Urology
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A combined abdominal and thoracic surgical approach is the treatment of choice for renal cell carcinoma with secondary thrombus extending to the supradiaphragmatic vena cava and initially into the right atrium. This procedure usually requires a median sternotomy with cardiopulmonary bypass and deep hypothermic circulation arrest or, alternatively, venovenous bypass. In this report, we present a transdiaphragmatic-intrapericardiac approach to supradiaphragmatic thrombus extending to the atrium that avoids the disadvantages, mortality, and morbidity related to cardiopulmonary bypass and deep hypothermic circulatory arrest or venovenous bypass. ⋯ This technique allows excellent exposure of the supradiaphragmatic inferior vena cava through a 10-cm incision and optimal control of the distal thrombus edge when it reaches the right atrium. This approach is safer, faster, easier, and minimally invasive and avoids cardiopulmonary bypass with deep hypothermic cardiac arrest or venovenous bypass.
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To determine whether pretreatment risk groups also predict for posttreatment prostate-specific antigen (PSA) doubling times (PSADTs). Pretreatment risk groups predict for posttreatment biochemical failure (BF) after conformal radiotherapy in patients with prostate cancer and posttreatment PSADTs can predict for prostate cancer-related deaths. ⋯ A significant association between the pretreatment risk group and posttreatment PSADT was demonstrated. Use of this selection criterion at diagnosis for more aggressive treatment appears warranted.
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Randomized Controlled Trial
Novel device to assist urethrovesical anastomosis during laparoscopic radical prostatectomy.
We evaluated a novel urethral sound (Benique sound-Karl Storz) to assist suturing during laparoscopic radical prostatectomy. This sound provides for a more secure grip compared with the traditional sound, thereby affording controlled traction of the gland during the procedure and smooth coordinated movements of the sound during the anastomosis.
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To evaluate the influence of perineural invasion (PNI) in the biopsy specimen on biochemical progression-free survival in hormone-naive patients with prostate cancer undergoing brachytherapy. ⋯ In hormone-naive brachytherapy patients implanted with generous periprostatic treatment margins, the presence of PNI in the biopsy specimen did not adversely affect 8-year biochemical progression-free survival.
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To evaluate whether the skin-to-stone distance (SSD), body mass index (BMI), and Hounsfield unit (HU) density can be used as independent predictors of stone-free (SF) status after shock wave lithotripsy (SWL) of lower pole kidney stones. No studies have evaluated the SSD by non-contrast-enhanced computed tomography (NCCT) as a predictor of SWL success. Studies have suggested that the BMI and HU density of urinary calculi on NCCT may predict the SF rate after SWL. ⋯ The SSD may predict the outcome after SWL of lower pole kidney stones. SWL in patients with an SSD greater than 10 cm is likely to fail. The use of the SSD may be transferable to the treatment of all urinary stones, regardless of location.