infection. The aim of this study is to determine the safety and efficacy of intraoperative vancomycin paste with regards to infection prevention during penile prosthesis placement. This is a multi-institutional nonrandomized retrospective IRB-approved study comparing patients who underwent placement of a primary inflatable penile prosthesis with intraoperative vancomycin paste to those without. Primary outcomes included pump fibrosis, infection, erosion, hematoma, and complete device malfunction. From April 2019 to October 2019, two surgeons utilized vancomycin paste intraoperatively during virginal penile prosthesis surgery on 90 patients, whose mean age was 60 years. These patients were compared to an historical control group that included 166 patients, also with a mean age of 60 years, who underwent the same penile prosthesis surgery between 2014 and 2017 without the paste. Among the intervention group, the overall complication rate was 1.1%, due to a scrotal hematoma. Ultimately, there was no statistically significant difference in infection rate (0% in both groups) or overall complication rate (1.1% in the intervention group compared to 1.2% in the control group). The use of vancomycin paste appears to be safe, however future prospective studies are needed to determine its efficacy in infection prevention.
• Krughoff, K., Bearelly, P., Apoj, M., Munarriz, N., Thirumavalavan, N., Pan, S., Gross, M., & Munarriz, R. (2022). Multicenter surgical outcomes of penile prosthesis placement in patients with corporal fibrosis and review of the literature. International Journal of Impotence Research, 34(1). doi:10.1038/s41443-020-00373-9
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  Penile prosthesis (PP) insertion in the setting of corporal fibrosis can be challenging and a variety of techniques have been described to accomplish this, however the necessity of these maneuvers is debatable. Our objective was to investigate techniques and outcomes of PP placement in patients with corporal fibrosis at tertiary referral centers. Multicenter outcomes of 42 patients (mean age 53.4 ± 1.9 years) with corporal fibrosis who underwent placement of PP over a 10-year period were reviewed. The most common etiology of corporal fibrosis was prior PP explant due to either infection (40.5%) and/or erosion (16.7%). Fourteen patients (33.3%) had a history of priapism, 5 (11.9%) of which had one or more distal surgical penile shunts. Techniques used for PP placement included: sequential dilation (8–12 mm) with standard dilators in 15 (35.7%), dilation with cavernotomes in 25 (59.5%) and limited sharp corporal excision and dilation with cavernotomes in 1 (2.4%). Narrow cylinders were employed in ten patients (23.8%). Major complications occurred in one patient (2.4%) who underwent explant for infection and distal erosion. Most patients with corporal fibrosis can undergo successful placement of a PP using standard dilators or cavernotomes. Sharp corporal excision and other measures are rarely required.
• Bearelly, P., Phillips, E., Pan, S., Asher, K., Martinez, D., Munarriz, R., & O’Brien, K. (2020). Long-term intracavernosal injection therapy: treatment efficacy and patient satisfaction. International Journal of Impotence Research, 32(3). doi:10.1038/s41443-019-0186-z
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  Intracavernosal injection therapy (ICI) was the first pharmacologic treatment in the management of erectile dysfunction. ICI allows for customization of medication composition and concentrations, making it a highly effective treatment with an acceptable side effect profile. The objective was to investigate the long-term results of ICI using validated and non-validated instruments. This is a retrospective, single-institution study of 105 patients (mean age 61.6 ± 11.1) patients using ICI. Mean duration of ICI was 8.4 ± 6.25 years. Pre- and post-treatment patient-reported penile rigidity were 41.1% ± 29.3 and 89.6% ± 13.6, respectively (p < 0.05). Statistical changes were also found in the pre and post International Index of Erectile Function (IIEF) scores (33.0 ± 14.4 and 60.0 ± 12.7, p < 0.05), erectile function (11.5 ± 1.3 and 27.3 ± 0.9, p < 0.05) and satisfaction domains (5.3 ± 1.5 and 8.1 ± 1.1, p < 0.05) of the IIEF. There were no statistical differences in questionnaire outcomes between difficult to treat patients (diabetes or radical prostatectomy) and the remainder of queried patients. Complications were rare and included priapism (7.1%), penile curvature (10%;
• Bearelly, P., Lis, C., Trussler, J., Katz, M., Babayan, R., & Wang, D. (2018). Nephrostomy tube placement prior to percutaneous nephrolithotomy does not impact outcomes. Canadian Journal of Urology, 25(5).
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  Introduction: This study aims to compare outcomes of percutaneous nephrolithotomy (PCNL) performed with a nephrostomy tube placed prior to surgery versus access at the time of surgery. Materials and methods: Between March 2005 and August 2014, 233 PCNLs were performed. One hundred and nine of those cases underwent placement of nephrostomy tubes at least 1 day prior to surgery (Group A), and the remaining 124 cases were performed in which access was obtained at the time of PCNL (Group B). Patient demographics, comorbidities, stone size, sepsis rates, and additional complication rates including bleeding and inability to access stone were compared. Results: There were no significant differences in patient demographics, stone size, or comorbidities when comparing the two groups. Success rates were not significantly different, 92.7% in Group A compared to 94.4% in Group B. Similarly, there was no significant difference in complication rates or ICU admissions. The rate of sepsis in Group A was 1.83% compared to 2.42% in Group B, which showed no statistical significance. Notably, there were more patients with neurogenic bladders in the preplacement group (p = 0.05). Conclusion: Pre-placement of a nephrostomy tube prior to PCNL did not result in a decreased incidence of complications or sepsis and did not demonstrate increased success rates. Patients with neurogenic bladders may be more vulnerable to suffering from sepsis and therefore role of timing of nephrostomy tube placement must be further studied.
• Murdoch, C., Shuler, M., Haeussler, D., Kikuchi, R., Bearelly, P., Han, J., Watanabe, Y., Fuster, J., Walsh, K., Ho, Y., Bachschmid, M., Cohen, R., & Matsui, R. (2014). Glutaredoxin-1 up-regulation induces soluble vascular endothelial growth factor receptor 1, attenuating post-ischemia limb revascularization. Journal of Biological Chemistry, 289(12). doi:10.1074/jbc.M113.517219
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  Glutaredoxin-1 (Glrx) is a cytosolic enzyme that regulates diverse cellular function by removal of GSH adducts from S-glutathionylated proteins including signaling molecules and transcription factors. Glrx is up-regulated during inflammation and diabetes, and Glrx overexpression inhibits VEGF-induced EC migration. The aim was to investigate the role of up-regulated Glrx in EC angiogenic capacities and in vivo revascularization in the setting of hind limb ischemia. Glrx-overexpressing EC from Glrx transgenic (TG) mice showed impaired migration and network formation and secreted higher levels of soluble VEGF receptor 1 (sFlt), an antagonizing factor to VEGF. After hind limb ischemia surgery Glrx TG mice demonstrated impaired blood flow recovery, associated with lower capillary density and poorer limb motor function compared with wild type littermates. There were also higher levels of anti-angiogenic sFlt expression in the muscle and plasma of Glrx TG mice after surgery. Noncanonical Wnt5a is known to induce sFlt. Wnt5a was highly expressed in ischemic muscles and EC from Glrx TG mice, and exogenous Wnt5a induced sFlt expression and inhibited network formation in human microvascular EC. Adenoviral Glrx-induced sFlt in EC was inhibited by a competitive Wnt5a inhibitor. Furthermore, Glrx overexpression removed GSH adducts on p65 in ischemic muscle and EC and enhanced NF-κB activity, which was responsible for Wnt5a-sFlt induction. Taken together, up-regulated Glrx induces sFlt in EC via NF-κB-dependent Wnt5a, resulting in attenuated revascularization in hind limb ischemia. The Glrx-induced sFlt explains part of the mechanism of redox-regulated VEGF signaling. © 2014 by The American Society for Biochemistry and Molecular Biology, Inc.