Scandinavian journal of urology
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Comparative Study
Comparison of arterial blood supply to the testicles in the preoperative and early postoperative period in patients undergoing subinguinal varicocelectomy.
Varicocele, which is the abnormal dilatation of internal spermatic veins, is known as the most surgically correctable cause of male infertility. In the evaluation of testicular arterial and venous blood supply, the scrotal colour Doppler ultrasound (CDU) is a valuable diagnostic method. The aim of this study was to investigate how the testicular blood flow is affected after varicocelectomy, and the place of scrotal CDU in the follow-up after varicocelectomy. ⋯ As confirmed by the results of semen analysis and CDU, testicular blood flow increases after varicocelectomy, resulting in the recovery of the haemodynamics of the testicle. CDU, which is generally used for diagnosis in the varicocele, can also be a valuable method of determining treatment success after surgery.
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Randomized Controlled Trial
Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: a prospective randomized controlled trial.
Radical cystectomy with lymph-node dissection is a complex procedure and often followed by high postoperative morbidity and physical impairments leading to prolonged length of stay (LOS). Fast-track principles are standard procedure in radical cystectomy. Additional preoperative and postoperative physical exercises and enhanced mobilization may reduce LOS and early complications. ⋯ There was no reduction in LOS due to the preoperative and postoperative rehabilitation programme, although enhanced mobilization was achieved. The optimized minimal surgical procedure may have affected the ability to reduce LOS further with available techniques and procedures. Alternative parameters for recovery may offer more precise and relevant information.
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Laparoscopy for urological surgery is usually carried out under general anesthesia. However, laparoscopy under epidural anesthesia has been reported to be successful for laparoscopic cholecystectomy, hernia repair, gynecological procedures, renal biopsy and renal cyst unroofing. ⋯ Retroperitoneoscopy for benign upper tract pathology combined with epidural anesthesia is a feasible and an attractive method for both surgeon and patient. No postoperative pain and early recovery are the most beneficial results of this technique. Further studies, applying this technique in patients with cardiopulmonary problems, should be conducted.
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Randomized Controlled Trial
Can low-intensity extracorporeal shockwave therapy improve erectile dysfunction? A prospective, randomized, double-blind, placebo-controlled study.
The aim of this study was to investigate whether low-intensity extracorporeal shockwave therapy (LI-ESWT) can be used as a treatment for men with erectile dysfunction of organic origin. ⋯ This placebo-controlled study over 5 weeks shows that 57% of the men who suffered from erectile dysfunction had an effect from LI-ESWT. After 24 weeks, seven (19%, active group) and nine (23%, active placebo group) men were still able to have intercourse without medication. This study shows a possible cure in some patients, but more research, longer follow-up in the placebo group and an international multicentre randomized study are needed.
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This article describes the authors' experiences with the implementation of the Enhanced Recovery After Surgery (ERAS) protocol for open radical cystectomy (ORC). Adherence to the ERAS cystectomy protocol was assessed; secondary outcome measures were impact on perioperative complication rate (Clavien-Dindo classification), time to first defecation, postoperative length of stay and hospital readmission rate. ⋯ Introduction of the ERAS protocol is clearly feasible in cystectomy, and may improve clinical outcomes in terms of faster return of bowel function and reduction of readmission within 30 days. However, more and larger studies are needed to prove the efficacy of ERAS for patients undergoing ORC.