Urology
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Randomized Controlled Trial
Zoledronic Acid improves clinical outcomes when administered before onset of bone pain in patients with prostate cancer.
To evaluate, in an exploratory analysis, the effect of zoledronic acid (ZOL) on skeletal-related event (SRE) incidence as determined by the bone pain levels at study entry. Bone metastases can undermine skeletal integrity long before the onset of symptoms. Treating patients before symptom onset might be more effective in preventing SREs and improving patients' quality of life. ZOL has shown significant reductions in SREs and pain compared with placebo in patients with bone metastases from advanced prostate cancer in a randomized placebo-controlled trial. ⋯ ZOL reduced bone pain and SREs compared with placebo in patients with bone metastases from castration-resistant prostate cancer, irrespective of the baseline pain status, and appeared more efficacious when initiated before the onset of pain.
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Comparative Study
Preemptive multimodal pain regimen reduces opioid analgesia for patients undergoing robotic-assisted laparoscopic radical prostatectomy.
Minimally invasive surgical techniques have many benefits, including reduced postoperative pain. Despite this, most patients require opioid analgesia, which can have significant side effects and toxicity. We report the first urologic study using multimodal analgesia with pregabalin, a gabapentinoid. ⋯ The present retrospective review has indicated that a multimodal analgesic approach with pregabalin and celecoxib administered preoperatively decreases intraoperative and postoperative opioid use in patients undergoing robotic-assisted laparoscopic radical prostatectomy.
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To critically evaluate the perioperative management of rectal injury during radical prostatectomy. ⋯ Rectal injury is an infrequent complication of radical prostatectomy. When recognized intraoperatively and primarily repaired, rectourethral fistula was prevented in 87.5% of men. Primary repair performed with vascularized tissue interposition prevented rectourethral fistula development. In men with unrecognized rectal injury, the rectourethral fistula tended to persist and eventually required delayed surgical repair.
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To explore whether socioeconomic status (SES) was associated with health-related quality of life (HRQL) and health care use among long-term prostate cancer survivors. ⋯ Prostate cancer survivors with a low SES exhibited a worse mental but not physical HRQL than those with a higher SES. Long-term health outcomes of patients with low SES may be maximized by paying extra attention to comorbid conditions.
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To describe a technique to facilitate the urethral stump exposure and aid the suture placement of vesicourethral anastomosis during laparoscopic radical prostatectomy. ⋯ Use of a Foley catheter for laparoscopic vesicourethral anastomosis is simple and easy and provided good surgical results in our experience.