Ruth Belay, MD

All Publications

• Multimodal Pain Control Utilizing Buprenorphine for Robotic-assisted Laparoscopic Prostatectomy: A Quality Improvement Comparison to Conventional Opioid Management. Urology practice Hajiha, M., Lien, D., Johnson, J. A., Muchiutti, I., Sran, J., Vacaru, A., Amasyali, A. S., Soloniuk, L., Shete, K., Wraich, S., Hu, B., Baldwin, D. D., Belay, R., Malonado, J., Keheila, M., Li, A., Stier, G., Calvert, J., Chang, M., Douglas, M., Assidon, A., Ruckle, H. 2023; 10 (6): 666-670

  Abstract

  This study investigated the effectiveness of buprenorphine as an alternative to the use of conventional opioids perioperatively in an effort to help mitigate the impact of the use of perioperative conventional opioids for patients undergoing robotic-assisted laparoscopic prostatectomy.Outcomes of patients with localized prostate cancer undergoing robotic-assisted laparoscopic prostatectomy were examined before and after implementation of novel quality improvement study that included receiving buprenorphine compared to conventional opioids for pain control intraoperatively and postoperatively. The primary end point was adequate pain control with secondary end points being analgesic consumption at home, opioid-related side effects, and patient satisfaction.When analyzing the secondary end point of oral morphine milligram equivalents, the buprenorphine group received significantly less morphine milligram equivalent compared to the conventional opioid group (15.19 vs 47.91, P = .006). The buprenorphine group also had lower reported pain scores at discharge (4.3; scale 1-10) compared to the conventional opioid group (5.4), though this did not reach significance (P = .069). In the buprenorphine group, 76.9% strongly agreed that their pain was adequately controlled in the hospital compared to 57.5% of the conventional opioid group (P = .223). There was no difference in overall satisfaction at postoperative day 5 (P = .358).Our study demonstrates buprenorphine's analgesic capabilities to maintain adequate pain control and patient satisfaction compared to conventional opioids during robotic-assisted laparoscopic prostatectomy, while decreasing perioperative opioid use.

  View details for DOI 10.1097/UPJ.0000000000000436

  View details for PubMedID 37498667

• The Impact of Caffeine Intake on Mental Health Symptoms in Postmenopausal Females with Overactive Bladder Symptoms: A Randomized, Double-Blind, Placebo-Controlled Trial. Journal of women's health (2002) Staack, A., Distelberg, B., Moldovan, C., Belay, R. E., Sabaté, J. 2022; 31 (6): 819-825

  Abstract

  Background: Caffeine has been associated with a dose-dependent variety of mental health changes, which have been found to precede or be a complication of overactive bladder (OAB) symptoms after menopause. The current study examines the effects of low and moderate caffeine intake on anxiety, depression, sleep, and stress in postmenopausal females with OAB. Materials and Methods: Eighty-one females were randomized in a prospective, double-blind, placebo-controlled study. Participants were allocated to 200 mg/day caffeine, 400 mg/day caffeine, and placebo capsules for 1 week each in a crossover design and evaluated using validated mental health questionnaires. Symptoms during each treatment phase were measured using Beck Anxiety and Depression Inventory, Insomnia Severity Index, and Perceived Stress Scale. Linear regression models were used to examine the impact of low (200 mg/day) and moderate (400 mg/day) dose of caffeine and placebo on mental health. Results: Fifty-six female participants finished the study. The mean age was 69.2 years (58.0-84.0 years). Two females dropped out during the treatment phase with 400 mg/day caffeine intake due to side effects associated with headaches and nausea. Moderate dose of caffeine showed a small positive effect on mental health, specifically a decrease in anxiety during 7 days of exposure (p < 0.05). Conclusions: Moderate caffeine use may decrease anxiety in postmenopausal patients with underlying OAB, whereas depression, insomnia, and perceived stress were not affected by low-to-moderate caffeine intake. Our results support that counseling efforts on moderate caffeine consumption in postmenopausal patients underline that low-to moderate caffeine intake may be appropriate and possibly beneficial unless contraindicated due to other underlying conditions. Clinical Trials Registration: clinicaltrials.gov (NCT02180048).

  View details for DOI 10.1089/jwh.2021.0467

  View details for PubMedID 35363563

• MULTIMODAL PAIN CONTROL UTILIZING BUPRENORPHINE FOR ROBOTIC ASSISTED LAPAROSCOPIC PROSTATECTOMY: A QUALITY IMPROVEMENT COMPARISON TO CONVENTIONAL OPIOID MANAGEMENT Johnson, J., Muchiutti, I., Wraich, S., Assidon, A., Amasyali, A. S., Hajiha, M., Lien, D., Belay, R., Maldonado, J., Li, A., Keheila, M., Shete, K., Stier, G., Soloniuk, L., Hogue, P., Hu, B., Baldwin, D., Ruckle, H. LIPPINCOTT WILLIAMS & WILKINS. 2022: E282

  View details for Web of Science ID 000836935502141

• Single-stage Simultaneous Retrograde and Antegrade Endoscopic Treatment of Giant Prostatic and Bladder Urethral Calculi. Urology Maldonado, J., Belay, R. E., Keheila, M., Amasyali, A., Groegler, J., Baldwin, D. D., Hajiha, M. 2020; 145: 299-300

  Abstract

  Calculi encountered in the lower urinary tract typically reside within the bladder, less often in the urethra. In this video, we present a minimally invasive endoscopic approach for removal of the largest total stone volume in the lower urinary tract reported in the literature to date.A 25-year-old male (body mass index 61 kg/m2) with neurogenic bladder presented with urosepsis and acute kidney injury secondary to obstructive uropathy. Computerized tomography (CT) of the abdomen and pelvis demonstrated bilateral severe hydroureteronephrosis, a 4.2-cm bladder stone, and 3 urethral stones, including a 7.7-cm prostatic urethral stone and 2 membranous urethral stones (Fig. 1). Urgent bilateral percutaneous nephrostomy tubes were placed. The patient elected for endoscopic management.The patient was placed in the supine lithotomy position. His buried penis and narrow urethra only accommodated a 16-French flexible cystoscope. Multiple stones were encountered in the membranous urethra. A 60-W SuperPulse Thulium Fiber laser at 2 J and 30 Hz was utilized to dust the urethral stones efficiently. Simultaneous ultrasound-guided percutaneous access into the bladder was obtained and ultrasonic lithotripsy via shockpulse was used to clear the bladder stone and prostatic stone from above. Total stone treatment time was 240 minutes. Suprapubic and urethral catheters were placed at the conclusion. Postoperative day 1 CT scan confirmed stone-free status and he was discharged postoperative day 2. Outpatient nephrostogram demonstrated patency of bilateral ureters and nephrostomy tubes were removed.Higher morbidity procedures including open or laparoscopic approaches have been described for management of large lower urinary tract stones. In this video, we demonstrate a minimally invasive approach of combined simultaneous antegrade and retrograde lithotripsy to achieve a stone-free status in this morbidly obese and complicated patient.

  View details for DOI 10.1016/j.urology.2020.07.022

  View details for PubMedID 32717249

• What Guidewire Is the Best for Bypassing an Impacted Ureteral Stone? Journal of endourology Amasyali, A. S., Groegler, J., Hajiha, M., Shah, M., Alsyouf, M., Stokes, P., Belay, R., Maldonado, J., Baldwin, D. D. 2020; 34 (5): 629-636

  Abstract

  Introduction and Objectives: To determine the optimal guidewire for bypassing an impacted ureteral stone. Materials and Methods: Three different benchtop models of varying impaction (300, 362, and 444 mm Hg pressure) were used to compare the ability of 13 different guidewires to bypass an impacted ureteral stone. In the first and second models, we recorded the maximum force required to bypass the stone. In the first model (300 mm Hg) 10 new wires for each of the 13 types were advanced past a ureteral stone using a series 5 digital force gauge. In the second model (362 mm Hg), the top 5 performing guidewires were similarly tested. In the third model (444 mm Hg), 5 attending urologists and 5 urology residents (blinded to wire type) compared the 13 guidewires and rated the wire performance using a Likert scale. Statistical analysis was performed with analysis of variance and the chi-square test. Results: In the first model, there was a significant difference between wires (p < 0.001) with the lowest mean force to bypass a stone seen in the Glidewire (0.117 ± 0.02 lbs) and HiWire (0.130 ± 0.01 lbs). Of the five wires tested in the second model, the Glidewire (0.24 ± 0.09 lbs) and UltraTrack (0.40 ± 0.35 lbs) both required less force than the other three wires (p = 0.018). In the third model, only two wires (Roadrunner and Glidewire) bypassed the impacted stone in 100% of trials. When comparing standard, hybrid, and hydrophilic wires, the hydrophilic had the highest success rate (standard = 0%, hybrid = 36.67%, and hydrophilic = 70.67%; p = 0.000) and Likert score (standard = 1.03, hybrid = 2.38, and hydrophilic = 3.24; p = 0.000). Hydrophilic wires required the least time to bypass the stone (hybrid = 82.81 seconds vs hydrophilic = 45.37 seconds, p = 0.000). Conclusions: In this benchtop study, standard wires performed poorly and hybrid wires were not as effective as hydrophilic wires. The Glidewire required the least force, the shortest insertion time, and had the highest surgeon satisfaction rating.

  View details for DOI 10.1089/end.2020.0058

  View details for PubMedID 32070125

• Excision and Reconstruction for Urachal Adenocarcinoma: A Case Report With an Emphasis on Cosmesis. Urology Belay, R. E., Maldonado, J., Hu, B. 2020; 139: 198-200

  Abstract

  We report a urachal adenocarcinoma case managed surgically with two incisions and an emphasis on cosmesis while maintaining oncologic principles.Depending upon the cancer, excision of the urachal remnant and umbilectomy may require abdominal wall reconstruction and potentially could leave the patient with an altered anterior abdominal wall. Restoring function and cosmesis after surgery can be very important to oncologic quality of life. Therefore, we present a patient with urachal adenocarcinoma who underwent open partial cystectomy, urachal ligament excision with umbilectomy, and neo-umbilicoplasty via two incisions.This case demonstrates the feasibility of performing an oncologically-sound operation for urachal adenocarcinoma while maintaining an emphasis on cosmesis.

  View details for DOI 10.1016/j.urology.2020.02.011

  View details for PubMedID 32087210

• HO:YAG LASER LONG PULSE AND STABILIZATION MODE SAVES TIME AND MONEY: A BENCHTOP KIDNEY STONE MODEL Amasyali, A. S., Brown, N., Maldonado, J., Greogler, J., Belay, R., Baldwin, D., Hajiha, M., Baldwin, D. LIPPINCOTT WILLIAMS & WILKINS. 2020: E209-E210

  View details for Web of Science ID 000527010301389

• Is a prior hernia repair a risk factor for post-operative incontinence following robotic prostatectomy? European Urology Open Science Sung, H., Amasyali, A., Groegler, J., Hajiha, M., Belay, R., Maldonado, J., Ruckle, H., Hu, B., Baldwin, D. D. 2020
• Synthetic Antioxidants Male Infertility Stokes, P., Belay, R., Ko, E. 2020
• Robotic transabdominal excision of retrocrural germ cell tumor metastasis Urology Video Journal Cheng, J., Maldonado, J., Belay, R., Sirkureja, D., Solomon, N., Hague, P., Selleck, M., Hu, B. 2020
• Adoption of a Urologic Oncology Perioperative Surgical Home is Associated with Decreased Total Length of Stay: A Pilot Study. Urology practice Cheriyan, S. K., Shen, J. K., Keheila, M., Baldwin, D. D., Stier, G. R., Ji, L., Li, R., Myklak, K. C., Belay, R. E., Hu, B. R., Ruckle, H. C. 2019; 6 (5): 309-316

  Abstract

  Urologists partnered with anesthesiologists to implement a model of perioperative and postoperative care known as the multidisciplinary perioperative surgical home in order to improve the quality and efficiency of care. We describe early outcomes associated with implementation of the perioperative surgical home.Retrospective chart review was performed of patients at a single institution undergoing radical prostatectomy, radical cystectomy, partial nephrectomy and radical nephrectomy from January 2014 to March 2016. Outcomes measured were length of stay and 30-day reoperation, readmission, unexpected intensive care unit admission and mortality rates. Statistical analysis was performed using the independent samples Mann-Whitney U test and Fisher exact test with p <0.05 considered significant. Univariate and multivariate analyses were performed to determine whether implementation of the perioperative surgical home was associated with improved outcomes.Length of hospital stay decreased from 4.79 to 3.19 days and 30-day complication rate decreased from 15.3% to 5.7% after implementation of the perioperative surgical home (p <0.01 for both). There was no change in the 30-day readmission rate. On multivariate analysis surgery occurring after perioperative surgical home implementation was associated with decreased length of stay (p = 0.008). The direct cost savings resulting from this length of stay reduction totaled $1,245,585 for the study period.The adoption of a perioperative surgical home is associated with a significantly decreased postoperative hospital stay and 30-day complication rate for urologic oncology cases.

  View details for DOI 10.1097/UPJ.0000000000000022

  View details for PubMedID 37317335

• Injury severity score associated with concurrent bladder injury in patients with blunt urethral injury. World journal of urology Eidelman, E., Stormont, I., Churukanti, G., Shreck, E., Belay, R., Capodice, S., Maass, D., Stein, D. M., Siddiqui, M. M. 2019; 37 (5): 983-988

  Abstract

  Delayed diagnosis of concurrent bladder damage in a patient with blunt urethral trauma can lead to a high rate of morbidity. In patients with a high index of suspicion, genitourinary workup is recommended. In complicated patients with multi-trauma, this workup has a risk of being delayed. A proven prognostic indicator to evaluate the likelihood of bladder injury in this population has not been established. The aim of this study was to determine if there was a clinical association between the Injury Severity Score (ISS) and bladder injury involvement among these patients.Retrospective analysis was performed on a cohort of 98 patients who presented with blunt urethral trauma to R. Adams Cowley Shock Trauma Center between 2002 and 2014. Univariate analysis was performed to determine if there was an association between concurrent bladder injuries and ISS among other factors. A receiver operating characteristic curve plot was performed to analyze the association between ISS and bladder involvement.Of the 98 patients with blunt urethral trauma, 28 had concurrent bladder injury. ISS was shown to have a significant correlation with concurrent bladder injury (OR = 2.2 per 10 unit change in ISS, p = 0.0001). ROC curve analysis showed an area under the curve for the prediction of bladder injury. Patients with ISS ≥ 34 had a 54% chance of bladder injury, while patients with ISS < 34 had a 13% chance.ISS ≥ 34, a score in the range of severe multi-trauma, may be a clinical indicator of bladder injury in patients presenting with blunt urethral trauma.This research was supported in part by the Proposed Research Initiated by Students and Mentors (PRISM) Program, University of Maryland School of Medicine Office of Student Research.

  View details for DOI 10.1007/s00345-018-2473-6

  View details for PubMedID 30178288

• Diagnosis of clinical and subclinical varicocele: how has it evolved? Asian journal of andrology Belay, R. E., Huang, G. O., Shen, J. K., Ko, E. Y. 2016; 18 (2): 182-5

  Abstract

  In this review, we examine the evolution and application of various diagnostic modalities for varicoceles starting with venography, scintigraphy, and thermography and their role in the evaluation of a varicocele patient. Some of these methods have been supplanted by less invasive and more easily performed diagnostic modalities, especially ultrasound and Doppler examination of the scrotum. Advances in ultrasound and magnetic resonance imaging hold the potential to expand the role of imaging beyond that of visual confirmation and characterization of varicoceles. The ability to identify the early indicators of testicular dysfunction based on imaging findings may have implications for the management of varicoceles in the future.

  View details for DOI 10.4103/1008-682X.169991

  View details for PubMedID 26780869

  View details for PubMedCentralID PMC4770483

• The perioperative surgical home decreases length of stay and cost AUA News Cheriyan, S., Shen, J., Myklak, K., Belay, R., Roger, L., Hu, B., Stier, G., Baldwin, D. D., Ruckle, H. 2016
• Ureteroscopy Without Fluoroscopy: A Feasibility Study and Comparison with Conventional Ureteroscopy- Beyond the Abstract UroToday Alsyouf, M., Belay, R., Baldwin, D. D. 2015