European urology
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Three girls with major urethral injuries following motor vehicle accidents are presented. Early diagnosis of this rare condition, which is often associated with vaginal injuries, is imperative and a cystourethrogram, examination under anesthesia and a cystovaginoscopy are usually indicated. Primary repair of these injuries is recommended and long-term follow-up is essential.
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Early diagnosis and monitoring of progression for relapsed prostatic carcinoma after primary treatment is necessary, and early intervention recommended. This has now been made possible with rising prostate-specific antigen levels as an indication of the endpoint of treatment failure. Patients with relapsed disease can be divided into three groups: those relapsing following curative treatment with surgery or radiotherapy with local or distant metastases; patients who have been treated with primary hormonal palliative therapy or combination hormonal-chemotherapy relapsing after the first palliative treatment, and patients relapsing after all acceptable therapies for the treatment of prostate cancer. The management of these groups of patients is discussed.
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We performed transurethral fulguration of the diverticular mucosa and incision of the diverticular neck in combination with transurethral prostatectomy or bladder neck resection to treat all aspects of diverticula in 9 patients. Eight cases with bladder outlet obstruction, involving 2 cases of large diverticula, have been successfully treated. A case with neurogenic bladder has failed. We found the transurethral procedure to be equally effective as open operation.
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From the physiochemical view on the formation of urolithiasis a high fluid intake, provided it resulted in a high urine volume, should reduce the propensity of crystallization, crystal growth and stone formation. This critical review of the literature, however, demonstrates that there is little epidemiologic support for the hypothesis that a low urine volume is an important risk factor for renal stones in temperate climates. ⋯ The annual recurrence rate was around 23% but there was no difference between those who maintained a high urine volume and those who did not. Thus, the available evidence does not indicate that variations of fluid intake markedly affect stone formation.
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Randomized Controlled Trial Clinical Trial
Hemodynamics of the legs and clinical symptoms following regional blocks for transurethral surgery.
In a prospective clinical study we compared the hemodynamics and clinical symptoms following regional blocks and general anesthesia. 115 patients undergoing transurethral resection of the prostate were randomized to spinal (n = 62) and epidural (n = 53) blocks. An additional 10 patients received general anesthesia. Calf arterial flow, determined by strain gauge plethysmography (SGP), was similar pre- and postoperatively in the regional block groups but decreased in the general anesthesia group (p less than 0.05) on the 5th postoperative day compared to the preoperative day. ⋯ Antiembolism stockings offered no hemodynamic or clinical advantages. During the hospital stay (screening by Doppler and SGP) and 3 months of follow-up, no deep vein thrombosis or pulmonary embolism was diagnosed. 3 months after the operation, unspecific pain and/or weakness in the legs were reported by 12 patients in the spinal group, while the epidural group remained asymptomatic (p less than 0.01). We conclude that the predictive value of negative Doppler and SGP findings is good and that spinal and epidural blocks are hemodynamically advantageous as compared to general anesthesia.