Techniques in urology最新文献

{"title":"Absorbable mesh envelope facilitates handling of pediatric en bloc kidneys during transplantation.","authors":"U Kumar,&nbsp;I S Gill","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>There is increasing evidence to favor the use of pediatric en bloc kidneys in renal transplantation. However, from a technical standpoint, pediatric en bloc renal transplantation is more complex because of difficulty in optimal intraoperative handling and positioning, as well as a higher potential for vascular complications. We describe our experience with a technique that has helped us to minimize the technical difficulties associated with the surgical procedure. Use of a tailored absorbable mesh envelope improves handling of the en bloc pediatric kidneys during performance of the vascular anastomoses and reduces the risk of torsion of renal pedicles.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 4","pages":"195-7"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21450019","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":"Evaluation of interstitial diode laser therapy for treatment of benign prostatic hyperplasia.","authors":"A J Costello,&nbsp;D K Agarwal,&nbsp;H R Crowe,&nbsp;W J Lynch","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the last decade, a number of new device technologies were developed for benign prostatic hyperplasia (BPH) therapy. These technologies were introduced in an effort to reduce the morbidity of BPH therapy associated with conventional electrocautery transurethral resection of the prostate (TURP). While morbidity is reduced, the aim of new therapy is to achieve near equivalence in efficacy of outcome measures, namely, improved voided flow rate and reduced symptom score. To gain acceptance by urologists, these technologies should be easy to apply and should reduce the economic cost of BPH treatment. The Indigo 830e diode laser system offers simplified laser therapy from a miniaturized solid-state system. This pilot study demonstrates outcome equivalence to TURP in preliminary evaluation and shows an acceptable side effect profile.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 4","pages":"202-6"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21450021","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 a shape-memory alloy (nitinol) in a removable prostate stent.","authors":"L S Marks,&nbsp;B Ettekal,&nbsp;M S Cohen,&nbsp;M L Macairan,&nbsp;J Vidal","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>An easily removable prostate stent would be useful in various clinical situations but is not currently available. Thus, we studied the safety, tolerability, and ease of removal of a nitinol (nickel-titanium alloy) prostate stent in 10 men with symptomatic benign prostatic hyperplasia. The circular-coil stent becomes hourglass in shape following deployment, with the narrowest diameter approximately 35F. A working hypothesis was that the temperature-sensitive shape memory of nitinol would allow for its easy removal vis-à-vis other available stents. Using several modifications of a prototype insertion device, we found that the nitinol stents were easily inserted, retained their shape during retention periods of 1 to 4 weeks, caused no gross tissue reaction, and were removed easily with gentle traction after in situ cooling with iced saline lavage. Stent migration was observed in two patients, but otherwise, the stents were well tolerated. Nitinol prostate stents appear to fulfill a theoretical promise of being biologically inert, \"superelastic,\" and pliable when cooled, allowing for easy removal. Further clinical investigation appears warranted.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 4","pages":"226-30"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21450027","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":"Prostate cancer gene therapy: outcome of basic research and clinical trials.","authors":"Y Nasu,&nbsp;B Djavan,&nbsp;M Marberger,&nbsp;H Kumon","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>With the advances in genetic engineering, tumor biology, and immunology, gene therapy has been recognized as a promising new treatment option for cancer, including prostate cancer. Several clinical trials of prostate cancer gene therapy currently underway are using therapeutic genes, including suicide genes, immunomodulatory genes, tumor suppressor genes, and antioncogenes. Although gene therapy for prostate cancer as a clinical alternative is still at an early stage that requires several technological breakthroughs, information obtained from clinical trials indicates the full potential of prostate cancer gene therapy. Concordant progress in basic research and gene therapy technology will ready prostate cancer gene therapy for widescale use in the future. In this report, the general concept and current progress in prostate cancer gene therapy are summarized.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 4","pages":"185-90"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21448031","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":"Beneficial effect of intranasal desmopressin for men with benign prostatic hyperplasia and nocturia: preliminary results.","authors":"M B Chancellor,&nbsp;A Atan,&nbsp;D A Rivas,&nbsp;T Watanabe,&nbsp;H L Tai,&nbsp;H Kumon","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The aim of this study was to determine the efficacy of intranasal desmopressin in the treatment of nocturnal polyuria in men with benign prostatic hyperplasia (BPH). Twelve men with BPH were treated with intranasal desmopressin at bedtime for nocturnal polyuria. All patients underwent video-urodynamic evaluation. The number of nocturia episodes was the dependent variable. Exclusion criteria included nephrolithiasis, active urinary tact infection, and history of myocardial infarction, congestive heart failure, and angina. Ten of 12 patients improved with the intranasal desmopressin therapy. Nocturia episodes decreased from a median of 3.6 +/- 0.5 episodes/night before treatment to 1.8 +/- 1.1 episodes/night 3 months after therapy (p = .01). The American Urological Association symptom index decreased from 19 +/- 6 before treatment to 12 +/- 6 after therapy (p = .02). Hyponatremia did not occur. We conclude that intranasal desmopressin is a promising therapy for nocturnal polyuria in selected BPH patients.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 4","pages":"191-4"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21448032","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":"Stent placement for the diagnosis of upper tract obstruction.","authors":"A L Plata,&nbsp;G J Faerber,&nbsp;J S Wolf","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The aim of this study was to evaluate the effectiveness of ureteral stent placement in diagnosing ureteropelvic junction (UPJ) obstruction in patients with negative or equivocal radiographic/nuclear studies and to assess relief of symptoms following definitive surgical procedures to relieve the obstruction. Patients undergoing ureteral stent placements performed by two attending urologists over an 18-month period were reviewed. All patients with equivocal or negative radiographic evaluations for ureteral obstruction in whom the stent was placed for diagnostic purposes were selected. Preoperative and postoperative information was obtained from the medical record or by telephone interview. Five patients were found who had equivocal radiographic studies along with symptoms of flank pain and who underwent diagnostic stent placement. All patients were female (average age 40 years, range 20-52). All had pain relief following stent placement and, on this basis, underwent an operative procedure to remove the presumed ureteral obstruction. Three underwent Acucise endopyelotomy, one had laparoscopic resection of the right ovarian vein, and one underwent nephrectomy. The average preoperative creatinine level was 0.9 mg/dL (range 0.8-1.0), and the average postoperative creatinine level was 1.0 mg/dL (range 0.9-1.1). All patients had relief of flank pain at a mean of 17 months following the surgical procedure. Relief of pain following stent placement in patients with clinical suspicion of ureteral obstruction portends a favorable outcome from procedures to relieve the presumed obstruction. In unusual cases where ureteral obstruction is suspected despite negative or equivocal radiographic findings, diagnostic stent placement appears to be useful.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 4","pages":"207-9"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21450022","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":"Mini-percutaneous antegrade endopyelotomy.","authors":"M Monga","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Antegrade endopyelotomy is the endourologic treatment of choice for ureteropelvic junction obstruction with a coexisting renal calculus. We report the use of a mini-percutaneous procedure that allows us to perform an antegrade endopyelotomy and stone extraction through a 20F nephrostomy sheath.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 4","pages":"223-5"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21450026","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":"Modified alpha wrap techniques for dynamic urethral graciloplasty in an animal model.","authors":"J S Walter,&nbsp;G J Andros,&nbsp;J H Griffin,&nbsp;W W King,&nbsp;B A Trockman,&nbsp;J P Norris,&nbsp;J S Wheeler","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Urethral sphincter reconstruction with a stimulated skeletal muscle flap has been used for treatment of severe intrinsic sphincter deficiency. Urethral strictures and failures were reported in some of the initial experiences. The etiology of these problems is not known, but elevated resting urethral pressures and excessive urethral displacement with stimulation are possible causes. We modified two operative techniques in forming dynamic urinary graciloplasty (DUG) in an attempt to minimize resting urethral pressure without stimulation and urethral mobility during stimulation. Two types of DUG were used. In the first group, a small flap (partial muscle wrap) from the gracilis muscle with an attachment site on the muscle was constructed in four dogs. In the second group, three dogs with a modified alpha wrap and proximal attachments were used. All of the gracilis muscle wraps were stimulated using an implanted programmable pulse stimulator with electrodes attached over the motor nerve. Following a 2-week, postrecovery period, urethral pressure measurements were obtained with and without stimulation. Five weeks were used for stimulation to condition the muscle. This was followed by 4 weeks of continuous stimulation. Thus, devices were implanted for 11 weeks. Before conditioning of the muscles was initiated, the partial muscle wrap pressure at rest was 42 +/- 27 cm H2O, which was higher than the incomplete alpha wrap resting pressure of 20 +/- 4 cm H2O. Stimulated partial flap pressure was 161 +/- 50 cm H2O, and stimulated modified alpha wrap pressures was 71 +/- 27 cm H2O. After conditioning with the modified alpha wrap, the resting and stimulated pressures were unchanged from before conditioning. Technical problems precluded collection of data during the conditioning period in dogs with partial flaps. During stimulation, the partial muscle wrap demonstrated marked deviation, whereas the modified alpha wrap had minimal urethral movement. Postmortem evaluation indicated no urethral stricture or fistula formation with either of the two types of wraps. The modified alpha wrap had several positive features. Advantages over the partial wrap were minimal resting pressures, reduced urethral mobility, and adequate sustained pressures during stimulation. Therefore, in contrast to the partial gracilis muscle wrap, aspects of the incomplete alpha wrap should be considered further for DUG.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 4","pages":"214-8"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21450024","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":"Pain associated with testicular retraction treated with Gore-Tex external inguinal ring reconstruction.","authors":"A J Deck,&nbsp;R E Berger","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We present our experience with three patients with chronic testicular pain due to retractile testes and propose a new operative solution to the problem. Three patients with chronic testicular pain associated with testicular retraction and relieved by pushing the testicle into the scrotum were identified. Full history and physical examinations were performed to rule out other causes of testicular pain. The patients underwent open inguinal exploration, aborted attempt at repair of an attenuated or obliterated external oblique aponeurosis, and construction of a neo-external inguinal ring with a Gore-Tex strip. The patients were reevaluated in the clinic postoperatively to determine change in physical examination and symptoms. All three patients had nonretractile testes on follow-up examination and reported improvement of their testicular pain. An attenuated or torn external oblique aponeurosis can result in a patulous external inguinal ring and painful retractile testicle. If traditional orchidopexy is insufficient to prevent severe retraction, reconstruction of the external inguinal ring with Gore-Tex mesh can correct the anatomical deficiency, reduce testicular retraction, and improve pain symptoms.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 4","pages":"219-22"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21450025","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":"Randomized trial of safety and efficacy of transurethral resection of the prostate using contact laser versus electrocautery.","authors":"B H Zorn,&nbsp;J J Bauer,&nbsp;H E Ruiz,&nbsp;J B Thrasher","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The aim of this study was to prospectively evaluate the safety and efficacy of contact laser ablation of the prostate (CLAP) vs. transurethral resection of the prostate (TURP) in symptomatic benign prostatic hypertrophy (BPH). During a 1-year period (1995-1996), 37 males 50 years of age or older were randomized to either CLAP using Nd:YAG laser treatment or TURP. Patients with Qmax <15 mL/s, American Urological Association (AUA) symptom score >12, and postvoid residual (PVR) >125 mL were enrolled. Patients were excluded if they had prior surgical treatment for BPH or known conditions that could affect bladder function. Comparisons of preoperative and postoperative symptom scores, Qmax, PVR, total catheter time, hospital stay, complications, and hematocrit changes were performed. A 2:1 randomization was used, which resulted in 26 CLAP and 12 TURP patients. One-year follow-up data were available for 21 CLAP and 7 TURP patients. The mean prostate volume, age, AUA symptom score, and Qmax were not significantly different between the two arms. Significant differences in favor of CLAP were shorter catheter time (27.2 vs. 40.4 hours; p < .05) and shorter hospital stays (28.5 vs. 60.0 hours; p < .05). The only other significant difference between the two arms was a lower AUA symptom score in favor of TURP at 1 year (4.7 vs. 8.4; p < .05). Qmax, PVR, and postoperative hematocrit were similar between the groups. The only complications included recatheterizations, which occurred more frequently in the TURP patients (25% vs. 14%). CLAP appears to be slightly less effective in AUA symptom score reduction; however, it is equally safe and is superior for shortening catheter time and hospital stay compared to TURP.</p>","PeriodicalId":79536,"journal":{"name":"Techniques in urology","volume":"5 4","pages":"198-201"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21450020","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}