European urology
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Biography Historical Article
Joseph-Frédéric-Benoît Charrière: master cutler and instrument designer.
Modern surgery owes its development to the innovations and skill of those craftsmen in the early 19th Century. Joseph-Frédéric-Benoît Charrière was a Parisian Cutler of renowned fame. ⋯ Charrière, most importantly, developed the French (Fr) or Charrière (Ch) gauge system used in sizing catheters and endoscopic equipment (1 Charr. = 0.333 mm). His contributions were widespread and are still evident today.
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To study the morbidity of radical cystectomy and radical radiotherapy in the treatment of patients with invasive carcinoma of the bladder and to report the long-term survival following these treatments. ⋯ This retrospective regional study shows that there is no significant difference in the 5-year survival of patients with invasive bladder cancer treated with either radical radiotherapy or radical cystectomy. All forms of radical treatment for bladder cancer are associated with a significant treatment-associated morbidity and mortality. Gastrointestinal complications were responsible for the majority of complications. The treatment-associated mortality at 3 months was two- or three-fold higher than the 30-day mortality; emphasising its importance as an indicator of the true risks of cystectomy. The clinical T stage, the sex and the ASA grade of the patient were the only independent predictors of survival. The data in this series suggests that radical radiotherapy and radical cystectomy should be both considered as valid primary treatment options for the management of invasive bladder cancer.
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Randomized Controlled Trial Clinical Trial
Lignocaine gel: does it cause urethral pain rather than prevent it?
To test the hypothesis that the chemical content of lignocaine gel is the cause of urethral pain during its instillation into the urethra. ⋯ This current study has shown that plain aqueous gel causes significantly less delivery discomfort in the male urethra than 2% lignocaine hydrochloride gel (Instillagel).
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Clinical Trial
New percutaneous technique of sacral nerve stimulation has high initial success rate: preliminary results.
We report on the new technique of sacral nerve stimulation in the treatment of voiding dysfunction. This new technique is characterized by percutaneous approach to the sacral nerves resulting in minimally invasiveness of the procedure and the ability to have patient awake during the electrode placement. ⋯ Success rate of this technique in selecting patients for the permanent implant is significantly higher than currently reported in the literature. Very beneficial clinical outcome of the implanted patients confirms better patient selection with no complications. Our experience with this technique shows the feasibility of percutaneous lead placement with major advantages such as: (1) use of local anesthesia and possibility to test sensitive responses during implant, (2) the possibility for more accurate patient selection by using the definitive lead for a longer test period before proceeding with the neurostimulator (IPG) implant. The presented percutaneous technique requiring fascial lead fixation represents a safe and effective method of Sacral Neuromodulation Therapy.
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Randomized Controlled Trial Clinical Trial
Randomised, placebo controlled, double blind study of alfuzosin SR in patients undergoing trial without catheter following acute urinary retention.
Acute urinary retention caused by bladder outlet obstruction resulting from prostatic enlargement is one of the commonest causes for acute admission to urology wards. More recently, there has been a trend to commence treatment with alpha-blockers after catheterisation followed by a trial without catheter (TWOC), in the hope that surgery may be avoided in a significant proportion of patients. There is no conclusive evidence of the efficacy of this treatment. We conducted a study to evaluate the efficacy of using the alpha-blocker alfuzosin SR in patients with acute urinary retention. ⋯ These data do not support the routine use of alpha-blockers in patients with acute urinary retention. Also continuing use of alpha-blockers does not seem to prevent further requirements of TURP, although larger studies are needed to support this.