Urology
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Because of the shortage of cadaveric kidneys for allograft transplantation, laparoscopic donor nephrectomy is becoming a more feasible option. Several large published series have reported hospital stays as long as 3.3 days. We report the positive effect of preoperative bowel rest and the use of ketorolac for postoperative analgesia on reducing the hospital stay after laparoscopic donor nephrectomy. ⋯ With implementation of a strict bowel preparation regimen and the use of ketorolac for postoperative analgesia, the donor length of stay was markedly improved from previously published results. We attribute the shorter hospital stay to the quicker return of bowel function and to less postoperative discomfort.
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Comparative Study
Is nasogastric tube drainage required after reconstructive surgery for neurogenic bladder dysfunction?
To determine whether the routine use of nasogastric tubes (NGTs) after bowel surgery for neurogenic bladder dysfunction improves outcomes. ⋯ Routine use of NGTs in patients undergoing bladder reconstruction or replacement for neurogenic bladder dysfunction seems to confer no benefit. The omission of NGTs in this population is possible without increasing overall morbidity. These findings parallel those previously reported in neurologically intact patients undergoing urinary diversion.
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To evaluate the effectiveness and safety of retroperitoneal laparoscopic adrenalectomy for pheochromocytoma and report our experience in adrenalectomy without previous control of the adrenal vein. ⋯ Retroperitoneal laparoscopic adrenalectomy without previous control of the adrenal vein is effective and safe for ablation of pheochromocytoma. For experienced surgeons, the tumors larger than 6 cm in diameter can also be removed using the retroperitoneal endoscopic approach.
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To test the validity of preoperative prostate-specific antigen velocity (PSAV) (the rate of PSA rise before diagnosis) as a predictor for relapse after radical prostatectomy, in the context of patient obesity as measured by body mass index (BMI). ⋯ Preoperative PSAV greater than 2 ng/mL/yr was associated with a higher risk of relapse after radical prostatectomy, but its clinical usefulness might be limited to nonobese patients. Obesity conferred higher relapse rates, regardless of other prognostic factors including preoperative PSAV.
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Ketamine hydrochloride is an N-methyl-D-aspartic acid receptor antagonist used as an anesthetic agent in human and veterinary procedures. Increasingly, it is being used as a recreational drug. Recreational ketamine users have anecdotally reported increased lower urinary tract symptoms while using the substance. ⋯ This case series has described a new clinical entity of severe ulcerative cystitis as a result of chronic ketamine use. As illicit ketamine becomes more easily available, ulcerative cystitis and potential long-term bladder sequelae related to its use may be a more prevalent problem confronting urologists.