Techniques in urology最新文献

{"title":"Endoscopic management of ureteropelvic junction obstruction in children.","authors":"G S Gerber,&nbsp;W J Cromie","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A variety of endoscopic methods are available for managing ureteropelvic junction obstruction in children, and these methods can be considered for use in selected circumstances.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 4","pages":"210-3"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21450023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combination therapy in the treatment of patients with staghorn calculi.","authors":"G S Gerber","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The treatment of patients with staghorn calculi remains a challenging problem. Combination therapy using percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy has been recommended as the best option for most patients. Using this technique, 10 (83%) of 12 renal units with partial or complete staghorn calculi were rendered stone-free, with no significant septic episodes or serious complications. Blood transfusion was necessary in three patients. \"Sandwich\" therapy using initial percutaneous debulking followed by extracorporeal shock wave lithotripsy and/or \"second-look\" nephroscopy offers patients a high likelihood of achieving a stone-free state while avoiding the morbidity and lengthy recovery associated with open surgery.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 3","pages":"155-8"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21388269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictability and significance of multifocal prostate cancer in the radical prostatectomy specimen.","authors":"B Djavan,&nbsp;M Susani,&nbsp;B Bursa,&nbsp;A Basharkhah,&nbsp;R Simak,&nbsp;M Marberger","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Multifocal prostate cancer has been reported in 50-76% of all cases of radical retropubic prostatectomy (RRP) specimens, but the clinical and prognostic significance of this finding is still unclear. A retrospective analysis of patients who underwent RRP between 1993 and 1997 was performed. Preoperative screening parameters and 4-mm RRP specimen sections were examined. The location, Gleason score, and extracapsular extension of the tumor recorded. Three hundred eight cases were reviewed. Mean follow-up was 4.2 +/- 1 years (range 2-6 years). Two hundred six patients (66.9%) had multifocal prostate cancer and 102 (33.1%) had unifocal prostate cancer. Of those with multifocal disease, 63% had two foci and 37% had three or more foci. There were statistical significant differences between both groups with respect to preoperative prostate-specific antigen (PSA) density of the transition zone (PSA-TZ), free/total (f/t) PSA, as well as percentage of patients with organ confined disease, high-grade tumors, and local recurrence. PSA-TZ (p = .001) and f/t PSA (p = .004) were significantly different between patients with unifocal and multifocal disease (0.9 vs. 2.2 ng/mL/cc and 18% vs. 6.5%, respectively). However, preoperative PSA (11.2 vs. 12.8 ng/mL; p = .09) and PSA density (0.17 vs. 0.19 ng/mL/cc; p = .07) were not able to predict unifocality or multifocality. These data suggest that multifocal prostate cancer is associated with higher grade, stage, and recurrence rate than unifocal prostate cancer. Preoperative PSA-TZ (> 1.5 ng/mL/cc) and f/t PSA (<9%) may predict multifocality in the RRP specimen.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 3","pages":"139-42"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21388265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repetitive prostatic massage therapy for chronic refractory prostatitis: the Philippine experience.","authors":"J C Nickel,&nbsp;J Downey,&nbsp;A E Feliciano,&nbsp;B Hennenfent","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Patients frustrated with failure of traditional therapy for prostatitis have traveled to the Philippines and elsewhere for repetitive prostatic massage combined with antibiotic therapy. The aim of our study was to evaluate prospectively the response of patients who traveled to Manila to undergo this treatment. Twenty-six patients consented and were registered by the Prostatitis Foundation (B.H.) and subsequently evaluated (J.C.N., J.D.) prior to and following treatment (A.E.F.). Evaluation at baseline and after treatment consisted of standardized history and previously validated prostatitis-specific Symptom Frequency Questionnaire (SFQ) and Symptom Severity Index (SSI), International Prostate Symptom Score (I-PSS) and Quality of Life (QoL) questionnaire, the O'Leary Sexual Function Inventory (SFI), and a Subjective Global Assessment (SGA). Treatment in Manila consisted of triweekly prostatic massage combined with specific culture directed and/or empirical antimicrobial therapy for 6 to 12 weeks. Twenty-two patients completed at least one follow-up assessment and 12 patients completed 2-year assessment (average follow-up of 17 months in 22 patients). There was a significant decrease in average symptom severity (SSI) by 4 months that continued for 2 years, but less improvement in symptom frequency (SFQ) and quality of life (QoL), and no significant improvement in voiding symptoms (I-PSS) or sexual function (SFI) at time of last assessment. Forty-six percent of the 22 evaluable patients had >60% decrease (significant improvement) in symptom severity (SSI), whereas 27% had similar significant improvement in frequency of symptoms (SFQ) when last assessed. Thirty-three percent reported marked subjective improvement (SGA) at last evaluation. Of the 12 patients who completed the 2-year follow-up, 5 of the original 26 had a significant and sustainable improvement in objective and subjective measurements of frequency and severity of symptoms. The combination of prostatic massage and antibiotics for treating difficult refractory cases of prostatitis may be promising, but its ultimate value needs to be confirmed. Studies in patients with less refractory and shorter duration disease may allow us to predict who will respond to this therapeutic approach.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 3","pages":"146-51"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21388267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In situ slings with concurrent cystocele repair.","authors":"S R Serels,&nbsp;R R Rackley,&nbsp;R A Appell","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Stress urinary incontinence (SUI) is commonly associated with varying degrees of genitourinary prolapse; therefore, it is customary to perform surgical corrections of both problems simultaneously. The type of surgical correction is based on the surgeon's discretion. We present a series of patients who underwent in situ vaginal wall slings as well as anterior vaginal wall (cystocele) repairs. Eighteen patients treated between 1994 and 1998 were evaluated. The average age was 61 years (range 35 to 74). Urodynamic evaluation was performed preoperatively. Postoperatively, the patients were assessed with objective testing as well as physician-performed Medical, Epidemiologic, and Social Aspects of Aging questionnaires. Follow-up ranged from 6 months to 4 years. SUI cure was defined as a patient who is completely dry and voiding. Sixteen (89%) of 18 patients were cured of both their cystocele and SUI; 2 of 18 had recurrent SUI with no evidence of recurrent cystocele. Fifty-six percent of the patients with good results had preoperative leak point pressures (LPP) of 50 to 100, and 44% had LPP > 100. None of the patients who were cured had an LPP <50, and only one patient in the failure group had an LPP <50. Seventeen percent of the patients had de novo urgency. In situ vaginal wall slings are a good procedure to use in combination with cystocele repairs in patients with LPP >50.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 3","pages":"129-32"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21388911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Needle imaging during ultrasound-guided permanent prostate implants.","authors":"V Feygelman,&nbsp;J M Pow-Sang,&nbsp;J L Friedland,&nbsp;R M Sanders","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>As demonstrated by water phantom experiments and clinical observations, the reverberation artifact associated with the ultrasound needle image during permanent prostate implants is extremely useful in determining precise radioactive seed positioning. It also serves as an independent quality assurance check of the number of seeds in the strand.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 3","pages":"143-5"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21388266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction or substitution of the pediatric urethra with buccal mucosa: indications, technical aspects, and results.","authors":"M Riccabona","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The main indication for using buccal mucosa in the urinary tract is in those who require complex secondary hypospadias surgery. Twenty-two children had inner lower lip mucosa onlay patch to reconstruct the urethra after 1 to 20 prior failed hypospadias/epispadias repairs. The mucosa was harvested from the lower inner lip by microsurgical dissection using optical magnification. The donor site was not sutured but was sealed with fibrin glue. The patches were anastomosed to the urethral plate using 7/0 polyglactin suture. The neourethra was covered with a vascularized dartos fascia or tunica vaginalis graft tunneled under the penile shaft skin. Special attention was given to closure of the glans and positioning of the meatus to the tip. Follow-up was between 12 and 72 months (mean 44). Complications included meatal stenosis in 1, fistula in 6, and wound infection in 1. The fistula rate decreased after changing the suture material and with increased experience. Lip mucosa was easy to harvest, and healing of the donor site was uncomplicated.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 3","pages":"133-8"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21388264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right intrathoracic renal ectopia: a case report and review of the literature.","authors":"J P Stein,&nbsp;E A Kurzrock,&nbsp;J A Freeman,&nbsp;D Esrig,&nbsp;D A Ginsberg,&nbsp;G D Grossfeld,&nbsp;B E Hardy","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We report a case of right intrathoracic renal ectopia associated with a previously unreported congenital anomaly (trisomy 21) and review of the literature.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 3","pages":"166-8"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21388271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hand-assisted laparoscopic donor nephrectomy versus standard laparoscopic donor nephrectomy: a comparison study in the canine model.","authors":"P I Ravizzini,&nbsp;D Shulsinger,&nbsp;E Guarnizo,&nbsp;C P Pavlovich,&nbsp;D Marion,&nbsp;R E Sosa","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The aim of this study was to compare live donor nephrectomy by hand-assisted laparoscopy to standard laparoscopy in a canine model. Fourteen dogs underwent a left laparoscopic nephrectomy; a standard laparoscopic nephrectomy technique was utilized in seven dogs. In a second group of seven dogs, a hand-assisted laparoscopic technique was used with a Dexterity Pneumo Sleeve hand port. All nephrectomies were performed as \"donor\" nephrectomies, dividing the vessels last. Total blood loss, operative warm ischemia, time and organ retrieval times were assessed for each group. The average operative time was significantly shorter for hand-assisted laparoscopic donor nephrectomy (32 +/- 8 minutes vs. 61 +/- 8 minutes; p = .02) than for the standard technique. The average warm ischemia (86 +/- 24 seconds vs. 224 +/- 52 seconds; p = .03) and average organ delivery times (4 +/- 3 seconds vs. 45 +/- 9 seconds; p < .01) also were shorter using the hand-assisted laparoscopic technique. No significant differences in average blood loss were found between the two groups (9 +/- 2 cc vs. 6 +/- 1 cc; p = 0.16, NS). Good parenchymal, ureteral, and vascular preservation was achieved by both techniques. Hand-assisted laparoscopy permits shorter operating times and warm ischemia times than standard laparoscopy in a canine model of donor nephrectomy. Hand assistance makes donor laparoscopic nephrectomy technically easier and significantly quicker to perform. If hand-assisted laparoscopy donor nephrectomy is confirmed to be a rapid and safe technique for removing an intact organ, laparoscopic nephrectomy will be a more widely accepted technique among urologists who participate in living related donor kidney transplantation.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 3","pages":"174-8"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21388273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of the laparoscopic knot introducer in urethrovesical anastomosis following radical prostatectomy.","authors":"A Cestari,&nbsp;G Guazzoni,&nbsp;M Riva,&nbsp;L Nava,&nbsp;P Rigatti","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>One of the most delicate stages of retropubic radical prostatectomy intervention is urethrovesical anastomosis, especially if it is performed in a deep bony pelvis with a short urethral stump. Correct knot tying is essential to avoid the risk of postoperative anastomotic leakage. In such conditions, the urethrovesical anastomosis is performed with six 4-0 Monocril sutures and the knots are tied under vision using the laparoscopic knot introducer. In a 2-year period we performed 106 retropubic radical prostatectomies in our urology department. In four cases (3.8%) we performed urethrovesical anastomosis with the aid of the described technique. Two weeks after catheter placement, the radiologic control showed no leakage or contracture of the anastomosis. Mean follow-up is 14.8 months (range 8 to 20); all of the patients are continent. A second radiologic study 6 months after the intervention documented in all cases a correct new anatomical repair without stenoses or contracture. This technique is a minor modification of the direct urethrovesical anastomosis that facilitates the anastomosis between the urethral stump and the bladder neck and reduces the risk of anastomotic leakage due to incorrect suture knot positioning and tying.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 3","pages":"152-4"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21388268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}